Multigeneration family with dominant SPG30 hereditary spastic paraplegia

Abstract

Autosomal recessive KIF1A missense mutations cause hereditary spastic paraplegia (HSP) type SPG30, while recessive truncations lead to sensory and autonomic neuropathy (HSN2C) and many de novo missense mutations are associated with cognitive impairment. Here, we describe family members across three generations with pure HSP. A heterozygous p.Ser69Leu KIF1A mutation segregates with those afflicted. The same variant was previously reported in a Finnish father and son with pure HSP as well as four members of a Sicilian kindred with more intrafamilial phenotypic variability. This further validates the pathogenicity of the p.Ser69Leu mutation and suggests that it may represent a mutation hot spot.

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Periodontitis: from Infection to Inflammation

Abstract

Purpose of the Review

The purpose of this study is to discuss the current understanding of periodontitis causation.

Recent Findings

The understanding of periodontitis as a monocausal infection has hindered the investigation of other potential causes that influence periodontitis morbidity and does not reflect the complexity of periodontitis etiology. Still today, the periodontal literature frequently defines periodontitis as an infection, whereas other potential causes of periodontitis, like smoking, which seems to be causally related to periodontitis, are typically called modifying or susceptibility factors. Instead of addressing the complexity of periodontitis, the field has narrowed its focus trying to find the most important bacteria or gene. Distal causes of periodontitis and interaction between constellations of causes at multiple levels have been commonly neglected.

Summary

Understanding periodontitis as a group of signs and symptoms characterized by inflammatory destruction of the periodontium would provide a better frame for future etiological research.

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Improved plan quality with automated radiotherapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial

Abstract

Background

Whole-brain radiation therapy (WBRT) with hippocampus sparing (HS) has been investigated by the radiation oncology working group (RTOG) 0933 trial for patients with multiple brain metastases. They showed a decrease of adverse neurocognitive effects with HS WBRT compared to WBRT alone. With the development of automated treatment planning system (aTPS) in the last years, a standardization of the plan quality at a high level was achieved. The goal of this study was to evaluate the feasibility of using an aTPS for the treatment of HS WBRT and see if the RTOG 0933 dose constraints could be achieved and improved.

Methods

Ten consecutive patients treated with HS WBRT were enrolled in this study. 10 × 3 Gy was prescribed according to the RTOG 0933 protocol to 92% of the target volume (whole-brain excluding the hippocampus expanded by 5 mm in 3-dimensions). In contrast to RTOG 0933, the maximum allowed point dose to normal brain was significantly lowered and restricted to 36.5 Gy. All patients were planned with volumetric modulated arc therapy (VMAT) technique using four arcs. Plans were optimized using Auto-Planning (AP) (Philips Radiation Oncology Systems) with one single AP template and optimization.

Results

All the constraints from the RTOG 0933 trial were achieved. A significant improvement for the maximal dose to 2% of the brain with a reduction of 4 Gy was achieved (33.5 Gy vs. RTOG 37.5 Gy) and the minimum hippocampus dose was reduced by 10% (8.1 Gy vs. RTOG 9 Gy). A steep dose gradient around the hippocampus was achieved with a mean dose of 27.3 Gy at a distance between 0.5 cm and 1 cm from the hippocampus. The effective working time to optimize a plan was kept below 6′.

Conclusion

Automated treatment planning for HS WBRT was able to fulfil all the recommendations from the RTOG 0933 study while significantly improving dose homogeneity and decreasing unnecessary hot spot in the normal brain. With this approach, a standardization of plan quality was achieved and the effective time required for plan optimization was minimized.

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Exclusion of emphysematous lung from dose-volume estimates of risk improves prediction of radiation pneumonitis

Abstract

Background

The risk factors for radiation pneumonitis (RP) in patients with chronic obstructive pulmonary disease (COPD) are unclear. Mean lung dose (MLD) and percentage of irradiated lung volume are common predictors of RP, but the most accurate dosimetric parameter has not been established. We hypothesized that the total lung volume irradiated without emphysema would influence the onset of RP.

Methods

We retrospectively evaluated 100 patients who received radiotherapy for lung cancer. RP was graded according to the Common Terminology Criteria for Adverse Events (version 4.03). We quantified low attenuation volume (LAV) using quantitative computed tomography analysis. The association between RP and traditional dosimetric parameters including MLD, volume of the lung receiving a dose of ≥2 Gy, ≥ 5 Gy, ≥ 10 Gy, ≥ 20 Gy, and ≥30 Gy, and counterpart measurements of the lung without LAV, were analyzed by logistic regression. We compared each dosimetric parameter for RP using multiple predictive performance measures including area under the receiver operating characteristic curve (AUC) and integrated discrimination improvement (IDI).

Results

Of 100 patients, RP of Grades 1, 2, 3, 4, and 5 was diagnosed in 24, 12, 13, 1, and 1 patients, respectively. Compared with traditional dosimetric parameters, counterpart measurements without LAV improved risk prediction of symptomatic RP. The ratio of the lung without LAV receiving ≥30 Gy to the total lung volume without LAV most accurately predicted symptomatic RP (AUC, 0.894; IDI, 0.064).

Conclusion

Irradiated lung volume without LAV predicted RP more accurately than traditional dosimetric parameters.

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Comparative study of the effects of different radiation qualities on normal human breast cells

Abstract

Background

As there is a growing number of long-term cancer survivors, the incidence of carcinogenesis as a late effect of radiotherapy is getting more and more into the focus. The risk for the development of secondary malignant neoplasms might be significantly increased due to exposure of healthy tissue outside of the target field to secondary neutrons, in particular in proton therapy. Thus far, the radiobiological effects of these neutrons and a comparison with photons on normal breast cells have not been sufficiently characterised.

Methods

MCF10A cells were irradiated with doses of up to 2 Gy with neutrons of different energy spectra and X-rays for comparison. The biological effects of neutrons with a broad energy distribution (<E _n > = 5.8 MeV), monoenergetic neutrons (1.2 MeV, 0.56 MeV) and of the mixed field of gamma's and secondary neutrons (<E _n > = 70.5 MeV) produced by 190 MeV protons impinging on a water phantom, were analysed. The clonogenic survival and the DNA repair capacity were determined and values of relative biological effectiveness were compared. Furthermore, the influence of radiation on the sphere formation was observed to examine the radiation response of the potential fraction of stem like cells within the MCF10A cell population.

Results

X-rays and neutrons caused dose-dependent decreases of survival fractions after irradiations with up to 2 Gy. Monoenergetic neutrons with an energy of 0.56 MeV had a higher effectiveness on the survival fraction with respect to neutrons with higher energies and to the mixed gamma - secondary neutron field induced by proton interactions in water. Similar effects were observed for the DNA repair capacity after exposure to ionising radiation (IR). Both experimental endpoints provided comparable values of the relative biological effectiveness. Significant changes in the sphere formation were notable following the various radiation qualities.

Conclusion

The present study compared the radiation response of MCF10A cells after IR with neutrons and photons. For the first time it was shown that monoenergetic neutrons with energies around 1 MeV have stronger radiobiological effects on normal human breast cells with respect to X rays, to neutrons with a broad energy distribution (<E _n > = 5.8 MeV), and to the mixed gamma - secondary neutron field given by interactions of 190 MeV protons in water. The results of the present study are highly relevant for further investigations of radiation-induced carcinogenesis and are very important in perspective for a better risk assessment after secondary neutron exposure in the field of conventional and proton radiotherapy.

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CT imaging features associated with recurrence in non-small cell lung cancer patients after stereotactic body radiotherapy

Abstract

Background

Predicting recurrence after stereotactic body radiotherapy (SBRT) in non-small cell lung cancer (NSCLC) patients is problematic, but critical for the decision of following treatment. This study aims to investigate the association of imaging features derived from the first follow-up computed tomography (CT) on lung cancer patient outcomes following SBRT, and identify patients at high risk of recurrence.

Methods

Fifty nine biopsy-proven non-small cell lung cancer patients were qualified for this study. The first follow-up CTs were performed about 3 months after SBRT (median time: 91 days). Imaging features included 34 manually scored radiological features (semantics) describing the lesion, lung and thorax and 219 quantitative imaging features (radiomics) extracted automatically after delineation of the lesion. Cox proportional hazard models and Harrel's C-index were used to explore predictors of overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS). Five-fold cross validation was performed on the final prognostic model.

Results

The median follow-up time was 42 months. The model for OS contained Eastern Cooperative Oncology Group (ECOG) performance status (HR = 3.13, 95% CI: 1.17–8.41), vascular involvement (HR = 3.21, 95% CI: 1.29–8.03), lymphadenopathy (HR = 3.59, 95% CI: 1.58–8.16) and the 1st principle component of radiomic features (HR = 1.24, 95% CI: 1.02–1.51). The model for RFS contained vascular involvement (HR = 3.06, 95% CI: 1.40–6.70), vessel attachment (HR = 3.46, 95% CI: 1.65–7.25), pleural retraction (HR = 3.24, 95% CI: 1.41–7.42), lymphadenopathy (HR = 6.41, 95% CI: 2.58–15.90) and relative enhancement (HR = 1.40, 95% CI: 1.00–1.96). The model for LR-RFS contained vascular involvement (HR = 4.96, 95% CI: 2.23–11.03), lymphadenopathy (HR = 2.64, 95% CI: 1.19–5.82), circularity (F13, HR = 1.60, 95% CI: 1.10–2.32) and 3D Laws feature (F92, HR = 1.96, 95% CI: 1.35–2.83). Five-fold cross-validated the areas under the receiver operating characteristic curves (AUC) of these three models were all above 0.8.

Conclusions

Our analysis reveals disease progression could be prognosticated as early as 3 months after SBRT using CT imaging features, and these features would be helpful in clinical decision-making.

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Combined high dose radiation and pazopanib in metastatic renal cell carcinoma: a phase I dose escalation trial

Abstract

Background

The primary objective was to determine maximum tolerated radiation dose in patients with metastatic renal cell carcinoma on pazopanib treatment.

Methods

Treatment-naïve patients received pazopanib according to standard of care. Stereotactic body radiotherapy (SBRT) was delivered concurrently to the largest metastatic lesion at day 8, 10 and 12. SBRT doses were escalated in 3 dose levels (24 Gy/3, 30 Gy/3 and 36 Gy/3). Dose level was assigned using Time-to-Event Continual Reassessment Method with the target dose-limiting toxicity rate set to 0.25.

Results

Thirteen patients were included. One patient experienced dose limiting toxicity (DLT) at dose level 3 (grade 4 hypoglycemia). Maximum tolerated dose was not reached with a recommended dose of 36 Gy/3 having a probability of DLT of 11%. One-year local control was 83% (95% confidence interval 61–100) and 1-year progression-free survival was 28% (95% confidence interval 1–55).

Conclusions

SBRT in combination with pazopanib is well tolerated with good local control and response rates outside the radiation field.

Trial registration

This trial was retrospectively registered on clinicaltrials.gov(NCT02334709) on January 6th, 2015.

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Comparison of volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with conventional radiotherapy in preoperative chemoradiation for rectal cancers: a propensity score case-matched analysis

Abstract

Background and purpose

The aim of this retrospective study was to compare volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with three-dimensional conformal radiotherapy (3D–CRT) in preoperative chemoradiation for rectal cancers.

Methods and materials

In the propensity score-matching analysis of 1:2, we selected 60 patients from the SIB-VMAT group and 120patients from the 3D–CRT group matched pairings out of 145 patients between 2005 and 2015. The regimen of concurrent combined chemotherapy was oral uracil/tegafur plus leucovorin with/without irinotecan.

Results

There were no significant differences between the two groups, in pathological complete response rates (pCR) (11% in the 3D–CRT group vs. 17% in the SIB-VMAT group, P = 0.39), pathological response rates (44% vs. 60%, P = 0.77), disease-free survival (P = 0.32), or local control (P = 0.52). The SIB-VMAT method marginally improved the rate of pathological grade 2–3 effects and the OS was significantly better in patients with grade 2–3 effects. Recurrence was seen in 36 patients (30%) in the 3D–CRT group and 19 patients (32%) in the SIB-VMAT group. The first distant recurrence site in the SIB-VMAT group was liver in 6 patients and lung in 8 patients. The obvious radiation-induced late toxicity in the SIB-VMAT group was recto-vesical fistula in two patients.

Conclusions

The SIB-VMAT may be a promising method for preoperative CRT of rectal cancer.

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Denosumab as a potential treatment alternative for patients suffering from diffuse sclerosing osteomyelitis of the mandible—a rapid communication

Diffuse sclerosing osteomyelitis (DSO) is a rare disease of the jaw bone. Its treatment is challenging. Different medical and surgical treatment protocols have been proposed; however, none of these treatment protocols produce reliable results. Recently, ibandronate administration has been attempted as a treatment alternative in acute cases of DSO. Due to the similar antiresorptive effect, we sought to explore the application of the human monoclonal antibody to the receptor activator of nuclear factor kappaB ligand (RANKL), denosumab, in the treatment of DSO.

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Evaluation of positional plagiocephaly: conventional anthropometric measurement versus laser scanning method

The incidence of plagiocephaly has increased in the 25 years since the "Back to Sleep" campaign in 1991 to prevent sudden infant death. Plagiocephaly is not considered to be a pathological condition. It is more of an esthetic impairment and could have potentially negative psychological or psychosocial consequences; therefore, treatment is recommended. The aim of this study is to compare conventional anthropometry and laser scanning – two different measurement methods – as diagnostic instruments for plagiocephaly.

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Single-unit activity of the anterior globus pallidus internus in Tourette patients and posterior globus pallidus internus in Dystonic patients

Dystonia is a movement disorder characterised by involuntary sustained muscle contractions that lead to twisting, repetitive movements and abnormal postures. Two types of Dystonia can be distinguished: Primary Dystonia has no evidence of other pathological abnormalities, and secondary Dystonia which is associated with neurological lesions, either degenerative or traumatic (Albanese et al. 2013). Tourette's Syndrome (TS) is a neuropsychiatric disorder that is chronic and typically characterised by motor and vocal tics.

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Local changes in computational non-rapid eye movement sleep depth in infants

Newborns and young infants spend most of their time sleeping, and the quality of sleep has been found to be important for their development. Although the contribution of each sleep stage is different, both REM and NREM sleep have important functional roles in brain maturation and in normal synaptic development (Graven, 2006). As for NREM, deep NREM is considered to be the most important sleep stage for infants. In adults, slow wave sleep and slow wave activity (SWA) of NREM sleep are homeostatically regulated and considered a measure of sleep pressure (Borbély and Achermann, 1999).

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Influence of Ginkgo Biloba extract (EGb 761) on expression of IL-1 Beta, IL-6, TNF-alfa, HSP-70, HSF-1 and COX-2 after noise exposure in the rat cochlea

The objective of this study was to investigate the influence of Ginkgo Biloba in early treatment of noise induced hearing loss on expression of IL-6, IL-1 Beta, TNF-alfa, HSP-70, HSF-1 and COX-2 in the rat cochlea.

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Effect of V–Y plasty on lip lengthening and treatment of gummy smile

The aim of this study was to assess the effect of isolated V–Y plasty on lip lengthening and the treatment of gummy smile. An isolated V–Y plasty was performed on 14 patients with a gummy smile. In each case, measurements of upper lip length and gingival display were recorded from posed-smile photographs taken preoperatively and at 1, 3, and 6 months postoperatively. Gingival display decreased significantly and lip length increased significantly over all intervals investigated. Applying this technique after Le Fort I surgery may be beneficial; however, as with other injection or surgical lip lengthening methods, its stand-alone application should be questioned.

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Intraoperative anaphylaxis to bacitracin during scleral buckle surgery

A 63-year-old man with a history of retinal detachment in the right eye repaired by scleral buckle presented with decreased peripheral vision in the left eye and was found to have a macula-sparing retinal detachment in the left eye, for which urgent repair by scleral buckle was recommended. The patient did not take any routine outpatient medications. Preoperative evaluation revealed no history of anesthetic complications, and he denied any drug allergies. He did not receive any preoperative prophylactic antibiotics.

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Cytokine profile changes in gingival crevicular fluid after placement different brackets types

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Ana Zilda Nazar Bergamo, Paulo Nelson-Filho, Cássio do Nascimento, Renato Corrêa Viana Casarin, Márcio Zaffalon Casati, Marcela Cristina Damião Andrucioli, Érika Calvano Kuchler, Daniele Lucca Longo, Léa Assed Bezerra da Silva, Mírian Aiko Nakane Matsumoto
ObjectiveThe aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence.DesignThe sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation^®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1β, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level.ResultsIncreased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria.ConclusionsThe bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.



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Multiple complex somatosensory systems in mature rat molars defined by immunohistochemistry

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Margaret R. Byers, Leanne M. Cornel
ObjectiveIntradental sensory receptors trigger painful sensations and unperceived mechanosensitivity, but the receptor bases for those functions are only partly defined. We present new evidence here concerning complex endings of myelinated axons in rat molars.DesignWe sectioned mature rat jaws in sagittal and transverse planes to analyze neural immunoreactivity (IR) for parvalbumin, peripherin, neurofilament protein, neurotrophin receptors, synaptophysin, calcitonin gene-related peptide (CGRP), or mas-related g-protein-receptor-d (Mrgprd).ResultsWe found two complex sensory systems in mature rat molar dentin that labeled with neurofilament protein-IR, plus either parvalbumin-IR or peripherin-IR. The parvalbumin-IR system made extensively branched, beaded endings focused into dentin throughout each pulp horn. The peripherin-IR system primarily made unbeaded, fork-shaped dentinal endings scattered throughout crown including cervical regions. Both of these systems differed from neuropeptide CGRP-IR. In molar pulp we found peripherin- and parvalbumin-IR layered endings, either near special horizontal plexus arrays or in small coiled endings near tangled plexus, each with specific foci for specific pulp horns. Parvalbumin-IR nerve fibers had Aβ axons (5–7μm diameter), while peripherin-IR axons were thinner Aδ size (2–5μm). Mechano-nociceptive Mrgprd-IR was only found in peripherin-IR axons.ConclusionsComplex somatosensory receptors in rat molars include two types of dentinal endings that both differ from CGRP-IR endings, and at least two newly defined types of pulpal endings. The PV-IR neurons with their widely branched, synaptophysin-rich, intradentinal beaded endings are good candidates for endodontic non-nociceptive, low threshold, unperceived mechanoreceptors. The complex molar dentinal and pulpal sensory systems were not found in rat incisors.



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Extending the service life of existing dental restorations with esthetic and functional limitations

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Malin Strasding, Vincent Fehmer, Bjarni E. Pjetursson, Irena Sailer
Adhesive cementation is a useful procedure not only for cementing restorations onto teeth but also for attaching new ceramic restorations to existing restorations to improve their esthetics and/or function. This clinical report presents a technique for modifying an existing nonsatisfactory implant-supported fixed dental prosthesis by means of adhesively cemented veneers and onlays bonded to the pre-existing metal–ceramic surface with resin cement. This modification may avoid the replacement of the fixed dental prosthesis, reducing both treatment costs and time while fulfilling the patient's demands.



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Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Ibrahim Tulunoglu, Meng Huan Lee, Mohammed Louay Taifur, Ozlem Tulunoglu
This clinical report describes the use of rapid prototyped mesh in a complete swing-lock prosthesis to restore masticatory function in an edentulous patient with severe microstomia and perioral scar tissue after an industrial hot tar accident.



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Marginal discrepancy dimensions of single unit metal crowns fabricated by using CAD-CAM–milled acrylate resin polymer blocks or a conventional waxing technique

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): David Lalande, Jeffrey A. Hodd, John S. Brousseau, Van Ramos, Daniel Dunham, Frederick Rueggeberg
Statement of problemBecause crowns with open margins are a well-known problem and can lead to complications, it is important to assess the accuracy of margins resulting from the use of a new technique. Currently, data regarding the marginal fit of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate a complete gold crown (CGC) from a castable acrylate resin polymer block are lacking.PurposeThe purpose of this in vitro study was to compare marginal discrepancy widths of CGCs fabricated by using either conventional hand waxing or acrylate resin polymer blocks generated by using CAD-CAM technology.Material and methodsA plastic model of a first mandibular molar was prepared by using a 1-mm, rounded chamfer margin on the entire circumference of the tooth. The master die was duplicated 30 times, and 15 wax patterns were fabricated by using a manual waxing technique, and 15 were fabricated by using CAD-CAM technology. All patterns were invested and cast, and resulting CGCs were cemented on their respective die by using resin-modified glass ionomer cement. The specimens were then embedded in acrylic resin and sectioned buccolingually. The buccal and lingual marginal discrepancies of each sectioned portion were measured by using microscopy at ×50 magnification. Data were subjected to repeated measures 2-way ANOVA, by using the Tukey post hoc pairwise comparison test (α=.05).ResultsThe factor of "technique" had no significant influence on marginal discrepancy measurement (P=.431), but a significant effect of "margin location" (P=.019) was noted. The confounding combination of factors was found to be significantly lower marginal discrepancy dimensions of the lingual margin discrepancy than on the buccal side by using CAD-CAM technology.ConclusionsThe marginal discrepancy of CAD-CAM acrylate resin crowns was not significantly different from those made with a conventional manual method; however, lingual margin discrepancies present from CAD-CAM–prepared crowns were significantly less than those measured on the respective buccal surface.



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Effect of thickness and surface modifications on flexural strength of monolithic zirconia

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Fusun Ozer, Andrew Naden, Volkan Turp, Francis Mante, Deniz Sen, Markus B. Blatz
Statement of problemA recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential.PurposeThe purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses.Material and methodsMonolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-μm Al2O3 particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05).ResultsThe 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05).ConclusionsThe mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.



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Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis

Publication date: Available online 14 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Sterre A.S. Hamann, Jenny Giang, Marianne G.R. De Maeseneer, Tamar E.C. Nijsten, Renate R. van den Bos
ObjectivesThe most frequently used treatment options for great saphenous vein incompetence are high ligation with stripping (HL+S), endovenous thermal ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The objective of this systematic review and meta-analysis was to compare the long-term efficacy of these different treatment modalities.MethodsA systematic literature search was performed. Randomised controlled trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of anatomical success, which was the primary outcome, rate of recurrent reflux at the saphenofemoral junction (SFJ), and mean difference in venous clinical severity score (VCSS) were compared using a z test or Student t test. Quality of life data were assessed and described.ResultsThree RCTs and 10 follow-up studies of RCTs were included of which 12 were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549 with HL+S, 121 with UGFS, and 114 with HL+EVLA. UGFS had significantly lower pooled anatomical success rates than HL+S, EVLA, and EVLA with high ligation: 34% (95% CI 26–44) versus 83% (95% CI 72–90), 88% (95% CI 82–92), and 88% (95% CI 17–100) respectively; p ≤ .001. The pooled recurrent reflux rate at the SFJ was significantly lower for HL+S than UGFS (12%, 95% CI 7–20, vs. 29%, 95% CI 21–38; p ≤ .001) and EVLA (12%, 95% CI 7–20, vs. 22%, 95% CI 14–32; p = .038). VCSS scores were pooled for EVLA and HL+S, which showed similar improvements.ConclusionEVLA and HL+S show higher success rates than UGFS 5 years after GSV treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.



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The effects of add-on exenatide to insulin on glycemic variability and hypoglycemia in patients with type 1 diabetes mellitus

Abstract

Objective

To investigate the effect of add-on exenatide to insulin on glycemic excursion and the counter-regulatory hormone in response to hypoglycemia in patients with type 1 diabetes mellitus (T1DM).

Methods

30 patients with T1DM were recruited and randomly assigned to exenatide + insulin-treated group (group 1, n = 15) or insulin-only-treated group (group 2, n = 15) for 4 weeks. All patients had continuous glucose monitor system (CGMS) applied at before (week-0) and after (week-4) treatment to evaluate the glycemic variability. All patients had an arginine-stimulated test at before and after treatment. Six patients from each group also had hypoglycemic clamp test to assess counter-regulatory hormone level.

Results

Patients in the exenatide group had significant reductions in body weight, body mass index (BMI), total insulin dose, bolus insulin dose, fructosamine, and glycemic excursion after 4 weeks' treatment. Compared with patients in group 2, the mean amplitude of glycemic excursion (MAGE) and coefficient of variation (CV) of exenatide group decreased significantly. Similarly, a significant decrease of glucagon (GLC) in the arginine-stimulated test was found in group 1. No significant changes of GLC, growth hormone (GH), cortisol (COR), epinephrine (E), and norepinephrine (NE) were found in both groups during hypoglycemia clamp test. However, patients who had residual islet function in group 1 showed an upward trend of basic C-peptide (C-P) and GLC during the hypoglycemia period.

Conclusion

Although exenatide could inhibit glucagon secretion during euglycemia or hyperglycemia in patients with T1DM, it has no effect on GLC and counter-regulatory hormones during hypoglycemia clamp in patients with no functional residual islet test.

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The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Ennio Giulio Favalli, Maria Gabriella Raimondo, Andrea Becciolini, Chiara Crotti, Martina Biggioggero, Roberto Caporali
The introduction of biologic disease–modifying anti-rheumatic drugs (bDMARDs) has dramatically changed the management of rheumatoid arthritis (RA). However, in a real-life setting about 30–40%.of bDMARD treated patients experience drug discontinuation because of either inefficacy or adverse events. According to international recommendations, to date the best strategy for managing first-line bDMARD failures has not been defined yet and available data (especially on TNF inhibitors [TNFis]) seem to drive toward a personalized approach for the individual patient. Some TNFi partial responders may benefit from optimization of concomitant methotrexate therapy or from switching to a different concomitant sDMARD such as leflunomide. Conversely, apart from infliximab, TNFi dose escalation seems to be poor efficacious and poor cost-effective compared with alternative strategies. Albeit counterintuitive, the use of a second TNFi after the failure of the first-one (cycling strategy) is supported by clear evidences and has become widespread in the 2000s as the result of the limited alternative options till the introduction of bDMARDs with a mechanism of action other than TNF blockade. Nowadays, the use of abatacept, rituximab, tocilizumab, or JAK inhibitors as second-line agent (swapping strategy) is strongly supported by RCTs and real-life experiences. In the absence of head-to-head trials directly comparing these two strategies, meta-analyses of separated RCTs failed to find significant differences in favor of one or another choice. However, results from most observational studies, including well designed prospective pragmatic randomised analyses, demonstrated the superiority of swapping over cycling approach, whereas only few studies reported a comparable effectiveness. In this review, we aimed to critically analyze all the potential therapeutic options for the treatment of first-line bDMARD failures in order to provide a comprehensive overview of available strategies to be applied in clinical practice.



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HLA-DRB1 alleles and juvenile idiopathic arthritis: Diagnostic clues emerging from a meta-analysis

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Annalisa De Silvestri, Cristina Capittini, Dimitri Poddighe, Gian Luigi Marseglia, Luca Mascaretti, Elena Bevilacqua, Annamaria Pasi, Miryam Martinetti, Carmine Tinelli
Juvenile Idiopathic Arthritis (JIA) is characterized with a variable pattern of articular involvement and systemic symptoms and, thus, it has been classified in several subtypes. Genetic predisposition to JIA is mainly due to HLA class II molecules (HLA-DRB1, HLA-DPB1), although HLA class I molecules and non-HLA genes have been implicated, too. Here, we carried out a meta-analysis on selected studies designed to assess HLA genetic background of JIA patients, compared to healthy controls and, particularly, we focused our attention on HLA-DRB1. In summary, our meta-analysis showed four main findings regarding HLA-DRB1 locus as a genetic factor of JIA: i) HLA-DRB1*08 is a strong factor predisposing to JIA, both for oligo-articular and poly-articular forms (oJIA > pJIA); ii) HLA-DRB1*01 and HLA-DRB1*04 may be involved in the genetic predisposition of Rheumatoid Factor (RF) positive forms of JIA; iii) HLA-DRB1*11 was confirmed to be predisposing to oligo-articular JIA; iv) HLA-DRB1*04 was confirmed to have a role in systemic JIA. Importantly, the positivity for the RF seems to select the JIA clinical subset with the strongest immunogenetic similarities with the adult form of rheumatoid arthritis.



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New Insights in the Pathogenesis of Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Marieke H. Heineke, Aranka V. Ballering, Agnès Jamin, Sanae Ben Mkaddem, Renato C. Monteiro, Marjolein Van Egmond
Immunoglobulin A vasculitis (IgAV), also referred to as Henoch-Schönlein purpura, is the most common form of childhood vasculitis. The pathogenesis of IgAV is still largely unknown. The disease is characterized by IgA1-immune deposits, complement factors and neutrophil infiltration, which is accompanied with vascular inflammation. Incidence of IgAV is twice as high during fall and winter, suggesting an environmental trigger associated to climate. Symptoms can resolve without intervention, but some patients develop glomerulonephritis with features similar to IgA nephropathy that include hematuria, proteinuria and IgA deposition in the glomerulus. Ultimately, this can lead to end-stage renal disease. In IgA nephropathy immune complexes containing galactose-deficient (Gd-)IgA1 are found and thought to play a role in pathogenesis. Although Gd-IgA1 complexes are also present in patients with IgAV with nephritis, their role in IgAV is disputed. Alternatively, it is has been proposed that in IgAV IgA1 antibodies are generated against endothelial cells. We anticipate that such IgA complexes can activate neutrophils via the IgA Fc receptor FcαRI (CD89), thereby inducing neutrophil migration and activation, which ultimately causes tissue damage in IgAV. In this Review, we discuss the putative role of IgA, IgA receptors, neutrophils and other factors such as infections, genetics and the complement system in the pathogenesis of IgA vasculitis.



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Radiation-induced cognitive toxicity: Pathophysiology and interventions to reduce toxicity in adults

Abstract

Radiotherapy is ubiquitous in the treatment of patients with both primary brain tumors as well as disease which is metastatic to the brain. This therapy is not without cost, however, as cognitive decline is frequently associated with cranial radiation, particularly with whole brain radiotherapy (WBRT). The precise mechanisms responsible for radiation-induced morbidity remain incompletely understood and continue to be an active area of ongoing research. In this article, we review the hypothetical means by which cranial radiation induces cognitive decline as well as potential therapeutic approaches to prevent, minimize or reverse treatment-induced cognitive deterioration. We additionally review advances in imaging modalities that can potentially be used to identify site-specific radiation-induced anatomic or functional changes in the brain and their correlation with clinical outcomes.

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Evaluation of aprepitant for acute chemotherapy-induced nausea and vomiting in children and adolescents with acute lymphoblastic leukemia receiving high-dose methotrexate

Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) negatively impacts patients' quality of life. The emetogenicity of high-dose methotrexate in children and adolescents with cancer is incompletely characterized. At our institution, a number of patients with acute lymphoblastic leukemia (ALL) have received aprepitant with courses of high-dose methotrexate after poor CINV control with prior courses.

Procedure

We conducted a retrospective cohort analysis on patients with ALL who received methotrexate 5 g/m²/dose with and without concomitant aprepitant at Texas. Children's Hospital between October 1, 2010 and January 31, 2016.

Results

We identified 16 patients who received a total of 69 courses of methotrexate. An enhanced antiemetic regimen containing aprepitant was administered with 42 methotrexate courses and resulted in a 54% reduction in the use of as-needed antiemetics (P = 0.002, 95% CI: 21–89%). There were no statistically significant differences in methotrexate area under the curve values (2,209 μM⋅hr/l ± 151 vs. 2,051 μM⋅hr/l ± 94, P = 0.355) or end-infusion methotrexate concentrations (80.5 μM ± 5.6 vs. 74.7 μM ± 3.2, P = 0.335) in patients receiving a standard versus an enhanced antiemetic regimen.

Conclusions

The addition of aprepitant reduces both CINV and the use of rescue antiemetics. Aprepitant does not appear to affect the pharmacokinetics of methotrexate. Granisetron was prescribed more frequently than ondansetron, but selection of secondary and tertiary agents, if any, was highly variable.

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Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug-specific antigens?

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Vascular Endothelial Mitochondrial Function Predicts Death or Pulmonary Outcomes in Preterm Infants

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 1040-1049, October 15, 2017.


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Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 985-992, October 15, 2017.


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Combined Impact of Smoking and Early-Life Exposures on Adult Lung Function Trajectories

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 1021-1030, October 15, 2017.


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Carbon Monoxide Exposure in Workplaces, Including Coffee Processing Facilities

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 1080-1081, October 15, 2017.


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Comparing Drivers and Dynamics of Tuberculosis in California, Florida, New York, and Texas

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 1050-1059, October 15, 2017.


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FULFIL an Unmet Need in Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 1082-1082, October 15, 2017.


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The Use of Modeling to Compare Tuberculosis Dynamics in Four U.S. States

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 953-954, October 15, 2017.


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Exposure Interaction: A Lifelong Phenomenon with Relevance to Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 8, Page 947-948, October 15, 2017.


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Implant-oriented navigation in orbital reconstruction. Part 1: technique and accuracy study

Publication date: Available online 14 October 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Schreurs, L. Dubois, A.G. Becking, T.J.J. Maal
Intraoperative navigation is frequently used to assess the position of the implant in orbital reconstruction. Interpretation of the feedback from the navigation system to a three-dimensional position of the implant needs to be done by the surgeon, and feedback is only gathered after the implant has been positioned. An implant-oriented navigation approach is proposed, with real-time intuitive feedback during insertion. A technical framework was set up for implant-oriented navigation, with requirements for planning, implant tracking, and feedback. A dedicated navigation instrument was designed and a software tool was developed in order to meet the technical requirements. An accuracy study was performed to investigate the accuracy of the method in comparison to the regular navigation pointer. A proof of concept was provided. The results showed a translation error of 1.12–1.15mm for implant-oriented navigation with regular registration (pointer 0.71–0.98mm) and 0.81mm with accurate registration (pointer 0.54mm). Rotational error was found to be small (<3°). Quantitative and intuitive qualitative feedback could be provided to the surgeon in real-time during insertion of an orbital implant. Following this proof of concept and accuracy study, the implications for the clinical workflow should be evaluated. An implant-oriented approach may form the foundation for augmented reality or robotic-aided implant insertion.



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The 7th Italian supplement: a selection from the Italian Spine Society and Scoliosis Study Group (SICV&GIS)

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Burden of migraine in a Kuwaiti population: a door-to-door survey

Migraine prevalence and disability imprints on Kuwaiti population are underreported. We aimed to measure the prevalence of migraine and to assess its burden in Kuwait.

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Theta-phase closed-loop stimulation induces motor paradoxical responses in the rat model of Parkinson disease

Publication date: Available online 13 October 2017
Source:Brain Stimulation
Author(s): Ivan Cordon, María Jesús Nicolás, Sandra Arrieta, Manuel Alegre, Julio Artieda, Miguel Valencia
BackgroundHigh-frequency deep brain stimulation (DBS) has become a widespread therapy used in the treatment of Parkinson's Disease (PD) and other diseases. Although it has proved beneficial, much recent attention has been centered around the potential of new closed-loop DBS implementations.ObjectiveHere we present a new closed-loop DBS scheme based on the phase of the theta activity recorded from the motor cortex. By testing the implementation on freely moving 6-OHDA lesioned and control rats, we assessed the behavioral and neurophysiologic effects of this implementation and compared it against the classical high-frequency DBS.ResultsResults show that both stimulation modalities produce significant and opposite changes on the movement and neurophysiological activity. Close-loop stimulation, far from improving the animals' behavior, exert contrary effects to those of high-frequency DBS which reverts the parkinsonian symptoms. Motor improvement during open-loop, high-frequency DBS was accompanied by a reduction in the amount of cortical beta oscillations while akinetic and disturbed behavior during close-loop stimulation coincided with an increase in the amplitude of beta activity.ConclusionCortical-phase-dependent close-loop stimulation of the STN exerts significant behavioral and oscillatory changes in the rat model of PD. Open-loop and close-loop stimulation outcomes differed dramatically, thus suggesting that the scheme of stimulation determines the output of the modulation even if the target structure is maintained. The current framework could be extended in future studies to identify the correct parameters that would provide a suitable control signal to the system. It may well be that with other stimulation parameters, this sort of DBS could be beneficial.



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Transcranial brain stimulation for the treatment of tinnitus: Positive lessons from a negative trial

Publication date: Available online 5 October 2017
Source:Brain Stimulation
Author(s): Christian Plewnia




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Effect of Deep Brain Stimulation of the ventromedial prefrontal cortex on the noradrenergic system in rats

Publication date: Available online 13 October 2017
Source:Brain Stimulation
Author(s): Sonia Torres-Sanchez, Laura Perez-Caballero, Juan A. Mico, Pau Celada, Esther Berrocoso
BackgroundDeep Brain Stimulation (DBS) of the subgenual cingulate cortex (SCC) is a promising therapeutic alternative to treat resistant major depressive disorder. In preclinical studies, DBS of the ventromedial prefrontal cortex (vmPFC, the rodent SCC correlate) provokes an antidepressant-like effect, along with changes in noradrenaline levels at the site of stimulation. Hence, DBS appears to activate the noradrenergic-locus coeruleus (LC) system.Objective/HypothesisThe aim of this study was to evaluate the effect of vmPFC DBS on the electrical activity of noradrenergic LC neurons, cortical oscillations and coherence between both brain areas in male rats.MethodsThe antidepressant-like effect of vmPFC DBS was evaluated through the forced swimming test. Tonic and evoked activity of LC neurons, LC activity of alpha2-adrenoceptors, local field potentials from LC and electrocorticogram signals were studied after DBS by electrophysiological recordings in anaesthetized rats. The effect of DBS on tyrosine hydroxylase (TH), noradrenaline transporters (NAT), phosphorylation of the extracellular signal–regulated kinase (ERK) and corticotropin releasing factor (CRF) expression in the LC were measured by western blot assays.ResultsDBS induced an antidepressant-like effect increasing climbing behaviour in the FST that was accompanied by a robust increase of TH expression in the rat LC. The tonic and evoked activity of LC neurons was enhanced by DBS, which impaired alpha2-adrenoceptors activity. DBS also promoted an increase in slow LC oscillations, as well as a shift in LC-cortical coherence.ConclusionDBS of the vmPFC appears to affect the LC, producing changes that may underlie its antidepressant-like effects.



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Lugol's solution eradicates Staphylococcus aureus biofilm in vitro

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Torstein Grønseth, Lene K. Vestby, Live L. Nesse, Even Thoen, Olivier Habimana, Magnus von Unge, Juha T. Silvola
ObjectivesThe aim of the study was to evaluate the antibacterial efficacy of Lugol's solution, acetic acid, and boric acid against Staphylococcus aureus biofilm.MethodsThe efficacy of Lugol's solution 1%, 0.1%, and 0.05%, acetic acid 5% or boric acid 4.7% for treatment of Staphylococcus aureus biofilm in vitro was tested using 30 clinical strains. Susceptibility in the planktonic state was assessed by disk diffusion test. Antiseptic effect on bacteria in biofilm was evaluated by using a Biofilm-oriented antiseptic test (BOAT) based on metabolic activity, a biofilm bactericidal test based on culturing of surviving bacteria and confocal laser scanning microscopy combined with LIVE/DEAD staining.ResultsIn the planktonic state, all tested S. aureus strains were susceptible to Lugol's solution and acetic acid, while 27 out of 30 tested strains were susceptible to boric acid. In biofilm the metabolic activity was significantly reduced following exposure to Lugol's solution and 5% acetic acid, while boric acid exposure led to no significant changes in metabolic activities. In biofilm, biocidal activity was observed for Lugol's solution 1% (30/30), 0.1% (30/30), and 0.05% (26/30). Acetic acid and boric acid showed no bactericidal activity in this test. Confocal laser scanning microscopy, assessed in 4/30 strains, revealed significantly fewer viable biofilm bacteria with Lugol's solution (1% p < 0.001, 0.1% p = 0.001 or 0.05% p = 0.001), acetic acid 5% for 10 min (p = 0.001) or 30 min (p = 0.015), but not for acetic acid for 1 min or boric acid.ConclusionLugol's solution 1.0% and 0.1% effectively eradicated S. aureus in biofilm and could be an alternative to conventional topical antibiotics where S. aureus biofilm is suspected such as external otitis, pharyngitis and wounds.



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Evaluation of speech reception threshold in noise in young Cochlear™ Nucleus® system 6 implant recipients using two different digital remote microphone technologies and a speech enhancement sound processing algorithm

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Sergio Razza, Monica Zaccone, Aannalisa Meli, Eliana Cristofari
ObjectiveChildren affected by hearing loss can experience difficulties in challenging and noisy environments even when deafness is corrected by Cochlear implant (CI) devices. These patients have a selective attention deficit in multiple listening conditions. At present, the most effective ways to improve the performance of speech recognition in noise consists of providing CI processors with noise reduction algorithms and of providing patients with bilateral CIs.The aim of this study was to compare speech performances in noise, across increasing noise levels, in CI recipients using two kinds of wireless remote-microphone radio systems that use digital radio frequency transmission: the Roger Inspiro accessory and the Cochlear Wireless Mini Microphone accessory.MethodsEleven Nucleus Cochlear CP910 CI young user subjects were studied. The signal/noise ratio, at a speech reception threshold (SRT) value of 50%, was measured in different conditions for each patient: with CI only, with the Roger or with the MiniMic accessory. The effect of the application of the SNR-noise reduction algorithm in each of these conditions was also assessed. The tests were performed with the subject positioned in front of the main speaker, at a distance of 2.5 m. Another two speakers were positioned at 3.50 m. The main speaker at 65 dB issued disyllabic words. Babble noise signal was delivered through the other speakers, with variable intensity.ResultsThe use of both wireless remote microphones improved the SRT results. Both systems improved gain of speech performances. The gain was higher with the Mini Mic system (SRT = −4.76) than the Roger system (SRT = −3.01). The addition of the NR algorithm did not statistically further improve the results.ConclusionThere is significant improvement in speech recognition results with both wireless digital remote microphone accessories, in particular with the Mini Mic system when used with the CP910 processor. The use of a remote microphone accessory surpasses the benefit of application of NR algorithm.



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Newborn hearing screening failure and maternal factors during pregnancy

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Yehuda Schwarz, Gabriel N. Kaufman, Sam J. Daniel
ObjectiveTemporary conductive hearing loss due to amniotic fluid accumulation in the middle ear cavity may lead to failure (false positive) in newborn hearing screening tests.The aim of this study was to identify whether amniotic fluid index has association with failure of the initial newborn otoacoustic emission (OAE) screening test.MethodsA cohort study in a tertiary hospital center (Royal Victoria Hospital, Montréal) was constructed from 70 newborns that failed the OAE test, but passed a subsequent auditory brainstem response (ABR) test, and 75 randomly selected newborns that passed initial otoacoustic emission testing. Maternal (including the amniotic fluid index in the third trimester) and newborn clinical data were extracted from medical records. Statistical association models were built to determine variables that influenced hearing screen passage or failure.ResultsThe two arms of the cohort had no significant differences in maternal or child clinical indices, including in amniotic fluid index. Calculated as individual odds ratios, maternal tobacco [95% CI of odds ratio: 0.04, 0.59, p = 0.0078], and drug use [95% CI of odds ratio: 0.0065, 0.72, p = 0.058] [borderline significance] were associated with failing the otoacoustic emission testing.ConclusionsAmniotic fluid index was not found to be associated with failure of otoacoustic emission screening in newborns. However, our study unveiled an interesting unexpected association of OAE failure with maternal smoking and/or drug use. This finding can help alleviate some of the time, cost and parental anxiety related to failed OAE screening.In selected cases of maternal smoking or drug use we might want to replace or add OAE to the ABR test in newborn hearing screening protocols, that don't perform both tests before discharge.



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Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Annette Kaspar, Obiga Newton, Joseph Kei, Carlie Driscoll, De Wet Swanepoel, Helen Goulios
ObjectiveAn understanding of parental knowledge and attitudes towards childhood hearing loss is essential to the successful implementation of audiology services. The present study aimed to investigate parental knowledge and attitudes among parents in the Solomon Islands.Methods and materialsA total of 100 mothers and 50 fathers were administered a questionnaire via semi-structured interviews.ResultsHighest parental awareness of aetiology of childhood hearing loss was noted for otitis media (94%), noise exposure (87.3%), and family history (72.7%). The highest parental awareness concerning public health initiatives to reduce/prevent otitis media was noted for routine childhood immunizations (84%) and breast-feeding (76%). Higher rates of knowledge in fathers than in mothers included otitis media (p = 0.038), noise exposure (p = 0.007), and breast-feeding (p = 0.031). Approximately half of parents (56%) agreed that curses may cause hearing loss. Overall parental responses showed positive support for infant hearing screening programs (96%) and school-based ear and hearing health examinations (99.3%).ConclusionsHigh levels of parental readiness and support for childhood hearing services in the Solomon Islands was evident. Knowledge of aetiology of childhood hearing loss was highest for otitis media, noise exposure, and family history. Knowledge and attitudes of fathers to childhood hearing loss and hearing services was either the same or better than that of mothers.



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Reversible profound sensorineural hearing loss due to propranolol sensitive hemangioma in an infant with PHACE syndrome

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): John N. Bangiyev, Richard Gurgel, Sheryll L. Vanderhooft, J. Fredrik Grimmer
PHACE syndrome is the association of large or segmental infantile hemangiomas of the face or scalp with abnormalities within the posterior fossa, arteries, cardiovascular system, and eyes. We present a case of reversible profound sensorineural hearing loss due to a cerebellopontine angle infantile hemangioma that was successfully treated with propranolol.



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Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers doi: 10.3390/cancers9100137

Authors: Hoda Soleymani Abyaneh Nidhi Gupta Aneta Radziwon-Balicka Paul Jurasz John Seubert Raymond Lai Afsaneh Lavasanifar

Hypoxia-induced chemoresistance (HICR) is a well-recognized phenomenon, and in many experimental models, hypoxia inducible factor-1α (HIF-1α) is believed to be a key player. We aimed to better understand the mechanism underlying HICR in a triple negative breast cancer cell line, MDA-MB-231, with a focus on the role of HIF-1α. In this context, the effect of hypoxia on the sensitivity of MDA-MB-231 cells to cisplatin and their stem-like features was evaluated and the role of HIF-1α in both phenomena was assessed. Our results showed that hypoxia significantly increased MDA-MB-231 resistance to cisplatin. Correlating with this, intracellular uptake of cisplatin was significantly reduced under hypoxia. Furthermore, the stem-like features of MDA-MB-231 cells increased as evidenced by the significant increases in the expression of ATP-binding cassette (ABC) drug transporters, the proportion of CD44+/CD24− cells, clonogenic survival and cisplatin chemoresistance. Under hypoxia, both the protein level and DNA binding of HIF-1α was dramatically increased. Surprisingly, siRNA knockdown of HIF-1α did not result in an appreciable change to HICR. Instead, signal transducer and activator of transcription 3 (STAT3) activation was found to be important. STAT3 activation may confer HICR by upregulating ABC transporters, particularly ABCC2 and ABCC6. This study has demonstrated that, in MDA-MB-231 cells, STAT3 rather than HIF-1α is important in mediating HICR to cisplatin.

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Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants: comparison with transthoracic echocardiography

Abstract

Background

Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT.

Objective

To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

Materials and methods

The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography.

Results

The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001).

Conclusion

Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

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Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

Several studies have revealed that robot-assisted technique might improve the pedicle screw insertion accuracy, but owing to the limited sample sizes in the individual study reported up to now, whether or not robot-assisted technique is superior to conventional freehand technique is indefinite. Thus, we performed this systematic review and meta-analysis based on randomized controlled trials to assess which approach is better.

Methods

Electronic databases including PubMed, EMBASE, CENTRAL, ISI Web of Science, CNKI and WanFang were systematically searched to identify potentially eligible articles. Main endpoints containing the accuracy of pedicle screw implantation and proximal facet joint violation were evaluated as risk ratio (RR) and the associated 95% confidence intervals (95% CIs), while radiation exposure and surgical duration were presented as mean difference (MD) or standard mean difference (SMD). Meta-analyses were performed using RevMan 5.3 software.

Results

Six studies involving 158 patients (688 pedicle screws) in robot-assisted group and 148 patients (672 pedicle screws) in freehand group were identified matching our study. The Grade A accuracy rate in robot-assisted group was superior to freehand group (RR 1.03, 95% CI 1.00, 1.06; P = 0.04), but the Grade A + B accuracy rate did not differ between the two groups (RR 1.01, 95% CI 0.99, 1.02; P = 0.29). With regard to proximal facet joint violation, the combined results suggested that robot-assisted group was associated with significantly fewer proximal facet joint violation than freehand group (RR 0.07, 95% CI 0.01, 0.55; P = 0.01). As was the radiation exposure, our findings suggested that robot-assisted technique could significantly reduce the intraoperative radiation time (MD − 12.38, 95% CI − 17.95, − 6.80; P < 0.0001) and radiation dosage (SMD − 0.64, 95% CI − 0.85, − 0.43; P < 0.00001). But the overall surgical duration was longer in robot-assisted group than conventional freehand group (MD 20.53, 95% CI 5.17, 35.90; P = 0.009).

Conclusions

The robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violation, less intraoperative radiation exposure but longer surgical duration than freehand technique. Powerful evidence relies on more randomized controlled trials with high quality and larger sample size in the future.

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Microvesicles releasing by oral cancer cells enhance endothelial cell angiogenesis via Shh/RhoA signaling pathway

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Expression of SESN1, UHRF1BP1, and miR-377-3p as prognostic markers in mutated TP53 squamous cell carcinoma of the head and neck

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Leptomeningeal carcinomatosis from gastric cancer successfully treated by the intrathecal methotrexate plus temozolomide and simultaneous radiotherapy: Case report and literatures review

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MALAT1/miR-124/Capn4 axis regulates proliferation, invasion and EMT in nasopharyngeal carcinoma cells

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Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp

Abstract

Background

Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are approved treatments for actinic keratosis (AK).

Objectives

Compare efficacy and safety of IngMeb 0.015% gel with DS 3% gel.

Methods

Patients with 4–8 visible, discrete AK lesions on face/scalp in a 25 cm² contiguous area of skin were randomised 1:1 to IngMeb once-daily for 3 consecutive days, or DS twice-daily for 90 days, following label instruction. Patients presenting with AK lesions at Week 8 following IngMeb were offered a second IngMeb course. The primary endpoint was complete clearance of AK lesions (AKCLEAR 100) at end of first treatment course (Week 8, IngMeb; Week 17, DS). Secondary endpoints included AKCLEAR 100 at end of last treatment course and Week 17; adverse events (AEs) were assessed at these time points. Patients completed Treatment Satisfaction Questionnaires for Medication (TSQM; Week 17).

Results

AKCLEAR 100 at end of first treatment course was higher with IngMeb (34.5%) versus DS (23.5%; p=0.006). AKCLEAR 100 at end of last IngMeb course (53.3%) and Week 17 (45.1%) was higher than DS (both p<0.001). The most frequent AE was application-site erythema (IngMeb 19%; DS 12%). Treatment-related AE (TRAE) duration was shorter with IngMeb. TRAE withdrawals were lower for IngMeb (2%) versus DS (6%). TSQM scores for global satisfaction (p<0.001) and effectiveness (p=0.002) were higher with IngMeb, as was dosing instruction adherence (≥90% versus 70%).

Conclusion

AKCLEAR 100, patient treatment satisfaction and effectiveness were significantly higher with IngMeb versus DS, demonstrating superiority of IngMeb for AK treatment on face/scalp (NCT02406014).

This article is protected by copyright. All rights reserved.

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Prognostication and Initiation of Therapy in Polycythemia Vera: Do We Have it Right?

Abstract

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Nipple shields and antibiotic prophylaxis in skin and nipple sparing risk reducing mastectomies—a multi-centre study

Abstract

Background

Florid and sub-clinical infection in implant-based breast reconstruction can cause significant problems. There are a wide and varied range of methods utilised in an attempt to reduce infection. Nipple shields are well known to reduce the spread of infection during surgery as are prophylactic antibiotics.

Methods

Twenty patients, in two centres, had microbiological swabs taken from the nipple-areolar complex after preparation with povidone-iodine and post-operatively from the underside of nipple shields. These swabs were cultured in the local microbiology laboratory.

Results

No swabs after preparation grew organisms. Five (12.5%) swabs taken post-operatively were positive. Of these, three grew coagulase-negative Staphylococcus and two grew mixed skin commensals. All were sensitive to Flucloxacillin.

Conclusions

Nipple shields are essential to reduce the risk of infection. Povidone-iodine is satisfactory for preparation in our cohort. Prophylactic antibiotics are indicated on induction.

Level of Evidence: Level III, risk/prognostic study.

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Functional Anatomic Computer Engineered Surgery (FACES) Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton

Publication date: Available online 14 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Baber Khatib, Karl Cuddy, Allen Cheng, Ashish Patel, Felix Sim, Melissa Amundson, Savannah Gelesko, Tuan Bui, Eric J. Dierks, R. Bryan Bell




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Nasolabial Flap improves Healing in Medication-Related Osteonecrosis of the Jaw

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Juliana Lemound, Thomas Muecke, Alexander-Nicolai Zeller, Jürgen Lichtenstein, André Eckardt, Nils-Claudius Gellrich
PurposeMedication-related osteonecrosis of the jaw (MRONJ) is an adverse side effect of antiresoptive and antiangiogenic therapeutics that is difficult to treat owing to its high relapse rate. The aim of the study was to answer the question: Among patients with MRONJ, do those managed using decortication and a nasolabial flap, when compared to those managed with decortication and mucoperiosteal flaps, have better outcome respectively stable wound closure.Materials and MethodsTwo groups of patients suffering from MRONJ with intraoral exposed bone were evaluated in a cohort clinical study retrospectively. The primary predictor variable is treatment groups: The experimental group used the nasolabial flap for wound closure, whereas in control group a mucoperiosteal closure was performed. The outcome variable was a successful wound closure defined as symptomless and closed wound after at least 12 months. Other study variables were factors as perioperative drug holiday, duration of post-operative oral antibiotic administration, or post-operative use of nasogastric feeding tubes. Cox proportional hazard regression, Kaplan-Meier curves were used to determine factors independently associated with the dependent variable. Mann-Whitney-U test and χ²-test were used for analyses regarding group related data.ResultsBoth groups showed similar demographics. 16 study patients receiving nasolabial flaps had a mean age of 69.9 years, whereas 16 control patients receiving mucoperiosteal flaps had a mean age of 71.8 years. Both groups each comprised of ten women and six men. 15 patients of each group received a bisphosphonate and one patient a monoclonal antibody therapy.All evaluated patients underwent combined treatment including decortication and intravenous antibiotic treatment. 16 patients receiving nasolabial flaps showed symptomless intact wound closure in 68.8% of the cases. 16 patients with mucoperiosteal closure developed relapse of MRONJ in 81,2% of cases, yielding the control group and revealing significant differences (p<0.001). There were no significant differences between the two groups for demographic variables. The mean time to relapse for the experimental and control group was 13.6 ± 7.8 and 8.2 ± 7.9, respectively (p =0.017).ConclusionMRONJ is a complication of the antiosteoclastic treatment of mostly oncological, palliative patients, which requires a very methodical approach to surgical treatment that has been reported in a variety of different methods. Nasolabial flaps can be considered as a highly reliable option for coverage the bone wound with less morbidity as microvascular free flaps and better long term results when compared to mucoperiosteal flaps.



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Dental Implants: The Last 100 Years

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Michael S. Block
This article on the History of Dental Implants spans beyond the last 100 years of the AAOMS. It was not until materials and methods became less traumatic to the bone that implants became firmly attached to the surrounding bone. This phenomenon is now utilized to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still utilized with modification to augment the environment for an implant. Technological changes allow patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.



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Does surgical fragmentation of odontogenic keratocystic capsule interfere with the recurrence rate?

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Natália Batista Daroit, Rúbia da Rocha Vieira, Fernanda Visioli, Fabio Del Moro Maito, Márcia Gaiger de Oliveira, Pantelis Varvaki Rados
PurposeThe investigators hypothesized that fragmentation of the cystic capsule during surgery influences the recurrence rate of odontogenic keratocysts (OKC) regardless of the treatment modality chosen.MethodsThis retrospective study reviewed cases diagnosed as odontogenic keratocysts on histopathological examination at the Oral Pathology Department between 1991 and 2013. Fragmentation data were obtained from the records of the Oral Surgical Department.ResultsFragmentation of the capsules of OKCs during surgery did not affect recurrence, irrespective of the chosen treatment modality. Addition of techniques such as cryotherapy lowered the risk of recurrence of OKCs (p = 0.013) when compared with the risk of recurrence of OKCs after enucleation. Furthermore, patients with associated nevoid basal cell carcinoma syndrome (NBCCS) had a higher recurrence rate compared to those with no associated syndrome (p = 0.033).ConclusionFragmentation of the cystic capsule does not play an important role in the rate of OKC recurrence. The rate of recurrence can be modified by using additional strategies such as cryotherapy.



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Relationship between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dmitry José de Santana Sarmento, Thiara Karine de Araújo, Germana de Queiroz Tavares Borges Mesquita, Denise Nóbrega Diniz, Fátima Roneiva Alves Fonseca, Paula Frassinetti V. Medeiros, Maria Teresa Botti Rodrigues dos Santos, Gustavo Pina Godoy
PurposeThe aim of this study was describe the relationship between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses.Materials and MethodsA cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, ten of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of the patient. The Pearson's Chi-squared, Fisher's exact and Mann-Whitney tests were used for data analysis, adopting a level of significance of 5%.ResultsMarked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had class III disorders. Radiography revealed the presence of impacted teeth (75%) and the prolonged retention of the deciduous teeth (65%). It was observed that patients with enzyme replacement therapy had a lower average maximum protrusion (p=0.033). A total of 75% of mothers said they had not been advised to take their children to the dentist, and 10% of children had never been to the dentist.ConclusionPatients with mucopolysaccharidoses exhibited significant occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.



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Analysis of facial symmetry after zygomatic bone fracture management

Publication date: Available online 14 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mohamad Saleh Khaqani, Fateme Tavosi, Mahdi Gholami, Hamid Reza Eftekharian, Leila Khojastepour
PurposeThe location of the zygomatic bone plays a significant role in facial symmetry and aesthetics. The aim of this study was to determine and compare the frequency of facial asymmetry in a sample of patients who had undergone treatment of unilateral ZMC fractures (study) and a sample of normal subjects (control).Patients and MethodsThis is a retrospective controlled cross-sectional study. The primary predictor variable was the type of ZMC fracture (linear or comminuted). The primary outcome variable was facial asymmetry characterized by the bilateral difference in the position of malar eminences (ME) in three dimensions based on a CT scan. The other variables for this study were classified into demographic (age and gender) and anatomic (side of ZMC fracture). Descriptive and bi-variate statistics were computed. Statistical significance was set at P < .05 with 95% reliability.ResultsThe samples in this study consisted of 134 subjects (n =67 per each group). The mean bilateral difference of ME position in the study subjects was significantly higher than that of the control subjects. More than half of the study subjects had facial symmetry, and just about 10 percent of them had marked asymmetry, while none of the control subjects had marked asymmetry. All the subjects with marked asymmetry and about 70 percent of the study subjects who were above the maximum normal asymmetry (MNA) had a comminuted fracture.ConclusionsThe results of this study show that although the frequency of facial asymmetry in the ZMC fracture patients was higher than the normal subjects, it was found in all individuals to a certain extent. The patients' awareness about this fact can reduce their dissatisfaction.



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Effectiveness of Immersive Virtual Reality in Surgical Training - A Randomized Control Trial

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yeshwanth Pulijala, Minhua Ma, Matthew Pears, David Peebles, Ashraf Ayoub
IntroductionThe surgical training methods are evolving with technological advancements including the application of virtual reality (VR) and augmented reality (AR). Yet, twenty-eight to forty percent of novice residents are not confident in performing a major surgical procedure. VR Surgery, an immersive virtual reality (iVR) experience was developed using Oculus Rift and Leap Motion devices to address this challenge. It is a multi-sensory, holistic surgical training application, that demonstrates a maxillofacial surgical technique, Le Fort I osteotomy.ObjectiveThe main objective of this study was to evaluate the impact of VR Surgery on the self-confidence and the knowledge of surgical residents.DesignA multisite, single-blinded, parallel, randomised controlled trial (RCT) was performed. The participants were novice surgical residents with a limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self- assessment scores of trainee's confidence on a Likert scale and objective assessment of the cognitive skills. Ninety-five residents from seven dental schools took part in the RCT. The participants were randomly divided into a study group n=51, and a control group n=44. Participants in the study group used the VR Surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. A repeated measures multivariate ANOVA was applied to the data to assess the overall impact of the intervention on the confidence of residents.ResultsThe study group participants showed a significantly higher perceived self-confidence levels compared to those in the control group (p=0.034, α=0.05). Novices in the first year of their training showed the highest improvement in their confidence, compared to those in the second and third year.ConclusioniVR experiences improve the knowledge and self-confidence of the surgical residents.



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Orthognathic Surgical Outcomes in Patients with and without Craniofacial Anomalies

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Zohra Metalwala, Christopher Okunseri, Steven Fletcher, Veerasathpurush Allareddy
ObjectiveThe objective of this study is to examine hospitalization outcomes following orthognathic surgeries. This study tests the hypothesis that those with craniofacial anomalies have higher billed hospital charges, longer length of stay, and increased odds for developing infectious complications when compared to those without craniofacial anomalies.MethodsThe Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients that underwent an orthognathic surgery were selected. The primary independent variable of interest was presence of a congenital cleft/craniofacial anomaly. The outcome variables were occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of a presence of craniofacial anomaly on outcomes.ResultsDuring the study period, a total of 16,515 patients underwent an orthognathic surgery in the United States. Of these, 2,760 patients had a cleft/craniofacial anomaly. 7.4% of those with a craniofacial anomaly had an infectious complication (compared to 0.6% in those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared to $56,189 in those without a craniofacial anomaly). The mean length of stay in hospital in those with craniofacial anomaly was 8.8 days (compared to 1.8 days in those without a craniofacial anomaly). These differences in outcomes between those with and without a craniofacial anomaly were significant after adjusting for patient and hospital level confounders.ConclusionsThose with a craniofacial anomaly are at a higher risk for developing infectious complications, have higher hospital charges, and stay in hospital for a longer duration of time following an orthognathic surgery when compared to those without a craniofacial anomaly.



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Le Morte d’Arthur, A Commentary on Hugo L. Obwegeser

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Robert Bruce MacIntosh




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Immunohistochemical analysis on cortex-to-cortex healing after mandibular vertical ramus osteotomy: A preliminary study

Publication date: Available online 13 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hwi-Dong Jung, Sang Yoon Kim, Han-Sung Jung, Hyung-Sik Park, Young-Soo Jung
PurposeThis study aimed to analyze the expression of specific cytokines among TGF-β superfamily over postoperative periods after mandibular VRO.Materials and MethodsA total of 4 beagle dogs were enrolled and euthanized at 1, 2, 4, and 8 weeks postoperatively for immunohistochemical (IHC) analysis using 6 specific antibodies (BMP-2/4, BMP-7, TGF-ß2, TGF-β3, MMP-3, and VEGF). The results from the surgical site and control (adjacent area) were compared.ResultsGeneralized upregulation of BMP-2/4 was observed in all healing periods while the strongest expression of BMP-7 was observed at 1 week. The strongest expression of TGF-ß2 was observed at 8 weeks with increasing pattern. The strong expression of TGF-β3 was observed at 1 and 4 weeks while VEGF at 1 week with decreasing pattern. There were no notable uptakes detected with 6 specific antobodies on adjacent bone (control).ConclusionThe absence of internal fixation following VRO lead to dynamic healing with a specific expression pattern of BMP-7 and TGF-β2. The anatomical factors including sufficient preexisting vascularity lead to the earlier expression pattern of VEGF.



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Clinical Characteristics of Patients Experiencing Pathologic Complete Response Following Neoadjuvant Therapy for Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma.

Objectives: The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy. Materials and Methods: A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment. Clinical and pathologic features of the patients who achieved pCR were acquired retrospectively. Results: Six patients were identified to have pCR on pathology of the postoperative specimen. On the basis of pretreatment clinical staging, 2 patients were considered to have BRPC and 4 LAPC. Four patients received gemcitabine-based chemotherapy and 2 patients received FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin). Five of 6 patients received radiation therapy before operative resection. Operative procedures included distal pancreatectomy (n=3) and pancreatoduodenectomy (n=3). Pancreatic intraepithelial neoplasia 1 to 2 was present in 3 cases, and pancreatic intraepithelial neoplasia 3 in 1 case. During a median follow-up of 21.3 months, 2 patients died, with a median survival of 11.0 months (range, 10.4 to 11.6 mo). Four patients are alive and continue to follow-up with median survival of 28.7 months (range, 20.1 to 42.4 mo). Conclusions: Multimodality neoadjuvant therapy may lead to complete pathologic response in a small number of patients with borderline resectable/locally advanced pancreatic adenocarcinoma. pCR to neoadjuvant therapy does not lead to cure in most cases, and the majority of patients appear to relapse locally or systemically. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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"Lost to Follow-up" Among Adult Cancer Survivors.

Background: Follow-up cancer care is important for patients who have received IV chemotherapy but some patients discontinue their care and are lost to follow-up (LFU) at the cancer center where they were treated. The purpose of this study was to determine what proportion of cancer survivors are LFU at 5 years after treatment, the timing of LFU, and the characteristics of those who do not continue survivorship care. Methods: Adult patients with cancer who were treated with chemotherapy at a large community teaching hospital in 2006 and 2007 were identified and linked with State tumor registry data. Hospital medical records were reviewed to obtain information on demographics, diagnosis, treatment, and date of last follow-up visit. Characteristics of patients with >=5 years of follow-up care were compared with those who were LFU. Results: In total, 487 patients received chemotherapy and 304 died (62%) during the 5-year follow-up period. Among the 183 cancer patients who were known to be alive at 5 years, 92 (50%) were LFU and 50% (46/92) of this LFU group were LFU within 1 year of diagnosis. At 5 years, follow-up care was continuing for 55% of women, compared with 39% of men. The highest proportion of follow-up was observed among lung cancer patients (84%), followed by patients with breast cancers (63%) and gastrointestinal cancers (40%). Patients with hematological cancers had the lowest follow-up proportion at 5 years (29%) (P=5 years beyond their diagnosis but there is little data on oncology follow-up rates. In our retrospective study of 183 patients who were treated with chemotherapy only 49.7% continue to follow-up at their treatment center. LFU has important implications in planning long-term care strategies for cancer survivors and in survivorship research. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Postoperative care after tonsillectomy: what's the evidence?.

Purpose of review: The purpose of this review is to evaluate the current literature regarding postoperative management after tonsillectomy in children. Recent findings: Controversy remains regarding the ideal medication regimen to manage pain after tonsillectomy. Acetaminophen and ibuprofen are routinely used, although concerns of more severe postoperative hemorrhage with ibuprofen remain. Narcotics are prescribed commonly, but with extreme caution in children with severe obstructive sleep apnea. Although not always utilized by the authors, additional adjunctive medications such as perioperative dexamethasone, ketamine, and local infiltration of lidocaine into tonsillar pillars may decrease postoperative pain. Systematic reviews have shown that dexamethasone does not increase risk of posttonsillectomy bleeding. Summary: Adenotonsillectomy is one of the most common procedures performed on children and may have significant morbidity from postoperative pain and bleeding. Managing pain remains challenging and the optimal treatment regimen has not been definitively identified. Many medications and alternative therapies have been studied and suggest possible benefit. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Bilateral Tolosa-Hunt syndrome mimicking pituitary adenoma

Abstract

The authors report a rare case of bilateral Tolosa-Hunt syndrome, which occurred in a 80-year-old female and remitted spontaneously. Inflammatory lesions were found not only in typical locations, i.e. superior orbital fissures and cavernous sinuses, but also in the pituitary; these imitated gland's macroadenoma in imaging studies.

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Nipple shields and antibiotic prophylaxis in skin and nipple sparing risk reducing mastectomies—a multi-centre study

Abstract

Background

Florid and sub-clinical infection in implant-based breast reconstruction can cause significant problems. There are a wide and varied range of methods utilised in an attempt to reduce infection. Nipple shields are well known to reduce the spread of infection during surgery as are prophylactic antibiotics.

Methods

Twenty patients, in two centres, had microbiological swabs taken from the nipple-areolar complex after preparation with povidone-iodine and post-operatively from the underside of nipple shields. These swabs were cultured in the local microbiology laboratory.

Results

No swabs after preparation grew organisms. Five (12.5%) swabs taken post-operatively were positive. Of these, three grew coagulase-negative Staphylococcus and two grew mixed skin commensals. All were sensitive to Flucloxacillin.

Conclusions

Nipple shields are essential to reduce the risk of infection. Povidone-iodine is satisfactory for preparation in our cohort. Prophylactic antibiotics are indicated on induction.

Level of Evidence: Level III, risk/prognostic study.

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Anatomy of lower eyelid and eyelid–cheek junction

Publication date: Available online 14 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): A. Mojallal, S. Cotofana
BackgroundUnderstanding the anatomy of the lower eyelid and the lid–cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment.MethodsA review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article.ResultsThe anatomy of the lower eyelid and the lid–cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization.ConclusionThe understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures.



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Laser-evoked potentials in painful radiculopathy

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): P. Hüllemann, C. von der Brelie, G. Manthey, J. Düsterhöft, A.K. Helmers, M. Synowitz, J. Gierthmühlen, R. Baron
ObjectiveThe aims of this exploratory study were (1) to develop a standardized objective electrophysiological technique with laser-evoked potentials to assess dorsal root damage quantitatively and (2) to correlate these LEP measures with clinical parameters and sensory abnormalities (QST) in the affected dermatome.MethodsThirty-eight patients with painful radiculopathy and 20 healthy subjects were investigated with LEP recorded from the affected dermatome and control areas as well as with quantitative sensory testing. Questionnaires evaluating severity and functionality were applied.ResultsOn average, LEP amplitudes and latencies from the affected dermatomes did not differ from the contralateral control side. In patients with left L5 radiculopathy (more severely affected) the N2 latency was longer and the amplitudes reduced.ConclusionsThe N2P2 amplitude correlated with pinprick evoked sensations in QST. The N2 latency from the affected dermatome correlates with pain intensity, chronicity, clinical severity and with a decrease of physical function.SignificanceAn increase in N2-latency indicates a more pronounced nerve root damage, which is associated with a decrease of function and an increase of severity and pain. LEP amplitudes are associated with the functional status of the nociceptive system and may distinguish between degeneration of neuronal systems and central sensitization processes.



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Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Tariq M. Abalkhail, David B. MacDonald, Ibrahim AlThubaiti, Faisal A. AlOtaibi, Bent Stigsby, Amal A. Mokeem, Iftetah A. AlHamoud, Maher I. Hassounah, Salah M. Baz, Abdulaziz AlSemari, Hesham M. AlDhalaan, Sameena Khan
ObjectiveTo determine optimal interstimulus interval (ISI) and pulse duration (D) for direct cortical stimulation (DCS) motor evoked potentials (MEPs) based on rheobase and chronaxie derived with two techniques.MethodsIn 20 patients under propofol/remifentanil anesthesia, 5-pulse DCS thenar MEP rheobase and chronaxie with 2, 3, 4 and 5ms ISI were measured by linear regression of five charge thresholds at 0.05, 0.1, 0.2, 0.5 and 1msD, and estimated from two charge thresholds at 0.1 and 1msD using simple arithmetic. Optimal parameters were defined by minimum threshold energy: the ISI with lowest rheobase2×chronaxie, and D at its chronaxie. Near-optimal was defined as threshold energy <25% above minimum.ResultsThe optimal ISI was 3 or 4 (n=7 each), 2 (n=4), or 5ms (n=2), but only 4ms was always either optimal or near-optimal. The optimal D was ∼0.2 (n=12), ∼0.1 (n=7) or ∼0.3ms (n=1). Two-point estimates closely approximated five-point measurements.ConclusionsOptimal ISI/D varies, with 4ms/0.2ms being most consistently optimal or near-optimal. Two-point estimation is sufficiently accurate.SignificanceThe results endorse 4ms ISI and 0.2msD for general use. Two-point estimation could enable quick individual optimization.



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