A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Publication date: Available online 4 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fábio Muradás Girardi, Laura Mezzomo da Silva, Cecilia Dias Flores
IntroductionA discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.ObjectiveThe purpose of this study was to create a statistical prediction model for thyroid nodules management.MethodsTwo hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.ResultsIn multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.ConclusionsThe prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hcfL9M

A case of dystrophic calcification in the masseter muscle

Abstract

Background

Dystrophic calcification can occur in any soft tissue with the absence of a systemic mineral imbalance and is often associated with trauma, infection, or inflammation. It is easily found in the site of the heart and skeletal muscles and rarely appears in the head and neck area.

Case report

We present a rare case of multiple calcified masses in the left masseter muscle of a 26-year-old female with a history of trauma in the area. In computed tomography, multiple radiopaque masses were observed inside the left masseter muscle and blood test results were normal. The calcified masses were diagnosed as dystrophic calcification and removed by surgery without any complications.

Conclusion

Different types of calcifications may occur in the cheek area, and they need to be distinguished from dystrophic calcification. Thorough clinical examination and history taking is required together with blood testing and radiographic examinations.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zebGGt

Recent advances in dental implants

Abstract

Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results. Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can be used as a successful treatment because it has the advantage of reducing treatment times and providing early function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic implants, and short implants, can be used. With the development of new technologies in three-dimension and computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or clinical studies. A long-term clinical trial and a more predictive study are needed.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y33tnc

A case of dystrophic calcification in the masseter muscle

Abstract

Background

Dystrophic calcification can occur in any soft tissue with the absence of a systemic mineral imbalance and is often associated with trauma, infection, or inflammation. It is easily found in the site of the heart and skeletal muscles and rarely appears in the head and neck area.

Case report

We present a rare case of multiple calcified masses in the left masseter muscle of a 26-year-old female with a history of trauma in the area. In computed tomography, multiple radiopaque masses were observed inside the left masseter muscle and blood test results were normal. The calcified masses were diagnosed as dystrophic calcification and removed by surgery without any complications.

Conclusion

Different types of calcifications may occur in the cheek area, and they need to be distinguished from dystrophic calcification. Thorough clinical examination and history taking is required together with blood testing and radiographic examinations.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zebGGt

Recent advances in dental implants

Abstract

Dental implants are a common treatment for the loss of teeth. This paper summarizes current knowledge on implant surfaces, immediate loading versus conventional loading, short implants, sinus lifting, and custom implants using three-dimensional printing. Most of the implant surface modifications showed good osseointegration results. Regarding biomolecular coatings, which have been recently developed and studied, good results were observed in animal experiments. Immediate loading had similar clinical outcomes compared to conventional loading and can be used as a successful treatment because it has the advantage of reducing treatment times and providing early function and aesthetics. Short implants showed similar clinical outcomes compared to standard implants. A variety of sinus augmentation techniques, grafting materials, and alternative techniques, such as tilted implants, zygomatic implants, and short implants, can be used. With the development of new technologies in three-dimension and computer-aided design/computer-aided manufacturing (CAD/CAM) customized implants can be used as an alternative to conventional implant designs. However, there are limitations due to the lack of long-term studies or clinical studies. A long-term clinical trial and a more predictive study are needed.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y33tnc

Chronic lesser tuberosity avulsion in an adolescent with an associated biceps pulley injury

Abstract

We report a case of a 15-year-old boy with chronic intermittent left shoulder pain due to an undiagnosed lesser tuberosity avulsion fracture, an associated biceps pulley injury and intra-articular dislocation of the long head of the biceps tendon. Lesser tuberosity avulsion fractures are rare injuries that are difficult to detect on clinical exam and radiographically, which may lead to delayed diagnosis and chronic shoulder instability. Few reports describe dislocations or subluxations of the biceps tendon in association with lesser tuberosity avulsions in children. We utilize this case to emphasize the importance of MR not only in detecting lesser tuberosity avulsions, but also in evaluating biceps pulley injuries, which are a rarely reported, but clinically important, association.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2h4qMGm

On Denny-Brown’s ‘spastic dystonia’ - what is it and what causes it?

There has been considerable debate in the scientific literature in recent years regarding the proper definition of spasticity (Biering-Sorensen et al. 2006; Burridge et al. 2005; Gracies 2005a, 2005b; Lorentzen et al. 2010; Malhotra et al. 2008; Pandyan et al. 2005; Sheean 2002). Much of this debate stems from documented differences in the understanding of which clinical signs define spasticity as well as a presumed variability in the clinical use of the term (Pandyan et al.2005a; 2005b). Without a clear consensus of what we understand by ́spasticitý there is a risk that research in the field remains confused and potentially leads to misunderstandings and wrong treatment decisions in the clinic.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Aj7ipQ

Predictive biomarkers in allergen specific immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): D. Barber, M.M. Escribese




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hcKvHJ

Biologics in the treatment of severe asthma

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): S. Quirce, E. Phillips-Angles, J. Domínguez-Ortega, P. Barranco
Severe asthma is defined as asthma which requires treatment with high dose inhaled corticosteroids and with a second controller drug to prevent it from becoming uncontrolled or which remains uncontrolled despite this therapy. Patients with uncontrolled severe asthma require additional treatment options as add-on therapy, including biologics. Biologic therapies in asthma are designed to block key immune regulators, such as IgE, or certain pro-inflammatory cytokines, e.g. interleukin (IL)-5, IL-4, IL-13 or IL-17. Patients with severe asthma and eosinophilic phenotype may benefit from biologic therapies aimed at reducing blood and tissue eosinophils, such as mepolizumab, reslizumab and benralizumab. Patients with Th2-high phenotype may also benefit from therapy with anti-IL-4/anti-IL-13 monoclonal antibodies (dupilumab). The main limitations of asthma treatment with biologic agents are the crossover and overlap of the different pathways in the pathogenesis of asthma which may cause lack of complete success of these therapies, in addition of high costs, which make pharmacoeconomic studies necessary to identify the ideal target patient population to receive these biologic drugs.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zg17VO

New insight into cancer immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M.M. Escribese, D. Barber
A key point for maintenance of the immune system homeostasis is the balance between the capacity to recognize and fight exogenous molecules and the capacity to avoid auto reactivity. The disruption of this balance induces the progression of several immune diseases such as autoimmune diseases, allergies, infections or cancer.A promising therapeutic approach to treat these diseases is immunotherapy. In cancer, both active and passive immunotherapies have been tested with promising results, such as the blocking of immunological checkpoints like CTLA-4 and PD-1. These treatments, in the market since a few years ago, aim to redirect the patient's immunological response by inhibiting the induction of regulatory T cells, both in the priming and effector phases.This strategy sheds light on the immunological mechanisms that control the regulatory response mediated by T cells and opens new lines of research into other immunological diseases such as allergy, in which the induction of a regulatory response is necessary to avoid allergic progression and which is the main objective of allergen-specific immunotherapies available today.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hgoqId

Biologics in chronic urticaria

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M. Ferrer, R. Madamba




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zgIBgi

Worldwide allergen immunotherapy guidelines: Evidence and experience-based

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): D.E.S. Larenas-Linnemann




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hdLXK5

Proposals for harmonization of allergens regulation in the European Union

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): M. Timón
Allergen medicinal products in the European Union are regulated differently across the different Member States. Thus, whereas in some countries strict quality, safety and efficacy requirements are in place, in others, most allergens are on the market as Named Patient Products, without any regulatory oversight. This situation results on European allergic patients being exposed to totally different standards depending on where they live. Initiatives to correct this situation are needed.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zdhgLU

Non-allergenic immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): E. Ibáñez Echevarría, J. Bartra Tomás, D. Hernández Fernández de Rojas




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hcwjyy

Epicutaneous immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): S. Scheurer, M. Toda




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zg138w

A language non-specific speech test to evaluate the speech of cleft patients from different language and cultural backgrounds - A pilot study

Cleft speech tests are not universally available. We have developed a tool to fill this gap, especially in the context of a cleft mission setting. We performed a pilot study to evaluate the test's ability to differentiate between the speech of cleft patients and healthy individuals from three different language backgrounds.We used 78 made-up, nonsensical syllables to evaluate hypernasality, nasal emissions, and consonant errors. Cleft (n = 41) and non-cleft (n = 39) individuals from three countries were included in this study.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j4k73v

Clinical survival of chair-side generated monolithic lithium disilicate crowns:10-year results

Abstract

Objectives

Nowadays, all-ceramic materials are routinely used within the treatment of patients in dentistry. The objective of this prospective clinical trial was the evaluation of chair-side generated monolithic lithium disilicate crowns after 10 years.

Materials and methods

Forty-one posterior full contour crowns made of lithium disilicate ceramics were inserted with a self-adhesive resin cement in 34 patients (20 university/14 private practice) using a chair-side CAD/CAM technique. One crown per patient was randomly selected for evaluation according to the modified US Public Health Service criteria.

Results

After a mean examination time of 10.1 years, 26 crowns were available for re-examination. Within the observation period, five failures occurred due to one crown fracture after 2.9 years, an abutment fracture after 6.0 years, one severe endodontic problem after 6.1 years, a root fracture after 7.0 years, and a replacement of one crown caused by a carious lesion after 10 years. Complications occurred as retention loss of one crown, two carious lesions, and a change in sensibility perception of two abutment teeth. All events were associated with molars. The Kaplan-Meier analysis revealed a survival rate of 83.5% and a complication-free rate of 71.0% after 10 years.

Conclusion

Due to the small amount of technical complications and failures, the clinical performance of monolithic lithium disilicate crowns was completely satisfying.

Clinical relevance

The insertion of chair-side fabricated monolithic lithium disilicate crowns can be recommended for long-term use in the posterior region.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ywWg30

Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]

The publisher regrets that S. B. Nayak's initial appeared incorrectly in the original article. It appears correctly above.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zf0SrQ

C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections

Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y1bQzF

Generations of oral and maxillofacial surgeons have read Maxillofacial Surgery for preparation for their...

Generations of oral and maxillofacial surgeons have read Maxillofacial Surgery for preparation for their FRCS examination or as "the" reference book. This third edition is led by Peter Brennan and continues to provide an update and review of the essential elements that encompass oral and maxillofacial surgical practice.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zf10HP

A case of lymphangioma-like mesenteric cysts diagnosed as adenocarcinoma of possible pancreatic origin on EUS-FNA

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zj3x5H

Invitro Evaluation of Torin2 and 2, 6-Dihydroxyacetophenone in Colorectal Cancer Therapy

Abstract

Colorectal cancer (CRC) is one of the most prevalent cancers diagnosed worldwide. Despite recent advances, resistance to cytotoxic and targeted therapy remains one of the greatest challenges in long-term management of colorectal cancer therapy. Recently established role of mTOR signaling in proliferation of CRC has incited for evaluation of mTOR kinase specific inhibitors in CRC therapy. Second generation mTOR kinase inhibitors including Torin2 has demonstrated efficient anticancer properties against variety of cancers and are in various stages of drug development. The time and financial constraints concomitant from discovery to development of efficient chemical inhibitors has redirected attention towards investigation of wide spread naturally occurring largely inexpensive compounds for their therapeutic potential. One such naturally occurring compound acetophenone derivative polyphenolic compound 2, 6-Dihydroxyacetophenone (DHAP) inhibits cell growth in different conditions. We investigated anticancer properties of both Torin2 and DHAP against colorectal cancer in HCT8 cell lines. Both Torin2 and DHAP inhibited growth of CRC cells at different concentrations by restricting multiple cellular functions e.g., cell cycle progression, cell migration and induced apoptosis. Treatment of HCT8 cells with natural compound DHAP resulted in reduced expression of mTOR pathway specific genes p70S6K1 and AKT1. In silico docking studies showed affinity of DHAP to mTOR kinase like Torin2. Taken together, our result vouches for role of Torin2 in CRC therapy and recommends DHAP an mTOR inhibitor, as a potential lead in the development of new therapeutic regimes against colorectal cancer.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2lPBgyy

Impact of rehabilitation intensity on mortality risk after stroke

Publication date: Available online 3 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cheng-Yang Hsieh, Hsiu-Chen Huang, Darren Philbert Wu, Chung-Yi Li, Meng-Jun Chiu, Sheng-Feng Sung
ObjectiveTo determine the relationship between rehabilitation intensity and post-stroke mortality.DesignRetrospective cohort study.Setting: Nationwide claims data.ParticipantsFrom Taiwan's National Health Insurance claims databases, a total of 6737 patients (mean age 66.9 years; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.InterventionThe intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the amount of rehabilitation sessions.Main Outcome MeasuresLong-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.ResultsPatients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.84) of mortality compared with the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR 0.94, 95% CI 0.84–1.06) to the low-intensity group. This association was not modified by stroke severity.ConclusionsAmong stroke patients with mild to moderate severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk compared to low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of stroke patients should be encouraged.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2heo5pF

Dual-Task of Fine Motor skill and Problem-Solving in Individuals with Multiple Sclerosis: A pilot study

Publication date: Available online 3 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Y. Goverover, B.M. Sandroff, J. DeLuca
ObjectiveTo examine and compare dual-task performance in patients with Multiple Sclerosis (MS) and healthy controls (HC) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task. Additionally, it examined whether difficulties in dual-task performance are associated with problems in performing an everyday internet task.DesignPilot study, mixed-design with both a within and between subjects' factorParticipantsand Setting: Participants included 19 persons with MS and 19 HC who were recruited from a nonprofit rehabilitation research institution and from the community.InterventionsNot applicableOutcomesParticipant were presented with two testing conditions—solving mathematical everyday problems or placing bolts into divots (single-task condition) vs. solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday Internet competence.ResultsAs expected, dual-task performance was significantly worse than either of the single-task tasks (i.e., number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet task.ConclusionsCognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zgAqk6

Clinical survival of chair-side generated monolithic lithium disilicate crowns:10-year results

Abstract

Objectives

Nowadays, all-ceramic materials are routinely used within the treatment of patients in dentistry. The objective of this prospective clinical trial was the evaluation of chair-side generated monolithic lithium disilicate crowns after 10 years.

Materials and methods

Forty-one posterior full contour crowns made of lithium disilicate ceramics were inserted with a self-adhesive resin cement in 34 patients (20 university/14 private practice) using a chair-side CAD/CAM technique. One crown per patient was randomly selected for evaluation according to the modified US Public Health Service criteria.

Results

After a mean examination time of 10.1 years, 26 crowns were available for re-examination. Within the observation period, five failures occurred due to one crown fracture after 2.9 years, an abutment fracture after 6.0 years, one severe endodontic problem after 6.1 years, a root fracture after 7.0 years, and a replacement of one crown caused by a carious lesion after 10 years. Complications occurred as retention loss of one crown, two carious lesions, and a change in sensibility perception of two abutment teeth. All events were associated with molars. The Kaplan-Meier analysis revealed a survival rate of 83.5% and a complication-free rate of 71.0% after 10 years.

Conclusion

Due to the small amount of technical complications and failures, the clinical performance of monolithic lithium disilicate crowns was completely satisfying.

Clinical relevance

The insertion of chair-side fabricated monolithic lithium disilicate crowns can be recommended for long-term use in the posterior region.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ywWg30

C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Mirochnik, S. Araida, V. Yaffe, I. Abu El-Naaj
Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe. The relations between degree of severity and CRP concentration on admission (<100mg/L compared with 100+), age (years), sex, and duration of hospital stay (days) were examined using Poisson regression (because the distribution of characteristics, and particularly the duration of stay, were skewed). The overall model was significant (p=0.003). Pearson and deviance chi square tests did not indicate overdispersion (p=0.97 in both cases), which suggested that the assumptions about the Poisson distribution were valid. Log-rank chi square tests indicated that only severity had a significant effect (p=0.0001), and C-reactive protein concentration was not significantly associated with group on admission, age, or sex. The moderately and very severe groups had longer median (range) durations of stay than the less severe group (5 (2-8) compared with 3 (1-8) days, respectively). CRP concentration was not a prognostic factor for the extent of odontogenic infections or presumed duration of stay, but severity scoring was a significant factor in the prediction of duration of stay in hospital.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zeJun4

Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.B. Nayak, P. Shetty, D. Reghunathan, A.P. Aithal, N. Kumar




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y0BILX

Maxillofacial Surgery, 3rd edition, P. Brennan, H. Schliephake, G. Ghali, L. Cascarini. Churchill Livingstone (2016)

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Kaveh Shakib




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zfcTNU

Letter to the Editor concerning “The utility of magnetic resonance imaging in addition to computed tomography scans in the evaluation of cervical spine injuries: a study of obtunded blunt trauma patients” by B.P.H. Lau, et al. [Eur Spine J (2017); doi:10.1007/s00586-017-5317-y]

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ivJyXy

Interobserver variability in rectum contouring in high-dose-rate brachytherapy for prostate cancer: A multi-institutional prospective analysis

Publication date: Available online 4 November 2017
Source:Brachytherapy
Author(s): Rodolfo Chicas-Sett, Francisco Celada-Alvarez, Susana Roldan, Silvia Rodriguez-Villalba, Miguel Santos-Olias, Pablo Soler-Catalan, Blanca Ibanez-Rosello, Leoncio Arribas, Alejandro Tormo, Jose M. Benlloch, Jose Perez-Calatayud
PurposeThe aim of this study was to evaluate the interobserver variability (IOV) of rectum contouring, and its dosimetric consequences, for high-dose-rate brachytherapy in patients with prostate cancer across multiple institutions.Methods and MaterialsFive radiation oncologists contoured rectums in 10 patients on transperineal ultrasound image sets after establishing a delineation consensus. The D0.1cc, D1cc, and D2cc rectum volume parameters were determined. The mean, standard deviation, and range of each dose–volume histogram parameter were evaluated for each patient. The IOV was determined using the coefficient of variation, and the dosimetric impacts on the total dose were analyzed by estimating the biologically equivalent dose (EQD2α/β = 3).ResultsThe interobserver coefficients of variation (±standard deviation) for the reported D0.1cc, D1cc, and D2cc were 5 ± 1.84%, 4 ± 1.26%, and 4 ± 1.33%, respectively. As for the impact on the total dose, the mean dose differences for D0.1cc, D1cc, and D2cc were 10 Gy, 7.3 Gy, and 6.6 Gy, respectively.ConclusionsThe D2cc is robust as evident by the low IOV (<5%). However, some variability ranges almost overlap with the clinical threshold level, which may present dosimetric and clinical complications. General rectal contouring guidelines for prostate high-dose-rate brachytherapy are desirable to reduce discrepancies in delineation.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2lOjJqy

Physical activity and autoimmune diseases: Get moving and manage the disease

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Kassem Sharif, Abdulla Watad, Nicola Luigi Bragazzi, Micheal Lichtbroun, Howard Amital, Yehuda Shoenfeld
Physical activity, by definition, is any skeletal muscle body movement that results in energy expenditure. In the last few decades, a plethora of scientific evidences have accumulated and confirmed the beneficial role of physical activity as a modifiable risk factor for a wide variety of chronic diseases including cardiovascular diseases (CVDs), diabetes mellitus and cancer, among others. Autoimmune diseases are a heterogeneous group of chronic diseases, which occur secondary to loss of self-antigen tolerance. With the advent of biological therapies, better outcomes have recently been noted in the management of autoimmune diseases. Nonetheless, recent research highlights the salient role of modifiable behaviors such as physical inactivity on various aspects of the immune system and autoimmune diseases. Physical activity leads to a significant elevation in T-regulatory cells, decreased immunoglobulin secretion and produces a shift in the Th1/Th2 balance to a decreased Th1 cell production. Moreover, physical activity has been proven to promote the release of IL-6 from muscles. IL-6 released from muscles functions as a myokine and has been shown to induce an anti-inflammatory response through IL-10 secretion and IL-1β inhibition. Physical activity has been shown to be safe in most of autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), inflammatory bowel diseases (IBD), as well as others. Additionally, the incidence of RA, MS, IBD and psoriasis has been found to be higher in patients less engaged in physical activity. As a general trend, patients with autoimmune diseases tend to be less physically active as compared to the general population. Physically active RA patients were found to have a milder disease course, better cardiovascular disease (CVD) profile, and improved joint mobility. Physical activity decreases fatigue, enhances mood, cognitive abilities and mobility in patients with MS. In SLE patients, enhanced quality of life and better CVD profile were documented in more physically active patients. Physically active patients with type 1 diabetes mellitus have a decreased risk of autonomic neuropathy and CVD. Both fibromyalgia and systemic sclerosis patients report decreased disease severity, pain, as well as better quality of life with more physical activity. Further, SSc patients improve their grip strength, finger stretching and mouth opening with increased level of exercise. The purpose of this paper is to review the clinical evidence regarding the safety, barriers to engagement, and impact of physical activity on autoimmune diseases.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y1cKw4

Can we withdraw immunosuppressants in patients with lupus nephritis in remission? An expert debate

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Gabriella Moroni, Mariele Gatto, Francesca Raffiotta, Valentina Binda, Eleni Frangou, Liz Lightstone, Dimitrios T. Boumpas
Lupus nephritis (LN) treatment requires an initial intensive period of therapy followed by a long-term maintenance treatment in order to stabilize disease control and eventually reach renal remission. In this section, Authors discuss the feasibility of safely lowering and even suspending maintenance therapy in LN patients having entered remission, highlighting hurdles in predicting the depth and durability of disease quiescence together with the need for minimizing potentially toxic therapies. Even though no firm conclusions can still be drawn, the treating physician has to find the wise balance between disease control and treatment-related drawbacks by following patients closely and recognizing as early as possible the ones who are likely to reach a deep and durable renal remission; there is consensus that is these are the only patients in whom a potential safe complete withdrawal can be foreseen so far.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zetRfa

TNF inhibitors in rheumatoid arthritis and spondyloarthritis: Are they the same?

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Andrea Rubbert-Roth, Fabiola Atzeni, Ignazio Francesco Masala, Roberto Caporali, Carlomaurizio Montecucco, Piercarlo Sarzi-Puttini
The advent of anti-tumour necrosis factor (TNF) drugs for rheumatoid arthritis (RA) or spondyloarthritis (SpA) has revolutionised the approach to patients with active disease who do not respond to conventional therapy. Although there are differences in their structure, morphology, pharmacokinetic properties and activity, all anti-TNF drugs ultimately neutralise the TNFα pathway of inflammation. However, despite their similar clinical efficacy, there are disagreements concerning drug survival and safety, with systematic reviews and meta-analyses confirming one result or the other. The fact that 20–30% of patients fail to respond to TNFα inhibitors indicates the possibility of primary resistance or the development of an immune response to the drugs themselves, which may act as antigens. The overall benefit of switching to another anti-TNF drug or a biological agent with a different mechanism of action, may be a valuable option in individual patients. There are few data concerning the use of anti-TNF drugs in patients with SpA but it seems that there are fewer adverse advents and higher drug survival in comparison with patients with RA.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zeLmMq

Can we manage lupus nephritis without chronic corticosteroids administration?

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Liz Lightstone, Andrea Doria, Hannah Wilson, Frank L. Ward, Maddalena Larosa, Joanne M. Bargman
The outcome of lupus nephritis (LN) has changed since the introduction of glucocorticoids (GCs), which dramatically reduced the mortality related to one of the most severe complications of systemic lupus erythematosus (SLE). Since the 1950′s, other immunosuppressants, including biologic drugs (i.e. rituximab) have aided in maintaining remission, preserving kidney function, but not preventing treatment-related toxicity.GCs still remain the cornerstone in the treatment of SLE, including LN, and they are widely used in clinical practice. However, GC administration represents a double-edged sword. Indeed, from one side they allow a fast and effective control of disease activity by dampening inflammation; from the other side, they have many and severe side effects leading to organ damage.In this paper, we will discuss pros and cons of the chronic use of GCs, especially focusing on LN.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zetNvW

Brain diffusion tensor MRI in systematic lupus erythematosus: A systematic review

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Beatriz Lavras Costallat, Daniel Miranda Ferreira, Aline Tamires Lapa, Letícia Rittner, Lilian Tereza Lavras Costallat, Simone Appenzeller
Diffusion tensor imaging (DTI) maps the brain's microstructure by measuring fractional anisotropy (FA) and mean diffusivity (MD). This systematic review describes brain diffusion tensor Magnetic resonance imaging (MRI) studies in systemic lupus erythematosus (SLE).The literature was reviewed following the PRISMA guidelines and using the terms "lupus", "systemic lupus erythematosus", "SLE", "diffusion tensor imaging", "DTI", "white matter" (WM), "microstructural damage", "tractography", and "fractional anisotropy"; the search included articles published in English from January 2007 to April 2017. The subjects included in the study were selected according to the ACR criteria and included 195 SLE patients with neuropsychiatric manifestation (NPSLE), 299 without neuropsychiatric manifestation (non-NPSLE), and 423 healthy controls (HC). Most studies identified significantly reduced FA and increased MD values in several WM regions of both NPSLE and non-NPSLE patients compared to HC. Subclinical microstructural changes were observed in either regional areas or the entire brain in both the non-NPSLE and NPSLE groups.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y2hOk3

Controversies in rheumatology and autoimmunity: Approaching the truth by the discussion

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Andrea Doria, Mariele Gatto, Luca Iaccarino, Piercarlo Sarzi-Puttini




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zetMrS

Is undifferentiated Spondyloarthritis a discrete entity? A debate

Publication date: Available online 3 November 2017
Source:Autoimmunity Reviews
Author(s): Atul Deodhar, Pierre Miossec, Xenofon Baraliakos
The concept of undifferentiated spondyloarthritis has been introduced recently to describe a clinical setting where the classical features of spondyloarthritis (SpA) are not fully present. Whether this is a discrete entity was the basis of a debate during the 4th International Congress on Controversies in Rheumatology & Autoimmunity held in Bologna, Italy 9–11 March 2017. The pro and con aspects of the debate are presented. The implications of the debate are important ranging from diagnostic aspects to consequences for the society and the payers.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xZz9tD

TiF4 incorporated into a self-etching primer in different concentrations: antimicrobial properties and effects on demineralization inhibition around the enamel-dentin/restoration interface

Publication date: Available online 3 November 2017
Source:Archives of Oral Biology
Author(s): G.L. Abbatepaulo, T.M.M.C. Gangana, E.F. Martinez, C.P. Turssi, FMG França, F.L.B. Amaral, R.T. Basting
PurposeTo evaluate the antimicrobial effect by minimum bactericidal concentration (MBC) of titanium tetrafluoride (TiF4) in an aqueous solution (AS) or incorporated into the primer (P) of a self-etching adhesive system against Streptococcus mutans (Sm) and Lactobacillus casei (Lc); the effect of dentin pre-treatment with TiF4 in an AS or incorporated into the P of CL regarding the potential to inhibit the development of carious lesions at the restoration interface.Materials and methodsFor MBC, AS or P with different concentrations (in %) of TiF4 were used (from 0.0 to 4.0). Also, 50 cavities were prepared at the enamel/dentin junction of third molars, which received the dentin pre-treatments (n=10): Clearfil SE Bond (CL); AS of 2.5%TiF4+CL (AS2.5%); AS of 4%TiF4+CL (AS4%); 2.5%TiF4 incorporated into the P (P2.5%); 4%TiF4 incorporated into the P (P4%). Cavities were restored and submitted to pH cycling for artificial caries lesions induction. Microhardness tests were performed after sectioning the restorations to assess the presence of demineralization in margins.ResultsANOVA and Tukey tests showed that TiF4 in AS presented MBC against Sm and Lc over 2.0%. TiF4 into the P of a self-ething adhesive presented MBC over 1% for Lc. For enamel, CL showed no significant differences in microhardness between the depths.ConclusionsAS had an antimicrobial effect against Sm and Lc over 2.0%. Pretreatment with AS or P did not promote inhibition of demineralization at enamel or dentin restoration interfaces.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zwyGnf

Enhanced levels of atmospheric low-molecular weight monocarboxylic acids in gas and particulates over Mt. Tai, North China, during field burning of agricultural wastes

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Tomoki Mochizuki, Kimitaka Kawamura, Shinnosuke Nakamura, Yugo Kanaya, Zifa Wang
To understand the source and atmospheric behaviour of low molecular weight monocarboxylic acids (monoacids), gaseous (G) and particulate (P) organic acids were collected at the summit of Mt. Tai in the North China Plain (NCP) during field burning of agricultural waste (wheat straw). Particulate organic acids were collected with neutral quartz filter whereas gaseous organic acids were collected with KOH-impregnated quartz filter. Normal (C1-C10), branched (iC4-iC6), hydroxy (lactic and glycolic), and aromatic (benzoic) monoacids were determined with a capillary gas chromatography employing p-bromophenacyl esters. We found acetic acid as the most abundant gas-phase species whereas formic acid is the dominant particle-phase species. Concentrations of formic (G/P 1 570/1 410 ng m⁻³) and acetic (3 960/1 120 ng m⁻³) acids significantly increased during the enhanced field burning of agricultural wastes. Concentrations of formic and acetic acids in daytime were found to increase in both G and P phases with those of K⁺, a field-burning tracer (r = 0.32–0.64). Primary emission and secondary formation of acetic acid is linked with field burning of agricultural wastes. In addition, we found that particle-phase fractions (Fp = P/(G + P)) of formic (0.50) and acetic (0.31) acids are significantly high, indicating that semi-volatile organic acids largely exist as particles. Field burning of agricultural wastes may play an important role in the formation of particulate monoacids in the NCP. High levels (917 ng m⁻³) of particle-phase lactic acid, which is characteristic of microorganisms, suggest that microbial activity associated with terrestrial ecosystem significantly contributes to the formation of organic aerosols.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A9yWEO

Impact of passenger car NOX emissions on urban NO2 pollution – Scenario analysis for 8 European cities

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Bart Degraeuwe, Philippe Thunis, Alain Clappier, Martin Weiss, Wouter Lefebvre, Stijn Janssen, Stijn Vranckx
Residents of large European cities are exposed to NO2 concentrations that often exceed the established air quality standards. Diesel cars have been identified as a major contributor to this situation; yet, it remains unclear to which levels the NOX emissions of diesel cars have to decrease to effectively mitigate urban NO2 pollution across Europe. Here, we take a continental perspective and model urban NO2 pollution in a generic street canyon of 8 major European cities for various NOX emission scenarios. We find that a reduction in the on-road NOX emissions of diesel cars to the Euro 6 level can in general decrease the regional and urban NO2 concentrations and thereby the frequency of exceedances of the NO2 air quality standard. High NO2 fractions in the NOX emissions of diesel cars tend to increase the urban NO2 concentrations only in proximity of intense road traffic typically found on artery roads in large cities like Paris and London. In cities with a low share of diesel cars in the vehicle fleet such as Athens or a high contribution from the NO2 background to the urban NO2 pollution such as Krakow, measures addressing heavy-duty vehicles, and the manufacturing, energy, and mining industry are necessary to decrease urban air pollution. We regard our model results as robust albeit subject to uncertainty resulting from the application of a generic street layout. With small modifications in the input parameters, our model could be used to assess the impact of NOX emissions from road transport on NO2 air pollution in any European city.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hERjek

Atmospheric Ice Nucleating Particle measurements at the high mountain observatory Mt. Cimone (2165 m a.s.l., Italy)

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): M. Rinaldi, G. Santachiara, A. Nicosia, M. Piazza, S. Decesari, S. Gilardoni, M. Paglione, P. Cristofanelli, A. Marinoni, P. Bonasoni, F. Belosi
Measurement campaigns at the high mountain Observatory Mt. Cimone (CMN; 2165 m a.s.l.) were performed during May 2014 and October 2015. The concentration of Ice Nucleating Particles (INPs) were measured offline with a dynamic filter processing chamber (DFPC), in the deposition and condensation mode, after collecting PM1 and PM10 aerosol samples. Presented INP data are the first ever published for a high mountain site in the Mediterranean basin. During the May campaign, parallel INP measurements were also carried out at San Pietro Capofiume (SPC), a low altitude rural background area within the Po Valley basin, by the same offline technique.The average INPPM10 concentration at CMN was 86 m⁻³ (saturation ratio Sw = 1.01; T = −18 °C) during the May 2014 campaign, while it was 171 m⁻³ at SPC, in the same period. A lower average INPPM10 concentration was observed at CMN during October 2015 (43 m⁻³). A significantly higher activated fraction (AF) characterized the October 2015 campaign, suggesting that the seasonal changes in the aerosol sources have an impact on the INP efficiency of the aerosol at CMN. Super-micrometer INP contributed for ∼30% of total INP in the May 2014 campaign, at both sites, and for ∼70% in the October 2015 campaign, showing the importance of coarse particles in the INP population.The analysis of meteorological parameters, gaseous tracers concentrations and backwards trajectories suggests that the INP population at CMN is contributed by transport processes occurring at diverse spatial scales, from the local to the synoptic scale. During the Saharan Dust transport Event observed in May 2014, a reduction of the AF was observed, suggesting, for this case, a limited ice nucleating activity for Saharan dust particles. This may be due to physico-chemical aging of the Saharan dust particles during transport or to the relatively high activation temperature at which the experiments were performed in this study.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A7oei9

On the influence of atmospheric super-saturation layer on China's heavy haze-fog events

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Jizhi Wang, Yuanqin Yang, Xiaoye Zhang, Hua Liu, Huizheng Che, Xiaojing Shen, Yaqiang Wang
With the background of global change, the air quality in Earth's atmosphere has significantly decreased. The North China Plain (NCP), Yangtze River Delta (YRD), Pearl River Delta (PRD) and Si-Chuan Basin (SCB) are the major areas suffering the decreasing air quality and frequent pollution events in recent years. Studying the effect of meteorological conditions on the concentration of pollution aerosols in these pollution sensitive regions is a hot focus now. This paper analyses the characteristics of atmospheric super-saturation and the corresponding H_PMLs (height of supersaturated pollution mixing layer), investigating their contribution to the frequently-seen heavy haze-fog weather. The results suggest that: (1) in the above-mentioned pollution sensitive regions in China, super-saturated layers repeatedly appear in the low altitude and the peak value of supersaturation S can reach 6–10%, which makes pollution particles into the wet adiabatic uplift process in the stable-static atmosphere. After low-level atmosphere reaches the super-saturation state below the H_PMLs, meteorological condition contributes to humidification and condensation of pollution particles. (2) Caculation of condensation function Fc, one of PLAM sensetive parameter, indicates that super-saturation state helps promote condensation, beneficial to the formation of Condensational Kink (CK) in the pollution sensitive areas. This favors the formation of new aerosol particles and intensities the cumulative growth of aerosol concentration. (3) By calculating the convective inhibition energy on average │CIN│ > 1.0 × 10⁴ J kg⁻¹, we found the value is about 100 times higher than the stable critical value. The uplifting diffusion of the particles is inhibited by the ambient airflow. So, this is the important reason for the aggravation and persistence of aerosol pollutants in local areas. (4) H_PMLs is negatively correlated to the pollution meteorological condition index PLAM which can describe the change of PM2.5 concentration. The lower the H_PMLs is, the higher the PLAM becomes, and the more conductive the air condition is to aggravation of pollutant aerosol concentration.

Graphical abstract

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hGqUg1

Quantification of amine functional groups and their influence on OM/OC in the IMPROVE network

Publication date: January 2018
Source:Atmospheric Environment, Volume 172
Author(s): Mohammed Kamruzzaman, Satoshi Takahama, Ann M. Dillner
Recently, we developed a method using FT-IR spectroscopy coupled with partial least squares (PLS) regression to measure the four most abundant organic functional groups, aliphatic C-H, alcohol OH, carboxylic acid OH and carbonyl C=O, in atmospheric particulate matter. These functional groups are summed to estimate organic matter (OM) while the carbon from the functional groups is summed to estimate organic carbon (OC). With this method, OM and OM/OC can be estimated for each sample rather than relying on one assumed value to convert OC measurements to OM. This study continues the development of the FT-IR and PLS method for estimating OM and OM/OC by including the amine functional group. Amines are ubiquitous in the atmosphere and come from motor vehicle exhaust, animal husbandry, biomass burning, and vegetation among other sources. In this study, calibration standards for amines are produced by aerosolizing individual amine compounds and collecting them on PTFE filters using an IMPROVE sampler, thereby mimicking the filter media and collection geometry of ambient standards. The moles of amine functional group on each standard and a narrow range of amine-specific wavenumbers in the FT-IR spectra (wavenumber range 1 550–1 500 cm⁻¹) are used to develop a PLS calibration model. The PLS model is validated using three methods: prediction of a set of laboratory standards not included in the model, a peak height analysis and a PLS model with a broader wavenumber range. The model is then applied to the ambient samples collected throughout 2013 from 16 IMPROVE sites in the USA. Urban sites have higher amine concentrations than most rural sites, but amine functional groups account for a lower fraction of OM at urban sites. Amine concentrations, contributions to OM and seasonality vary by site and sample. Amine has a small impact on the annual average OM/OC for urban sites, but for some rural sites including amine in the OM/OC calculations increased OM/OC by 0.1 or more.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hFBKTn

Properties of particulate pollution in the port city of Valparaiso, Chile

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Julio C. Marín, Graciela B. Raga, Jorge Arévalo, Darrel Baumgardner, Ana M. Córdova, Diana Pozo, Ana Calvo, Amaya Castro, Roberto Fraile, Mar Sorribas
The city of Valparaiso is home to one of the largest commercial ports on the west coast of South America. Port activities, that continue year-round, 24 h a day and seven days a week, produce emissions of pollutants, particularly aerosol particles composed of black and brown carbon (BC and BrC) that have serious impact on human population and the local environment. A measurement program was launched to document the magnitude of selected pollutants, to identify their sources and to evaluate the meteorological processes that enhance and transport these pollutants locally and regionally. In this study, we report the measurements made during four months: 25July - 25August 2014 (referred to as August 2014 throughout the manuscript), December 2014, January 2015 and March 2015. The daily mass concentrations of equivalent black carbon (eBC), derived from measurements of the light absorption coefficient, regularly exceed 5 μg m⁻³, a magnitude similar to values found in megacities such as Mexico City. The daily maximum number concentration of condensation nuclei (CN) is usually larger than 30000 cm⁻³. The Angstrom absorption exponent (AAE), derived from the absorption coefficients at 550 nm and 870 nm, is used to identify the primary sources of BC and BrC. In colder weather, emissions from the diesel fueled buses and trucks and the consumption of kerosene and wood for residential heating are the main sources of BC. In December, local wildfires contributed to the particle mass loading, but the day-to-day variability in boundary layer height and the presence of clouds and fog in occasions inhibited high concentrations. In March, the port activities reach a yearly peak during the seasonal export of agricultural products that translates into much more ship and truck traffic leading to very high eBC concentrations, comparable to values observed during August. The variability in weather patterns underscores the complexity of meteorological processes that drive the evolution and transport of pollution in Valparaiso.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A7o6zb

Receptor modelling and risk assessment of volatile organic compounds measured at a regional background site in South Africa

Publication date: January 2018
Source:Atmospheric Environment, Volume 172
Author(s): Kerneels Jaars, Mika Vestenius, Pieter G. van Zyl, Johan P. Beukes, Heidi Hellén, Ville Vakkari, Marcell Venter, Miroslav Josipovic, Hannele Hakola
Volatile organic compounds (VOCs) can have significant impacts on climate and human health. Certain VOCs are proven to be carcinogenic and toxic, which can affect human health directly and indirectly. In order to develop climate change reduction strategies and to assess the impacts of VOCs on human health, it is crucial to determine the sources of VOCs, which can be emitted from biogenic and anthropogenic sources. The aim of this study was to perform source apportionment using positive matrix factorisation (PMF) analysis on VOC data collected at a regional background location affected by the major sources in the interior of South Africa, which include the western- and eastern Bushveld Igneous Complex, the Johannesburg-Pretoria metropolitan conurbation, the Vaal Triangle, the Mpumalanga Highveld and also a region of anti-cyclonic recirculation of air mass over the interior of South Africa. In addition, a risk assessment study was also performed in view of the major source regions affecting Welgegund in order to quantify the impacts of anthropogenic VOCs measured at Welgegund on human health. Measurements were conducted at the Welgegund measurement station located on a commercial farm approximately 100 km west of Johannesburg for a period of more than two years. PMF analysis revealed ten meaningful factor solutions, of which five factors were associated with biogenic emissions and five with anthropogenic sources. Three of the biogenic factors were characterised by a specific biogenic species, i.e. isoprene, limonene and 2-methyl-3-buten-2-ol (MBO), while the other two biogenic factors comprised mixtures of biogenic species with different tracer species. The temporal factor contribution for the isoprene, limonene and MBO factors correlated relatively well with the seasonal wet pattern. One anthropogenic factor was associated with emissions from a densely populated anthropogenic source region to the east of Welgegund with a large number of industrial activities, while another anthropogenic factor could be related to coal combustion. An anthropogenic factor was also identified that reflected the influence of solvents on atmospheric VOC concentrations, while two anthropogenic factors were determined that indicated the influence of farming activities in close proximity to Welgegund. A lifetime cancer risk- (LCR) and non-cancer hazard ratio (HR) assessment study conducted for VOCs measured at Welgegund in relation to three source regions indicated that the non-cancerous influence of VOCs measured in the source regions is significantly lower compared to the cancerous influence of these species on human health, which raises concern. However, LCR values were within an acceptable range. Factor analysis performed in this paper also identified sources that could be targeted to minimise VOC-related LCRs and HRs e.g. benzene-related cancers can be reduced by targeting incomplete combustion sources and coal combustion.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hFGaJU

Editorial board

Publication date: December 2017
Source:Atmospheric Environment, Volume 171





from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hFG594

Aerosol concentrations and composition in the North Pacific marine boundary layer

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Yongjoo Choi, Tae Siek Rhee, Jeffrey L. Collett, Taehyun Park, Seung-Myung Park, Beom-Keun Seo, Gyutae Park, Keyhong Park, Taehyoung Lee
Ship-borne measurements of inorganic and organic aerosols, including methanesulfonic acid (MSA), were conducted over the Northern Pacific using a High Resolution Time of Flight Aerosol Mass Spectrometer (AMS). This study, conducted aboard the Korean ice breaker R/V Araon, was part of the SHIP-borne Pole-to-Pole Observations (SHIPPO) project. Based on air mass source region, the cruise track could be divided into five sections. Overall, the South Asia and Northern Japan ship transects showed higher aerosol concentrations due to continental pollution and biomass burning sources, respectively. In all five regions, the average mass concentrations of sulfate and organic aerosols (OA) were much higher than concentrations of nitrate and ammonium. Positive matrix factorization (PMF) analysis distinguished two organic aerosol factors as hydrocarbon-like and oxidized OA (HOA and OOA). HOA peaked in South Asia under the influence of anthropogenic pollution source areas, such as China and Korea, and generally decreased with increasing latitude across the full study region. OOA concentrations peaked in Northern Japan near the Tsugaru Strait and appear to reflect fine particle contributions from biomass burning. The mean HOA concentration in the clean marine area (Aleutian Island to Siberia) was 0.06 μg/m³ and comprised approximately 8% of the OA mass fraction. The highest MSA concentrations peaked in the Aleutian Islands at nearly 15 μg/m³, suggesting influence from higher dimethyl sulfide (DMS) emissions resulting from biological nutrient uptake during summer. The MSA/sulfate ratio, an indicator of the relative fine particle contributions of DMS and anthropogenic sources, revealed a sharp gradient as the ship approached the clean marine areas where the dominance of DMS increased. The patterns in OOA, HOA, and MSA concentrations found in this study provide a better understanding of the characteristics of inorganic and organic aerosols in the Northern Pacific Ocean.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A7Pld1

Formation of secondary aerosols from the ozonolysis of styrene: Effect of SO2 and H2O

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Yolanda Díaz-de-Mera, Alfonso Aranda, Ernesto Martínez, Ana Angustias Rodríguez, Diana Rodríguez, Ana Rodríguez
In this work we report the study of the ozonolysis of styrene and the reaction conditions leading to the formation of secondary aerosols. The reactions have been carried out in a Teflon chamber filled with synthetic air mixtures at atmospheric pressure and room temperature. We have found that the ozonolysis of styrene in the presence of low concentrations of SO2 readily produces new particles under concentrations of reactants lower than those required in experiments in the absence of SO2. Thus, nucleation events occur at concentrations around (5.6 ± 1.7) × 10⁸molecule cm⁻³ (errors are 2σ±20%) and SO2 is consumed during the experiments. The reaction of the Criegee intermediates with SO2 to produce SO3 and then H2SO4 may explain (together with OH reactions' contribution) the high capacity of styrene to produce particulate matter in polluted atmospheres. The formation of secondary aerosols in the smog chamber is inhibited under high H2O concentrations. So, the potential formation of secondary aerosols under atmospheric conditions depends on the concentration of SO2 and relative humidity, with a water to SO2 rate constants ratio kH2O/kSO2 = (2.8 ± 0.7) × 10⁻⁵ (errors are 2σ±20%).

Graphical abstract

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hFFSCO

Land use regression modeling of oxidative potential of fine particles, NO2, PM2.5 mass and association to type two diabetes mellitus

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Bryan Hellack, Dorothea Sugiri, Roel P.F. Schins, Tamara Schikowski, Ursula Krämer, Thomas A.J. Kuhlbusch, Barbara Hoffmann
While land use regression models (LUR) are commonly used, e.g. for the prediction of spatially variable air pollutant mass concentrations, they are scarcely used for predicting the oxidative potential (OP), a suggested unifying predictor of health effects. Therefore a LUR model was developed to examine if long-term OP of fine particulate exposure can be reasonably predicted by LUR modeling and whether it is related to health effects in a study region comprised of urban and rural areas. Four 14-day sampling periods over 1 year at 40 sites in the western Ruhr Area and adjacent northern rural area, Germany, in 2002/2003 were conducted and annual Nitrogen Dioxide (NO2), fine particles (PM2.5), and OP were calculated. LUR models were developed to estimate spatially-resolved annual OP, NO2 and PM2.5 concentrations. The model performance was checked by leave-one-out cross validation (LOOCV) and cox regression was used to analyze the association of modeled residential OP and NO2 with incident type 2 diabetes mellitus (T2DM) in 1784 elderly women during a mean follow-up of 16 years (baseline 1985–1994). The measured OP and NO2 concentrations were moderately correlated (rSpearman 0.57). The LUR models explained 62% and 92% of the OP and NO2 variance (adjusted LOOCV R² 57% and 90%). PM10 emission from combustion in a 5000 m buffer was the most important predictor for OP and NO2. Modeled pollutants were highly correlated (rSpearman 0.87). Model quality for OP was sensitive to the inclusion of a single influential measurement site. For PM2.5 mass only an insufficient model with a low explained variance of 22% (adjusted R²) was developed so no health effects analyses were conducted with estimated PM2.5.Increases in OP and NO2 were associated with an increase in risk of T2DM by a hazard ratio of 1.38 (95% CI 1.06–1.80) and 1.39 (95% CI 1.07–1.81) per interquartile range of OP and NO2, respectively. We conclude that spatially-resolved OP can be predicted by LUR modeling, but future work is needed to investigate the possibility to increase OP model quality with refined predictors.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hGqF4B

Simulations of the effect of intensive biomass burning in July 2015 on Arctic radiative budget

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): K.M. Markowicz, J. Lisok, P. Xian
The impact of biomass burning (BB) on aerosol optical properties and radiative budget in the polar region following an intense boreal fire event in North America in July 2015 is explored in this paper. Presented data are obtained from the Navy Aerosol Analysis and Prediction System (NAAPS) reanalysis and the Fu-Liou radiative transfer model. NAAPS provides particle concentrations and aerosol optical depth (AOD) at 1° x 1° spatial and 6-hourly temporal resolution, its AOD and vertical profiles were validated with field measurements for this event. Direct aerosol radiative forcings (ARF) at the surface, the top of the atmosphere (TOA) and within the atmosphere are calculated for clear-sky and all-sky conditions, with the surface albedo and cloud properties constrained by satellite retrievals. The mean ARFs at the surface, the TOA, and within the atmosphere averaged for the north pole region (latitudes north of 75.5N) and the study period (July 5–15, 2015) are −13.1 ± 2.7, 0.3 ± 2.1, and 13.4 ± 2.7 W/m² for clear-sky and −7.3 ± 1.8, 5.0 ± 2.6, and 12.3 ± 1.6 W/m² for all-sky conditions respectively. Local ARFs can be a several times larger e.g. the clear-sky surface and TOA ARF reach over Alaska −85 and −30 W/m² and over Svalbard −41 and −20 W/m² respectively. The ARF is found negative at the surface (almost zero over high albedo region though) with the maximum forcing over the BB source region, and weaker forcing under all-sky conditions compared to the clear-sky conditions. Unlike the ARFs at the surface and within the atmosphere, which have consistent forcing signs all over the polar region, the ARF at the TOA changes signs from negative (cooling) over the source region (Alaska) to positive (heating) over bright surfaces (e.g., Greenland) because of strong surface albedo effect. NAAPS simulations also show that the transported BB particle over the Arctic are in the low-to-middle troposphere and above low-level clouds, resulting in little difference in ARFs at the TOA between clear- and all-sky conditions over the regions with high surface albedo. Over dark surfaces, the negative TOA forcing increases with AOD about 50% slower under all-sky conditions compared to clear-sky case. The boreal BB event resulted in large magnitude of ARFs and the high variabilities of the forcings over the polar region has a significant impact on the polar weather conditions and important implications for the polar climate.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A6Lv3V

Total OH reactivity measurements for the OH-initiated oxidation of aromatic hydrocarbons in the presence of NOx

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Kei Sato, Yoshihiro Nakashima, Yu Morino, Takashi Imamura, Jun-ichi Kurokawa, Yoshizumi Kajii
The total OH reactivity of the secondary products formed from the OH-initiated oxidation of toluene, p-xylene, and 1,3,5-trimethylbenzene was directly measured in the presence of NOx using a laboratory environmental chamber in order to investigate unidentified reactive species in urban air. The total OH reactivity was also calculated from the concentrations of the reactants and products, which were monitored by Fourier-transform infrared spectroscopy. The difference between the measured and calculated OH reactivity, the so-called missing OH reactivity, comprised 58–81% of the total OH reactivity of the secondary products. These results suggest that the secondary products formed from the oxidation of aromatic hydrocarbons may be important candidates in accounting for the missing OH reactivity in the analyses of urban environments. The Master Chemical Mechanism (MCM) calculations were performed to predict the temporal variation in the total OH reactivity for the oxidation of aromatic hydrocarbons. The MCM calculations successfully reproduced the observed total OH reactivity when the particle and semi-volatile product concentrations were negligibly low. The MCM calculations were used to identify the missing secondary products. The results suggest that important components of the missing OH reactivity are unsaturated multifunctional products such as unsaturated dicarbonyls, unsaturated epoxydicarbonyls, and furanones.

Graphical abstract

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hFFF2u

Toward understanding atmospheric physics impacting the relationship between columnar aerosol optical depth and near-surface PM2.5 mass concentrations in Nevada and California, U.S.A., during 2013

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): S. Marcela Loría-Salazar, Anna Panorska, W. Patrick Arnott, James C. Barnard, Jayne M. Boehmler, Heather A. Holmes
Determining the relationship between columnar aerosol optical depth (τext) and surface particulate matter concentrations (PM2.5) is desired to estimate surface aerosol concentrations over broad spatial and temporal scales using satellite remote sensing. However, remote sensing studies incur challenges when surface aerosol pollution (i.e. PM2.5) is not correlated with columnar conditions (i.e., τext). PM2.5 data fusion models that rely on satellite data and statistical relationships of τext and PM2.5 may not be able to capture the physical conditions impacting the relationships that cause columnar and surface aerosols to not be correlated in the western U.S. Therefore, an extensive examination of the atmospheric conditions is required to improve surface estimates of PM2.5 that rely on columnar aerosol measurements. This investigation uses datasets from both routine monitoring networks and models of meteorological variables and aerosol physical parameters to understand the atmospheric conditions under which surface aerosol pollution can be explained by column measurements in California and Nevada during 2013. A novel quadrant method, that utilizes statistical analysis, was developed to investigate the relationship between τext and PM2.5. The results from this investigation show that τext and PM2.5 had a positive association (τext and PM2.5 increase together) when local sources of pollution or wildfires dominated aerosol pollution in the presence of a deep and well-mixed planetary boundary layer (PBL). Moreover, τext and PM2.5 had no association (where the variables are not related) when stable conditions, long-range transport, or entrainment of air from above the PBL were observed. It was found that seasonal categorization of the relationship between τext and PM2.5, an approach commonly used in statistical models to estimate surface concentrations with satellite remote sensing, may not be enough to account for the atmospheric conditions that drive the relationships between τext and PM2.5. For all stations, winter showed the maximum average PM2.5 concentrations (14.1 μg m⁻³, σ = 11.6 μg m⁻³) meanwhile, τext reached minimum values (0.06 μg m⁻³, σ = 0.04) during the same season. Conversely, spring presented the minimum average PM2.5 concentrations (9.4 μg m⁻³, σ = 6.9 μg m⁻³) and the average values of τext during spring had the second highest values (0.11, σ = 0.06) averaged for all stations.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hGqp5D

Strong influence of deposition and vertical mixing on secondary organic aerosol concentrations in CMAQ and CAMx

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Qian Shu, Bonyoung Koo, Greg Yarwood, Barron H. Henderson
Differences between two air quality modeling systems reveal important uncertainties in model representations of secondary organic aerosol (SOA) fate. Two commonly applied models (CMAQ: Community Multiscale Air Quality; CAMx: Comprehensive Air Quality Model with extensions) predict very different OA concentrations over the eastern U.S., even when using the same source data for emissions and meteorology and the same SOA modeling approach. Both models include an option to output a detailed accounting of how each model process (e.g., chemistry, deposition, etc.) alters the mass of each modeled species, referred to as process analysis. We therefore perform a detailed diagnostic evaluation to quantify simulated tendencies (Gg/hr) of each modeled process affecting both the total model burden (Gg) of semi-volatile organic compounds (SVOC) in the gas (g) and aerosol (a) phases and the vertical structures to identify causes of concentration differences between the two models. Large differences in deposition (CMAQ: 69.2 Gg/d; CAMx: 46.5 Gg/d) contribute to significant OA bias in CMAQ relative to daily averaged ambient concentration measurements. CMAQ's larger deposition results from faster daily average deposition velocities (VD) for both SVOC (g) (VD,cmaq = 2.15 × VD,camx) and aerosols (VD,cmaq = 4.43 × Vd,camx). Higher aerosol deposition velocity would be expected to cause similar biases for inert compounds like elemental carbon (EC), but this was not seen. Daytime low-biases in EC were also simulated in CMAQ as expected but were offset by nighttime high-biases. Nighttime high-biases were a result of overly shallow mixing in CMAQ leading to a higher fraction of EC total atmospheric mass in the first layer (CAMx: 5.1–6.4%; CMAQ: 5.6–6.9%). Because of the opposing daytime and nighttime biases, the apparent daily average bias for EC is reduced. For OA, there are two effects of reduced vertical mixing: SOA and SVOC are concentrated near the surface, but SOA yields are reduced near the surface by nighttime enhancement of NOx. These results help to characterize model processes in the context of SOA and provide guidance for model improvement.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A7rp9y

Elucidative analysis and sequencing of two respiratory health monitoring methods to study the impact of varying atmospheric composition on human health

Publication date: December 2017
Source:Atmospheric Environment, Volume 171
Author(s): Amit Awasthi, Navjot Hothi, Prabhjot Kaur, Nirankar Singh, Monojit Chakraborty, Sangeeta Bansal
Atmospheric composition of ambient air consists of different gases in definite proportion that affect the earth's climate and its ecological system. Due to varied anthropogenic reasons, this composition is changed, which ultimately have an impact on the health of living beings. For survival, the human respiratory system is one of the sensitive systems, which is easily and closely affected by the change in atmospheric composition of an external environment. Many studies have been conducted to quantify the effects of atmospheric pollution on human health by using different approaches. This article presents different scenario of studies conducted to evaluate the effects on different human groups. Differences between the studies conducted using spirometry and survey methods are presented in this article to extract a better sequence between these two methodologies. Many studies have been conducted to measure the respiratory status by evaluating the respiratory symptoms and hospital admissions. Limited numbers of studies are found with repeated spirometry on the same subjects for long duration to nullify the error arising due to decrease in efforts by the same subjects during manoeuvre of pulmonary function tests. Present study reveals the importance of methodological sequencing in order to obtain more authentic and reliable results. This study suggests that impacts of deteriorating atmospheric composition on human health can be more significantly studied if spirometry is done after survey analysis. The article also proposes that efficiency and authenticity of surveys involving health impacts will increase, if medical data information of patients is saved in hospitals in a proper format.

Graphical abstract

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2A8rQ3p

A Comparison of Indirect and Direct Methods for Estimating Transglottal Airflow Rate

Publication date: Available online 3 November 2017
Source:Journal of Voice
Author(s): Ashwini Joshi, Christopher R. Watts
ObjectiveThe purpose of this study was to compare indirect estimates of transglottal airflow rate using measures of phonation quotient with direct measures of mean airflow rate derived from a pneumotachograph.Study designThis study used prospective, repeated measures design.MethodsNineteen male and female participants, matched for age, completed tasks for maximum phonation time and vital capacity in addition to the comfortable sustained phonation protocol of the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated from the vital capacity and phonation time measures, whereas actual transglottal airflow was obtained from the flow waveforms recorded on the PAS system. Statistical analyses compared transglottal airflow rate measures as a function of instrument and separately as a function of gender.ResultsStatistically significant differences were present only as a function of gender on airflow measures but not as a function of the instrument. There were no interaction effects present between instrument and gender.ConclusionsPhonation quotient can be used as an estimate of transglottal airflow in the absence of a pneumotachograph-based system.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2h4SzGY

Effects of Vocal Function Exercises: A Systematic Review

Publication date: Available online 3 November 2017
Source:Journal of Voice
Author(s): Vrushali Angadi, Daniel Croake, Joseph Stemple
ObjectivesThe purpose of the present review was to systematically analyze the evidence for the effectiveness of vocal function exercises (VFEs) in improving voice production.MethodsA systematic literature search was performed by two independent reviewers using PubMed and EBSCOHost to access relevant databases and to locate outcome studies that used VFEs as an intervention. Articles that met inclusion criteria were appraised based on the American Speech-Language and Hearing Association's levels of evidence. Effect sizes for outcomes were calculated using Hedge's g. Voice outcomes were categorized according to the five domains of voice assessment: visual perceptual analysis, acoustic analysis, aerodynamic analysis, auditory-perceptual analysis, and patient self-report measures.ResultsTwenty-one articles were included for the final appraisal. All studies demonstrated positive effects of VFEs as demonstrated by effect sizes across selected voice parameters. Effect sizes across parameters ranged from −0.59 to 1.55. None of the included studies reported adverse voice outcomes as a result of VFEs.ConclusionsOutcome studies demonstrate that VFEs are efficacious in enhancing vocal function in individuals with normal and disordered voices, presbylaryngeus, and professional voice users. The available research suggests moderate to strong evidence to support the use of VFEs for a variety of voice disorders.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2itHrDu

Trends in surgery, hospital admissions and imaging for pituitary adenomas in Australia

Abstract

Purpose

There is a paucity of epidemiological information on treatment and imaging of pituitary adenomas in Australia.

Methods

Australian data on pituitary surgery, hospital admissions for pituitary adenomas, and pituitary imaging on patients 15 years and over were obtained from administrative databases between 2000/2001 and 2014/2015. Changes over time and by age and sex were assessed.

Results

In 2014/15 there were 37.7 pituitary procedures/million population, corresponding to a 35.4% (p < 0.05) increase over the 2000/2001 rate. Overall, most (87.2%) procedures were partial excisions of pituitary gland via transsphenoidal surgery (TSS). Admissions for acromegaly increased from 7.1/million in 2000/2001 to 17.2/million in 2003/2004 and then decreased to 6.5/million in 2014/2015. The average age-adjusted rate of pituitary imaging over the study period was 689.6/million/year, which increased significantly (p < 0.05). There was a significant increase in pituitary MRIs (p < 0.05) and a significant decline in pituitary CTs (p < 0.05). Surgical procedure rates were correlated with the pituitary imaging rates (r = 0.62, p < 0.05).

Conclusion

Pituitary surgery rates increased between 2000/2001 and 2014/2015. The most common procedure was partial excision of the pituitary gland via TSS. Admissions for pituitary neoplasms increased over the study while admissions for acromegaly rose to their highest rate in 2003/2004 and then decreased. There was a substantial increase in the rate of pituitary imaging, which may have resulted in increased detection of pituitary incidentalomas. The underlying reasons for the increased rate of pituitary surgery, and the non-sustained increased rate of admissions for acromegaly are unclear and warrant further investigation.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2lQH8HV

Monitoring the estimated glomerular filtration rate (eGFR) in patients with small-cell lung cancer during chemotherapy: equations based on serum creatinine or cystatin C?

Abstract

Background

This study compared the differences between the estimated glomerular filtration rate (eGFR) calculated by several equations based on serum creatinine (Scr) and cystatin C (CysC) concentrations for monitoring renal function in patients with small-cell lung cancer (SCLC) during chemotherapy.

Methods

Seventy-one patients with SCLC were retrospectively analyzed. The eGFR before and after each chemotherapy cycle was calculated by the following equations: the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, the modification of diet in renal disease (MDRD) equation, the Cockcroft–Gault (CG) equation, and five CysC-based equations. The patients were compared among the different eGFR groups.

Results

The mean decreases in eGFR_CKD-EPI (−2.25 ± 9.89 ml/min/1.73 m²) between each treatment cycle were more significant than the decreases in eGFR_CG (−0.46 ± 10.17 ml/min/1.73 m²), eGFR_MDRD (−0.48 ± 9.79 ml/min/1.73 m²), and five calculated eGFR_CysC (p < 0.05). Single-/multiparameter analyses showed that patients with a higher body mass index (BMI >23) and receiving more treatment cycles (>3) were at increased risk for developing renal impairment with an eGFR less than 60 ml/min/1.73 m² during chemotherapy.

Conclusions

The eGFR calculated by the CKD-EPI equation changed more significantly between each chemotherapy cycle than did the eGFR from the other equations based on Scr or CysC in patients with SCLC. Oncologists should pay more attention to the renal function of specific patient groups during treatment.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zxPJ8A

Trends in surgery, hospital admissions and imaging for pituitary adenomas in Australia

Abstract

Purpose

There is a paucity of epidemiological information on treatment and imaging of pituitary adenomas in Australia.

Methods

Australian data on pituitary surgery, hospital admissions for pituitary adenomas, and pituitary imaging on patients 15 years and over were obtained from administrative databases between 2000/2001 and 2014/2015. Changes over time and by age and sex were assessed.

Results

In 2014/15 there were 37.7 pituitary procedures/million population, corresponding to a 35.4% (p < 0.05) increase over the 2000/2001 rate. Overall, most (87.2%) procedures were partial excisions of pituitary gland via transsphenoidal surgery (TSS). Admissions for acromegaly increased from 7.1/million in 2000/2001 to 17.2/million in 2003/2004 and then decreased to 6.5/million in 2014/2015. The average age-adjusted rate of pituitary imaging over the study period was 689.6/million/year, which increased significantly (p < 0.05). There was a significant increase in pituitary MRIs (p < 0.05) and a significant decline in pituitary CTs (p < 0.05). Surgical procedure rates were correlated with the pituitary imaging rates (r = 0.62, p < 0.05).

Conclusion

Pituitary surgery rates increased between 2000/2001 and 2014/2015. The most common procedure was partial excision of the pituitary gland via TSS. Admissions for pituitary neoplasms increased over the study while admissions for acromegaly rose to their highest rate in 2003/2004 and then decreased. There was a substantial increase in the rate of pituitary imaging, which may have resulted in increased detection of pituitary incidentalomas. The underlying reasons for the increased rate of pituitary surgery, and the non-sustained increased rate of admissions for acromegaly are unclear and warrant further investigation.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2lQH8HV

Extreme proximal junctional kyphosis—a complication of delayed lambdoid suture closure in Hajdu–Cheney syndrome: a case report and literature review

Abstract

Purpose

To describe the manifestations, surgical treatment, and potential complications of Hajdu–Cheney syndrome (HCS), and the management of these complications.

Methods

The clinical presentation, management and outcome of HCS with severe osteoporosis and open skull sutures is presented, together with a literature review.

Results

A 20-year-old female with HCS underwent posterior occipitocervical fusion for symptoms of progressive basilar invagination. Because of delayed lambdoid suture closure, the stiff fusion construct lead to increased suture distraction, most notably in the upright (suture-open) position, with relief in the supine (suture-closed) position. This was successfully remedied with extension of the fusion construct anteriorly over the skull vertex to the frontal bones.

Conclusions

In patients with HCS and other conditions with delayed suture closure, the surgeon must be cognizant of the presence of mobility at the suture lines, and consider extending the fusion construct anteriorly over the skull vertex up to the frontal bones. Because of significant osteoporosis in these syndromes, multiple fixation points and augmentation with bone graft are important principles.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ze6DZd

Preoperative pulmonary function tests before low-risk surgery in Japan: a retrospective cohort study using a claims database

Abstract

Purpose

Routine preoperative pulmonary function tests (PFTs) are not recommended prior to low-risk surgery because their prognostic value is limited. However, only a few studies have assessed the utilization of healthcare resources regarding preoperative PFTs in a real-world setting. Here, we aimed to assess the prevalence and determinant factors of preoperative PFTs before low-risk surgery in Japan.

Methods

In this retrospective cohort study, we used the nationwide insurance claims databases. Patients who underwent low-risk surgeries under general anesthesia between April 1, 2012, and March 31, 2016, were included. The primary outcome was the receipt of PFTs within 60 days before an index surgery. We performed descriptive analyses to estimate the rates of preoperative PFTs annually starting in 2012, and examined the associations between patient- and institutional-level factors and preoperative PFTs using multilevel logistic regression analyses.

Results

The cohort included 9495 procedures (8866 patients) at 1487 institutions. Preoperative PFTs were conducted before 71.8% of the procedures. The temporal trend of preoperative PFTs remained constant from 72.4% in 2012 to 72.2% in 2015. Multilevel regression analysis revealed that preoperative PFTs were associated with older age, number of beds at a medical facility, and inpatient procedures. The median institutional-specific proportion of PFTs was 75.0% (interquartile range, 14.3–100%) with wide inter-institutional variation.

Conclusions

Our analysis found that preoperative PFTs were performed before 72% of low-risk surgeries under general anesthesia. Apart from age, preoperative PFTs were determined primarily by non-medical factors. Additionally, we observed substantial institutional variation in the use of preoperative PFTs.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2lQCcCW

A Comparison of Indirect and Direct Methods for Estimating Transglottal Airflow Rate

Publication date: Available online 3 November 2017
Source:Journal of Voice
Author(s): Ashwini Joshi, Christopher R. Watts
ObjectiveThe purpose of this study was to compare indirect estimates of transglottal airflow rate using measures of phonation quotient with direct measures of mean airflow rate derived from a pneumotachograph.Study designThis study used prospective, repeated measures design.MethodsNineteen male and female participants, matched for age, completed tasks for maximum phonation time and vital capacity in addition to the comfortable sustained phonation protocol of the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated from the vital capacity and phonation time measures, whereas actual transglottal airflow was obtained from the flow waveforms recorded on the PAS system. Statistical analyses compared transglottal airflow rate measures as a function of instrument and separately as a function of gender.ResultsStatistically significant differences were present only as a function of gender on airflow measures but not as a function of the instrument. There were no interaction effects present between instrument and gender.ConclusionsPhonation quotient can be used as an estimate of transglottal airflow in the absence of a pneumotachograph-based system.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2h4SzGY

Androgenic alopecia in a postmenopausal Sicilian baroness

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j1aulM

Translating computer-aided design and surgical planning into successful mandibular reconstruction using a vascularized iliac-crest flap

Publication date: Available online 3 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lei Zheng, Xiaoming Lv, Jie Zhang, Shuming Liu, Jianguo Zhang, Yi Zhang
PurposeThis study is to evaluate the computer-aided approach to the reconstruction of mandibular defects using a vascularized iliac-crest flap.Methods and materialsFrom December 2015 to October 2016, 14 patients (8 males and 6 females) aged between 18 and 64 years (median age, 29 years) were treated at the Peking University School and Stomatology Hospital, China. All of the patients were confirmed by histological examination prior to segmental mandibulectomy. Computer-based surgical techniques, including virtual surgical planning, CAD/CAM, rapid prototyping, and intraoperative navigation, were used to restore the anatomical continuity and configuration of the mandible using a vascularized iliac-crest flap. 2 transverse and 1 anterior-posterior (A-P) dimensions were evaluated based on the virtual plan and postoperative CT. The lines from the condylar head to condylar head and from the gonial angle to gonial angle were defined as the transverse dimensions. Measuring a perpendicular line drawn from the mandibular midline to the center point on the condylar head to condylar head measurement was defined as the A-P dimension. Complications were also evaluated during follow-up.ResultsFlap success rate of the patients was 92.9% (13/14), with one flap failure. Post-operation, there were no other serious complications in 13/14 patients who exhibited a good mandibular configuration with good occlusion. Furthermore, the height of bone graft was sufficient for implants. Healing of both the recipient and donor sites with no serious complication was uneventful. The average surgical error in the A-P dimension and transverse dimensions was 1.8±1.0 mm (Range: 0.2 - 3.7 mm), 2.2±1.1 mm (Range: 0.9 – 5.0 mm) and 2.6±1.6 mm (Range: 0.3 – 7.2 mm), respectively.ConclusionsThe use of these digital techniques was found to be a viable option for reconstruction of mandibular defects, but should be interpreted cautiously due to the small number of patients and the relatively short follow-up.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y0bER7

Androgenic alopecia in a postmenopausal Sicilian baroness

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j1aulM

Evaluation of Swallow Function in Patients with Craniofacial Microsomia: A Retrospective Study

Abstract

Craniofacial microsomia (CFM) is characterized by underdevelopment of the structures derived from the first and second pharyngeal arches resulting in aesthetic, psychological, and functional problems including feeding and swallowing difficulties. The aim of this study is to gain more insight into swallowing difficulties in patients with CFM. A retrospective study was conducted in the population of patients diagnosed with CFM at three major craniofacial units. Patients with feeding difficulties and those who underwent video fluoroscopic swallow (VFS) studies were included for further analyses. The outcome of the VFS-studies was reviewed with regard to the four phases of swallowing. In our cohort, 13.5% of the 755 patients were diagnosed with swallowing difficulties. The outcome of the VFS-studies of 42 patients showed difficulties in the oral and pharyngeal phases with both thin and thick liquids. Patients with more severe mandibular hypoplasia showed more difficulties to form an appropriate bolus compared to patients who were less severely affected. This is the first study to document swallowing problems in patients with CFM. Difficulties were seen in both the oral and pharyngeal phases. We recommend routine screening for swallowing issues by a speech and language therapist in all patients with CFM and to obtain a VFS-study in patients with a type III mandible.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yuZ80l

Sleep spindle and psychopathology characteristics of frequent nightmare recallers

Publication date: Available online 4 November 2017
Source:Sleep Medicine
Author(s): Claudia Picard-Deland, Michelle Carr, Tyna Paquette, Kadia Saint-Onge, Tore Nielsen
Idiopathic nightmares are a common disturbance of REM sleep but studies of comorbid pathologies and sleep architecture suggest that NREM sleep is also affected. Sleep spindles are a NREM sleep characteristic linked to both pathophysiology and sleep-dependent memory consolidation but they have not yet been evaluated in frequent nightmare recallers. The morning naps of 38 participants with frequent idiopathic nightmares (mean age: 23.7±3.78 yrs) and 25 age- and sex-matched controls (23.9±3.65 yrs) were recorded and their sleep evaluated. A custom spindle detector assessed N2 sleep spindles on 6 EEG derivations (F3, F4, C3, C4, O1, O2) for density (number spindles/N2 time), mean frequency and amplitude. Total spindles (11-16 Hz range), slow spindles (11-13 Hz) and fast spindles (14-16 Hz) were all assessed separately. Compared with the Control group, the Nightmare group had longer N2 sleep latency and a marginally greater %N2 sleep. The Nightmare group also had a lower than normal density of slow spindles in most EEG derivations, a higher density of fast spindles in frontal derivations, and an elevated fast spindle oscillatory frequency—'faster fast' spindles—mainly in central derivations. These differences withstood controls for pre-existing group differences in depression. Correlational analyses demonstrated a further pattern of group differences by which higher pathology scores were associated with higher slow spindle densities and slower spindle frequencies for the Nightmare but not the Control group. A similar pattern was observed for some dream content measures, i.e., the Nightmare group showed positive correlations between slow spindle density and dreamed fear and word count and negative correlations with dreamed positive-emotion. The Control group showed opposite trends. Results thus demonstrate abnormalities in the composition of N2 sleep—and especially in N2 spindles—among frequent nightmare recallers and link these abnormalities to both trait (psychopathology) and state (dream content) factors. Spindle findings for psychopathology resemble, but are not identical with, previous findings for patients with major depression, social anxiety and schizophrenia and are thus consistent with an explanation implicating spindles as trait markers of psychopathology. Correlational analyses go beyond a trait explanation to suggest several possible state-based explanations involving memory consolidation mechanisms, specifically, the possibility that spindles index either emotional or verbal task-based processes.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AjzvwU

Cancer-Specific Survival Stratification Derived from Tumor Expression of Tissue Inhibitor of Metalloproteinase-2 in Non-Metastatic Renal Cell Carcinoma

Abstract

Degradation of the extracellular matrix is a prerequisite for the processes of cancer cell invasion and metastasis. The purpose of our study was to assess the association of matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9) and their inhibitors (TIMP-1 and TIMP-2) with renal cell carcinoma (RCC) progression and cancer-specific survival (CSS), using immunohistochemical analysis of 60 formalin-fixed, paraffin-embedded sections of tumor tissue and normal tissue near the tumor from surgical T1-3bN0 M0 RCC specimens. Significant overexpression of MMP-2 in tumor and normal tissue was correlated with advanced stages, tumor size, sarcomatous differentiation and clinical symptoms. Overall survival was 31.7% (55.2% M0, 9.7% M1) and CSS 56.7% (100% M0, 16.1% M1) with a follow-up of 76 (5–230) months. Fuhrman grade [HR 2.87 (95% CI: 1.28–6.45); p = 0.01], tumor size [HR 1.13 (95% CI: 1.03–1.26); p = 0.009] and low TIMP-2 expression [HR 0.35 (95% CI: 0.16–0.78); p = 0.01] were independent predictive factors of CSS and stratified the patients into three groups with different rates of 10-year CSS; [100%, 73.9% and 20.5% for the good, intermediate and poor prognosis group respectively (p = 0.000006)] . This study offers strong evidence that TIMP-2 expression in tumor tissue may play a crucial role in progression and poor prognosis in human localized and locally advanced RCC.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2y1qh6O