Comparison of the CIELab and CIEDE 2000 Color Difference Formulas on Gingival Color Space

Abstract

Purpose

To evaluate the CIELAB and CIEDE2000 formulas to determine which better reflects the difference in color perception, and whether there are gender differences in color perception.

Materials and Methods

Fifty-six participants grouped 21 different-colored disks made of pink porcelain (color range: from 36.8 to 63.9 for L^*, from 16.4 to 35.2 for a^*, from 6.2 to 21.6 for b^*), in which the only requirement was that each group be comprised of disks with chromatically indistinguishable colors. Each participant was free to choose the number and composition of the groups. Using the results obtained, a dissimilarity matrix was generated, and nonmetric multidimensional scaling (MDS) was applied to obtain the coordinates of the disks within a Euclidean space.

Results

The linear correlation coefficient between the interpoint distances of the MDS configuration (MDS_total sample) and the color differences with the CIELAB formula (ΔE^*_ab) was 0.719 (p < 0.001), whereas with the CIEDE2000 formula (ΔE00), it was 0.726 (p < 0.001). For the configuration obtained in the women's group (MDS_w), the correlations between the interpoint distances and the CIELab color difference was 0.720 (p < 0.001), and the CIEDE2000 color differences was 0.730 (p < 0.001). For the configuration obtained in the men's group (MDS_m), the perceived color differences, calculated with both formulas, were less sensitive, 0.670 for CIELab formula and 0.677 for CIEDE2000 formula.

Conclusions

Considering the limitations of this study, the data analyzed indicated that the CIEDE2000 formula reflected the color differences perceived by the human eye similar to the CIELAB formula (ΔE^*_ab). Also, women were confirmed to be more sensitive than men to differences in color.

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Marginal Fit of Metal-Ceramic Copings: Effect of Luting Cements and Tooth Preparation Design

Abstract

Purpose

To evaluate the effect of the triad finish line design, axial wall convergence angle, and luting cement on the marginal fit of metal copings used in metal-ceramic crowns.

Materials and Methods

Schematic dies and their respective copings were cast in NiCr alloy. The dies exhibited the following finish line/convergence angle combinations: sloping shoulder/6°, sloping shoulder/20°, shoulder/6°, shoulder/20°. Marginal fit was evaluated under a stereomicroscope, before and after cementation. Copings were air-abraded with 50 μm Al₂O₃ particles and cemented with Cimento de Zinco, RelyX U100, or Panavia F cements (n = 10/group). Data were square-root transformed and analyzed by 3-way factorial random effect model and Tukey's post hoc test (α = 0.05).

Results

Statistical analysis showed significance for the interactions finish line and convergence angle (p < 0.05), convergence angle and time (p < 0.001), and luting cement and time (p < 0.001). Sloping shoulder/20° provided the highest marginal discrepancy when compared to the other finish line/convergence angle combinations, which were statistically similar among each other. For both convergence angles and for all luting cements, the marginal discrepancy was significantly higher after cementation. Before and after cementation, 6° provided better marginal fit than 20°. After cementation, Panavia F provided higher marginal discrepancy than Cimento de Zinco.

Conclusion

Lower convergence angle combined with shoulder and a low-consistency luting cement is preferable to cement metal copings.

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The underreporting of cost perspective in cost-analysis research: a systematic review of the plastic surgery literature

Publication date: Available online 21 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Madeleine M. Blank, Lilian Chen, Marianna Papageorge, Daniel Driscoll, Roger Graham, Abhishek Chatterjee
BackgroundCost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.MethodsA systematic review was completed to retrieve cost-utility and cost-effectiveness research within the scope of Plastic Surgery. The search was limited to English-language studies in North America and Europe published between 2006 and 2016. Articles were selected using predefined data fields and specific inclusion criteria.ResultsA total of 2304 abstracts were identified, of which 47 met inclusion criteria. Seventy-two percent of studies (n=34) declared a cost perspective. Of the studies that identified a cost perspective, 32% incorrectly identified the cost perspective. Only 49% of all studies (n=23) both accurately declared and justified their chosen perspective.ConclusionsOnly half of studies correctly declare their cost perspective and justify why the perspective was chosen. Not doing so potentially hides bias from the reader. Future efforts when performing cost-analysis studies should require a clear declaration and justification of the cost perspective taken. A table of our recommendations for reporting cost perspective is provided.



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Negative-delay sources in distortion product otoacoustic emissions

Publication date: Available online 22 December 2017
Source:Hearing Research
Author(s): Renata Sisto, Christopher A. Shera, Arturo Moleti
Long-delay components showing a symmetrical pattern with positive and negative delays can be observed in the time-frequency representation (or in the inverse Fourier transform) of distortion product otoacoustic emissions. Positive-only phase-gradient delays are predicted by place-fixed backscattering mechanisms, such as coherent reflection due to roughness, whereas the nonlinear distortion wave-fixed mechanism should generate an almost null-delay component. The symmetrical delay pattern arises whenever spectral amplitude fluctuations are not fully correlated to phase fluctuations. An interpretation of this phenomenon is proposed, involving place-fixed modulation of the spectral strength of the wave–fixed nonlinear generator.Experimental data are shown in which these negative-delay sources are particularly strong, and further amplified by contralateral stimulation, suggesting that this effect could be dynamically enhanced. Analytical solutions of a linear 1-d transmission line model, in which cubic nonlinearity and roughness were added as small perturbations, have been used to test this hypothesis.



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Intentional switching in auditory selective attention: Exploring attention shifts with different reverberation times

Publication date: Available online 22 December 2017
Source:Hearing Research
Author(s): Josefa Oberem, Julia Seibold, Iring Koch, Janina Fels
Using a well-established binaural-listening paradigm the ability to intentionally switch auditory selective attention was examined under anechoic, low reverberation (0.8 s) and high reverberation (1.75 s) conditions. Twenty-three young, normal-hearing subjects were tested in a within-subject design to analyze influences of the reverberation times. Spoken word pairs by two speakers were presented simultaneously to subjects from two of eight azimuth positions. The stimuli consisted of a single number word, (i.e., 1 to 9), followed by either the direction "UP" or "DOWN" in German. Guided by a visual cue prior to auditory stimulus onset indicating the position of the target speaker, subjects were asked to identify whether the target number was numerically smaller or greater than five and to categorize the direction of the second word. Switch costs, (i.e. reaction time differences between a position switch of the target relative to a position repetition), were larger under the high reverberation condition. Furthermore, the error rates were highly dependent on reverberant energy and reverberation interacted with the congruence effect, (i.e. stimuli spoken by target and distractor may evoke the same answer (congruent) or different answers (incongruent)), indicating larger congruence effects under higher reverberation times.



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Olivocochlear Efferents: Their action, effects, measurement and uses, and the impact of the new conception of cochlear mechanical responses

Publication date: Available online 21 December 2017
Source:Hearing Research
Author(s): John J. Guinan
The anatomy and physiology of olivocochlear (OC) efferents are reviewed. To help interpret these, recent advances in cochlear mechanics are also reviewed. Lateral OC (LOC) efferents innervate primary auditory-nerve (AN) fiber dendrites. The most important LOC function may be to reduce auditory neuropathy. Medial OC (MOC) efferents innervate the outer hair cells (OHCs) and act to turn down the gain of cochlear amplification. Cochlear amplification had been thought to act only through basilar membrane (BM) motion, but recent reports show that motion near the reticular lamina (RL) is amplified more than BM motion, and that RL-motion amplification extends to several octaves below the local characteristic frequency. Data on efferent effects on AN-fiber responses, otoacoustic emissions (OAEs) and human psychophysics are reviewed and reinterpreted in the light of the new cochlear-mechanical data. The possible origin of OAEs in RL motion is considered. MOC-effect measuring methods and MOC-induced changes in human responses are also reviewed, including that ipsilateral and contralateral sound can produce MOC effects with different patterns across frequency. MOC efferents help to reduce damage due to acoustic trauma. Many, but not all, reports show that subjects with stronger contralaterally-evoked MOC effects have better ability to detect signals (e.g. speech) in noise, and that MOC effects can be modulated by attention.



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Use of the hCONSORT Criteria as a Reporting Standard for Herbal Interventions for Common Dermatoses - A Systematic Review

Abstract

Background

The use of complementary and alternative medicine (CAM) is increasing in western countries, including in the area of dermatology. However, western healthcare providers have not integrated CAM into regular practice due to a lack of reliable data supporting its use. In order to encourage high quality research related to the use of CAM and specifically herbal interventions, the CONSORT extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.

Objectives

This study aimed to evaluate the adherence of randomized controlled trials investigating herbal interventions for 3 common dermatoses (acne, atopic dermatitis, and psoriasis) to the hCONSORT criteria.

Methods

A comprehensive search of Medline, Embase, and Cochrane library databases was conducted. Randomized control trials published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, atopic dermatitis, or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. Analysis of variance was used to examine differences in scores by disease entity.

Results

The vast majority of reviewed studies reported less than 50% of information recommended in the hCONSORT criteria.

Limitations

Limitations include small number of dermatologic conditions examined, exclusion of reports based on language, and lack of assessment of overall adherence to CONSORT criteria

Conclusions

Our data indicates lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers.

This article is protected by copyright. All rights reserved.

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Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review

Abstract

Background

Plenty of surgical strategies for treatment of simple syndactyly have been reported in the past decades. We are most interested in what progresses have been made over the recent 10 years. Our aim was to make a summary of the modified techniques that have been described in the last decade.

Methods

We reviewed English articles from PubMed and Chinese articles from CKNI and CQVIP published between January 2007 and December 2016. We limited the inclusion criteria to simple syndactyly and excluded complex, complicated, and syndrome-associated syndactylies.

Results

We identified 1650 articles and selected 94 for inclusion. Almost half of the included papers proposed modified flaps for web reconstruction. In most cases, a zigzag incision and Buck-Gramcko flaps were still the first choice to separate the fused digits and create the nail folds. Several new donor sites were recommended for skin grafts and several substitute biomaterials were introduced to replace skin grafts. External fixator devices were applied in a wider range for desyndactylization. However, it was not considered to be superior to other graft-less strategies. Postoperative complications were discussed in most papers, but an effective strategy to eradicate these is lacking.

Conclusions

With the development of biomaterials and surgeon's experiences, more and more modified techniques have been conceived. However, no specific technique can be announced to be superior to others. Furthermore, more sensitive outcome measures should be established, and relationship between operative procedures and postoperative complications should be further defined.

Level of evidence: not ratable.

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Red and processed meat consumption and breast cancer: UK Biobank cohort study and meta-analysis

Publication date: February 2018
Source:European Journal of Cancer, Volume 90
Author(s): Jana J. Anderson, Narisa D.M. Darwis, Daniel F. Mackay, Carlos A. Celis-Morales, Donald M. Lyall, Naveed Sattar, Jason M.R. Gill, Jill P. Pell
AimRed and processed meat may be risk factors for breast cancer due to their iron content, administration of oestrogens to cattle or mutagens created during cooking. We studied the associations in UK Biobank and then included the results in a meta-analysis of published cohort studies.MethodsUK Biobank, a general population cohort study, recruited participants aged 40–69 years. Incident breast cancer was ascertained via linkage to routine hospital admission, cancer registry and death certificate data. Univariate and multivariable Cox proportional hazard models were used to explore the associations between red and processed meat consumption and breast cancer. Previously published cohort studies were identified from a systematic review using PubMed and Ovid and a meta-analysis conducted using a random effects model.ResultsOver a median of 7 years follow-up, 4819 of the 262,195 women developed breast cancer. The risk was increased in the highest tertile (>9 g/day) of processed meat consumption (adjusted hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.08–1.35, p = 0.001). Collation with 10 previous cohort studies provided data on 40,257 incident breast cancers in 1.65 million women. On meta-analysis, processed meat consumption was associated with overall (relative risk [RR] 1.06, 95% CI 1.01–1.11) and post-menopausal (RR 1.09, 95% CI 1.03–1.15), but not pre-menopausal (RR 0.99, 95% CI 0.88–1.10), breast cancer. In UK Biobank and the meta-analysis, red meat consumption was not associated with breast cancer (adjusted HR 0.99 95% CI 0.88–1.12 and RR 1.03, 95% CI 0.99–1.08, respectively).ConclusionsConsumption of processed meat, but not red meat, may increase the risk of breast cancer.



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Optimal adjuvant endocrine treatment of ER+/HER2+ breast cancer patients by age at diagnosis: A population-based cohort study

Publication date: February 2018
Source:European Journal of Cancer, Volume 90
Author(s): G.M.H.E. Dackus, K. Jóźwiak, G.S. Sonke, E. van der Wall, P.J. van Diest, M. Hauptmann, S. Siesling, S.C. Linn
BackgroundPrior randomised controlled trials on adjuvant hormonal therapy included HER2any patients; however, a differential effect of aromatase inhibitors (AIs) versus tamoxifen (TAM) may have been missed in ER+/HER2+ patients that comprise 7–15% of all breast cancer patients.In addition, a woman's hormonal microenvironment may influence sensitivity to TAM and AIs in the adjuvant setting, which changes during menopausal transition, a process that takes years. We studied the efficacy of AIs versus TAM in ER+/HER2+ breast cancer patients grouped by age at diagnosis as a proxy for menopausal status using treatment and outcome data from the nationwide population-based Netherlands Cancer Registry (NCR).Patients and methodsAll women diagnosed between 2005 and 2007 with endocrine-treated, TanyNanyM0, ER+/HER2+ breast cancer were identified through the NCR (n = 1155). Patients were divided by age at diagnosis: premenopausal (≤45 years; n = 326), perimenopausal (45<years≤55; n = 304) and postmenopausal (>55 years; n = 525). A time-dependent variable, indicating whether AI or TAM was received for >50% of endocrine treatment duration, was applied to subdivide groups by predominant treatment received. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan–Meier survival estimation and Cox regression. Hazard ratios (HRs) were adjusted for chemotherapy, trastuzumab, age at diagnosis, N-status, grade, pT-stage and ovarian ablation.ResultsDuring follow-up, 237 recurrences and 182 deaths occurred. Perimenopausal women derived significant RFS and OS benefit from AI compared with TAM, HR 0.47 (95% CI 0.25–0.91; P = 0.03) and HR 0.37 (95% CI 0.18–0.79; P = 0.01), respectively, whereas premenopausal women derived no benefit from AI compared with TAM. Treatment effects differed significantly between these age groups (interaction P = 0.03 and P = 0.02, respectively). Among postmenopausal women a small but non-significant AI benefit was observed.ConclusionAI treatment, preferably without any TAM treatment, was associated with the best RFS and OS outcome in ER+/HER2+ perimenopausal breast cancer patients.



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3-Methoxytyramine: An independent prognostic biomarker that associates with high-risk disease and poor clinical outcome in neuroblastoma patients

Publication date: February 2018
Source:European Journal of Cancer, Volume 90
Author(s): I.R.N. Verly, A.B.P. van Kuilenburg, N.G.G.M. Abeling, S.M.I. Goorden, M. Fiocco, F.M. Vaz, M.M. van Noesel, C.M. Zwaan, G.J.L. Kaspers, J.H.M. Merks, H.N. Caron, G.A.M. Tytgat
IntroductionPrognosis of neuroblastoma patients is very diverse, indicating the need for more accurate prognostic parameters. The excretion of catecholamine metabolites by most neuroblastomas is used for diagnostic purposes, but their correlation with prognosis has hardly been investigated. Therefore, we performed an in-depth analysis of a panel of elevated urinary catecholamine metabolites at diagnosis and their correlation with prognosis.Patients and methodsRetrospective study of eight urinary catecholamine metabolites in a test (n = 96) and validation (n = 205) cohort of patients with neuroblastoma (all stages) at diagnosis.ResultsMultivariate analyses, including risk factors such as stage and MYCN amplification, revealed that 3-methoxytyramine (3MT) was an independent risk factor for event-free survival (EFS) and overall survival (OS). Furthermore, only 3MT appeared to be an independent risk factor for both EFS and OS in high-risk patients, which was independent of modern high-risk therapy and immunotherapy. Among high-risk patients, those with elevated 3MT and older than 18 months had an extremely poor prognosis compared to patients with non-elevated 3MT and younger than 18 months (5-year EFS of 14.3% ± 4% and 66.7% ± 18%, respectively, p = 0.001; 5-year OS of 21.8% ± 5% and 87.5% ± 12%, respectively, p < 0.001).ConclusionsElevated 3MT at diagnosis was associated with high-risk disease and poor prognosis. For high-risk patients, elevated 3MT at diagnosis was the only significant risk factor for EFS and OS. 3MT was also able to identify subgroups of high-risk patients with favourable and extremely poor prognosis.



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Real-World Experience with Targeted Therapy for the Treatment of Anaplastic Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Recent Pregnancy Is Not Associated with High-Risk Pathological Features of Well-Differentiated Thyroid Cancer

Thyroid , Vol. 0, No. 0.


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Re: “Low-Dose Childhood Radiation Effects to the Thyroid Follow a Linear Dose–Response Trend and Persist Even 45+ Years After Exposure”

Thyroid , Vol. 0, No. 0.


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Rutin Scavenges Reactive Oxygen Species, Inactivates 5′-Adenosine Monophosphate-Activated Protein Kinase, and Increases Sodium–Iodide Symporter Expression in Thyroid PCCL3 Cells

Thyroid , Vol. 0, No. 0.


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Cancer Risk Associated with Nuclear Atypia in Cytologically Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

Thyroid , Vol. 0, No. 0.


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Bone microarchitecture and bone mineral density in multiple sclerosis

Background

Multiple sclerosis (MS) patients are at increased risk of reduced bone mineral density (BMD) and fractures. The aetiology of bone loss in MS is unclear. Trabecular bone score (TBS) is a novel analytical tool that provides a measurement of the bone microarchitecture. Decreased TBS predicts increased fracture risk independently of BMD. To date, no studies have investigated TBS in MS patients.

Objectives

To assess bone quality in MS patients by TBS and to evaluate potential risk factors that may affect BMD and TBS in patients with MS.

Methods

Two hundred sixty MS patients were included. TBS was calculated using TBS iNsight software (MediMaps^®). Multivariable regression analyses were performed with information on smoking, alcohol, glucocorticoid (GC) treatment, sun exposure, physical activity, vitamin D and BMI.

Results

Trabecular bone score was not significantly different from an age-matched reference population. Low TBS was associated with high age (P = .014) and smoking (P = .03). Smoking and physical inactivity were associated with low BMD in spine (P = .034, P = .032). GC treatment was not associated with TBS.

Conclusion

We could not find altered TBS values among MS patients, suggesting that BMD alone, and not the bone microarchitecture, is affected in MS. However, larger studies are needed to verify these findings and to establish the role of TBS in MS. As in the background population, physical activity and non-smoking habits are associated with better bone health in MS.

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Progress in surgical strategies for treatment of simple congenital syndactyly: A systematic review

Abstract

Background

Plenty of surgical strategies for treatment of simple syndactyly have been reported in the past decades. We are most interested in what progresses have been made over the recent 10 years. Our aim was to make a summary of the modified techniques that have been described in the last decade.

Methods

We reviewed English articles from PubMed and Chinese articles from CKNI and CQVIP published between January 2007 and December 2016. We limited the inclusion criteria to simple syndactyly and excluded complex, complicated, and syndrome-associated syndactylies.

Results

We identified 1650 articles and selected 94 for inclusion. Almost half of the included papers proposed modified flaps for web reconstruction. In most cases, a zigzag incision and Buck-Gramcko flaps were still the first choice to separate the fused digits and create the nail folds. Several new donor sites were recommended for skin grafts and several substitute biomaterials were introduced to replace skin grafts. External fixator devices were applied in a wider range for desyndactylization. However, it was not considered to be superior to other graft-less strategies. Postoperative complications were discussed in most papers, but an effective strategy to eradicate these is lacking.

Conclusions

With the development of biomaterials and surgeon's experiences, more and more modified techniques have been conceived. However, no specific technique can be announced to be superior to others. Furthermore, more sensitive outcome measures should be established, and relationship between operative procedures and postoperative complications should be further defined.

Level of evidence: not ratable.

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Strategies for Reducing Fatal Complications in Liposuction

Find out about the most common severe complications associated with liposuction, and learn how they can best be prevented.
Plastic Reconstructive Surgery-Global Open (PRS Global Open)

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Autophagy and proteostasis in the control of synapse aging and disease

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): YongTian Liang, Stephan Sigrist
The maintenance of neuronal homeostasis is severely threatened by aging, probably partially due to compromised autophagic clearance. Hence, rejuvenating autophagy in aging neurons is considered a promising strategy to restore cognitive performance. Research in recent years has shown that autophagosome biogenesis takes place mainly in distal axons and, thus, close to presynaptic specializations, and that efficient macro-autophagy is essential for neuronal homeostasis and survival. Retrograde transport of autophagosomes might play a role in neuronal signaling processes, promoting neuronal complexity and preventing neurodegeneration. Here, we discuss recent advances concerning the intersection of aging, neurodegeneration and autophagy, and try to create a unified view of how neuronal autophagy and proteostasis might control synaptic aging and disease.



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LIF drives neural remodeling in pancreatic cancer and offers a new candidate biomarker

Pancreatic ductal adenocarcinoma (PDAC) is characterized by extensive stroma and pathogenic modifications to the peripheral nervous system that elevate metastatic capacity. In this study, we show that the IL-6-related stem cell promoting factor LIF supports PDAC-associated neural remodeling (PANR). LIF was overexpressed in tumor tissue compared to healthy pancreas, but its receptors LIFR and gp130 were expressed only in intratumoral nerves. Cancer cells and stromal cells in PDAC tissues both expressed LIF, but only stromal cells could secrete it. Biological investigations showed that LIF promoted the differentiation of glial nerve sheath Schwann cells and induced their migration by activating JAK/STAT3/AKT signaling. LIF also induced neuronal plasticity in dorsal root ganglia neurons by increasing the number of neurites and the soma area. Notably, injection of LIF-blocking antibody into PDAC-bearing mice reduced intratumoral nerve density, supporting a critical role for LIF function in PANR. In serum from human PDAC patients and mouse models of PDAC, we found that LIF titers positively correlated with intratumoral nerve density. Taken together, our findings suggest LIF as a candidate serum biomarker and diagnostic tool and a possible therapeutic target for limiting the impact of PANR in PDAC pathophysiology and metastatic progression.

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Tumor side as model of integrative molecular classification of colorectal cancer

It has long since been recognized that colorectal cancer is molecularly heterogeneous and its clinical behavior differs if primary tumor was located in the right or left side of the colon. Recent studies have shown that part of this heterogeneity is captured by the anatomical location of the tumor.

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Alteration of the tumor stroma using a consensus DNA vaccine targeting Fibroblast Activation Protein (FAP) synergizes with anti-tumor vaccine therapy in mice

Purpose: Fibroblast activation protein (FAP) is over-expressed in cancer-associated fibroblasts and is an interesting target for cancer immune therapy, with prior studies indicating a potential to impact the tumor stroma. Our aim was to extend this earlier work through development of a novel FAP immunogen with improved capacity to break tolerance for use in combination with tumor antigen vaccines. Experimental Design: We used a synthetic consensus (SynCon) sequence approach to provide MHC class II help to support breaking of tolerance. We evaluated immune responses and anti-tumor activity of this novel FAP vaccine in pre-clinical studies, and correlated these findings to patient data. Results: This SynCon FAP DNA vaccine was capable of breaking tolerance and inducing both CD8+ and CD4+ immune responses. In genetically diverse, outbred mice, the SynCon FAP DNA vaccine was superior at breaking tolerance compared to a native mouse FAP immunogen. In several tumor models, the SynCon FAP DNA vaccine synergized with other tumor-antigen specific DNA vaccines to enhance anti-tumor immunity. Evaluation of the tumor microenvironment showed increased CD8+ T cell infiltration and a decreased macrophage infiltration driven by FAP immunization. We extended this to patient data from the Cancer Genome Atlas, where we find high FAP expression correlates with high macrophage and low CD8+ T cell infiltration. Conclusions: These results suggest that immune therapy targeting tumor antigens in combination with a micro-consensus FAP vaccine provides a two fisted punch inducing responses that target both the tumor microenvironment and tumor cells directly.

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Biomarker Based Therapy in Pancreatic Ductal Adenocarcinoma: An Emerging Reality?

Over the last decade many of the major solid organ cancers have seen improvements in survival due to development of novel therapeutics and corresponding biomarkers that predict treatment efficacy or resistance. In contrast, in pancreatic ductal adenocarcinoma (PDAC) favorable outcomes remain challenging, in part related to the lack of validated biomarkers for patient and treatment selection and thus optimal clinical decision-making. Nonetheless, increasingly therapeutic development for PDAC is accompanied by bioassays to evaluate response and study mechanism of actions with a corresponding increase in the number of trials in mid to late-stage with integrated biomarkers. Additionally, blood based biomarkers that provide a measure of disease activity and allow for minimally invasive tumor analyses are emerging, including circulating tumor DNA, exosomes and circulating tumor cells. In this article, we will review potential biomarkers for currently approved therapies as well as emerging biomarkers for therapeutics under development.

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The underreporting of cost perspective in cost-analysis research: a systematic review of the plastic surgery literature

Cost-analysis research can influence healthcare policies and practices. There is inherent bias depending on the chosen cost perspective (hospital, third-party payer, societal), and conclusions can change based on the perspective used. These perspectives may or may not be well declared or justified when performing cost analysis research. The goal of this study was to perform a literature review of cost-analysis research in the Plastic Surgery literature to determine the prevalence of studies declaring and justifying their perspective, and to inform the reader on why such declarations are important in understanding potential bias.

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Cost-effectiveness of adjuvant intravaginal brachytherapy in high-intermediate risk endometrial carcinoma

Publication date: Available online 21 December 2017
Source:Brachytherapy
Author(s): John M. Stahl, Shari Damast, Trevor J. Bledsoe, Yi An, Vivek Verma, James B. Yu, Melissa R. Young, Nataniel H. Lester-Coll
PURPOSEWe assessed the cost-effectiveness of adjuvant intravaginal brachytherapy (IVBT) vs. observation after total hysterectomy and bilateral salpingo-oophorectomy (TH/BSO) for high-intermediate risk (HIR) endometrial carcinoma.Methods AND MATERIALSA Markov model was used to assess the cost-effectiveness of IVBT by comparing average cumulative costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) between patients allocated to (1) 'observation' or (2) 'IVBT' after TH/BSO. We used a prototype Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)–defined HIR patient in the base case analysis. We calibrated the model to match the outcomes reported in the PORTEC-1 and PORTEC-2 trials. Utilities were obtained from published estimates, and costs were calculated based on Medicare reimbursement ($5445 for IVBT). The societal willingness-to-pay threshold was set at $100,000 per QALY. The time horizon was 5 years.ResultsIVBT was associated with a net increase of 0.094 QALYs (4.512 vs. 4.418) as well as an increase in mean cost ($17,453 vs. $15,620) relative to observation. The ICER for IVBT was $19,500 per QALY. On one-way sensitivity analysis, IVBT remained cost-effective when its cost was less than $12,937. If the probability of vaginal recurrence in the observation arm was increased or decreased by 25%, the ICER became $1335 per QALY and $87,925 per QALY, respectively. Probabilistic sensitivity analysis revealed that IVBT was the preferred management option in 86% of simulations.ConclusionsIVBT is cost-effective compared with observation after TH/BSO for HIR endometrial carcinoma by commonly accepted willingness-to-pay thresholds.



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Anticholinergics for asthma: a long history

Purpose of review To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Recent findings Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Summary Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options.

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Editorial introductions

No abstract available

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Collection of nasal secretions and tears and their use in allergology

Purpose of review The identification of immunological markers in nasal secretions and tears is becoming essential in the study of allergic diseases. The collection procedure of nasal and ocular secretions directly influences the results, thus it is of paramount importance to validate and standardize the sampling process. Recent findings Current techniques for nasal secretions sampling are mainly based on three principles: collection of spontaneous secretions, nasal washings, and absorption. Collection of spontaneous secretions is appropriate in subjects with nasal hypersecretion, whereas in healthy individuals the collected volume is frequently insufficient. Nasal washings are associated with an unpredictable, high dilution and concentrations of markers often fall below detection limits of immunological assays. Absorption seem to provide the best compromise between sufficient sample amounts and detectability of inflammatory mediators and immunoglobulin E. Tear samples can be obtained by glass capillary tubes, filter paper strips and ophthalmic sponges. Volumes are however small or highly diluted through reflex tearing. Summary Secretions reflect the local inflammatory activity and provide valuable information about the immunological reaction to allergens at the target organ. There is increasing evidence of the potential clinical role of their analysis, for diagnosis, and monitoring of allergic rhino-conjunctivitis. Appropriate collection and processing is very important and requires special attention.

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Role of epigenetics and DNA-damage in asthma

Purpose of review Although asthma is a common disease worldwide, its pathogenesis remains to be fully elucidated. There is increasing evidence of the interaction between epigenetics, DNA-damage, and environmental allergens in the development of asthma. In this review, we will focus on the role of epigenetics and DNA-damage in asthma. Recent findings There is growing evidence of environmental allergens, particularly house dust mite, stimulating oxidative DNA damage in airway epithelial cells. The repair of this DNA damage has been implicated in the secretion of Th2 cytokines and the induction of allergic inflammation. Summary Studies of the role of epigenetics, DNA-damage, and environmental allergens have begun to reveal the their complex interactions and their roles in the development of asthma. Further study in these areas may lead to novel prevention and treatment approaches.

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Association between allergic and nonallergic rhinitis and obstructive sleep apnea

Purpose of review Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. Recent findings In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep–wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea–hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. Summary Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.

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Update on questionnaires for assessing adherence to inhaler devices in respiratory patients

Purpose of review It has been estimated that adherence to inhaled medications in patients with asthma and chronic obstructive pulmonary disease (COPD) is around 50%. This low adherence rate increases morbidity and mortality of these disorders. The objective of this review was to update information on main questionnaires used in daily for assessing adherence to inhalers of patients with chronic respiratory diseases. Recent findings The test of the adherence to inhalers (TAI) is a recently developed and validated 12-item questionnaire to assess adherence to inhalers of aerosolized drugs in patients with asthma or COPD. The instrument can easily identify nonadherence, classify the level of adherence into good, intermediate and poor, and establish three nonadherence behaviour patterns of erratic, deliberate, and unwitting, which are useful for tailoring corrective measures. Summary Adherence to inhaler devices may be underestimated with the use of validated self-report questionnaires as compared with other more sensitive methods. However, validated self-report questionnaires are more advantageous from a cost-effective perspective in clinical practice. The recently validated TAI is a reliable and homogeneous instrument to identify easily nonadherence and behavioural barriers to the use of inhalers in patients with asthma or COPD.

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Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5

Purpose of review Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD. Recent findings Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different. Summary Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD.

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Drug-induced anaphylaxis: is it an epidemic?

Purpose of review The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. Recent findings Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. Summary Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated.

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The Influence of Gender and Age on the Acoustic Voice Quality Index and Dysphonia Severity Index: A Normative Study

The Acoustic Voice Quality Index (AVQI) and the Dysphonia Severity Index (DSI) are commonly used in research and clinical practice to quantify voice quality. The aim of this study was to investigate the influence of gender and age on AVQI and again on DSI.

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Discussion: Abdominal Contouring Outcomes in Class III Obesity: Analysis of the ACS-NSQIP Database

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Comment on: Complications and Treatment Strategy After Breast Augmentation by Polyacrylamide Hydrogel Injection—Summary of 10 Years’ Clinical Experience

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Public Interest in Breast Augmentation: Analysis and Implications of Google Trends Data

Abstract

Introduction

Breast augmentation is the most common aesthetic surgery performed in the United States (US) annually. Analysis of Google Trends (GT) data may give plastic surgeons useful information regarding worldwide, national, and regional interest for breast augmentation and other commonly performed aesthetic surgeries.

Methods

Data were collected using GT for breast augmentation and associated search terms from January 2004 to May 2017. Case volume was obtained from the American Society of Plastic Surgeons (ASPS) annual reports for the calendar year 2005–2016.

Results

Trend analysis showed that total search term volume for breast augmentation and breast implants gradually decreased worldwide and in the US over the study period while the search term boob job slowly increased. Univariate linear regression demonstrated a statistically significant positive correlation between average annual Google search volume of "breast augmentation" and the annual volume of breast augmentations performed in the US according to ASPS data (R ² = 0.44, p = 0.018). There was no significant correlation between national volume of breast augmentations performed and search volume using the terms "breast implants" or "boob job" over time (p = 0.84 and p = 0.07, respectively). In addition, there appears to be country specific variation in interest based on time of year and peaks in interest following specific policies.

Conclusions

To our knowledge, this is the first and only analysis of GT data in the plastic surgery literature to date. To that end, this study highlights this large and potentially powerful data set for plastic surgeons both in the US and around the world.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline

Abstract

Introduction

Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices.

Materials and Methods

Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Patient characteristics, surgical technique, adjuvant therapies, indications, complications, culture results were obtained. Data were analyzed according to timing of explantation.

Results

A total of 55 TE and implants were removed in 43 patients. Reasons for explantation were infection (58%), patient request (22%), and wound-related complications (20%). The majority of explantations occurred after 30 days (62%), and after Stage I (81%). Median days to explantation was 62. Patients of older age (p = 0.01) and higher BMI (p = 0.02) were more likely to undergo explantation after Stage I. The most commonly cultured organisms were S. epidermidis (10.9%), S. aureus (10.9%) and P. aeruginosa (10.9%). Antibiotic resistance was commonly encountered for ampicillin, cefazolin, penicillin, and erythromycin.

Conclusion

Infection is the most common reason for explantation after prosthetic breast reconstruction. Patients should be carefully monitored for a prolonged period of time after Stage I, as the majority of explantations occur in this stage but beyond 30 days. For oral treatment, fluoroquinolones and trimethoprim–sulfamethoxazole and for IV treatment a combination of vancomycin or daptomycin with piperacillin–tazobactam or imipenems/carbapenems appear to be appropriate choices according to our culture results.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Commentary for Modified Island Technique for Prominent Ears

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Preoperative Evaluation is not Predictive of Transpyloric Feeding Conversion in Gastrostomy Dependent Pediatric Patients

ABSTRACTObjectives:Limited literature exists as to whether preoperative gastrostomy (GT)evaluation may predict which patients will go onto require gastrojejunostomy tube (GJ) feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds.Methods:We identified patients at Boston Children's Hospital who underwent GT placement and required GJ feeding between 2006–2012. GT patients were matched according to age, neurologic, and cardiac status with GJ converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory related admissions were reviewed.Results:79 GJ patients (median (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) vs GJ (83.1%), p = 1.0), upper GI series (GT (89.1%) vs GJ (93.2%), p = 0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) vs GJ (62.2%), p = 0.4), and completion of gastric emptying studies (GT (10.1%) vs GJ (5.1%), p = 0.22). No differences were seen in preoperative hospitalization rates (p = 0.25), respiratory admissions (p = 0.36), although GJ patients had a mean reduction in the number of hospitalization of −1.5 ± 0.5 days, p 

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Endotracheal Tube Connector: Holding Breaths!

No abstract available

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The Effect of High-Frequency, Structured Expert Feedback on the Learning Curves of Basic Interventional Ultrasound Skills Applied to Regional Anesthesia

BACKGROUND: Proficiency in needle-to-ultrasound beam alignment and accurate approach to structures are pivotal for ultrasound-guided regional anesthesia. This study evaluated the effects of high-frequency, structured expert feedback on simulation training of such abilities. METHODS: Forty-two subjects randomly allocated as controls or intervention participated in two 25-trial experiments. Experiment 1 consisted of inserting a needle into a bovine muscular phantom parallel to the ultrasound beam while maintaining full imaging of the needle. In experiment 2, the needle aimed to contact a target inside the phantom. Intervention subjects received structured feedback between trials. Controls received a global critique after completing the trials. The slopes of the learning curves derived from the sequences of successes and failures were compared. Change-point analyses identified the start and the end of learning in trial sequences. The number of trials associated with learning, the number of technical errors, and the duration of training sessions were compared between intervention and controls. RESULTS: In experiment 1, learning curves departed from 73% (controls) and 76% (intervention) success rates; slopes (standard error) were 0.79% (0.02%) and 0.71% (0.04), respectively, with mean absolute difference of 0.18% (95% confidence interval [CI], 0.17%–0.19%; P = 0). Intervention subjects' learning curves were shorter and steeper than those of controls. In experiment 2, the learning curves departed from 43% (controls) and 80% (intervention) success rates; slopes (standard error) were 1.06% (0.02%) and 0.42% (0.03%), respectively, with a mean difference of 0.65% (95% CI, 0.64%–0.66%; P = 0). Feedback was associated with a greater number of trials associated with learning in both experiment 1 (mean difference, 1.55 trials; 95% CI, 0.15–3 trials; P = 0) and experiment 2 (mean difference, 4.25 trials; 95% CI, 1.47–7.03 trials; P = 0) and a lower number of technical errors per trial in experiments 1 (mean difference, 0.19; 95% CI, 0.07–0.30; P = .02) and 2 (mean difference, 0.58; 95% CI, 0.45–0.70; P = 0), but longer training sessions in both experiments 1 (mean difference, 9.2 minutes; 95% CI, 4.15–14.24 minutes; P = .01) and 2 (mean difference, 7.4 minutes; 95% CI, 1.17–13.59 minutes; P = .02). CONCLUSIONS: High-frequency, structured expert feedback compared favorably to self-directed learning, being associated with shorter learning curves, smaller number of technical errors, and longer duration of in-training improvement, but increased duration of the training sessions. Accepted for publication November 10, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Getúlio Rodrigues de Oliveira Filho, MD, PhD, Department of Surgery, Federal University of Santa Catarina, Rua Luiz Delfino 111/902, Florianópolis, Santa Catarina 88015, Brazil. Address e-mail to getulio.filho@ufsc.br. © 2017 International Anesthesia Research Society

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Why a Proactive Perioperative Medicine Policy Is Crucial for a Sustainable Population Health Strategy

No abstract available

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Intravenous Iron for Treatment of Anemia in the 3 Perisurgical Phases: A Review and Analysis of the Current Literature

Anemia is a common comorbidity throughout the entire hospital stay. Treatment options include intravenous (IV) iron, oral iron, erythropoietin, and red blood cell (RBC) transfusions. IV iron has gained in popularity with the implementation of patient blood management programs. A variety of studies have been performed to investigate the use of IV iron in preoperative, perioperative, and postoperative settings. An objective review on these studies has yet to be performed. The current narrative review provides an overview of trials investigating IV iron use in the preoperative, perioperative, and postoperative settings. We performed a literature research of English articles published between 1964 and March 2017 in Pubmed including Medline and The Cochrane Library. Only studies with a control group were included. The final review includes 20 randomized controlled trials (RCTs), 7 observational trials, and 5 retrospective studies. Measured outcomes included hemoglobin (Hb) levels, reticulocyte counts, and/or RBC concentrates. Meta-analyses of RCTs using IV iron administration before surgery led to an increase in Hb levels, a reduction of RBC use, and an improvement in patient outcome. Only a few studies investigated the use of IV iron in the perioperative setting. These studies recommended the use of perioperative IV iron in cases of severe anemia in orthopedic surgery but not in all types of surgery. Published RCTs in the postoperative setting have shown positive effects of IV iron on Hb levels, length of hospital stay, and transfusion requirements. Some studies demonstrated an increase of Hb of 0.5–1 g/dL over 4 weeks postoperatively, but the clinical relevance and effect of this increase on an improvement of patient's long-term outcomes are uncertain. To summarize, the evidence to use IV iron is strongest in the preoperative setting, while it remains an individual treatment decision to administer IV iron perioperatively or postoperatively. Accepted for publication September 15, 2017. Funding: A.U.S. is supported by a DFG grant (STE-1895-4/1). The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Andrea U. Steinbicker, MD, MPH, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Albert-Schweitzer Campus 1, Bldg A1, 48149 Muenster, Germany. Address e-mail to andrea.steinbicker@ukmuenster.de. © 2017 International Anesthesia Research Society

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Prospective Observational Study of Intraoperative Anesthetic Events in District Hospitals in Namibia

BACKGROUND: Access to safe surgery and anesthesia care is grossly inadequate in low- and middle-income countries, with a shortage of anesthesia providers contributing to this crisis. In Namibia, medical officers typically receive no >3 months of informal training in anesthesia. This study sought to determine the prevalence, currently unknown, of intraoperative adverse anesthetic events in this setting. Further, we assessed surgical volume, complications, and mortality outcomes at the district hospital level. METHODS: This was a prospective observational study over 7 months involving 4 district hospitals from geographically separate and diverse areas of Namibia. A standardized protocol was used to record adverse anesthetic events during surgery, surgical volume, and complications including mortality. RESULTS: A total of 737 surgical procedures were performed during the study period. There was a 10% prevalence of adverse anesthetic events intraoperatively. Of these, 70% were related to hypotension and 17% due to hypoxia and/or difficult/failed intubation. Ninety-eight percent of patients were classed as low risk (American Society of Anesthesiologists I or II). Seventy-two percent of the surgical workload was in obstetrics and gynecology, with over half being for urgent obstetrics. Perioperative mortality rate was 1.4/1000, with an overall surgical complication rate of 1.6% and a surgical infection rate of 0.8%. CONCLUSIONS: We found a 10% prevalence of adverse anesthetic events intraoperatively when anesthesia was administered by medical officers with no >3 months of informal training in this low-resource environment. The patients were considered low risk by the medical officers responsible for the anesthesia, yet these events had the potential to lead to patient harm. Accepted for publication October 23, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Andrew J. Ottaway, BMBS, MPH, FANZCA, Hobart Anaesthetic Group, 303 Macquarie St, Hobart, Tasmania 7000, Australia. Address e-mail to aottaway@internode.on.net. © 2017 International Anesthesia Research Society

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Continuous Noninvasive Arterial Pressure Monitoring Using the Vascular Unloading Technique (CNAP System) in Obese Patients During Laparoscopic Bariatric Operations

BACKGROUND: Increasing rates of obesity create new challenges for hemodynamic monitoring in the perioperative phase. Continuous monitoring of arterial pressure (AP) is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive AP monitoring are now available. In this study, we aimed to compare continuous noninvasive AP measurements using the vascular unloading technique (CNAP system; CNSystems, Graz, Austria) compared with invasive AP measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery. METHODS: In 29 severely obese patients (mean body mass index 48.1 kg/m2), we simultaneously recorded noninvasive and invasive AP measurements over a period of 45 minutes and averaged the measurements using 10-second episodes. We compared noninvasive (test method) and invasive (reference method) AP measurements using Bland-Altman analysis and 4-quadrant plot/concordance analysis (2-minute interval). RESULTS: We observed a mean of the differences (±SD, 95% limits of agreement) between the AP values obtained by the CNAP system and the invasively assessed AP values of 7.9 mm Hg (±9.6 mm Hg, −11.2 to 27.0 mm Hg) for mean AP, 4.8 mm Hg (±15.8 mm Hg, −26.5 to 36.0 mm Hg) for systolic AP, and 9.5 mm Hg (±10.3 mm Hg, −10.9 to 29.9 mm Hg) for diastolic AP, respectively. The concordance rate was 97.5% for mean AP, 95.0% for systolic AP, and 96.7% for diastolic AP, respectively. CONCLUSIONS: In the setting of laparoscopic bariatric surgery, continuous noninvasive AP monitoring with the CNAP system showed good trending capabilities compared with continuous invasive AP measurements obtained with a radial arterial catheter. However, absolute CNAP- and arterial catheter–derived AP values were not interchangeable. Accepted for publication September 27, 2017. Funding: CNSystems Medizintechnik AG (Graz, Austria) provided the technical equipment for the study. CNSystems Medizintechnik AG was not involved in the collection of the data, drafting of the manuscript, or decision to submit the manuscript for publication. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Dorothea E. Rogge, MD, Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Address e-mail to d.rogge@uke.de. © 2017 International Anesthesia Research Society

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Misaligned Feeding May Aggravate Pain by Disruption of Sleep–Awake Rhythm

BACKGROUND: Increasing evidence suggests that patients with eating disorders are more likely to develop chronic pain. A misaligned diet has been reported to disrupt the sleep–awake rhythms. Combined with our previous investigation on circadian pain, we aimed to investigate the role of misaligned diet in the pain sensitivity and the underlying mechanisms. METHODS: Two-month-old C57BL/6J male mice were administered chronic constriction injury (CCI) surgery to establish neuropathic pain models. CCI mice were randomized to scheduled food access throughout the whole day (CCI-free), during the daytime (CCI-misaligned), and at night (CCI-aligned), respectively. The paw withdrawal mechanical threshold, indicating pain behavior, was measured by Von Frey. The gross motor activity pattern indicating the sleep–awake rhythm was monitored by Mini-Mitter. Melatonin (Mel) was administered to ameliorate the sleep–awake rhythm (CCI-free + Mel and CCI-misaligned + Mel). The expressions of circadian pain–related proteins were detected by quantitative polymerase chain reaction and western blot. The primary outcome is the pain threshold and the secondary outcome is the sleep–awake rhythm. RESULTS: Misaligned diet during the peri-CCI surgery period significantly decreased the paw withdrawal mechanical threshold compared with the CCI-free mice (day 14: 0.40 ± 0.09 vs 0.64 ± 0.15; P = .03;) and altered the sleep–awake rhythm. Mel pretreatment alleviated the increased pain (day 14, CCI-misaligned + Mel versus CCI-misaligned: day 14: 0.60 ± 0.13 vs 0.35 ± 0.12; P = .022) and the disrupted sleep–awake rhythm caused by misaligned feeding. The mRNA levels of N-methyl-D-aspartate receptor subtype 2B (NR2B), Ca2+/calmodulin-dependent protein kinase II (CaMKII), and cyclic adenosine monophosphate-response element binding protein (CREB) in the spinal dorsal horn increased in CCI-misaligned mice compared with the CCI-free mice. The phosphor-NR2B, phosphor-CaMKII, and phosphor-CREB also increased in CCI-misaligned mice compared with the CCI-free mice. However, the expressions of NR2B, CaMKII, and CREB were decreased in CCI-misaligned + Mel mice compared to CCI-misaligned mice at both transcriptional and translational levels. CONCLUSIONS: Misaligned diet might aggravate pain sensitivity through the disruption of the sleep–awake cycle, which could be recovered by Mel. NR2B-CaMKII-CREB may participate in the disruption of sleep–awake rhythm–mediated pain aggravation. Accepted for publication November 2, 2017. Funding: This study was supported by National Natural Science Foundation of China (81371207, 81171047, 81070892, and 81171048), Natural Science Foundation of Jiangsu Province (BK2010105), and the Grant from the Department of Health of Jiangsu Province of China (XK201140, RC2011006). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). The first authors Xu and Zhao contributed equally to this study. The authors Ma and Gu contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Xiaoping Gu, PhD, MD, and Zhengliang Ma, PhD, MD, Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, 321 Zhong Shan Rd, Nanjing, Jiangsu 210008, People's Republic of China. Address e-mail to xiaopinggu@nju.edu.cn and mazhengliang1964@nju.edu.cn. © 2017 International Anesthesia Research Society

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Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach

We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient's minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of 6 days in 2014 (first quartile [Q1]–third quartile [Q3], 3–10) to 5 days in 2015 (Q1–Q3, 2.5–8) and in 2016 (Q1–Q3, 1–8). Our statistical methods do not allow us to conclude that this change was due to our intervention, and it is possible that the observed decreases would have occurred whether or not the rounding process was implemented. Accepted for publication October 26, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Michael Nurok, MBChB, PhD, Division of Cardiac Surgery, Department of Surgery and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd, Suite 3100, Los Angeles, CA 90048. Address e-mail to michael.nurok@cshs.org. © 2017 International Anesthesia Research Society

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Significance of Body Mass Index for Postoperative Outcomes after Lung Cancer Surgery in Elderly Patients

Abstract

Background

Although the frequency of elderly patients undergoing surgery for lung cancer has been increasing, indications for surgery in elderly patients are still controversial. Low body mass index is a significant predictor of poor prognosis in elderly patients with various medical conditions. Then, we examined the long-term outcome of elderly patients who had undergone thoracic surgery for lung cancer, focusing especially on body mass index.

Patients and methods

Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Among these patients, we retrospectively examined 158 patients aged 80 years or older.

Results

Perioperative morbidity and mortality rates were 41.8 and 1.3%, respectively. Among 149 patients who were completely followed up, 80 patients (53.7%) died. The overall postoperative survival rates at 3 and 5 years were 66.9 and 49.9%, respectively. Univariate analysis demonstrated that sex (female), smoking index (pack-years <20), histology (non-squamous cell carcinoma), pathological stage (stage I) and BMI (within normal BMI) were statistically significant factors associated with better outcome. Multivariate analysis revealed that patients with a low (<18.5 kg/m²) or high (≥25 kg/m²) body mass index had a significantly and poorer prognosis than patients with a normal body mass index.

Conclusion

Body mass index is a more useful prognostic factor than other clinical factors including pathological stage in elderly patients. Because elderly patients with low and high body mass index have a significant poor prognosis, surgeons and pulmonologist should take this into account when consider surgical indication for such elderly patients.

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Tube Thoracostomy Complications: More to Learn

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Radical Nephrectomy for Primary Retroperitoneal Liposarcoma Near the Kidney has a Beneficial Effect on Disease-Free Survival

Abstract

Background

The purpose of this study is to analyze the clinical impact of radical nephrectomy on retroperitoneal liposarcoma near the kidney.

Methods

Data of patients who underwent surgery for unilateral primary retroperitoneal liposarcoma near the kidney were retrospectively collected. Patients were divided into four groups according to whether they underwent nephrectomy and combined resection of other organs. Kaplan–Meier survival analysis was used to estimate disease-free survival and overall survival. Multivariable Cox analysis was used to analyze factors related to disease-free survival and overall survival.

Results

Nephrectomy (HR = 0.260, CI = 0.078–0.873, p = 0.029) had a beneficial effect on disease-free survival, while interaction model of nephrectomy*other organ resection (HR = 4.655, CI = 1.767–12.263, p = 0.002) showed poor disease-free survival. Other organ resection was not related to disease-free survival (HR = 1.543, CI = 0.146–16.251, p = 0.718). Operation method (p = 0.007) and FNCLCC grade (p < 0.001; G2, HR = 1.833, CI = 0.684–4.915, p = 0.228; G3, HR = 9.190, CI = 3.351–25.199, p < 0.001) were significant factors for disease-free survival. While combined organ resection without nephrectomy group (HR = 1.604, CI = 0.167–15.370, p = 0.682) and radical nephrectomy with combined organ resection group (HR = 1.309, CI = 0.448–3.825, p = 0.622) did not show significant difference in disease-free survival from the mass excision only group, radical nephrectomy without combined organ resection group (HR = 0.279, CI = 0.078–0.991, p = 0.048) showed superior disease-free survival.

Conclusions

Radical nephrectomy of unilateral primary retroperitoneal liposarcoma near the kidney has a beneficial effect on disease-free survival.

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Pen Torch Transillumination: Difficult Venepuncture Made Easy

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Scientific Integrity Issues to Discuss

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The World Journal of Surgery Announces Julie Ann Sosa, MD MA FACS, as Editor-in-Chief

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Intracorporeal Traction of the Rectum with a Beaded Plastic Urinary Drainage Bag Hanger: Comparison with Conventional Laparoscopic Rectal Cancer Surgery

Abstract

Background

Laparoscopic rectal cancer surgery with proper total mesorectal excision is a challenge for colorectal surgeons during trouble shooting. We used a beaded plastic urinary drainage bag hanger to encircle the rectum and clamp laparoscopic rectal transaction in this study.

Methods

Sixty-three patients with rectal cancer underwent laparoscopic radical rectal resection with curative intent between February 2015 and December 2015. Plastic beaded form urinary Foley catheter bag hanger was inserted intracorporeally via right lower 12-mm trocar, encircling the rectal tube distal to the rectal lesion followed by fastening. Thirty patients in the rectal resection group (28 laparoscopic, 2 robotic-assisted) using the commercial beaded plastic hanger for Foley catheter drainage were compared to 33 patients who underwent conventional laparoscopic rectal resection.

Results

Low anterior resection was performed for both groups. The Foley bag hanger group had less operation time (162.6 min vs. 187.3 min, p = 0.006) and fewer numbers of stapler cartilage (1.6 vs. 2.1, p = 0.001).

Conclusions

Intracorporeal ligation of the rectum with a beaded plastic Foley catheter bag hanger could be used as a valuable method for rectal handling and transaction in laparoscopic rectal cancer surgery.

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A Novel Lateral Approach to the Assessment of Vocal Cord Movement by Ultrasonography

Abstract

Background

Ultrasonography is a non-invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the assessment of vocal cord movement by these specialists. However, previous studies reported a low rate of successful visualization of vocal cord movement by ultrasonography. To address this issue, we devised a novel ultrasonographic procedure for assessing vocal cord movement indirectly by observing the arytenoid movement from a lateral view.

Methods

Subjects were 188 individuals, including 23 patients with vocal cord paralysis and 13 with vocal cord paresis. We performed ultrasonographic assessment of vocal cord movement using two different procedures: the conventional middle transverse procedure and the novel lateral vertical procedure.

Results

The rate of visualization of vocal cords with the middle transverse procedure was 70.2% and that of the arytenoid cartilage with the lateral vertical procedure was 98.4%. The lateral vertical procedure enabled visualization of all patients with vocal cord paresis/paralysis and detected all 23 patients with vocal paralysis; only one of 13 patients with vocal cord paresis was positively identified. The conventional procedure enabled visualization of 21 of 36 patients with vocal cord paresis/paralysis with high accuracy. There was no false-positive case in either procedure.

Conclusion

The proposed lateral vertical procedure improved the rate of visualization of vocal cord movement by ultrasonography, suggesting that it is a useful technique to screen for vocal cord paralysis by ultrasonography.

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Impact of Abdominal Wall Hernias and Repair on Patient Quality of Life

Abstract

Background

The modified Activities Assessment Scale (AAS) is a 13-question abdominal wall quality of life (AW-QOL) survey validated in patients undergoing ventral hernia repair (VHR). No studies have assessed AW-QOL among individuals without abdominal wall pathology. The minimal clinically important difference (MCID) of the modified AAS and its implications for the threshold at which VHR should be offered also remain unknown. Our objectives were to (1) establish the AW-QOL of patients with a clinical abdominal wall hernia versus those with no hernia, (2) determine the MCID of the modified AAS, and (3) identify the baseline quality of life (QOL) score at which patients derive little clinical benefit from VHR.

Methods

Patient-centered outcomes data for all patients presenting to General Surgery and Hernia Clinics October–December 2016 at a single safety-net institution were collected via a prospective, cross-sectional observational study design. Primary outcome was QOL measured using the modified AAS. Secondary outcome was the MCID.

Results

Patients with no hernia had modified AAS scores of 81.6 (50.4–94.4), while patients with a clinically apparent hernia had lower modified AAS scores of 31.4 (12.6–58.7) (p < 0.001). The MCID threshold was 7.6 for a "slight" change and 14.9 for "definite" change. Above a modified AAS score of 81, the risk of worsening a patient's QOL by surgery is higher than the chances of improvement.

Conclusions

VHR can improve 1-year postsurgical AW-QOL to levels similar to that of the general population. The MCID of the modified AAS is 7.6 points. Patients with high baseline scores should be counseled about the lack of potential benefit in QOL from elective VHR.

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Inhibition of the receptor for advanced glycation promotes proliferation and repair of human periodontal ligament fibroblasts in response to high glucose via the NF-κB signaling pathway

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Danting Zhan, Ling Guo, Lige Zheng
ObjectiveTo observe if inhibition of the receptor for advanced glycation endproducts (RAGE) promotes proliferation and repair of human periodontal ligament fibroblasts (hPDLFs) stimulated by high glucose. In addition, we also discuss the effects of the NF-κB signaling pathway in relation to this process.MethodsPrimary cultured hPDLFs were exposed to either low glucose (5.5 mmol/L) or high glucose (25 mmol/L), and RAGE expression was measured by Western blot analysis. Cells were cultured in high glucose with different concentrations of the RAGE inhibitor, FPS-ZM1. We measured cell proliferation using the Cell Counting Kit-8 and expression of collagen type 1 and fibronectin by real-time PCR and ELISA, respectively. The relative protein expression levels of NF-κB p65 and phosphorylated p65 were measured by Western blot analysis.ResultsHigh glucose enhanced RAGE expression and suppressed cell growth. While FPS-ZM1 increased proliferation and expression of repair-related factors in high glucose, there was a concurrent decline in the phosphorylation level of NF-κB p65.ConclusionFPS-ZM1 rescued the proliferative capacity and repair capability of hPDLFs via the RAGE-NF-κB signaling pathway in response to high glucose.



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Predictive Modeling of Hamstring Strain Injuries in Elite Australian Footballers

AbstractPurposeThree of the most commonly identified hamstring strain injury (HSI) risk factors are age, previous HSI and low levels of eccentric hamstring strength. However, no study has investigated the ability of these risk factors to predict the incidence of HSI in elite Australian footballers. Accordingly, the purpose of this prospective cohort study was to investigate the predictive ability of HSI risk factors using machine learning techniques.MethodsEccentric hamstring strength, demographic and injury history data were collected at the start of pre-season for 186 and 176 elite Australian footballers in 2013 and 2015 respectively. Any prospectively occurring HSIs were reported to the research team. Using various machine learning techniques, predictive models were built for 2013 and 2015 within-year HSI prediction and between-year HSI prediction (2013 to 2015). The calculated probabilities of HSI were compared to the injury outcomes and area under the curve (AUC) was determined and used to assess the predictive performance of each model.ResultsThe minimum, maximum and median AUC values for the 2013 models were 0.26, 0.91 and 0.58 respectively. For the 2015 models, the minimum, maximum and median AUC values were, correspondingly, 0.24, 0.92 and 0.57. For the between-year predictive models the minimum, maximum and median AUC values were 0.37, 0.73 and 0.52 respectively.ConclusionWhile some iterations of the models achieved near perfect prediction, the large ranges in AUC highlight the fragility of the data. The 2013 models performed slightly better than the 2015 models. The predictive performance of between-year HSI models was poor however. In conclusion, risk factor data cannot be used to identify athletes at an increased risk of HSI with any consistency. Purpose Three of the most commonly identified hamstring strain injury (HSI) risk factors are age, previous HSI and low levels of eccentric hamstring strength. However, no study has investigated the ability of these risk factors to predict the incidence of HSI in elite Australian footballers. Accordingly, the purpose of this prospective cohort study was to investigate the predictive ability of HSI risk factors using machine learning techniques. Methods Eccentric hamstring strength, demographic and injury history data were collected at the start of pre-season for 186 and 176 elite Australian footballers in 2013 and 2015 respectively. Any prospectively occurring HSIs were reported to the research team. Using various machine learning techniques, predictive models were built for 2013 and 2015 within-year HSI prediction and between-year HSI prediction (2013 to 2015). The calculated probabilities of HSI were compared to the injury outcomes and area under the curve (AUC) was determined and used to assess the predictive performance of each model. Results The minimum, maximum and median AUC values for the 2013 models were 0.26, 0.91 and 0.58 respectively. For the 2015 models, the minimum, maximum and median AUC values were, correspondingly, 0.24, 0.92 and 0.57. For the between-year predictive models the minimum, maximum and median AUC values were 0.37, 0.73 and 0.52 respectively. Conclusion While some iterations of the models achieved near perfect prediction, the large ranges in AUC highlight the fragility of the data. The 2013 models performed slightly better than the 2015 models. The predictive performance of between-year HSI models was poor however. In conclusion, risk factor data cannot be used to identify athletes at an increased risk of HSI with any consistency. Corresponding author: Joshua D. Ruddy, joshua.ruddy@myacu.edu.au, 17 Young Street, Fitzroy, VIC, Australia, 3065 The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of this study do not constitute endorsement by ACSM. AS and DO are listed as co-inventors on a patent filed for a field testing device of eccentric hamstring strength (PCT/AU2012/001041.2012) as well as being minority shareholders in Vald Performance Pty Ltd, the company responsible for comercializng the device. The remaining authors declare no competing interests. No funding was received. Accepted for Publication: 14 December 2017 © 2017 American College of Sports Medicine

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Effect of Carbohydrate Mouth Rinse on Performance after Prolonged Submaximal Cycling

ABSTRACTPrevious studies have shown improved shorter-duration (~1 h) performance with carbohydrate (CHO) mouth-rinsing (WASH), especially in overnight fasted/non-fuelled subjects.Purposeto determine the effect of WASH on cycling time-trial (TT) performance and muscle activity (EMG) after 2 h of sub-maximal cycling while receiving CHO.MethodsIn a double-blind, placebo-controlled crossover design, 10 well-trained males cyclists (VO2max: 65 mL·kg-1·min-1) completed two experimental trials. Each trial consisted of a standardized pre-trial snack (2-h prior) followed by 120 min of steady-state (SS) cycling (~60% VO2max) followed by a ~30 min TT, randomized as follows: 1) FEDWASH: 30g CHO·h-1 during SS + WASH during TT (every 20% of TT); 2) FEDPLA: 30g CHO·h-1 during SS + placebo-wash during TT.ResultsWhile FEDWASH was not significantly different than FEDPLA (P = 0.51), there was a 1.7% (+6.4 to -3.2% 90% CI; ES = 0.21) decrease in TT time (35s) for FEDWASH compared to FEDPLA, with qualitative probabilities of a 60% positive and 23% trivial outcome. For EMG, Soleus showed significant increase while medial gastrocnemius showed significant decrease in muscle recruitment from the beginning 20% TT segment to the last 20% only in the FEDPLA condition, which coincided with a slower (P = 0.01) last 20% of the TT in FEDPLA vs. FEDWASH.ConclusionsContrary to previous studies, this investigation utilized conditions of high ecological validity including a pre-trial snack and CHO during SS. Significant changes in muscle recruitment and time over the last 20% of the TT, along with an average 1.7% improvement in TT time, suggest CHO mouth rinse helps maintain power output late in TT's compared to placebo. Although marginal gains were achieved with a CHO mouth rinse (35 s), small performance effects can have significant outcomes in real-world competitions. Previous studies have shown improved shorter-duration (~1 h) performance with carbohydrate (CHO) mouth-rinsing (WASH), especially in overnight fasted/non-fuelled subjects. Purpose to determine the effect of WASH on cycling time-trial (TT) performance and muscle activity (EMG) after 2 h of sub-maximal cycling while receiving CHO. Methods In a double-blind, placebo-controlled crossover design, 10 well-trained males cyclists (VO2max: 65 mL·kg-1·min-1) completed two experimental trials. Each trial consisted of a standardized pre-trial snack (2-h prior) followed by 120 min of steady-state (SS) cycling (~60% VO2max) followed by a ~30 min TT, randomized as follows: 1) FEDWASH: 30g CHO·h-1 during SS + WASH during TT (every 20% of TT); 2) FEDPLA: 30g CHO·h-1 during SS + placebo-wash during TT. Results While FEDWASH was not significantly different than FEDPLA (P = 0.51), there was a 1.7% (+6.4 to -3.2% 90% CI; ES = 0.21) decrease in TT time (35s) for FEDWASH compared to FEDPLA, with qualitative probabilities of a 60% positive and 23% trivial outcome. For EMG, Soleus showed significant increase while medial gastrocnemius showed significant decrease in muscle recruitment from the beginning 20% TT segment to the last 20% only in the FEDPLA condition, which coincided with a slower (P = 0.01) last 20% of the TT in FEDPLA vs. FEDWASH. Conclusions Contrary to previous studies, this investigation utilized conditions of high ecological validity including a pre-trial snack and CHO during SS. Significant changes in muscle recruitment and time over the last 20% of the TT, along with an average 1.7% improvement in TT time, suggest CHO mouth rinse helps maintain power output late in TT's compared to placebo. Although marginal gains were achieved with a CHO mouth rinse (35 s), small performance effects can have significant outcomes in real-world competitions. Correspondence: Matt Jensen, University of Victoria, Room 120, McKinnon Building, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada, Email: mpjensen@uvic.ca All authors approved the final version of the paper. This study was financially supported by MITACS accelerate fellowship and the Canadian Sport Institute - Pacific. The authors wish to thank all the participants for volunteering for the study. The authors have no conflict of interest and made every attempt to present the results of the study clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The authors also acknowledge that results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 15 December 2017 © 2017 American College of Sports Medicine

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Physiatry Reviews for Evidence in Practice (PREP) Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty The HIHO Randomized Clinical Trial.

No abstract available

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Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults with Mild Cognitive Impairment and Intact Cognition

ABSTRACTOBJECTIVEThis study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment (aMCI) and normal cognition (NC), and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia.DESIGNThis was a cross sectional study of 46 community dwelling older adults, ages 70–95 with aMCI (n=23) and NC (n=23). Structural magnetic resonance imaging (MRI) was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function.RESULTSDuring fast paced walking, older adults with aMCI demonstrated significantly slower gait speed and shorter stride length compare to older adults with NC. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P

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Intraarticular Triamcinolone versus Hyaluronate Injections for Low Back Pain with Symptoms Suggestive of Lumbar Zygapophyseal Joint Arthropathy: A Pragmatic, Double Blind Randomized Controlled Trial

AbstractObjectiveTo compare hyaluronate to triamcinolone injections in treating chronic low back pain (CLBP) suggestive of lumbar zygopophyseal joint (ZJT) arthropathy.DesignProspective, double-blind, randomized controlled trial. 30 subjects were randomly assigned to receive bilateral L3-S1 ZJT injections with triamcinolone (KA) or Synvisc-One® (HA). Pain [Visual Analog Scale (VAS)] and Pain Disability Questionnaire (PDQ) scores at 1, 3, and 6-months were evaluated.ResultsNo significant inter-group differences (p>.05) in outcomes were noted in the 30 recruited subjects. (KA/HA, baseline; 1-month; 3-month; 6-month)-VAS scores: 70±15/74±10; 58±29/45±25; 58±29/56±25; 59±28/63±24. PDQ scores: 100±23/102±28; 77±30/74±34; 87±26/74±36; 96±25/79±25. Overall percent improvement@6months: KA(51±35) and HA(42±33) [p=.51]. HA group VAS scores improved significantly (70±20 to 45±25@1m, p=.008). PDQ scores improved at 1m (100±23 to 77±30, p=.009) in the KA group and at all time points in the HA group (102±28 to 74±34@1m, p=.002; 74±36@3m, p=.037; 79@6m [Median; 52-99.5, p<.001 medians and quartiles were used in statistical analysis when data did not pass normality.conclusionspatients with clbp suggestive of lumbar zjt arthropathy responded similarly to triamcinolone or hyaluronate injections. ha group showed significant short- long-term functional improvement short-term pain ka only benefit no improvement. objective compare injections treating chronic low back zygopophyseal joint arthropathy. design prospective double-blind randomized controlled trial. subjects randomly assigned receive bilateral l3-s1 synvisc-one analog scale disability questionnaire scores at evaluated. results inter-group differences>.05) in outcomes were noted in the 30 recruited subjects. (KA/HA, baseline; 1-month; 3-month; 6-month)-VAS scores: 70±15/74±10; 58±29/45±25; 58±29/56±25; 59±28/63±24. PDQ scores: 100±23/102±28; 77±30/74±34; 87±26/74±36; 96±25/79±25. Overall percent improvement@6months: KA(51±35) and HA(42±33) [p=.51]. HA group VAS scores improved significantly (70±20 to 45±25@1m, p=.008). PDQ scores improved at 1m (100±23 to 77±30, p=.009) in the KA group and at all time points in the HA group (102±28 to 74±34@1m, p=.002; 74±36@3m, p=.037; 79@6m [Median; 52-99.5, p<.001 medians and quartiles were used in statistical analysis when data did not pass normality. conclusions patients with clbp suggestive of lumbar zjt arthropathy responded similarly to triamcinolone or hyaluronate injections. ha group showed significant short- long-term functional improvement short-term pain ka only benefit no improvement. affiliation where the research was conducted correspondence: thiru m. annaswamy md ma s. lancaster road dallas tx-75216. email: thiru.annaswamy author disclosures: this funded by any grant foundation agency. paper is report a clinical trial. however trial time period at which point there requirements for all trials be registered. therefore rct does have registration registry. abstract previously presented at: tm armstead c avraham r carlson l bierner sm. scientific presentations: intraarticular vs. injections zygapophyseal joint arthropathy: pragmatic double blind randomized controlled presentation. annual assembly aapmr. boston ma. september pm page s91. doi: http: versus abstracts papers posters meeting association academic physiatrists san antonio tx. american journal physical medicine rehabilitation supplement a6-a7. march copyright wolters kluwer health inc. rights reserved.>

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Some Autonomic Deficits of Acute or Chronic Cervical Spinal Contusion Reversed by Interim Brainstem Stimulation

Journal of Neurotrauma , Vol. 0, No. 0.


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IMMUNE RESPONSES OF HLA-HIGHLY-SENSITIZED AND NONSENSITIZED PATIENTS TO GENETICALLY-ENGINEERED PIG CELLS

AbstractBackgroundWe investigated in vitro whether HLA-highly-sensitized patients with end-stage renal disease (ESRD) will be disadvantaged immunologically after a genetically-engineered pig kidney transplant.MethodsBlood was drawn from patients with a cPRA 99-100% (Gp1, n=10) or cPRA 0% (Gp2, n=12), and from healthy volunteers (Gp3, n=10). Serum IgM and IgG binding was measured (i) to Gal and Neu5Gc glycans by ELISA, and (ii) to pRBC, pAEC, and pPBMC from GTKO/CD46 and GTKO/CD46/CMAHKO pigs by flow cytometry. (iii) T and B cell phenotypes were determined by flow cytometry, and (iv) proliferation of T and B cells CFSE-MLR.Results(i) By ELISA, there was no difference in IgM or IgG binding to Gal or Neu5Gc between Gps1 and 2, but binding was significantly reduced in both groups compared to Gp3. (ii) IgM and IgG binding in Gps1 and 2 was also significantly lower to GTKO/CD46 pig cells than in healthy controls, but there were no differences between the 3 groups in binding to GTKO/CD46/CMAHKO cells. (iii and iv) Gp1 patients had more memory T cells than Gp2, but there was no difference in T or B cell proliferation when stimulated by any pig cells. The proliferative responses in all 3 groups were weakest when stimulated by GTKO/CD46/CMAHKO pPBMC.Conclusions(i) ESRD was associated with low anti-pig antibody levels. (ii) Xenoreactivity decreased with increased genetic engineering of pig cells. (iii) High cPRA status had no significant effect on antibody binding or T and B cell response. Background We investigated in vitro whether HLA-highly-sensitized patients with end-stage renal disease (ESRD) will be disadvantaged immunologically after a genetically-engineered pig kidney transplant. Methods Blood was drawn from patients with a cPRA 99-100% (Gp1, n=10) or cPRA 0% (Gp2, n=12), and from healthy volunteers (Gp3, n=10). Serum IgM and IgG binding was measured (i) to Gal and Neu5Gc glycans by ELISA, and (ii) to pRBC, pAEC, and pPBMC from GTKO/CD46 and GTKO/CD46/CMAHKO pigs by flow cytometry. (iii) T and B cell phenotypes were determined by flow cytometry, and (iv) proliferation of T and B cells CFSE-MLR. Results (i) By ELISA, there was no difference in IgM or IgG binding to Gal or Neu5Gc between Gps1 and 2, but binding was significantly reduced in both groups compared to Gp3. (ii) IgM and IgG binding in Gps1 and 2 was also significantly lower to GTKO/CD46 pig cells than in healthy controls, but there were no differences between the 3 groups in binding to GTKO/CD46/CMAHKO cells. (iii and iv) Gp1 patients had more memory T cells than Gp2, but there was no difference in T or B cell proliferation when stimulated by any pig cells. The proliferative responses in all 3 groups were weakest when stimulated by GTKO/CD46/CMAHKO pPBMC. Conclusions (i) ESRD was associated with low anti-pig antibody levels. (ii) Xenoreactivity decreased with increased genetic engineering of pig cells. (iii) High cPRA status had no significant effect on antibody binding or T and B cell response. Address Correspondence to: Martin Wijkstrom, MD, Thomas E Starzl Transplantation Institute, Montefiore University Hospital, MUH 756.2, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15261, USA. Email: wijkstrommn@upmc.edu Author Contributions: All authors participated in revising and approving the manuscript. ZZ, HQ, HH, MW, DKCC designed and initiated this study. ZZ, CL, IH, HH participated in laboratory assay. Data were collected and analyzed by ZZ, CL, HH, CM, MM, AZ, ME, MW, DKCC. The manuscript was prepared by ZZ, HH, ME, CM, AZ, MW, DKCC. Genetically-engineered pig cells were provided by DA. Conflicts of interest: David Ayares is an employee of Revivicor, Inc. No other author has a conflict of interest. Funding: Zhongqiang Zhang was supported by the China Scholarship Council (File No. 201506370112). Work on xenotransplantation in the Thomas E. Starzl Transplantation Institute of the University of Pittsburgh is, or has been, supported in part by NIH grants #U19 AI090959, #U01 AI068642, and # R21 A1074844, and by Sponsored Research Agreements between the University of Pittsburgh and Revivicor, Inc., Blacksburg, VA. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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EM Nerd-The Case of the Aimless Convoy Continues

Evidence has consistently demonstrated the lack of clinical utility provided by natriuretic peptides. Further studies documenting their incompetencies are no longer necessary, but it is rather enjoyable to highlight their dependable failures. The most recent illustration of natriuretic peptides clinical ineptitude was published this week in CIRCULATION by Stienen et al (1). The authors randomized […]

EMCrit Project by Rory Spiegel.

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Paraneoplastic Optic Neuropathy and Pineal Germinoma With Collapsin Response-Mediating Protein Antibodies

No abstract available

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Herpes Zoster Optic Neuropathy

Background: Herpes zoster optic neuropathy (HZON) is a rare manifestation of herpes zoster ophthalmicus (HZO). The aim of our study was to better characterize the clinical features, therapeutic choices, and visual outcomes in HZON. Methods: A retrospective chart review was performed at multiple academic eye centers with the inclusion criteria of all eyes presenting with optic neuropathy within 1 month of cutaneous zoster of the ipsilateral trigeminal dermatome. Data were collected regarding presenting features, treatment regimen, and visual acuity outcomes. Results: Six patients meeting the HZON inclusion criteria were identified. Mean follow-up was 2.75 months (range 0.5–4 months). Herpes zoster optic neuropathy developed at a mean of 14.1 days after initial rash (range 6–30 days). Optic neuropathy was anterior in 2 eyes and retrobulbar in 4 eyes. Other manifestations of HZO included keratoconjunctivitis (3 eyes) and iritis (4 eyes). All patients were treated with systemic antiviral therapy in addition to topical and/or systemic corticosteroids. At the last follow-up, visual acuity in 3 eyes had improved relative to presentation, 2 eyes had worsened, and 1 eye remained the same. The 2 eyes that did not receive systemic corticosteroids had the best observed final visual acuity. Conclusion: Herpes zoster optic neuropathy is an unusual but distinctive complication of HZO. Visual recovery after HZON is variable. Identification of an optimal treatment regiment for HZON could not be identified from our patient cohort. Systemic antiviral agents are a component of HZON treatment regimens. Efficacy of systemic corticosteroids for HZON remains unclear and should be considered on a case-by-case basis. Address correspondence to Karl C. Golnik, MD, MEd, Cincinnati Eye Institute, University of Cincinnati, 1945 CEI Drive, Cincinnati, OH 45242; E-mail: golnikkarl@gmail.com Presented as poster "Herpes Zoster Optic Neuropathy in Patients With Herpes Zoster Ophthalmicus" at the 2016 American Academy of Ophthalmology Annual Meeting, October 15–18, 2016; Chicago, IL. The authors report no conflicts of interest. © 2017 by North American Neuro-Ophthalmology Society

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