Needle biopsy derived myofascial tissue samples are sufficient for quantification of myofibroblast density

Abstract

Introduction: Quantification of myofibroblasts is a promising method for assessing tissue properties in the field of fascia research. This is commonly performed by immunohistochemistry for α-smooth muscle actin. However, usually larger tissue samples sizes are required for quantification. The aim of this investigation was to explore whether a microscopic quantification of myofibroblasts can be conducted with fascial tissue samples derived via percutaneous needle biopsy.

Materials and Methods: Fascial tissues were derived via percutaneous needle biopsy from the fascia lata of 11 persons (aged 19 to 40 years). Following immunohistochemistry, selected fields for photomicroscopic analysis were chosen by a Monte Carlo method based randomization procedure. On these fields a digital quantification for the relative density of α-smooth muscle actin was attempted.

Results: The newly developed quantification method could successfully be applied in all tissue samples. The median α-smooth muscle actin density in the selected tissue samples ranged between 0% and 1.7% (median 0%, IQR 0%–0.001%).

Conclusions: The applied protocol proved to be workable for the purpose of an estimation of the α-smooth muscle actin density in fascial tissue samples derived via percutaneous needle biopsy. Since this type of biopsy is less invasive than the commonly performed open muscle biopsy, this offers a new and useful perspective for future histological investigations of fascial tissue properties in living patients. This article is protected by copyright. All rights reserved.

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British Association of Dermatologists guidelines for the management of lichen sclerosus 2018

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of lichen sclerosus (LS) in adults (18+ years), children (0-12 years) and young people (13-17 years). The document aims to.

offer an appraisal of all relevant literature up to July 2017, focusing on any key developments.

address important, practical clinical questions relating to the primary guideline objective.

provide guideline recommendations and if appropriate research recommendations.

The guideline is presented as a detailed review with highlighted recommendations for practical use in primary care and in secondary care clinics, in addition to an updated Patient Information Leaflet (PIL; available on the BAD website, http://ift.tt/1tltLhk).

This article is protected by copyright. All rights reserved.

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Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model

Abstract

Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.

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Progesterone Receptor (PGR) Gene Variants Associated with Breast Cancer and Associated Features: a Case-Control Study

Abstract

Insofar as altered estrogen receptor-progesterone receptor (PR) expression contribute to breast cancer pathogenesis, previous studies examined the association of genetic variation in PR gene (PGR) with breast cancer, but with mixed outcome. We evaluated the association between PGR variants, and breast cancer and associated features. A retrospective case-control study involving 183 female breast cancer patients, and 222 control women. PGR genotyping was done by real-time PCR. Minor allele frequencies of rs1042838, rs590688, and rs10895068 PGR gene polymorphisms were significantly higher in breast cancer patients compared to controls. Patients carrying rs1042838 G/T, rs590688 C/C, and rs10895068 G/A genotypes had higher risk of breast cancer, while carriage of rs3740753 G/G genotype was associated with marginal reduction in breast cancer risk. In addition, carriage of rs1042839, rs3740753, and rs10895068 minor allele was associated with Her2 status, while rs3740753 and rs10895068 were associated with effective hormone replacement therapy. Furthermore, carriage of rs10895068 minor allele in breast cancer women were also associated with age at first pregnancy, hormone receptor (RH) status, and previous use of oral contraceptives. PGR haploview analysis documented moderate-strong linkage disequilibrium (non-random association of alleles at different loci) between 7 of the 8 tested PGR SNPs, thus allowing construction of 7-locus PGR haplotypes. Two haplotypes, ATGCCGA and GTGCCGA, both containing rs590688, were positively associated with breast cancer, thus assigning a breast cancer-susceptible nature to these haplotypes. PGR rs1042838, rs590688, and rs10895068, and ATGCCGA and GTGCCGA haplotypes are related with increased breast cancer susceptibility in Tunisian women.

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Lacrimoplasty: a new bone fixation technique for recurrent lacrimal gland prolapse

Abstract

Lacrimal gland prolapse is an often ignored and undiagnosed condition in patients seeking blepharoplasty. Recognition and correct treatment can avoid poor outcomes in such cases. Traditional techniques of treating the prolapsed lacrimal gland include light cautery, partial excision, and periosteal suture fixation. A few series of lacrimal gland prolapse have been published in the literature. But a literature search failed to reveal any reports on the recurrence of surgically treated lacrimal gland prolapse. We report the incidence of lacrimal gland prolapse purely based on the external deformity and also report a case of recurrence following surgical lacrimal gland periosteal hitching, in a patient with blepharochalasis syndrome 4 years post the original correction. A new technique of true bony fixation of the recurrent prolapsed lacrimal gland to the lacrimal fossa is described. We call the new technique 'lacrimoplasty'. An operative video is also included to demonstrate the technique step by step.

Level of Evidence: level V, therapeutic study.

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The Singer's and the Clinician's Perspective on Vitamin B12 Treatment for Vocal Benefits

Publication date: Available online 3 January 2018
Source:Journal of Voice
Author(s): Hagit Shoffel-Havakuk, Christian X. Lava, Edie R. Hapner, Karla O'Dell, Lindsay Reder, Michael M. Johns
IntroductionThere is a belief among vocalists that there are voice benefits from vitamin B12 treatment. Yet there are no previous reports regarding vitamin B12 effects on voice.ObjectivesTo assess the prevalence of vitamin B12 use among singers and their beliefs regarding vitamin B12 therapy.MethodsAnonymous online survey administered to singers, singing-teachers, speech-language pathologists, and laryngologists.ResultsA total of 192 participants completed the surveys; 128 singers (68 singing-teachers, 30 speech-language pathologists) and 64 laryngologists. Among singers, 12% have perceived voice benefits from vitamin B12 treatment taken for any reason. Four percent used vitamin B12 for voice benefits; all perceived voice benefits as a result. The leading voice benefits were improved stamina, reduced effort, confidence, and control. Nineteen percent of the singers would recommend vitamin B12 treatment to a friend; 15% of the singing-teachers would recommend it to a student. Among laryngologists, 33% been asked by a singer to prescribe vitamin B12 for voice benefits; 9% have prescribed it in the past. Yet only 3% would you recommend it to a patient.When asked "Do you believe vitamin B12 therapy improves vocal performance?" 31% of the singers responded "Yes," compared with none in the laryngologists. When asked "Do you think the singing community believes vitamin B12 therapy improves vocal performance?" 26% of the singers responded "Yes," compared with 53% of the laryngologists (P = 0.0002).ConclusionsThere is a discrepancy between the singers' and the laryngologists' beliefs regarding vocal benefits perceived by vitamin B12. Blinded randomized trials are required to verify or refute this belief.



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

Lacrimoplasty: a new bone fixation technique for recurrent lacrimal gland prolapse

Abstract

Lacrimal gland prolapse is an often ignored and undiagnosed condition in patients seeking blepharoplasty. Recognition and correct treatment can avoid poor outcomes in such cases. Traditional techniques of treating the prolapsed lacrimal gland include light cautery, partial excision, and periosteal suture fixation. A few series of lacrimal gland prolapse have been published in the literature. But a literature search failed to reveal any reports on the recurrence of surgically treated lacrimal gland prolapse. We report the incidence of lacrimal gland prolapse purely based on the external deformity and also report a case of recurrence following surgical lacrimal gland periosteal hitching, in a patient with blepharochalasis syndrome 4 years post the original correction. A new technique of true bony fixation of the recurrent prolapsed lacrimal gland to the lacrimal fossa is described. We call the new technique 'lacrimoplasty'. An operative video is also included to demonstrate the technique step by step.

Level of Evidence: level V, therapeutic study.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E5W9do

Laryngotracheal anomalies associated with esophageal atresia: importance of early diagnosis

Abstract

Objective

Esophageal atresia (EA) is the most common congenital esophageal malformation. Airway pathology, in particular, tracheomalacia and laryngotracheal anomalies is a major cause of morbidity and mortalilty in patients with EA. The aim of this study was to report the incidence and type of laryngotracheal anomalies seen in a large series of patients with EA, and to evaluate their impact on the management of children with EA.

Study design

Retrospective study.

Materials and methods

Retrospective cohort including all patients referred to the EA National Reference Center from January 2002 to December 2014. Airway assessment was based on endoscopy performed before, during and/or after esophageal surgery.

Results

One-hundred and fifty-eight patients were included in the study. Endoscopy revealed tracheomalacia in 141 cases (89.2%) and other laryngotracheal anomalies in 43 patients (27.2%). Ninety-six patients (60.7%) presented with persistent respiratory symptoms, including acute life-threatening events in 21 cases, leading to death in 6 cases. A correlation was observed between degree of tracheal collapse and presence of acute life-threatening events. Laryngotracheal surgery was required in 35 cases (22%).

Conclusion

Laryngotracheal anomalies are frequently associated with EA and represent an important etiology of morbidity and mortality that can be prevented by early and systematic diagnosis and aggressive management. An early systematic endoscopic evaluation is recommended to coordinate the airway management with the EA surgery.

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

The Singer's and the Clinician's Perspective on Vitamin B12 Treatment for Vocal Benefits

Publication date: Available online 3 January 2018
Source:Journal of Voice
Author(s): Hagit Shoffel-Havakuk, Christian X. Lava, Edie R. Hapner, Karla O'Dell, Lindsay Reder, Michael M. Johns
IntroductionThere is a belief among vocalists that there are voice benefits from vitamin B12 treatment. Yet there are no previous reports regarding vitamin B12 effects on voice.ObjectivesTo assess the prevalence of vitamin B12 use among singers and their beliefs regarding vitamin B12 therapy.MethodsAnonymous online survey administered to singers, singing-teachers, speech-language pathologists, and laryngologists.ResultsA total of 192 participants completed the surveys; 128 singers (68 singing-teachers, 30 speech-language pathologists) and 64 laryngologists. Among singers, 12% have perceived voice benefits from vitamin B12 treatment taken for any reason. Four percent used vitamin B12 for voice benefits; all perceived voice benefits as a result. The leading voice benefits were improved stamina, reduced effort, confidence, and control. Nineteen percent of the singers would recommend vitamin B12 treatment to a friend; 15% of the singing-teachers would recommend it to a student. Among laryngologists, 33% been asked by a singer to prescribe vitamin B12 for voice benefits; 9% have prescribed it in the past. Yet only 3% would you recommend it to a patient.When asked "Do you believe vitamin B12 therapy improves vocal performance?" 31% of the singers responded "Yes," compared with none in the laryngologists. When asked "Do you think the singing community believes vitamin B12 therapy improves vocal performance?" 26% of the singers responded "Yes," compared with 53% of the laryngologists (P = 0.0002).ConclusionsThere is a discrepancy between the singers' and the laryngologists' beliefs regarding vocal benefits perceived by vitamin B12. Blinded randomized trials are required to verify or refute this belief.



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

Stiripentol for the treatment of super-refractory status epilepticus with cross-sensitivity

Background

Cross-sensitivity of rash has been reported between various antiepileptic drugs (AEDs). However, few studies have determined the frequency and management of cross-sensitivity in patients with super-refractory status epilepticus (SRSE).

Aims of the study

To examine the optimal AED for treating SRSE with cross-sensitivity.

Methods

We performed a retrospective review of adult patients with SRSE treated at Nagoya City University Hospital, in which we investigated the frequency of cross-sensitivity among patients with SRSE and their clinical and medical profiles.

Results

We identified 10 adult patients with SRSE, 5 of whom had cross-sensitivity. Stiripentol (STP) was administered when previously used AEDs had demonstrated cross-sensitivity and failed to control seizures. After initiation of STP, the dose of general anaesthetics was reduced, and status epilepticus (SE) eventually ceased with co-administered AEDs without additional adverse effects. The mean time to SE cessation after initiation of STP was 30.8 days (range, 18-46 days), mean duration of general anaesthesia was 101.2 days (range, 74-128 days), and mean number of AEDs was 9.0 (range, 6-11).

Conclusions

This study suggests that cross-sensitivity between AEDs is common in adults with SRSE and that STP may be useful for treating SRSE with cross-sensitivity.

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Re: “Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors” by Berkman et al. (J Adolesc Young Adult Oncol. 2017;6(3):414–21)

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


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A Narrative Review of Models of Care for Adolescents and Young Adults with Cancer: Barriers and Recommendations

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


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Antineoplastic Agents and (In)fertility: Informing Patients to Improve Decisions

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


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

Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life

Summary

Objective

Given the significant impact epilepsy can have on health-related quality of life (HRQoL) of individuals with this condition and their families, there is great clinical interest in evidence-based psychological treatments aimed at enhancing well-being in people with epilepsy (PWE). An evaluation of the current evidence is needed to assess the effects of psychological treatments for PWE on HRQoL outcomes to inform future therapeutic recommendations and research designs.

Methods

The operational definition of psychological treatments included a broad range of interventions that use psychological or behavioral techniques designed to improve HRQoL, psychiatric comorbidities, and seizure frequency and severity for adults and children with epilepsy. A systematic literature search was conducted in line with Cochrane criteria for randomized controlled trials (RCTs) and quasi-RCTs investigating psychological treatments and using HRQoL outcome measures as primary or secondary outcome measures. Standard methodological procedures required by the Cochrane Collaboration were used for data collection and analysis.

Results

Twenty-four completed RCTs were included in this review (2439 participants). Based on satisfactory methodological homogeneity, data from 9 studies (468 participants) providing Quality of Life in Epilepsy-31 (QOLIE-31) outcomes were pooled for meta-analyses, showing significant mean changes for QOLIE-31 total score and 6 subscales. The significant mean changes of QOLIE-31 total score (mean improvement of 5.68 points; 95% confidence interval = 3.11-8.24, P < .0001) and 3 subscales (emotional well-being, energy/fatigue, overall quality of life [QoL]) exceeded the threshold of minimally important change, indicating a clinically meaningful postintervention improvement of QoL. Overall, the meta-analysis quality of evidence was characterized as "moderate" due to the risk of bias present in 8 of the 9 included studies (Handbook for Systematic Reviews of Interventions, Version 5.1.0, 2011, Chapters 8 and 12). A narrative synthesis was conducted for all trials and outcomes that were not entered in the meta-analysis.

Significance

These results provide moderate-quality evidence that psychological treatments for adults with epilepsy may enhance HRQoL in people with epilepsy.

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Rolipram-Loaded Polymeric Micelle Nanoparticle Reduces Secondary Injury after Rat Compression Spinal Cord Injury

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


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A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus

Abstract

The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus using a systematic review of the literature. Electronic and hand searches were performed until July 2017. The inclusion criteria were defined as follows: (1) randomized trial with a dietary approach; (2) adults with type 2 diabetes mellitus; (3) outcome either HbA1c (%) and/or fasting glucose (mmol/l); (4) minimum intervention period of 12 weeks. For each outcome measure, random effects network meta-analysis was performed in order to determine the pooled effect of each intervention relative to each of the other interventions. A total of 56 trials comparing nine dietary approaches (low-fat, Vegetarian, Mediterranean, high-protein, moderate-carbohydrate, low-carbohydrate, control, low GI/GL, Palaeolithic) enrolling 4937 participants were included. For reducing HbA1c, the low-carbohydrate diet was ranked as the best dietary approach (SUCRA: 84%), followed by the Mediterranean diet (80%) and Palaeolithic diet (76%) compared to a control diet. For reducing fasting glucose, the Mediterranean diet (88%) was ranked as the best approach, followed by Palaeolithic diet (71%) and Vegetarian diet (63%). The network analysis also revealed that all dietary approaches significantly reduce HbA1c (− 0.82 to − 0.47% reduction) and fasting glucose (− 1.61 to − 1.00 mmol/l reduction) compared to a control diet. According to the network meta-analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients.

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

Signia Expert Series: Hearing Aid Speech Mapping Verification - Some Explanations for Puzzling Outcomes

Speech mapping has become a routine method to verify prescriptive fittings. Sometimes, however, things just don't look right, and we wonder if the problem is the equipment, the hearing aid, the patient, or that we are doing something wrong. This course takes a look at some of these unusual findings to determine the culprit for more efficient and successful fittings.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E2c6kM

Laryngotracheal anomalies associated with esophageal atresia: importance of early diagnosis

Abstract

Objective

Esophageal atresia (EA) is the most common congenital esophageal malformation. Airway pathology, in particular, tracheomalacia and laryngotracheal anomalies is a major cause of morbidity and mortalilty in patients with EA. The aim of this study was to report the incidence and type of laryngotracheal anomalies seen in a large series of patients with EA, and to evaluate their impact on the management of children with EA.

Study design

Retrospective study.

Materials and methods

Retrospective cohort including all patients referred to the EA National Reference Center from January 2002 to December 2014. Airway assessment was based on endoscopy performed before, during and/or after esophageal surgery.

Results

One-hundred and fifty-eight patients were included in the study. Endoscopy revealed tracheomalacia in 141 cases (89.2%) and other laryngotracheal anomalies in 43 patients (27.2%). Ninety-six patients (60.7%) presented with persistent respiratory symptoms, including acute life-threatening events in 21 cases, leading to death in 6 cases. A correlation was observed between degree of tracheal collapse and presence of acute life-threatening events. Laryngotracheal surgery was required in 35 cases (22%).

Conclusion

Laryngotracheal anomalies are frequently associated with EA and represent an important etiology of morbidity and mortality that can be prevented by early and systematic diagnosis and aggressive management. An early systematic endoscopic evaluation is recommended to coordinate the airway management with the EA surgery.

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

A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus

Abstract

The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus using a systematic review of the literature. Electronic and hand searches were performed until July 2017. The inclusion criteria were defined as follows: (1) randomized trial with a dietary approach; (2) adults with type 2 diabetes mellitus; (3) outcome either HbA1c (%) and/or fasting glucose (mmol/l); (4) minimum intervention period of 12 weeks. For each outcome measure, random effects network meta-analysis was performed in order to determine the pooled effect of each intervention relative to each of the other interventions. A total of 56 trials comparing nine dietary approaches (low-fat, Vegetarian, Mediterranean, high-protein, moderate-carbohydrate, low-carbohydrate, control, low GI/GL, Palaeolithic) enrolling 4937 participants were included. For reducing HbA1c, the low-carbohydrate diet was ranked as the best dietary approach (SUCRA: 84%), followed by the Mediterranean diet (80%) and Palaeolithic diet (76%) compared to a control diet. For reducing fasting glucose, the Mediterranean diet (88%) was ranked as the best approach, followed by Palaeolithic diet (71%) and Vegetarian diet (63%). The network analysis also revealed that all dietary approaches significantly reduce HbA1c (− 0.82 to − 0.47% reduction) and fasting glucose (− 1.61 to − 1.00 mmol/l reduction) compared to a control diet. According to the network meta-analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients.

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

A Follow-Up Strategy for Patients with an Excellent Response to Initial Therapy for Differentiated Thyroid Carcinoma: Less Is Better

Thyroid , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Czk33x

Practical Initial Risk Stratification Based on Lymph Node Metastases in Pediatric and Adolescent Differentiated Thyroid Cancer

Thyroid , Vol. 0, No. 0.


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Globus Symptoms in Patients Undergoing Thyroidectomy: Relationships with Psychogenic Factors, Thyroid Disease, and Surgical Procedure

Thyroid , Vol. 0, No. 0.


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Risk factors for unplanned discontinuation of scheduled treatment in elderly patients with castration-resistant prostate cancer: results of the IBuTu study

Abstract

Purpose

To gain knowledge about the factors associated with discontinuation of scheduled treatment in elderly men with castration-resistant prostate cancer (CRPC).

Methods

Patients ≥ 70 years with CRPC starting a new line of treatment were included in a prospective cohort study. A geriatric assessment (CGA) was performed at baseline, including comorbidity, mobility, functional/mental/nutritional status, as well as depression. Furthermore, pain intensity, quality of life, ECOG-performance status, and physicians' and patients' perception of health were documented. Reasons for and factors associated with discontinuation of scheduled treatment were analysed by univariate and multivariate analysis.

Results

After inclusion of 177 of 300 planned patients, the study was closed due to slow recruitment. 160 patients were eligible for final analysis. Median age was 77.5 years. 46% received chemotherapy, and 54% hormonal treatment. Discontinuation of scheduled treatment occurred in 91 patients (57.6%). The main reasons were progressive disease/death in 63%, adverse events/toxicity in 22%, and withdrawal of consent in 8%. In bivariate analyses, factors associated with discontinuation of treatment were age ≥ 80 years, ECOG PS ≥ 2, compromised/poor health status (physicians'/patients' assessment), and compromised functional or nutritional status. In multivariate analysis, the only remaining factor independently associated with discontinuation of scheduled treatment was impairment of activities of daily living (ADL < 100 points) (OR = 4.2 for discontinuation; p < 0.05).

Conclusion

Despite limitations due to early termination of the study, our results demonstrate that discontinuation of scheduled treatment was common, and that compromised ADL seems to be a significant risk factor for treatment failure in elderly patients with CRPC.

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

Laryngotracheal anomalies associated with esophageal atresia: importance of early diagnosis

Abstract

Objective

Esophageal atresia (EA) is the most common congenital esophageal malformation. Airway pathology, in particular, tracheomalacia and laryngotracheal anomalies is a major cause of morbidity and mortalilty in patients with EA. The aim of this study was to report the incidence and type of laryngotracheal anomalies seen in a large series of patients with EA, and to evaluate their impact on the management of children with EA.

Study design

Retrospective study.

Materials and methods

Retrospective cohort including all patients referred to the EA National Reference Center from January 2002 to December 2014. Airway assessment was based on endoscopy performed before, during and/or after esophageal surgery.

Results

One-hundred and fifty-eight patients were included in the study. Endoscopy revealed tracheomalacia in 141 cases (89.2%) and other laryngotracheal anomalies in 43 patients (27.2%). Ninety-six patients (60.7%) presented with persistent respiratory symptoms, including acute life-threatening events in 21 cases, leading to death in 6 cases. A correlation was observed between degree of tracheal collapse and presence of acute life-threatening events. Laryngotracheal surgery was required in 35 cases (22%).

Conclusion

Laryngotracheal anomalies are frequently associated with EA and represent an important etiology of morbidity and mortality that can be prevented by early and systematic diagnosis and aggressive management. An early systematic endoscopic evaluation is recommended to coordinate the airway management with the EA surgery.

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

MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial

Abstract

Objectives

White spot lesions (WSLs) are a complication of orthodontic therapy. This study investigated the effect of MI (minimally invasive) Paste Plus (MIPP) and MI Varnish (MIV) on WSLs in orthodontic patients during a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial.

Materials and methods

Forty subjects, recruited from the UCSF School of Dentistry Orthodontics Clinic, were randomly assigned to the experimental (twice-daily 1100 ppm fluoride toothpaste, daily MIPP, quarterly MIV application) or control group (twice-daily 1100 ppm fluoride toothpaste, fluoride rinse recommendation). Facial surfaces of incisors, canines, and first bicuspids were evaluated at baseline, 3, 6, and 12 months using the enamel decalcification index (EDI) and the international caries detection and assessment system (ICDAS).

Results

Findings from 37 subjects are reported. At 12 months, teeth receiving experimental treatment were at lower but not significantly different odds of increased EDI scores (odds ratio, OR 0.63; intra-patient cluster-adjusted 95% CI 0.43, 1.18) and not associated with increased ICDAS scores (OR 0.99; 95% CI 0.64, 1.54). There was no statistically significant difference in mean patient-level EDI sum (experimental group 40.2; control 41.3; t test p = 0.80), ICDAS score (experimental 22.3; control 22.6; Mann-Whitney U test p = 0.80), or percentage of scored surfaces with ICDAS > 0 (experimental 54.6%; control 55.2%; t test p = 0.88). Salivary fluoride levels were significantly higher at 12 months for the experimental than for the control group (0.20 ± 0.26 versus 0.04 ± 0.04 ppm, Mann-Whitney U test p < 0.01).

Conclusions

Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in EDI sum and ICDAS scores. Higher salivary fluoride levels in the experimental group suggest that MIPP and MIV effectively deliver fluoride when used clinically.

Clinical relevance

Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.

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A clinical trial protocol paper discussing the BRIGHTER study

Future Oncology, Ahead of Print.


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MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial

Abstract

Objectives

White spot lesions (WSLs) are a complication of orthodontic therapy. This study investigated the effect of MI (minimally invasive) Paste Plus (MIPP) and MI Varnish (MIV) on WSLs in orthodontic patients during a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial.

Materials and methods

Forty subjects, recruited from the UCSF School of Dentistry Orthodontics Clinic, were randomly assigned to the experimental (twice-daily 1100 ppm fluoride toothpaste, daily MIPP, quarterly MIV application) or control group (twice-daily 1100 ppm fluoride toothpaste, fluoride rinse recommendation). Facial surfaces of incisors, canines, and first bicuspids were evaluated at baseline, 3, 6, and 12 months using the enamel decalcification index (EDI) and the international caries detection and assessment system (ICDAS).

Results

Findings from 37 subjects are reported. At 12 months, teeth receiving experimental treatment were at lower but not significantly different odds of increased EDI scores (odds ratio, OR 0.63; intra-patient cluster-adjusted 95% CI 0.43, 1.18) and not associated with increased ICDAS scores (OR 0.99; 95% CI 0.64, 1.54). There was no statistically significant difference in mean patient-level EDI sum (experimental group 40.2; control 41.3; t test p = 0.80), ICDAS score (experimental 22.3; control 22.6; Mann-Whitney U test p = 0.80), or percentage of scored surfaces with ICDAS > 0 (experimental 54.6%; control 55.2%; t test p = 0.88). Salivary fluoride levels were significantly higher at 12 months for the experimental than for the control group (0.20 ± 0.26 versus 0.04 ± 0.04 ppm, Mann-Whitney U test p < 0.01).

Conclusions

Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in EDI sum and ICDAS scores. Higher salivary fluoride levels in the experimental group suggest that MIPP and MIV effectively deliver fluoride when used clinically.

Clinical relevance

Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.

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Etiology of chronic urticaria: the Ecuadorian experience

The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association ...

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Editorial Board/Reviewing Committee

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Phase 1 trial of M7824 (MSB0011359C), a bifunctional fusion protein targeting PD-L1 and TGF-{beta}, in advanced solid tumors

Purpose: M7824 (MSB0011359C) is an innovative first-in-class bifunctional fusion protein composed of a monoclonal antibody against programmed death ligand 1 (PD-L1) fused to a transforming growth factor-β (TGF-β) "trap." Experimental DesignIn the 3+3 dose-escalation component of this phase 1 study (NCT02517398), eligible patients with advanced solid tumors received M7824 at 1, 3, 10, or 20 mg/kg once-every-2-weeks until confirmed progression, unacceptable toxicity, or trial withdrawal; additionally, a cohort received an initial 0.3 mg/kg dose to evaluate pharmacokinetics/pharmacodynamics (PK/PD), followed by 10 mg/kg dosing. The primary objective is to determine the safety and maximum tolerated dose (MTD); secondary objectives include PK, immunogenicity, and best overall response. Results: Nineteen heavily pretreated patients with ECOG 0-1 have received M7824. Grade ≥3 treatment-related adverse events occurred in 4 patients (skin infection secondary to localized bullous pemphigoid, asymptomatic lipase increase, colitis with associated anemia, and gastroparesis with hypokalemia). The MTD was not reached. M7824 saturated peripheral PD-L1 and sequestered any released plasma TGF-β1, -β2, and -β3 throughout the dosing period at >1 mg/kg. There were signs of efficacy across all dose levels, including 1 ongoing confirmed complete response (cervical cancer), 2 durable confirmed partial responses (PRs; pancreatic cancer; anal cancer), 1 near-PR (cervical cancer), and 2 cases of prolonged stable disease in patients with growing disease at study entry (pancreatic cancer; carcinoid). Conclusions: M7824 has a manageable safety profile in patients with heavily pretreated advanced solid tumors. Early signs of efficacy are encouraging and multiple expansion cohorts are ongoing in a range of tumors.

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Development and preclinical validation of a cysteine knottin peptide targeting Integrin {alpha}v{beta}6 for near-infrared fluorescent-guided surgery in pancreatic cancer

Purpose: Intraoperative near-infrared fluorescence (NIRF) imaging could help stratification for the proper primary treatment for patients with pancreatic ductal adenocarcinoma (PDAC), and achieve complete resection since it allows visualization of cancer in real time. Integrin αvβ6, a target specific for PDAC, is present in >90% of patients, and is able to differentiate between pancreatitis and PDAC. A clinically translatable αvβ6-targeting NIRF agent was developed, based on a previously developed cysteine knottin peptide for PET imaging, R01-MG, and validated in preclinical mouse models. Experimental Design: The applicability of the agent was tested for cell and tissue binding characteristics using cell-based plate assays, subcutaneous and orthotopic pancreatic models, and a transgenic mouse model of PDAC development (Pdx1-Cre tg/+;KRas LSL G12D/+;Ink4a/Arf). IRDye800CW was conjugated to R01-MG in a 1:1 ratio. R01-MG-IRDye800, was compared to a control peptide and IRDye800 alone. Results: In subcutaneous tumor models a significantly higher tumor-to-background ratio (TBR) was seen in BxPC-3 tumors (2.5±0.1) compared to MiaPaCa-2 (1.2±0.1) (p<0.001), and to the control peptide (1.6±0.4) (p<0.005). In an orthotopic tumor model tumor-specific uptake of R01-MG-IRDye800 was shown compared to IRDye800 alone (TBR 2.7 versus 0.86). The fluorescent signal in tumors of transgenic mice was significantly higher, TBR of 3.6±0.94, compared to the normal pancreas of wild type controls, TBR of 1.0±0.17 (p<0.001). Conclusion: R01-MG-IRDye800 shows specific targeting to αvβ6, and holds promise as a diagnostic and therapeutic tool to recognize PDAC for fluorescence-guided surgery. This agent can help improve the stratification of patients for a potentially curative, margin-negative resection.

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Development and validation of a gene signature for patients with head and neck squamous cell carcinomas treated by postoperative radio(chemo)therapy

Purpose: The aim of this study was to identify and independently validate a novel gene signature predicting loco-regional tumor control (LRC) for treatment individualization of patients with locally advanced HPV-negative head and neck squamous cell carcinomas (HNSCC) who are treated with postoperative radio(chemo)therapy (PORT-C). Experimental Design: Gene expression analyses were performed using nanoString technology on a multicenter training cohort of 130 patients and an independent validation cohort of 121 patients. The analyzed gene set was composed by genes with previously reported association to radio(chemo)sensitivity or resistance to radio(chemo)therapy. Gene selection and model building were performed comparing several machine-learning algorithms. Results: We identified a 7-gene signature consisting of the 3 individual genes HILPDA, CD24,TCF3 and one metagene combining the highly correlated genes SERPINE1, INHBA, P4HA2, ACTN1. The 7-gene signature was used, in combination with clinical parameters, to fit a multivariable Cox model to the training data (concordance index, ci=0.82), which was successfully validated (ci=0.71). The signature showed improved performance compared to clinical parameters alone (ci=0.66) and to a previously published model including hypoxia-associated genes and cancer stem cell markers (ci=0.65). It was used to stratify patients into groups with low and high risk of recurrence, leading to significant differences in LRC in training and validation (p<0.001). Conclusions: We have identified and validated the first hypothesis-based gene signature for HPV-negative HNSCC treated by PORT-C including genes related to several radiobiological aspects. A prospective validation is planned in an ongoing prospective clinical trial before potential application in clinical trials for patient stratification.

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Targeting HER2 Aberrations in Non-Small Cell Lung Cancer with Osimertinib

Purpose: HER2 (or ERBB2) aberrations, including both amplification and mutations, have been classified as oncogenic drivers that contribute to 2-6 percent of lung adenocarcinomas. HER2 amplification is also an important mechanism for acquired resistance to EGFR tyrosine kinase inhibitors (TKIs). However, due to limited preclinical studies and clinical trials, currently there is still no available standard of care for lung cancer patients with HER2 aberrations. To fulfill the clinical need for targeting HER2 in non-small cell lung cancer (NSCLC) patients, we performed a comprehensive pre-clinical study to evaluate the efficacy of a third-generation TKI, osimertinib (AZD9291).  Experimental Design:Three genetically modified mouse models (GEMMs) mimicking individual HER2 alterations in NSCLC were generated and osimertinib was tested for its efficacy against these HER2 aberrations in vivo. Results:Osimertinib treatment showed robust efficacy in HER2wt overexpression and EGFR del19/HER2 models but not in HER2 exon 20 insertion tumors. Interestingly, we further identified that combined treatment with osimertinib and the BET inhibitor JQ1 significantly increased the response rate in HER2-mutant NSCLC while JQ1 single treatment did not show efficacy. Conclusions: Overall, our data indicated robust anti-tumor efficacy of osimertinib against multiple HER2 aberrations in lung cancer, either as a single agent or in combination with JQ1. Our study provides a strong rationale for future clinical trials using osimertinib either alone or in combination with epigenetic drugs to target aberrant HER2 in NSCLC patients.

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Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

Abstract

Background

Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented.

Methods

We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N = 71). In all patients, a trained coordinator conducted and scored a baseline GA with pre-determined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3–5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays, and early treatment discontinuation.

Results

The mean participant age was 76 (70–89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3–5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups.

Conclusions

An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.

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How to report adherence to treatment as clinically relevant data—making a case of CML and TKI

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Does grip strength decrease in the very early stages of hematological treatment?

Abstract

Muscle weakness in hematological cancer patients undergoing acute stages of treatment is an important concern and strong predictor of poor outcomes. However, evidence of strength loss in the very early stages of cancer treatment is not addressed. Here, we found that grip strength was compromised within the first 7 days of hematological treatment (− 2.3 kg, P = 0.002). These findings are novel in elucidating lower handgrip strength in the first week of hematological treatment and encourage additional research focusing on handgrip strength in oncology patients under initial high-dose chemotherapy routine.

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Long-term quality of life profile in oncology: a comparison between cancer survivors and the general population

Abstract

Purpose

Understanding the quality of life (QoL) of cancer survivors is relevant to both clinical practice and health care policy. The current study compared the QoL profile in this specific population with that of a normative sample for the general population, as well as with those of both healthy and oncological patients normative sub-samples. In addition, associations between the obtained QoL profile and the main socio-demographic and clinical characteristics of the sample were examined.

Methods

Three hundred and ninety-two adult long-term cancer survivors (i.e., people 5 + years from their cancer diagnosis who were free from it and its treatments) were enrolled during follow-up visits and compiled the Short Form 36 Health Survey.

Results

In comparison with the normative data for the adult general population, the present sample showed lower scores in Physical functioning, Role-physical limitation, and Role-emotional limitations (all differences were both statistically and clinically significant); the difference in Vitality was only statistically significant. In all eight SF-36 scales, scores of the present sample were clinically and statistically lower than those of the normative healthy subsample, whereas they were statistically and clinically higher than those of normative subsample which had experienced cancer, except for Role-physical limitation. The QoL profile was associated with gender (p = 0.002), age (p = 0.001), education (p < 0.001), occupational status (p < 0.001), and the presence of other health issues (p < 0.001).

Conclusion

These data support the utility of rehabilitative programs which integrate both healthcare and social interventions. In addition, they encourage the monitoring of the health status of this specific population, within a broad frame which simultaneously takes into consideration health and QoL.

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An investigation of the prevalence of swallowing difficulties and impact on quality of life in patients with advanced lung cancer

Abstract

Background

Dysphagia can occur in advanced lung cancer due to direct tumour invasion or nerve compression. Anti-cancer treatments and co-morbid conditions may also cause or compound dysphagic symptoms. Speech and language therapy (SLT), medical and surgical interventions are available to address dysphagic symptoms in patients with lung cancer, however, management options are not described in national guidelines. Given the potentially short prognoses for patients with lung cancer, the aim of care should be to reduce symptom burden and maximise quality of life (QOL). Central to that aim is the identification and treatment of swallowing difficulties.

Purpose

This study sought to identify the prevalence and impact of dysphagia on QOL in patients with advanced lung cancer.

Methods

A single-site, prospective, exploratory study was undertaken. Previously validated patient-reported outcome measures of swallowing were used to identify the presence and impact of dysphagia on QOL: EAT-10 assessment and the SWAL-QOL assessment.

Results

Seventy-two participants were recruited with 18.1% identified as having dysphagia on completion of the EAT-10 assessment. On further evaluation using the SWAL-QOL, compromised quality of life was noted with increased fatigue and meal time duration, difficulties with food selection and reduced eating desire. Frequent throat clearing, coughing and perceived pharyngeal stasis were reported.

Conclusions

Dysphagia is a potential symptom in advanced lung cancer which may impact QOL. Patients, carers and healthcare professionals should be aware of this so that early referral to SLT can be expedited. More robust prevalence and interventional studies are required to inform optimal management of this distressing condition.

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A predictive model of inflammatory markers and patient-reported symptoms for cachexia in newly diagnosed pancreatic cancer patients: methodological issues to avoid misinterpretation

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Acute impact of home parenteral nutrition in patients with late-stage cancer on family caregivers: preliminary data

Abstract

Purpose

Since there is no information regarding quality of life of caregivers assisting patients with advanced malignancy on home parenteral nutrition, herewith we report a preliminary series of 19 patients who received total parenteral nutrition at home under the strict supervision of their relatives.

Methods

The relatives of 19 incurable patients with cancer-related cachexia, discharged from the hospital with a home parenteral nutrition program, were prospectively studied. They filled out a validated questionnaire, the Family Strain Questionnaire Short Form, prior to patient discharge and after 2 weeks of home care. The questionnaire included 30 items, which explored different domains regarding the superimposed burden on caregivers in relation to the assistance given to their relatives.

Results

Our findings show that the basal level of strain was relatively high (about three quarters of positive answers) but did not increase after 2 weeks of home care. Similarly, there was no difference in the nutritional status and quality of life of the patients. Eight patients and their relatives could be also analyzed after 2 months and the results maintained unchanged.

Conclusion

This preliminary investigation shows that home parenteral nutrition does not exacerbate the level of strain on caregivers involved in surveillance of such a supportive intervention. It is possible that the perception of an active contribution to the benefit of patients, who maintained unchanged their nutritional status and quality of life, could gratify caregivers despite the objective burden in the constant supervision of administering Parenteral Nutrition.

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Madarosis: a qualitative study to assess perceptions and experience of Australian patients with early breast cancer treated with taxane-based chemotherapy

Abstract

Purpose

Eyebrow and eyelash loss (madarosis) is a common and distressing side effect of chemotherapy for which no protective strategies have yet been developed. The purpose of this study was to develop an overview of perceptions and experiences of women undergoing taxane-based treatment for early breast cancer.

Methods

A total of 25 women with a diagnosis of invasive early breast cancer participated in a focus group (n = 5), ages ranging from 35 to 64 (median 50), all had completed therapy with a taxane-based chemotherapy treatment. This focus group used targeted questions to explore participants' perceptions and experience of madarosis during and following chemotherapy and identified issues associated with impact of madarosis on quality of life (QoL). Thematic analysis was conducted to identify important issues experienced by participants.

Results

Seven themes emerged from the data: (1) timing of regrowth and permanent changes, (2) meaning/importance of eyebrow/eyelashes, (3) preparedness/information given, (4) impact of the hair loss of self, (5) impact of hair loss on others, (6) physiological side effects of loss of eyebrows/eyelashes, and (7) management of loss of eyebrows/eyelashes. In addition, participants noted physical symptoms of eye irritation during their treatment that they attributed to madarosis.

Conclusion

This study highlights the significant impact of madarosis on patients, providing the first published analysis of patient's attitude and perception of eyelash and eyebrow loss during chemotherapy. Further research in this area is required and will be benefitted from the development of a dedicated instrument/questionnaire that can capture and measure the impact of madarosis on QoL and allow development of clinical trial strategies.

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Management of superior vena cava syndrome in critically ill cancer patients

Abstract

Purpose

The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS).

Methods

All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included.

Results

Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0–3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02–0.60), p < 0.01).

Conclusion

Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.

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Patient and provider perceptions of Internet-delivered cognitive behavior therapy for recent cancer survivors

Abstract

Purpose

Although most cancer survivors adjust well, a subset experiences clinical levels of anxiety and depression following cancer treatment. Internet-delivered cognitive behavior therapy (iCBT) is a promising intervention for symptoms of anxiety and depression among survivors; however, patient and provider perceptions of iCBT have not been examined.

Methods

We employed an exploratory qualitative method and conducted semi-structured interviews with 13 cancer survivors and 10 providers to examine iCBT strengths and weaknesses, areas for improvement, and perceived barriers to program completion. A thematic content analysis approach was used to analyze the data.

Results

The majority of survivors liked the flexible, convenient, and private nature of the program. Many viewed the program as helping them feel less alone following cancer treatment. Areas of improvement included suggestions of additional information regarding cancer treatment side effects. Barriers to completing the program were identified by a minority of survivors and included finding time to complete the program and current symptoms. Providers liked the program's accessibility and its ability to provide support to patients after cancer treatment. All providers perceived the program as useful in their current work with survivors. Concerns around the fit of the program (e.g., for particular patients) were expressed by a minority of providers.

Conclusions

Results provide additional evidence for the acceptability of an iCBT program among recent cancer survivors and providers in oncology settings. The current study highlights the value of research exploring iCBT for cancer survivors and provides insights for other groups considering Internet-delivered care for survivors.

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Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis

Abstract

Context

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) by bilateral or unilateral approach is widely used in palliative abdominal pain management in pancreatic cancer patients, but the analgesic effect and relative risks of the two different puncture routes remain controversial.

Objectives

The aim of this systematic review was to evaluate the analgesic efficacy and safety of bilateral EUS-CPN compared with unilateral EUS-CPN.

Methods

An electronic database search was performed for randomized controlled trials comparing bilateral and unilateral approaches of EUS-CPN using the Pubmed, Cochrane Library, Web of Science, Google Scholar, and CNKI databases. Meta-analysis was performed using RevMan 5.3 after screening and methodological evaluation of the selected studies. Outcomes included pain relief, treatment response, analgesic reduction, complications, and quality of life (QOL).

Results

Six eligible studies involving 437 patients were included. No significant difference was found in short-term pain relief [SMD = 0.31, 95% CI (− 0.20, 0.81), P = 0.23] and response to treatment [RR = 0.99, 95% CI (0.77, 1.41), P = 0.97] between the bilateral and unilateral neurolysis groups. However, only the bilateral approach was associated with a statistically significant reduction in the postoperative use of analgesics [RR = 0.66, 95% CI (0.47, 0.94), P = 0.02] compared to the unilateral approach. A descriptive analysis was performed for complications and QOL.

Conclusion

The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.

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Longitudinal assessment of the impact of adapted physical activity on upper limb disability and quality of life in breast cancer survivors from an Italian cohort

Abstract

Purpose

The purpose of this study was to evaluate the effectiveness of a specific adapted physical activity (APA) protocol on upper limb disability and quality of life in breast cancer survivors and to assess longitudinally the possible role of APA on long-term benefits.

Methods

Breast cancer survivors from an Italian cohort were assessed by fitness tests (shoulder-arm mobility, range of motion, and back flexibility) before and after 8-week APA. Quality of life and back and surgical shoulder pain intensity were evaluated by Short Form-12 and numerical rating scale questionnaires, respectively. At 1.5-year post-APA follow-up, survivors were evaluated as at baseline/post-APA to assess long-term effects.

Results

A statistically significant improvement in shoulder-arm mobility, pain perception, and quality of life was observed in breast cancer survivors after APA intervention. Longitudinal analyses indicated an overall decrease in the achieved benefits at 1.5-year post-APA.

Conclusions

The survivorship phase of breast cancer requires a multidisciplinary collaboration involving either the cancer-care medical team or APA professionals to manage psychophysical outcomes. A specific APA protocol may represent an effective countermeasure to reduce post-treatment upper limb disability and improve the quality of life in breast cancer survivors. Participation in structured APA protocols should be maintained over time to preserve the achieved benefits.

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Olanzapine for prevention of chemotherapy-induced nausea and vomiting in children and adolescents: a multi-center, feasibility study

Abstract

Context

There are no prospective pediatric trials evaluating olanzapine for chemotherapy-induced nausea and vomiting (CINV) prevention.

Objective

This study evaluated the feasibility of a trial of olanzapine to evaluate the contribution of olanzapine to CINV control in pediatric oncology patients.

Methods

Patients < 18 years receiving CINV prophylaxis with ondansetron/granisetron/palonosetron ± dexamethasone ± aprepitant were eligible to participate in this prospective, single-arm, open-label study. All patients received olanzapine (0.14 mg/kg/dose; max 10 mg/dose) once daily orally starting before the first chemotherapy dose and continuing for up to four doses after the last chemotherapy administration. A future trial was considered feasible if mean time to enroll 15 patients was ≤ 12 months/site, ≥ 12/15 took at least half of the planned olanzapine doses, and ≤ 3/15 experienced significant sedation or dizziness despite dose reduction. The proportion of children who experienced complete CINV control (no nausea, vomiting, or retching) was described.

Results

Fifteen patients (range 4.1–17.4 years) participated; mean recruitment period was 9.3 months/site. All patients took at least half of the planned olanzapine doses. Six patients experienced sedation which resolved with olanzapine dose reduction (N = 5) or bedtime administration (N = 1). Olanzapine was stopped in one patient with blurry vision and in another with increased plasma GGT values. In both the acute and delayed phases, eight patients experienced complete control of vomiting but almost all (14/15) had nausea.

Conclusion

A pediatric trial of olanzapine for CINV control is feasible. Our findings will inform the design of a future study.

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A comparison of early prostate-specific antigen decline between prostate brachytherapy and different fractionation of external beam radiation—Impact on biochemical failure

Publication date: Available online 3 January 2018
Source:Brachytherapy
Author(s): Daniel Taussky, Stéphane Bedwani, Nissan Meissner, Jean-Paul Bahary, Carole Lambert, Maroie Barkati, Marie-Claude Beauchemin, Cynthia Ménard, Guila Delouya
PurposeThe aim of this study was to compare early prostate-specific antigen (PSA) decline patterns and PSA nadirs between low-dose-rate seed prostate brachytherapy (LDR-PB) and different fractionations of external beam radiotherapy (EBRT) and their predictive importance for biochemical failure (bF).Methods and MaterialsPatients with D'Amico low- or intermediate-risk prostate cancer who underwent a single-modality treatment without androgen deprivation were included in this study. Three different treatment groups were compared: (1) normofractionation EBRT up to 70.2–79.2 Gy/1.8–2.0 Gy, (2) LDR-PB, and (3) EBRT with hypofractionation 60 Gy/3 Gy daily or 5–7.25 Gy once a week over 9–5 weeks, to a total dose of 45–36.25 Gy, respectively. The log-rank test, Cox regression analysis, and nonparametric tests were used.ResultsWe analyzed 892 patients: the median followup for patients without bF was 84 months (interquartile range 60–102 months), with 12% of patients experiencing bF. The PSA decline within the first 15 months was generally exponential. LDR-PB showed a faster early exponential decline compared with EBRT treatments, but whether decline was fast or slow had no influence on recurrence. The only factors that were positive predictive factors in univariate and multivariate analyses were the time to nadir >48 months (median), PSA nadir <0.5 ng/mL, and <0.2 ng/mL (all p < 0.001).ConclusionsAlthough there are significant differences in early exponential PSA decline between different treatments, only the PSA nadir and longer time to nadir were predictive factors for bF.



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Prevalence of burnout syndrome in oncology nursing: a meta-analytic study

Abstract

Objective

To determine the prevalence of high levels of emotional exhaustion and depersonalization and low personal accomplishment in nursing professionals in oncology services.

Methods

A meta-analytical study was performed. The search was carried out in March 2017 in Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases. Studies using Maslach Burnout Inventory (MBI) for the assessment of burnout were included.

Results

The total sample of oncology nurses was n=9959. The total number of included studies was n=17, with n=21 samples for the meta-analysis of emotional exhaustion and n=18 for depersonalization and low personal accomplishment. The prevalence of emotional exhaustion and of depersonalization was 30% (95% CI = 26-33%) and 15% (95% CI = 9-23%), respectively, and that of low personal performance was 35% (95% CI = 27-43%)

Conclusions

The are many oncology nurses with emotional exhaustion and low levels of personal accomplishment. The presence and the risk of burnout among these staff members is considerable.

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Correction to: Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

Abstract

This article was updated to correct a formatting error in Table 1.

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Bite or Brain: Implication of sensorimotor regulation and neuroplasticity in oral rehabilitation procedures

Abstract

Tooth loss, decreased mass and strength of the masticatory muscles leading to difficulty in chewing have been suggested as important determinants of eating and nutrition in the elderly. To compensate for the loss of teeth, in particular, a majority of the elderly rely on dental prosthesis for chewing. Chewing function is indeed an important aspect of oral health and therefore, oral rehabilitation procedures should aim to restore or maintain adequate function. However, even if the possibilities to anatomically restore lost teeth and occlusion have never been better; conventional rehabilitation procedures may still fail to optimally restore oral functions. Perhaps this is due to the lack of focus on the importance of the brain in the rehabilitation procedures. Therefore, the aim of this narrative review is to discuss the importance of maintaining or restoring optimum chewing function in the super-aging population and to summarize the emerging studies on oral motor task performance and measures of cortical neuroplasticity induced by systematic training paradigms in healthy participants. Further, brain imaging studies in patients undergoing or undergone oral rehabilitation procedures will be discussed. Overall, this information is believed to enhance the understanding and develop better rehabilitative strategies to exploit training-induced cortical neuroplasticity in individuals affected by impaired oral motor coordination and function. Training or relearning of oral motor tasks could be important to optimize masticatory performance in dental prosthesis users and may represent a much-needed paradigm shift in the approach to oral rehabilitation procedures.

This article is protected by copyright. All rights reserved.

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Outcomes of sphenopalatine and internal maxillary artery ligation inside the pterygopalatine fossa for posterior epistaxis.

Related Articles

Outcomes of sphenopalatine and internal maxillary artery ligation inside the pterygopalatine fossa for posterior epistaxis.

Rhinology. 2018 Jan 02;:

Authors: Piastro K, Scagnelli R, Gildener-Leapman N, Pinheiro-Neto CD

Abstract
OBJECTIVE: Analysis of the efficacy of sphenopalatine artery (SPA) and internal maxillary artery (IMAX) ligation within the pterygopalatine fossa to control posterior epistaxis.
METHODS: Demographic and clinical data were collected in sixty-two consecutive patients who had SPA/IMAX ligation surgery. Clinical outcomes such as re-bleed rates and complications were acquired.
RESULTS: A total of 62 patients were studied. Thirty-eight percent of patients had previously undergone silver nitrate nasal cautery for epistaxis. Nine patients had undergone previous attempt of SPA procedure or embolization in other services. Two patients returned to the operating room for anterior ethmoid ligation. There was one mortality within 30 days of surgery. Follow up ranged from 3 months to 56 months (median= 28 months).
CONCLUSIONS: Dual SPA and IMAX ligation is effective in the control of difficult epistaxis cases, even in those patients with prior surgical intervention.

PMID: 29292416 [PubMed - as supplied by publisher]

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Correction to: Aminoglycoside Damage and Hair Cell Regeneration in the Chicken Utricle

Abstract

This article was updated to correct a formatting error in Table 1.

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MicroRNAs as effective surrogate biomarkers for early diagnosis of oral cancer

Abstract

Background

Oral squamous cell carcinomas (OC) are life-threatening diseases emerging as major international health concerns.

Objective

Development of an efficient clinical strategy for early diagnosis of the disease is a key for reducing the death rate. Biomarkers are proven to be an effective approach for clinical diagnosis of cancer. Although mechanisms underlying regulation of oral malignancy are still unclear, microRNAs (miRNAs) as a group of small non-coded RNAs may be developed as the effective biomarkers used for early detection of oral cancer.

Methods

A literature search was conducted using the databases of PubMed, Web of Science, and the Cochrane Library. The following search terms were used: miRNAs and oral cancer or oral carcinoma. A critical appraisal of the included studies was performed with upregulated miRNAs and downregulated miRNAs in oral cancer.

Results

In this review, we summarize the research progress made in miRNAs for diagnosis of oral cancer. The involvement of miRNAs identified in signal transduction pathways in OC, including Ras/MAPK signaling, PI3K/AKT signaling, JAK/STAT signaling, Wnt/β-catenin signaling, Notch signaling, and TGF-β/SMAD signaling pathway.

Conclusions

A number of studies demonstrated that miRNAs may be developed as an ideal set of biomarkers used for early diagnosis and prognosis of cancers because of the stability in human peripheral blood and body fluids and availability of non-invasive approaches being developed for clinical utility. Clinical relevance: These findings suggest that miRNAs as biomarkers may be useful for diagnosis of OC.

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Positive correlation of airway resistance and serum asymmetric dimethylarginine (ADMA) in bronchial asthma patients lacking evidence for systemic inflammation

Contribution of nitric-oxide (NO) pathway to the pathogenesis of bronchial asthma (asthma) is ambiguous as NO may confer both protective and detrimental effects depending on the NO synthase (NOS) isoforms, tis...

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MicroRNAs as effective surrogate biomarkers for early diagnosis of oral cancer

Abstract

Background

Oral squamous cell carcinomas (OC) are life-threatening diseases emerging as major international health concerns.

Objective

Development of an efficient clinical strategy for early diagnosis of the disease is a key for reducing the death rate. Biomarkers are proven to be an effective approach for clinical diagnosis of cancer. Although mechanisms underlying regulation of oral malignancy are still unclear, microRNAs (miRNAs) as a group of small non-coded RNAs may be developed as the effective biomarkers used for early detection of oral cancer.

Methods

A literature search was conducted using the databases of PubMed, Web of Science, and the Cochrane Library. The following search terms were used: miRNAs and oral cancer or oral carcinoma. A critical appraisal of the included studies was performed with upregulated miRNAs and downregulated miRNAs in oral cancer.

Results

In this review, we summarize the research progress made in miRNAs for diagnosis of oral cancer. The involvement of miRNAs identified in signal transduction pathways in OC, including Ras/MAPK signaling, PI3K/AKT signaling, JAK/STAT signaling, Wnt/β-catenin signaling, Notch signaling, and TGF-β/SMAD signaling pathway.

Conclusions

A number of studies demonstrated that miRNAs may be developed as an ideal set of biomarkers used for early diagnosis and prognosis of cancers because of the stability in human peripheral blood and body fluids and availability of non-invasive approaches being developed for clinical utility. Clinical relevance: These findings suggest that miRNAs as biomarkers may be useful for diagnosis of OC.

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Functional network stability and average minimal distance – A framework to rapidly assess dynamics of functional network representations

Publication date: 15 February 2018
Source:Journal of Neuroscience Methods, Volume 296
Author(s): Jiaxing Wu, Quinton M. Skilling, Daniel Maruyama, Chenguang Li, Nicolette Ognjanovski, Sara Aton, Michal Zochowski
BackgroundRecent advances in neurophysiological recording techniques have increased both the spatial and temporal resolution of data. New methodologies are required that can handle large data sets in an efficient manner as well as to make quantifiable, and realistic, predictions about the global modality of the brain from under-sampled recordings.New methodTo rectify both problems, we first propose an analytical modification to an existing functional connectivity algorithm, Average Minimal Distance (AMD), to rapidly capture functional network connectivity. We then complement this algorithm by introducing Functional Network Stability (FuNS), a metric that can be used to quickly assess the global network dynamic changes over time, without being constrained by the activities of a specific set of neurons.ResultsWe systematically test the performance of AMD and FuNS (1) on artificial spiking data with different statistical characteristics, (2) from spiking data generated using a neural network model, and (3) using in vivo data recorded from mouse hippocampus during fear learning. Our results show that AMD and FuNS are able to monitor the change in network dynamics during memory consolidation.Comparison with other methodsAMD outperforms traditional bootstrapping and cross-correlation (CC) methods in both significance and computation time. Simultaneously, FuNS provides a reliable way to establish a link between local structural network changes, global dynamics of network-wide representations activity, and behavior.ConclusionsThe AMD-FuNS framework should be universally useful in linking long time-scale, global network dynamics and cognitive behavior.



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Randomized Trial Comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy of solid pancreatic mass lesions

Recently, 3-plane symmetric needle with Franseen geometry and Fork-tip biopsy needle have been developed for histological tissue procurement. We compared 22-gauge Franseen and 22-gauge Fork-tip needles in patients undergoing EUS-guided sampling of pancreatic masses.

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Sleep Duration on Workdays or Non-workdays and Cardiac-cerebral Vascular Diseases in Southern China

This study aimed to assess the relationship between sleep duration on work or non-workdays and myocardial infarction (MI) and stroke in Southern China.

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Alcohol and the risk of sleep apnoea: A systematic review and meta-analysis

A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults.

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Sleep disturbances and later cognitive status: A multi-centre study

To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status.

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Profiling insomnia using subjective measures: Where are we and where are we going

Over the last decades, significant advances have been made in the conceptualization, diagnosis and treatment of insomnia [1]. Despite this progress, the "gold standard" for diagnosing insomnia is still a comprehensive clinical interview. Moreover, subjective and objective tools are available to evaluate multiple aspects of insomnia experience [2].

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Differences in sleep problems between Japanese and Chinese preschoolers: a cross-cultural comparison within the Asian region

Previous studies have performed cross-cultural comparisons of differences in childhood sleep problems between Asian and Western countries. However, whether such differences can be observed among Asian countries remains unclear. The present study aimed to investigate differences in the pattern of sleep problems between Japanese and Chinese preschoolers.

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Flow cytometry analysis of T-cell subsets in cerebrospinal fluid of narcolepsy type 1 patients with long-lasting disease

Type 1 narcolepsy (NT1) is a central hypersomnia linked to the destruction of hypocretin-producing neurons. A great body of genetic and epidemiological data points to likely autoimmune disease aetiology. Recent reports have characterized peripheral blood T-cell subsets in NT1, whereas data regarding the cerebrospinal fluid (CSF) immune cell composition are lacking. The current study aimed to characterize the T-cell and NK-cell subsets in NT1 patients with long disease course.

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Cognitive evaluation in patients with obstructive sleep apnea syndrome

Introduction: Cognitive disorders were described in patients with poor sleep quality. Obstructive sleep apnea syndrome (OSA) is a natural condition that allows and favors the study of cognition in people affected by the disease, since it is possible to separate individuals with different degrees of sleep fragmentation, changes in their macrostructure, efficiency, arterial saturation, and different levels of education.

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The evening chronotype independently predicts emotion dysregulation and increased impulsivity in bipolar disorder. A pilot study

Introduction: In Bipolar Disorder (BD), both chronobiological rhythms and emotion dysregulation play an important role by negatively influencing its trajectory; particularly, impulsivity can contribute to risky behavior including substance abuse, aggressiveness and sucidality. The aim was to assess the possible association between chronobiological rhythms and of emotion regulation in subjects with Bipolar Disorder while controlling for disease severity.

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Effect of adenotonsillectomy on central apnea index in children with obstructive sleep apnoea

Introduction: In children with Obstructive Sleep Apnea (OSA), polysomnogram often shows central apnea events. Central apnoea index (CAI) is defined as the number of central apneas per hour of sleep. CAI ≥1 is considered abnormal in children. In children with OSA, significant improvement in CAI has been reported post-adenotonsillectomy.

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The prospective study of nigrostriatal dopaminergic function using by striatal dopamine transporter imaging (FMT/PET) in patients with idiopathic REM sleep behavior disorder

Introduction: In recent studies, some REM sleep behavior disorder (RBD) patients reported an increased risk to develop Lewy body-related diseases such as Parkinson's disease (PD) and dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Recent dopamine transporter SPECT and PET studies demonstrated decreased striatal dopaminergic innervations in some idiopathic RBD patients. Thus, we prospectively assessed a nigrostriatal dopaminergic function using by striatal dopamine transporter imaging in patients with idiopathic RBD and compared the finding with age matched healthy controls to clarify predictors of pathological neurodegenerative process of nigrostriatal dopaminergic neurons.

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Sleep changes in Alzheimer's disease spectrum disorders measured by home-based polysomnography

Introduction: There have been several human studies regarding sleep parameters and their potential relationship with Alzheimer's disease (AD) pathogenesis. In this pilot study we investigated sleep architecture in subjective memory impairment (SMI), mild cognitive impairment (MCI), and AD patients who completed amyloid PET scans prior to assessment of their sleep architecture using WatchPAT® which enables measurements of sleep parameters at home. We hypothesized that patients with AD spectrum disorders or subjects with amyloid pathology in the brain may have more sleep problems.

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Evolution of sleep architecture and level of alertness measured by MWT in apneic patients treated by genioglossus stimulation (inspire ® therapy)

Introduction: Genioglossus stimulation (Inspire ® therapy) is a novel therapy for patients suffering of obstructive sleep apnea syndrome (OSAS). It has proven its efficacy in reducing apnea-hypopnea index (IAH) but the impact on sleep architecture and level of alertness has been poorly investigated. Thus the aims of this study were: i) to compare sleep architecture and level of alertness before therapy and 6 months after implantation and ii) to explore the relationship between changes in sleep architecture and in level of alertness, in patients with sever OSAS.

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Fragmentary myoclonus in idiopathic rapid eye movement sleep behavior disorder

Introduction and Objectives: Fragmentary myoclonus (FM) is the manifestation of muscle activity characterized by brief asynchronous potentials, registered by the surface EMG during polysomnography. Excessive fragmentary myoclonus (EFM) is the form of FM, defined by pathologically increased presence of these potentials at the polysomnographic recording.

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Effects of deep brain stimulation (DBS) of the pedunculopontine nucleus (PPTG) of the reticular activating system (RAS) in Parkinson's disease (PD): motor and non motor benefits

Introduction: The human pedunculopontine nucleus (PPTg) is located in the ponto–mesencephalic region delimited by three sensitive pathways; PPTg has two main sub-regions: the pars compacta and the pars dissipata The PPTg presents mainly ACh neurons. Moreover GABAergic and glutamatergic neurons of PPTg receives corticostriatal inputs and projects to structures involved in motor control, such as GPi, SNr and the STN. However, PPTg is not only a locomotor structure and it is a part of RAS. Diffuse ascending cholinergic projections affects rapid-eye-movement and sleep.

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Automatic estimation of sleep and wakefulness using a single-channel EEG and home polygraphy signals

Introduction: The identification of total sleep time (TST) is crucial for Apnea and Hypopnea Index (AHI) calculation. In polysomnography (PSG), sleep/wake scoring implies the use of EEG, EOG and EMG, which are costly and time consuming. In type III home polygraphy (HPG), TST is overestimated due to the lack of electrophysiological recordings. The aim of this study is to assess the performance of an automatic sleep/wake estimation algorithm based on a single EEG channel in comparison with manual scoring of routine PSG.

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Bedtime to morning variation of mobility after nocturnal sleep in Parkinson's disease

Introduction: Up to 50% of the patients with Parkinson´s disease experience a transient but clinically relevant improvement in mobility on morning awakening, even before taking their habitual antiparkinsonian medications. This phenomenon has been described as "Sleep Benefit" (SB). We aimed to evaluate the effect of nocturnal sleep on mobility on morning awakening, compared to the effect of habitual morning dopaminergic medications. Moreover, we explored if this effect varied differently among patients experiencing or not SB and if it was influenced by overall quality of nocturnal sleep macrostructure.

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Effects of chronic insomnia on balance indicators in patients with mild cognitive impairments

Introduction: Sleep disorders are one of the most frequent problems of elderly patients and their prevalence increases with every decade of life. In some studies sleep deprivation in young people worsens the compensatory possibilities of balance. The aim of our study is to investigate the effect of chronic insomnia on balance indicators in elderly patients.

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Phenoconversion of Czech idiopathic REM sleep behavior disorder patients

Introduction: Idiopathic REM sleep behavior disorder (iRBD) is regarded as the initial stage of neurodegenerative diseases, especially synucleinopathies. The aim of this study was to evaluate the phenoconversion into parkinsonism and cognitive deficit in patients diagnosed with iRBD in our Centre.

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Eradicating HPV-Associated Cancer Through Immunization: A Glass Half Full…

Viral Immunology , Vol. 0, No. 0.


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Review of HaNDLE-on-QoL: a database of published papers that use questionnaires to report quality of life in patients with cancer of the head and neck

HaNDLE-on-QoL (Head And Neck Database Listing Evidence on QoL) is a searchable database that comprises abstracts of papers that have used questionnaires to report on quality of life (QoL) in patients with cancer of the head and neck. It can be searched by title, first author, year of publication, words used in the abstract, site of cancer, study design, and questionnaires used. The aim of this paper was to summarise its contents. In May 2017 we searched the website using the criteria above. It contained 1498 papers (including 149 reviews), and the number is increasing each year.

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Concentric, double-puncture arthrocentesis using unwelded Y-shaped needle

Arthrocentesis was first described for the treatment of disorders of the temporomandibular joint (TMJ) in 1991, by Nitzan et al.1 Since then, it has been an effective treatment for managing internal derangement of the TMJ, particularly in patients with limited mouth opening and pain who have not responded well to conservative treatments.2 It includes irrigation of the upper joint space to allow inflammatory fluids to flow out of the joint and to relieve the adverse intra-articular pressure. Many methods of arthrocentesis of the TMJ have been designed to facilitate it and minimise the patient's discomfort.

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Bilateral symmetrical lipomatosis in MERRF Syndrome: A case report and review of the literature

Introduction: MEERF Syndrome refers to the acronym of myoclonus epilepsy associated with ragged-red fibres and was first reported as a new nosological entity belonging to mitochondrial encephalomyopathies in 1982.

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Sentinel Node Biopsy in oral squamous cell carcinoma: Analysis of error in a cohort of 100 consecutive cases

Introduction: UK 2016 national guidelines recommend SNB to be offered to all T1-T2 N0 patients who don't require reconstructive procedures. Thus we believe the case for SNB in oral cancer is made, but we hope to highlight potential avoidable pitfalls.

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Pulpal blood flow recorded from exposed dentine with a laser Doppler flow meter using red or infrared light

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Kanittha Kijsamanmith, Noppakun Vongsavan, Bruce Matthews
ObjectiveTo determine the percentage of the blood flow signal that is derived from dental pulp when recording from exposed dentine in a human premolar.DesignRecordings were made from 7 healthy teeth in 5 subjects (aged 22–33 yr.) with a laser Doppler flow meter (Periflux 4001) using either a red (635 nm) or an infrared (780 nm) laser. After exposing dentine above the buccal pulpal horn (cavity diam. 1.6 mm, depth 3 mm) and isolating the crown with opaque rubber dam, blood flow was recorded alternately with infrared or red light from the exposed dentine under four conditions: before and after injecting local anaesthetic (3% Mepivacaine without vasoconstrictor) (LA) over the apex of the root of the tooth; after exposing the pulp by cutting a buccal, class V cavity in the tooth; and after sectioning the coronal pulp transversely through the exposure.ResultsThere was no significant change in mean blood flow recorded with either light source when the tooth was anaesthetized or when the pulp was exposed. After the pulp had been sectioned, the blood flow recorded with infrared light fell by 67.8% and with red light, by 68.4%. The difference between these effects was not significant.ConclusionsWhen recording blood flow from exposed coronal dentine with either infrared or red light in a tooth isolated with opaque rubber dam, about 68% to the signal was contributed by the pulp. The signal:noise ratio was better with infrared than red light, and when recording from dentine than enamel.



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Association of weight and height with timing of deciduous tooth emergence

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Ashraf I. Shaweesh, Ola B. Al-Batayneh
ObjectivesThe aim of this study was to associate weight and height with the timing of deciduous tooth emergence.Methods1756 children, aged from 1 to 33 months (755 females and 1001 males) had been previously examined for the timing of deciduous tooth emergence and their weights and heights measured. Children were categorized into weight and height groups (underweight, normal, overweight, short stature, normal and tall stature). Probit regression analysis was used to calculate the ages at emergence of each deciduous tooth. Tooth emergence ages were compared pairwise across the weight and height groups.ResultsThe deciduous dentition emerged between 7.9–31.5, 7.8–29.6 and 6.3–26.5 months in the underweight, normal and overweight children, respectively. In the height groups, the ranges were 9.0–31.3, 7.4–27.0 and 6.7–24.3 in the short, normal and tall children, respectively. The extremes of weight and height were related to the times at deciduous tooth emergence where a substantial increase in weight or height was associated with earlier emergence, and vice versa. However, only canines, lateral incisors and upper central incisor showed statistically significant association with weight and none of the teeth exhibited statistically significant association with height. Moreover, no emergence sequence change was associated with weight and height.ConclusionsThe present study provides the first weight and height– specific data on the timing of deciduous tooth emergence. Although both weight and height are generally associated with the timing of deciduous tooth emergence, weight shows a stronger association for canines, lateral incisors and upper central incisor. The findings will aid assessing normal emergence timing in children with variant weights and heights.



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Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia

Abstract

Background

Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines.

Methods

The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices.

Results

Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01–1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08–1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84–0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86–0.99). Only 1% of patients were referred for psychological care.

Conclusions

Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.

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Image analysis of the interarytenoid area to detect laryngopharyngeal reflux disease

We reviewed the article entitled: "Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method" by Nayak et al. [1]. This is an interesting work. The authors used computer based red, green, and blue (RGB) color analysis of laryngoscopic findings as objective measurements of the interarytenoid and posterior commissure inflammation related to laryngopharyngeal reflux (LPR); then concluded that the value of R>139.2 on image analysis is diagnostic of LPR and higher the R value, the greater is the mucosal inflammation.

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Slit2/Robo1 signaling is involved in angiogenesis of glomerular endothelial cells exposed to a diabetic-like environment

Abstract

Abnormal angiogenesis plays a pathological role in diabetic nephropathy (DN), contributing to glomerular hypertrophy and microalbuminuria. Slit2/Robo1 signaling participates in angiogenesis in some pathological contexts, but whether it is involved in glomerular abnormal angiogenesis of early DN is unclear. The present study evaluated the effects of Slit2/Robo1 signaling pathway on angiogenesis of human renal glomerular endothelial cells (HRGECs) exposed to a diabetic-like environment or recombinant Slit2-N. To remove the effect of Slit2 derived from mesangial cells, human renal mesangial cells (HRMCs) grown in high glucose (HG) medium (33 mM) were transfected with Slit2 siRNA and then the HG-HRMCs-CM with Slit2 depletion was collected after 48 h. HRGECs were cultured in the HG-HRMCs-CM or recombinant Slit2-N for 0, 6, 12, 24, or 48 h. The mRNA and protein expressions of Slit2/Robo1, PI3K/Akt and HIF-1α/VEGF signaling pathways were detected by quantitative real-time PCR, western blotting, and ELISA, respectively. The CCK-8 cell proliferation assay, flow cytometry and the scratch wound-healing assay were used to assess cell proliferation, cycles, and migration, respectively. Matrigel was used to perform a tubule formation assay. Our results showed that the HG-HRMCs-CM with Slit2 depletion enhanced the activation of Slit2/Robo1, PI3K/Akt, and HIF-1α/VEGF signaling in HRGECs in time-dependent manner (0–24 h post-treatment). In addition, the HG-HRMCs-CM with Slit2 depletion significantly promoted HRGECs proliferation, migration, and tube formation. Pretreatment of HRGECs with Robo1 siRNA suppressed the activation of PI3K/Akt and HIF-1α/VEGF signaling and inhibited angiogenesis, whereas PI3K inhibitor suppressed HIF-1α/VEGF signaling, without influencing Robo1 expression. In the HRGECs treated with Slit2-N, Slit2-N time-dependently enhanced the activation of Robo1/PI3K/Akt/VEGF pathway but not HIF-1α activity, and promoted HRGECs proliferation, migration, and tube formation. The effects induced by Slit2 were also abolished by Robo1 siRNA and PI3K inhibitor. Taken together, our findings indicate that in a diabetic-like environment, in addition to mesangial cells, autocrine activation of Slit2/Robo1 signaling of HRGECs may contribute to angiogenesis of HRGECs through PI3K/Akt/VEGF pathway; therefore, Slit2/Robo1 signaling may be a potent therapeutic target for the treatment of abnormal angiogenesis in early DN and may have broad implications for the treatment of other diseases dependent on pathologic angiogenesis.

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Chronic mild hypoxia promotes profound vascular remodeling in spinal cord blood vessels, preferentially in white matter, via an α5β1 integrin-mediated mechanism

Abstract

Spinal cord injury (SCI) leads to rapid destruction of neuronal tissue, resulting in devastating motor and sensory deficits. This is exacerbated by damage to spinal cord blood vessels and loss of vascular integrity. Thus, approaches that protect existing blood vessels or stimulate the growth of new blood vessels might present a novel approach to minimize loss or promote regeneration of spinal cord tissue following SCI. In light of the remarkable power of chronic mild hypoxia (CMH) to stimulate vascular remodeling in the brain, the goal of this study was to examine how CMH (8% O₂ for up to 7 days) affects blood vessel remodeling in the spinal cord. We found that CMH promoted the following: (1) endothelial proliferation and increased vascularity as a result of angiogenesis and arteriogenesis, (2) increased vascular expression of the angiogenic extracellular matrix protein fibronectin as well as concomitant increases in endothelial expression of the fibronectin receptor α5β1 integrin, (3) strongly upregulated endothelial expression of the tight junction proteins claudin-5, ZO-1 and occludin and (4) astrocyte activation. Of note, the vascular remodeling changes induced by CMH were more extensive in white matter. Interestingly, hypoxic-induced vascular remodeling in spinal cord blood vessels was markedly attenuated in mice lacking endothelial α5 integrin expression (α5-EC-KO mice). Taken together, these studies demonstrate the considerable remodeling potential of spinal cord blood vessels and highlight an important angiogenic role for the α5β1 integrin in promoting endothelial proliferation. They also imply that stimulation of the α5β1 integrin or controlled use of mild hypoxia might provide new approaches for promoting angiogenesis and improving vascular integrity in spinal cord blood vessels.

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Factors influencing the decision to share cancer genetic results among family members: an in-depth interview study of women in an Asian setting

Abstract

OBJECTIVE

Reluctance to share hereditary cancer syndrome genetic test results with family is reported among Asian patients. This study aims to explore patient factors influencing result-sharing with family, to improve overall testing uptake.

METHODS

Participants were women with a personal/family history of breast and/or ovarian cancer who received a positive, negative, or variant of uncertain significance (VUS) test result. In-depth interviews were conducted to theme saturation to explore facilitators and barriers for sharing results with family. Grounded theory with thematic analysis was applied in analysis and interpretation.

RESULTS

Twenty-four women participated. Three themes representing facilitators emerged for all results categories: family closeness; involvement of families in the testing process; and perception of low emotional impact of results. In the positive result category, two facilitator themes emerged: presence of actionable results; and perception of family members' acceptance. In the negative and VUS result categories, two themes representing barriers to sharing emerged: perception of no genetic or medical implication for family; and result ambiguity respectively.

CONCLUSIONS

Facilitators and barriers for result-sharing are similar to those among Western women. A framework to explain Asian patients' decision-making process identifies optimal counselling opportunities to enhance communication with family.

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