No mode of ventilation is burdened with more emotional baggage than airway pressure release ventilation (APRV). The mere suggestion of its use is met with either the delight of recognizing an old friend whom you are meeting for the first time, or the type of disgust typically reserved for the likes of snake oil salesmen. […]
EMCrit Project by Rory Spiegel.
Publication date: Available online 27 January 2018
Source:Cancer Cell
Author(s): Manuel Sanclemente, Sarah Francoz, Laura Esteban-Burgos, Emilie Bousquet-Mur, Magdolna Djurec, Pedro P. Lopez-Casas, Manuel Hidalgo, Carmen Guerra, Matthias Drosten, Monica Musteanu, Mariano Barbacid
A quarter of all solid tumors harbor KRAS oncogenes. Yet, no selective drugs have been approved to treat these malignancies. Genetic interrogation of the MAPK pathway revealed that systemic ablation of MEK or ERK kinases in adult mice prevent tumor development but are unacceptably toxic. Here, we demonstrate that ablation of c-RAF expression in advanced tumors driven by KrasG12V/Trp53 mutations leads to significant tumor regression with no detectable appearance of resistance mechanisms. Tumor regression results from massive apoptosis. Importantly, systemic abrogation of c-RAF expression does not inhibit canonical MAPK signaling, hence, resulting in limited toxicities. These results are of significant relevance for the design of therapeutic strategies to treat K-RAS mutant cancers.
Publication date: Available online 27 January 2018
Source:Cancer Cell
Author(s): Markus Eberl, Doris Mangelberger, Jacob B. Swanson, Monique E. Verhaegen, Paul W. Harms, Marcus L. Frohm, Andrzej A. Dlugosz, Sunny Y. Wong
Hedgehog (Hh) pathway inhibitors such as vismodegib are highly effective for treating basal cell carcinoma (BCC); however, residual tumor cells frequently persist and regenerate the primary tumor upon drug discontinuation. Here, we show that BCCs are organized into two molecularly and functionally distinct compartments. Whereas interior Hh+/Notch+ suprabasal cells undergo apoptosis in response to vismodegib, peripheral Hh+++/Notch− basal cells survive throughout treatment. Inhibiting Notch specifically promotes tumor persistence without causing drug resistance, while activating Notch is sufficient to regress already established lesions. Altogether, these findings suggest that the three-dimensional architecture of BCCs establishes a natural hierarchy of drug response in the tumor and that this hierarchy can be overcome, for better or worse, by modulating Notch.
Background/Aim: The purpose of this study was to identify adverse prognostic factors for patients with advanced esophageal cancer undergoing chemotherapy with docetaxel, cisplatin and 5-fluorouracil (DCF). Patients and Methods: The study cohort comprised of 45 patients with advanced esophageal cancer who underwent induction DCF therapy followed by esophagectomy or chemoradiotherapy. Treatment outcomes and factors affecting early recurrence and death were analyzed. Results: Overall 3-year survival was 61.4%, and 3-year disease-free survival was 44.7%. Clinically evident lymph node metastasis and clinical stage were associated with recurrence within 1 year and death within 2 years. Low maximum standardized uptake value (SUVmax) after induction DCF therapy and small decreases in SUVmax from pre- to post-DCF therapy were also predictors of recurrence and poor prognosis. Conclusion: Induction DCF therapy may be ineffective for advanced-stage esophageal cancer and clinical lymph node metastasis (≥N2, ≥stage IIIB). Moreover, small decreases in SUVmax DCF therapy are associated with early disease relapse and death.
Background: In ulcerative colitis (UC), the majority of colorectal carcinomas (CRC) arise in the vast colorectal mucosal domain built with mucus-producing goblet cells and columnar cells. Conversely, CRC in UC rarely evolve in the tiny, spotty gut-associated lymphoid tissue (GALT) mucosal domain. Here we review the four reported cases of colonic carcinoma developing in GALT mucosa in UC, searching for possible precursor lesions connected with the evolution of these tumours. Materials and Methods: The clinical history, age, gender, endoscopic descriptions, and the pathology (localization, gross and histological descriptions of the luminal surface) of the four UC-GALT carcinomas reported in the literature were reviewed. Results: The luminal surface in three out of the four carcinomas revealed conventional (tubular/villous) adenomas or high-grade dysplasia. All four UC-GALT-carcinomas were detected at an early stage (T1N0). Conclusion: GALT carcinomas do occur, albeit infrequently, in patients with UC. The finding that three out of the four GALT carcinomas on record were covered by conventional adenomas or by high-grade dysplasia strongly suggests that non-invasive conventional neoplasias might often precede GALT carcinomas in UC.
While nuclear cofactors that contribute to vitamin D receptor (VDR)-mediated gene transcription, including retinoid X receptors, nuclear co-activators and co-repressors, have been extensively investigated, little is known about cytoplasmic VDR-binding partners and the physiological relevance of their interaction. To gain new insight into this topic, we isolated whole-cell protein extracts of 1,25-dihydroxyvitamin D3 stimulated and UV-B-irradiated vs. non-irradiated HEK 293T cells transfected with a plasmid called pURB VDR C-Term TAP tag. VDR complex was purified by tandem affinity purification (TAP). The nuclear tumor-suppressor protein p53 and its negative regulator novel INHAT repressor (NIR), in addition to 43 other nuclear or cytoplasmatic VDR binding partners, were identified using nano high-performance liquid chromatography–electrospray ionization tandem mass spectrometric analysis. VDR binding to p53 was confirmed by western blot analysis. Future studies are required to further elucidate the functional significance of these interactions.
Background: Vitamin D is known for its anticancer potential. Prostaglandin E2 (PGE2) is a proliferative and inflammation-activating agent. The production of PGE2 is dependent on the activity of cyclooxygenase-2 (COX2). A link between vitamin D and PGE2 metabolism was shown recently. Materials and Methods: In MDA-MB-231 and MCF-7 breast cancer cell lines, we investigated the influence of calcitriol and the COX2 inhibitor celecoxib on cell growth via the MTT test, as well as on the protein and mRNA expression of COX2 using western blot and quantitative real-time polymerase chain reaction (qRT-PCR). Results: The proliferation of MCF-7 and MDA-MB-231 was inhibited by both calcitriol and the COX2 inhibitor celecoxib and even more strongly by their combination. Moreover, calcitriol inhibited COX2 protein expression in MDA-MB-231 cells, as well as COX2 mRNA expression in both cell lines. Conclusion: The combination of calcitriol and celecoxib demonstrated a synergistic growth-inhibitory effect in breast cancer cell lines.
Background/Aim: Exposure of the skin to sunshine is the major natural source of vitamin D. In order to imitate this natural production of vitamin D for patients with chronic kidney disease, hemodialysis patients were exposed three times a week to radiation of the front part of both legs to normalize the vitamin D status. Patients and Methods: Partial body UVB irradiation was performed during the routine dialysis session. Twenty-two patients took part, with a mean age of 61.7 (range=35-81) years. Results: Serum levels of 25(OH)D3 and 1,25(OH)2D3 increased into the mid normal range. Intact parathyroid hormone decreased by 25% and osteocalcin by 45%. 24-Hour blood-pressure monitoring demonstrated decreases in systolic and diastolic blood pressure. Conclusion: Partial body exposure to UVB radiation normalized not only the serum level of 25(OH)D3, but also that of 1,25(OH)2D3, which resulted in a significant decrease in parathyroid hormone, osteocalcin levels, and also in blood pressure. Sunshine imitating UVB exposure utilizes the capacity of the skin to convert extrarenally vitamin D3 to 25(OH)D3 and 1,25(OH)2D3.
This review was conducted to assess the dose–response relationship between vitamin D and cardiovascular disease (CVD) outcomes in humans: Prospective cohort studies indicate a multivariable-adjusted non-linear increase in CVD events at levels of circulating 25-hydroxyvitamin D [25(OH)D] of less than 50 nmol/l. However, Mendelian randomization studies do not support these findings. Although meta-analyses of randomized controlled trials (RCTs) do not rule out small beneficial vitamin D effects on surrogate parameters of CVD risk, such as arterial stiffness, at vitamin D doses equivalent to 1,000-5,333 IU daily, other meta-analyses of RCTs show no reduction in CVD events by vitamin D supplementation. Notably, some cohort studies and a recent RCT provide evidence for harmful effects of vitamin D on CVD outcomes at 25(OH)D levels in excess of 100 nmol/l. In conclusion, more studies in individuals with a deficient 25(OH)D level (i.e. <30 nmol/l) are needed, but caution is necessary regarding supplementation with vitamin D doses achieving a 25(OH)D level which exceeds 100 nmol/l.
For a long time, skin cancer has been known to be related to extensive UV exposure. New emerging data have, however, shown low UV exposure/low vitamin D levels to be related to increased mortality rate due to skin cancer. In addition, low sun exposure habits in regions of low solar intensity have been shown to be a major risk factor for all-cause mortality in the same range as that for smoking. This is mainly due to lower all-cause mortality due to cardiovascular disease (CVD) and non-CVD/non-cancer disease among women with active sun exposure. Women with active sun exposure habits were estimated to have a 1- to 2-year longer life-expectancy during the Melanoma in Southern Sweden study interval. These findings are in line with those to be expected from an evolutionary perspective and research findings, but in opposition to present guidelines and recommendations.
Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95% confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case–control studies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04-1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a–) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.
Ultraviolet (UV)-induced DNA lesions are almost exclusively removed by the nucleotide excision repair (NER) pathway, which is essential for prevention of skin cancer development. Patients with xeroderma pigmentosum (XP) are extremely sun sensitive due to a genetic defect in components of the NER cascade. They present with first signs of premature skin aging at an early age, with a considerably increased risk of developing UV-induced skin cancer. XP belongs to the group of DNA repair defective disorders that are mainly diagnosed in the clinic and in hindsight confirmed at the molecular level. Unfortunately, there are no causative treatment options for this rare, autosomal-recessive disorder, emphasizing the importance of an early diagnosis. Subsequently, UV-protective measures such as the reduction of exposure to environmental UV and regular skin cancer screenings should be undertaken to substantially improve prognosis as well as the disease course.
UV radiation is acknowledged as the primary cause of photocarcinogenesis and therefore contributes to the development of skin cancer entities such as squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. Typical DNA photoproducts and indirect DNA damage caused by reactive oxygen species are the result of UV radiation. UV-induced DNA damage is repaired by nucleotide excision repair, which consequently counteracts the development of mutations and skin carcinogenesis. Tumour-suppressor genes are inactivated by mutation and growth-promoting pathways are activated leading to disruption of cell-cycle progression. Depending on the skin cancer entity, some genes are more frequently affected than others. In BCC mutations in Patched or Smoothened are common and affect the Sonic hedgehog pathway. In SCC, cell regulator protein p53 (TP53) mutations are prevalent, as well as mutations of the epidermal growth factor receptor (EGFR), cyclin-dependent kinase 2A (CDKN2A), Rat sarcoma (RAS), or the tyrosine kinase Fyn (FYN). UV-induced mutations in TP53 and CDKN2A are frequent in melanoma. UV-induced inflammatory processes also facilitate photocarcinogenesis. Recent studies showed a connection between photocarcinogenesis and citrus consumption, phytochemicals, alcohol consumption, hormone replacement therapy, as well as oral contraceptive use. Preventative measures include adequate use of sun protection and skin cancer screening at regular intervals, as well as the use of chemopreventative agents.
Background/Aim: To optimize public health campaigns concerning UV exposure, it is important to characterize factors that influence UV-induced cutaneous vitamin D production. This systematic review and meta-analysis investigated the impact of different individual and environmental factors including exposed body surface area (BSA), UVB dose and vitamin D status, on serum 25(OH)D concentration. Materials and Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses, and Meta-analysis of Observational studies in Epidemiology guidelines, a systematic literature search was conducted (MEDLINE; 01/1960-07/2016) investigating the impact of these factors on vitamin D status after artificial UV exposure as main outcome measure. Summary mean differences [and 95% confidence interval (CI)] were derived from random-effects meta-analysis to account for possible heterogeneity across studies. Meta-regression was conducted to account for impact of UVB dose, baseline 25(OH)D level and BSA. Results: We identified 15 studies, with an estimated mean 25(OH)D rise per standard erythema dose (SED) of 0.19 nmol/l (95% CI 0.11-0.26 nmol/l). Results from meta-regression suggest a significant impact of UV dose and baseline 25(OH)D concentration on serum 25(OH)D level (p<0.01). Single UVB doses between 0.75 and 3 SED resulted in the highest rise of serum 25(OH)D per dose unit. BSA exposed had a smaller, non-proportional, not significant impact. Partial BSA exposure resulted in relatively higher rise compared to whole-body exposure (e.g. exposure of face and hands caused an 8-fold higher rise of serum 25(OH)D concentration/SED/1% BSA compared to whole-body exposure). Our findings support previous reports, estimating that the half-life of serum 25(OH)D varies depending on different factors. Conclusion: Our results indicate that partial BSA exposure (e.g. 10%) with moderate UV doses (e.g. 1 SED) is effective in generating or maintaining a healthy vitamin D status. However, due to limitations that include possible confounding factors such as skin type, which could not be considered, these findings should be interpreted with caution.
A plethora of contradictory research surrounds vitamin D and its influence on health and disease. This may, in part, result from analytical difficulties with regard to measuring vitamin D metabolites in serum. Indeed, variation exists between analytical techniques and assays used for the determination of serum 25-hydroxyvitamin D. Research studies into the effects of vitamin D on clinical endpoints rely heavily on the accurate assessment of vitamin D status. This has important implications, as findings from vitamin D-related studies to date may potentially have been hampered by the quantification techniques used. Likewise, healthcare professionals are increasingly incorporating vitamin D testing and supplementation regimens into their practice, and measurement errors may be also confounding the clinical decisions. Importantly, the Vitamin D Standardisation Programme is an initiative that aims to standardise the measurement of vitamin D metabolites. Such a programme is anticipated to eliminate the inaccuracies surrounding vitamin D quantification.
The vitamin D–cancer prevention hypothesis has been evaluated through several types of studies, including geographical ecological studies related to indices of solar ultraviolet-B (UVB) dose (the primary source of vitamin D for most people), observational studies related to UVB exposure or serum 25-hydroxyvitamin D [25(OH)D] concentrations, laboratory studies of mechanisms, and clinical trials. Each approach has strengths and limitations. Ecological studies indirectly measure vitamin D production and incorporate the assumption that vitamin D mediates the effect of UVB exposure. Findings from observational studies with long follow-up times are affected by changing 25(OH)D concentrations over time. Most clinical trials have been poorly designed and conducted, based largely on guidelines for pharmaceutical drugs rather than on nutrients. However, three clinical trials do support the hypothesis. In general, the totality of the evidence, as evaluated using Hill's criteria for causality in a biological system, supports the vitamin D–cancer prevention hypothesis.
Vitamin D is of public health interest because its deficiency is common and is associated with musculoskeletal diseases, as well as extraskeletal diseases, such as cancer, cardiovascular diseases, and infections. Several health authorities have reviewed the existing literature and published nutritional vitamin D guidelines for the general population. There was a wide consensus that serum 25-hydroxyvitamin D [25(OH)D] concentration should be used to assess vitamin D status and intake, and that musculoskeletal, and not extraskeletal, effects of vitamin D should be the basis for nutritional vitamin D guidelines. Recommended target levels for 25(OH)D range from 25 to 50 nmol/l (10 to 20 ng/ml), corresponding to a vitamin D intake of 400 to 800 International Units (10 to 20 μg) per day. It is of concern that significant sections of the general population do not meet these recommended vitamin D levels. This definitely requires action from a public health perspective.
Background/Aim: To demonstrate the value of Ki-67 in distinguishing between partial and complete hydatidiform moles. Materials and Methods: We searched electronic databases included Medline, WOK, Cochrane Library and CNKI, through January 24, 2015. Experts were consulted, and references from related articles were examined. The meta-analysis was conducted with RevMan5.3, according to the PRISMA guidelines. Mantel-Haenszel estimates were calculated and pooled under a random effect model, with data expressed as odds ratio (OR) and 95% confidence interval (CI). Results: We analyzed eight trials with a total of 337 participants who underwent uterine curettage and met the inclusion criteria. A significantly higher expression of Ki-67 was observed in complete than in partial hydatidiform moles (OR=3.28; 95%CI=1.80-5.96; p<0.0001). Conclusion: The Ki-67 expression was higher in complete than in partial hydatidiform moles. Therefore, Ki-67 may be of diagnostic value in distinguishing between partial and complete hydatidiform moles. However, the present study had only a limited number of samples, so investigation of a greater number of cases is needed to confirm this conclusion.
Background/Aim: Combination of perioperative chemotherapy with gastrectomy with D2 lymphadenectomy improves long-term survival in patients with gastric cancer. The aim of this study was to investigate the predictive value of preoperative levels of CRP, albumin, fibrinogen, neutrophil-to-lymphocyte ratio and routinely used tumor markers (CEA, CA 19-9, CA 72-4) for lymph node involvement. Materials and Methods: This retrospective study was conducted in 136 patients who underwent surgery between 2007 and 2015. Bivariable and multivariable analyses were performed in order to identify important characteristics associated with the risk of lymph node involvement. Kaplan-Meier survival curves and log-rank tests were used to compare overall survival. Results: Lymph node involvement was significantly affected by preoperative fibrinogen (p=0.008) and albumin (p=0.023). Poor clinical condition, T and N staging and fibrinogen level above 3.5 g/l were significantly associated with worse overall survival. Conclusion: Preoperative fibrinogen and albumin levels are significantly associated with lymphoid metastases in patients with gastric cancer.
The European Commission's Scientific Committee on Health, Environmental and Emerging Risks and the World Health Organization recently published reports which concluded that a large proportion of melanoma and non-melanoma skin cancer is attributable to sunbed use, and that there is no need to use sunbeds as there are no health benefits and they are not needed to achieve an optimal vitamin D level. The overall conclusion from both bodies was that there is no safe limit for UV irradiance from sunbeds. We are, however, deeply concerned that these assessments appear to be based on an incomplete, unbalanced and non-critical evaluation of the literature. Therefore, we rebut these conclusions by addressing the incomplete analysis of the adverse health effects of UV and sunbed exposure (what is 'safe'?) and the censored representation of beneficial effects, not only but especially from vitamin D production. The stance taken by both agencies is not sufficiently supported by the data and in particular, current scientific knowledge does not support the conclusion sunbed use increases melanoma risk.
Aim: The purpose of this IRB-approved, retrospective study was to compare image quality between 2D and high-resolution 3D, T2-weighted (T2WI) magnetic resonance imaging (MRI) sequences and to investigate the additional value of ultra-high b-value diffusion-weighted imaging (DWI; b=2,000 mm/s2) for both rectal cancer staging and evaluating treatment response. Materials and Methods: From 12 February to 24 August 2016, 26 consecutive patients (22 males, four females; mean age: 61.9±14.0 years) with histologically-proven rectal cancer. In total 31 examinations [12 prior to and 19 after chemoradiation (CRT)] were included. The patients underwent pelvic MRI on a 3.0-T scanner (Magnetom Skyra, Erlangen, Germany). Three radiologists (3, 4, and 5 years of experience in MRI, respectively) independently assessed all images and rated the image quality of DWI (b=800 mm/s2), apparent diffusion coefficient map, DWI (b=2,000 mm/s2), 3D sagittal T2WI, 3D axial T2WI, 2D sagittal T2WI, and 2D axial T2WI of each patient, respectively. In addition, signal intensity ratios (SIR) were calculated between rectal cancer and obturator internus muscle (background) in all patients after CRT on DWI (b=2,000 mm/s2) and correlated with histopathological regression grade (RG). Results: Tumor delineation was significantly better by 2D T2WI than 3D T2WI both before and after CRT (before CRT: Z=–3.2, p=0.02; after CRT: Z=–4.408, p<0.001; all: Z=–5.192; p<0.001) and was the preferred method, although image quality ratings were not significantly different (3D sagittal: 4.00±0.48; 2D sagittal: 4.03±0.34, p=0.713; 3D axial: 3.85±0.61, 2D axial: 3.78±0.64, p=0.537). Independent t-test showed significantly higher SIR between those with RG 1 or 2 (moderate response: mean score=2.02) and those with RG 3+4 (good response: mean score=0.8) (t=3.044, p=0.011). In those with RG 4 (complete response), SIR of b2000 was 0.946 compared to a 1.41 average of the whole cohort. In two patients, tumor was invisible on b2000 following CRT (RG 3 and 4, respectively). Interobserver agreement was mostly good (≥0.6) regarding image quality assessment, except for poor agreement (=0.4) in DWI (b2000) between the two less-experienced readers. Conclusion: In conclusion, 3D T2WI might be useful for evaluating response to neoadjuvant therapy in a comprehensive, cost-effective protocol, where 2D imaging seems to be preferable. In addition, DWI (b2000) may be beneficial in assessing both the primary and the residual tumor after CRT in rectal cancer and SIR may be helpful in assessing response to CRT.
Background/Aim: Recent clinical trials have shown that immune checkpoint blockades that target either PD-1 or PD-L1 yield remarkable responses in a subgroup of patients with non-small cell lung cancer (NSCLC). Materials and Methods: We retrospectively examined, by immunohistochemical analysis, 211 NSCLC samples. Using 32 independent samples, we also evaluated PD-L1 expression in NSCLC patients with EGFR gene mutations treated by EGFR-TKIs. Results: Overall survival of PD-L1-positive stages I-III NSCLC and stage I NSCLC and stages I-III squamous cell carcinoma (SQ) were significantly shorter than those of PD-L1-negative NSCLC (p<0.01 and p=0.02 and p=0.01, respectively). In stage I NSCLC and stages I-III SQ, PD-L1 expression was found to be independent predictor of death after multivariate analysis. Response to EGFR-TKIs was not significantly different between PD-L1-positive and PD-L1-negative NSCLC patients with EGFR mutations. Conclusion: PD-L1 expression was a significant independent predictor of poor outcome in NSCLC patients.
Background/Aim: It is possible that the degree of enhancement on contrast-enhanced spectral mammography (CESM), a new diagnostic method, might provide prognostic information for breast cancer patients. Therefore, in a group of 82 breast cancer patients, we analyzed the prognostic significance of degree and pattern of enhancement on CESM as well as its relation to: (a) breast cancer immunophenotype (based on ER/PR/HER2 status) (b) podoplanin expression in cancer stroma (lymphatic vessel density plus podoplanin-positivity of cancer-associated fibroblasts), and (c) other histological parameters. Materials and Methods: For each tumor the intensity of enhancement on CESM was qualitatively assessed as strong or weak/medium, while the pattern – as homogenous and heterogenous. Results: Herein we report, for the first time, that strong and heterogenous enhancement on CESM was related to unfavorable disease-free survival of breast cancer patients (p=0.005). Moreover, the strong enhancement was more frequent in large and node-positive tumors (pT>1, pN>0) (p=0.002), as well as in carcinomas with podoplanin-sparse stroma (p=0.008). Conclusion: Intensity and pattern of enhancement on CESM might provide (together with the results of other diagnostic imaging methods) not only the confirmation of presence or absence of tumor, but also prognostic information.
The American Joint Committee on Cancer (AJCC) staging system is inadequate for an accurate prognosis in nasopharyngeal carcinoma (NPC). Thus, new biomarkers are under intense investigation. Here, we investigated whether the density of TILs could predict prognosis in NPC. First, we used 1490 cases of nasopharyngeal carcinoma samples from two independent cohorts to evaluate the density and distribution of tumor-infiltrating lymphocytes (TILs). Second, in one cohort, we assessed associations between TILs and clinical outcomes in 593 randomly selected samples (defined as the training set) and validated findings in the remaining 593 samples (defined as the validation set). Furthermore, we confirmed the prognostic value of TILs in a second independent cohort of 304 cases (defined as the independent set). Based on multivariable Cox regression analysis, we also established an effective prognostic nomogram including TILs to improve accuracy in predicting disease-free survival (DFS) for patients with non-disseminated NPC. We found that high TILs in the training set were significantly associated with favorable DFS [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28–0.58, P < 0.001], overall survival (OS, HR 0.42, 95% CI 0.27–0.64, P < 0.001), distant metastasis-free survival (DMFS, HR 0.37, 95% CI 0.23–0.58, P < 0.001) and local-regional recurrent free survival (LRRFS, HR 0.43, 95% CI 0.25–0.73, P = 0.002). Multivariate analysis showed that TILs are an independent prognostic indicator for DFS in all cohorts. In summary, this study indicated that TILs may reflect the immunological heterogeneity of NPC and could represent a new prognostic biomarker. This article is protected by copyright. All rights reserved.
Referred or secondary otalgia is the complaint of ear pain arising from pathology of non-otologic locations with which the ear shares common neural pathways. The pain can present in various degrees of intensity and characteristics while severity is not proportional to the seriousness of the underlying cause1,2.
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The authors describe the use of superiorly curved scalp Incision for Implantation of Magnetic Transcutaneous Bone Conduction Devices
They describe a new technical aspect to minimise numbness issues in a series of 60 patients from two tertiary referral centres.
An inferiorly-based flap design will help to preserve branches of the great auricular and lesser occipital nerves, which normally sacrificed with the original technique.
Superiorly curved scalp Incision will be suitable for subsequent retroauricular incision that is used in auricular reconstruction in microtia patients.
These easily reproducible technical modification comfortable be used safely for Implantation of Magnetic Transcutaneous Bone Conduction Devices, especially patients with auricular dysplasia where auricular reconstruction is planned
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In the Picardie region of northern France, the prevalence of intracranial suppurative complications (particularly empyema) of ear, nose and throat infections seems to have increased over the last 10 to 15 years.
Three possible reasons for the increased incidence in this region are the inappropriate use of antibiotics, low socioeconomic status, and poor access to high-quality healthcare.
Intracranial complications affect both sexes and all ages.
If a patient suffering from sinusitis or (especially) otitis media complains of headache, the possible presence of an intracranial suppurative complication must be always be considered and should prompt immediate medical imaging (a cranial CT scan and MRI) for confirmation of the diagnosis.
Early diagnosis and multidisciplinary pharmacological and surgical management (focused on the intracranial complication) should enable complete recovery in more than three quarters of these cases
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A peritonsillar abscess (PTA) is a collection of pus between the pharyngeal musculature and palatine tonsil capsule. It is the most common deep space infection of the head and neck region and the most common indication for acute ORL hospital admission 1. Causative microorganisms include Gram negative rods, Gram positive cocci and anaerobes 2. Usual treatment is aspiration +/- incision and drainage of PTA, but there is practice variation based on geographical location 3.
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Summary: As technology and interventional techniques continue to evolve, both the volume and complexity of cardiac catheterizations will increase, leading to a rise in the number of complications. One of the most morbid complications of cardiac catheterization is vascular injury. We report the case of a 31-day-old, 3.0-kg infant with hypoplastic left heart syndrome who experienced a left common iliac artery disruption during cardiac catheterization resulting in a retroperitoneal hemorrhage. The extent of the vascular injury combined with the vessel caliber posed a technically challenging surgical scenario. Ultimately, the vascular supply to the left lower extremity was reconstructed by the plastic surgery team with a reverse autologous vein graft. To our knowledge, this multidisciplinary approach with the involvement of plastic surgery represents a unique case.
Summary: Women desire beautiful breasts that are functional, pain free, and without foreign material. Vertical scars, insufficient elevation, inadequate upper pole fullness, nipple numbness, and loss of breast feeding are undesirable. Relieving pain attributed to enlarged breasts has required significant tissue removal. Software analysis of chest images, physical measurements, and desires are combined to generate a surgical blueprint. The breast is divided horizontally into two components preserving the neurovascular supply and major lactiferous ducts. The skin flap cephalad to the areola provides external coverage. The areola remains attached to a deepithelialized mound, which is rotated into a cone. Dermal straps originating from the base of the cone are looped through the pectoralis major muscle and the cone repeatedly. Weight transfer to the pectoralis major muscles eliminates pain in 54% and decreases pain in 38%. Incisions are concealed at the areola cutaneous junction and in the shadow of the breast. Upper pole fullness increased in 86% without implants or fat transfer. Nipple sensation was increased in 37% and unchanged in 44%. Overall results were excellent in 50% and good in 36%. Complications consisted of dog-ears, periareolar infection, and fat necrosis. No patient required a return to the operation room. Combing computer-aided design with plastic surgical principles creates beautiful, functional breasts without foreign material. Vertical scars are avoided, and weight transfer relieves pain.A systematic review and meta-analysis was conducted to evaluate the association between periodontitis (PD) and chronic kidney disease (CKD) and to explore the potential influence of periodontal treatment in CKD patients. Databases (PubMed, Web of Science, Science direct, Cochrane Database) were screened for relevant articles, focusing on the periodontal status of patients with CKD, published until December 2017. Five-hundred fifty-three articles were identified and 37 fulfilled the inclusion criteria and were considered in this systematic review. Seventeen articles were included in the meta-analysis and 7 in the review focusing on the impact of periodontal treatment. Most of the identified studies indicated an increased incidence of PD in CKD patients. Meta-analysis showed an association between CKD and PD and strength of this association was increased when severe PD was considered (OR=2.39 (1.70 – 3.36)). The association could be observed even after adjustment for major CKD risk factors or use of precise diagnosis criteria (OR=2.26 for severe PD (1.69 – 3.01)). Analysis of cohort studies indicated an incident rate ratio (IRR) of 1.73. Periodontitis is associated with CKD after multivariable adjustment. Further studies are necessary to determine whether prevention or treatment of PD can reduce the incidence and/or severity of CKD.
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[Papillomavirus, could we speak about cancer and prevention?]
Bull Cancer. 2018 Jan 16;:
Authors: Pernot S, Pavie J, Péré H, Menard M, Hurel S, Cochand-Priollet B, Bats AS, Badoual C
PMID: 29373106 [PubMed - as supplied by publisher]
InnerScope Hearing Technologies (http://www.innd.com/) now offers purchase options and hearing resources to personal sound amplifier products (PSAPs) consumers on its direct-to-consumer e-commerce site, Hearingbenefit.com. They can sign up to receive an e-book produced by InnerScope called The Senior Medical Controversy on Hearingbenefit.com to learn about the consequences of untreated hearing loss, including cognitive issues such as Alzheimer's and dementia. InnerScope has also created a separate landing page (http://www.howtohearbetter.com/) to assist consumers through the evaluation and decision phase of choosing a device. Matthew Moore, CEO of InnerScope, said once people click onto their e-commerce store, it is easy for them to navigate and make a decision to purchase. "We have taken the stress off the buying process, by offering easy payments with zero down and zero interest. We know that for years the tens of millions of hearing impaired people have been an underserved market… We offer these people through our Hearingbenefit.com website easy and simple access to hearing products that can help improve their hearing immediately without hurting their pocketbook, and even a money back guarantee," Moore said.
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Home Non-Invasive Ventilation for COPD: How, Who and When?
Arch Bronconeumol. 2018 Jan 19;:
Authors: Murphy PB, Hart N
Abstract
Patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure have high levels of morbidity and mortality. The clinical efficacy of long term home oxygen therapy has been well documented in this patient group but despite the efficacy of non-invasive ventilation (NIV) during acute decompensated respiratory failure the addition of home NIV has been associated with equivocal results. The physiological efficacy of home NIV to improve gas exchange in chronic stable hypercapnic respiratory failure has been proven in small studies but larger clinical trials failed to translate this into clinical efficacy. Criticisms of early clinical trials include the use of marginally hypercapnic patients and failure to demonstrate effective delivery of home NIV. When considering recent trial data it is important to clearly evaluate the patient phenotype and timing and delivery of NIV. Recent data supports the delivery of home NIV in patients with chronic hypercapnia (PaCO2>7kPa or 50mmHg) and the frequent or infrequent exacerbator phenotype. Importantly in the frequent exacerbator the timing of the assessment needs to be in the recovery phase, 2-4 weeks after resolution of acute acidosis, to delineate transient from persistent hypercapnia. In patient with persistent hypercapnia NIV must be titrated to achieve control of sleep disordered breathing with the aim of improving daytime respiratory failure. Furthermore there are observational data to support the use of home positive airway pressure therapy (NIV or continuous positive airway pressure; CPAP) in patients with COPD and obstructive sleep apnoea (OSA) both with and without hypercapnia.
PMID: 29371025 [PubMed - as supplied by publisher]
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Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia.
Dysphagia. 2018 Jan 25;:
Authors: DePietro JD, Rubin S, Stein DJ, Golan H, Noordzij JP
Abstract
The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.
PMID: 29372358 [PubMed - as supplied by publisher]
Ectopic intratracheal thyroid tissue (EITT) is a rare abnormality with only limited cases reported so far. The presenting symptoms can be very similar to those of bronchial asthma. We discuss the case of a 29-year-old man with subglottic ectopic thyroid, with a history of thyroid surgery for goiter, which has been managed with laser-assisted endoscopic approach. We have also included presenting symptoms, pathophysiology, diagnosis, and management of EITT. We aim to include EITT in the differentials of airway obstruction, particularly in those patients who have goiter or previous thyroid surgeries.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ncri8Y
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An unusual swelling of the supraorbital region.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 23;:
Authors: Rennie A, Elias G, Romain KE, Williams KH, Burke E
PMID: 29373259 [PubMed - as supplied by publisher]
The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty ...
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BxRQWe
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Primary Breast Atypical Lipomatous Tumor/ Well-Differentiated Liposarcoma and Dedifferentiated Liposarcoma.
Arch Pathol Lab Med. 2018 Feb;142(2):268-274
Authors: Briski LM, Jorns JM
Abstract
Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and its higher-grade counterpart, dedifferentiated liposarcoma (DDL), are extraordinarily rare tumors in the breast. The main differential diagnostic consideration of primary breast ALT/WDL is malignant phyllodes tumor with liposarcomatous differentiation, and the main differential diagnostic consideration of DDL in the breast is metaplastic breast carcinoma, particularly the spindle cell type, with heterologous sarcomatous differentiation. These differential diagnoses may be particularly challenging when evaluating limited core needle biopsy sampling. MDM2 and/or CDK4 protein overexpression and gene amplification are beneficial ancillary studies that can help establish the diagnosis of primary breast ALT/WDL and DDL, and effectively rule out the diagnoses of malignant phyllodes tumor and metaplastic breast carcinoma.
PMID: 29372852 [PubMed - in process]
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A New Kind of Autopsy for 21st Century Medicine.
Arch Pathol Lab Med. 2018 Feb;142(2):158
Authors: Wolf DA
PMID: 29372851 [PubMed - in process]
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In Defense of the Academic Autopsy.
Arch Pathol Lab Med. 2018 Feb;142(2):157-158
Authors: Krywanczyk A, Mount S
PMID: 29372850 [PubMed - in process]
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Historical Insights for Early Adopters of Whole Slide Imaging.
Arch Pathol Lab Med. 2018 Feb;142(2):161b-162
Authors: Wright JR
PMID: 29372849 [PubMed - in process]
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Hepatic Epithelioid Hemangioendothelioma.
Arch Pathol Lab Med. 2018 Feb;142(2):263-267
Authors: Studer LL, Selby DM
Abstract
Epithelioid hemangioendothelioma is a rare vascular tumor, composed of epithelioid and histiocytoid vascular endothelial cells in myxoid or fibrotic stroma, which can arise in multiple locations throughout the body. In the liver, this neoplasm usually presents on imaging as an incidental finding of multifocal, heterogeneously enhancing nodules in both lobes or presents clinically with nonspecific abdominal symptoms. Histologically, the tumor has been mistaken for metastatic carcinoma, angiosarcoma, hepatocellular carcinoma, and cholangiocarcinoma. The neoplasm usually stains positive for vascular markers, such as factor VIII-related antigen, CD31, and CD34, and negative for cytokeratins. The translocation t(1;3)(p36.3;q25), resulting in the CAMTA1- WWTR1 fusion product, is the most commonly identified genetic abnormality with this tumor. Although hepatic epithelioid hemangioendothelioma can have a varied clinical course, it is generally considered less aggressive than angiosarcoma. There is no consensus treatment protocol and techniques including liver transplantation, liver resection, chemotherapy and/or radiation therapy, and surveillance have all been used with varying outcomes.
PMID: 29372848 [PubMed - in process]
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In Reply.
Arch Pathol Lab Med. 2018 Feb;142(2):158b-159
Authors: Laposata M
PMID: 29372847 [PubMed - in process]
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Pathology of Melanotic Schwannoma.
Arch Pathol Lab Med. 2018 Jan 26;:
Authors: Alexiev BA, Chou PM, Jennings LJ
Abstract
CONTEXT: - Melanotic schwannoma (MS) is a nerve sheath tumor with a uniform composition of variably melanin-producing Schwann cells and metastatic potential. The MS is an uncommon neoplasm, accounting for less than 1% of all nerve sheath tumors, with a predilection for spinal nerve involvement. Microscopically, the tumors are characterized by spindle and epithelioid cells arranged in interlacing fascicles, with marked accumulation of melanin in neoplastic cells and associated melanophages. The MSs are frequently associated with Carney complex, showing features of psammoma bodies and adipose-like cells. Strict criteria of malignancy in MS are not well developed, although a combination of worrisome histologic features (large, vesicular nuclei, with macronucleoli, brisk mitotic activity, and necrosis) raises concern for aggressive behavior.
OBJECTIVE: - To review the current status of the MS literature, discussing putative etiology, histopathology, current genetics, and differential diagnoses, including overlap with other pigmented tumors.
DATA SOURCES: - Search of the literature database (PubMed, National Center for Biotechnology Information, Bethesda, Maryland) and the authors' own experiences.
CONCLUSIONS: - The occurrence of MS at several unusual anatomic sites and its spectrum of morphologic patterns can result in significant diagnostic difficulty, and correct diagnosis is particularly important because of its high tendency to recur locally and to metastasize, which highlights the importance of diagnostic recognition, ancillary molecular genetic testing, and close clinical follow-up of patients with MS.
PMID: 29372846 [PubMed - as supplied by publisher]
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Myeloid Neoplasm With Germline Predisposition: A 2016 Update for Pathologists.
Arch Pathol Lab Med. 2018 Jan 26;:
Authors: Gao J, Gong S, Chen YH
Abstract
CONTEXT: - Myeloid neoplasms with familial occurrence have been rarely reported in the past. With the advance of molecular technology and better understanding of the molecular pathogenesis of myeloid neoplasms, investigating the genetic causes of familial acute myeloid leukemia or myelodysplastic syndrome has become feasible in the clinical setting. Recent studies have identified a rapidly expanding list of germline mutations associated with increased risks of developing myeloid neoplasm in the affected families. It is important to recognize these entities, as such a diagnosis may dictate a unique approach in clinical management and surveillance for the patients and carriers.
OBJECTIVE: - To raise the awareness of myeloid neoplasms arising in the setting of familial inheritance among practicing pathologists.
DATA SOURCES: - Based on recent literature and the 2016 revision of the World Health Organization classification of hematopoietic neoplasms, we provided an up-to-date review of myeloid neoplasm with germline predisposition.
CONCLUSIONS: - This short review focused on the clinical, pathologic, and molecular characterization of myeloid neoplasm with germline predisposition. We emphasized the important features that will help practicing pathologists to recognize these newly described entities.
PMID: 29372845 [PubMed - as supplied by publisher]
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Molecular Testing of Non-Small Cell Lung Carcinoma Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Fine-Needle Aspiration.
Arch Pathol Lab Med. 2018 Jan 26;:
Authors: Doxtader EE, Cheng YW, Zhang Y
Abstract
CONTEXT: - Given the increasing demand for molecular testing of non-small cell lung carcinoma specimens to guide therapeutic decision-making, and the trend toward minimally invasive techniques for obtaining diagnostic tissue, cytopathology laboratories must devise strategies to maximize DNA yield for necessary molecular testing.
OBJECTIVE: - To describe our experience at Cleveland Clinic with epidermal growth factor receptor ( EGFR) mutation testing by next-generation sequencing and anaplastic lymphoma kinase ( ALK) gene rearrangement testing by fluorescence in situ hybridization of non-small cell lung carcinomas diagnosed by cytology, with an emphasis on specimens obtained by endobronchial ultrasound-guided transbronchial fine-needle aspiration.
DATA SOURCES: - Data sources include a review of the current literature, including published articles from our institution.
CONCLUSIONS: - At our institution, liquid-based cytology specimens are the primary resource used for molecular testing of non-small cell lung carcinomas; in most instances, adequate DNA can be extracted from the residual cell pellet for next-generation sequencing, and ThinPrep slides can be used reliably for fluorescence in situ hybridization testing for ALK gene rearrangements. In occasional cases where the cell pellet material is not adequate for molecular testing, cell blocks and/or surgical pathology specimens are secondary options. The cytopathologist's role in specimen handling and triage is essential to ensure that molecular testing can be carried out successfully.
PMID: 29372844 [PubMed - as supplied by publisher]
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Analysis of Fusion Genes by NanoString System: A Role in Lung Cytology?
Arch Pathol Lab Med. 2018 Jan 26;:
Authors: Alì G, Bruno R, Savino M, Giannini R, Pelliccioni S, Menghi M, Boldrini L, Proietti A, Chella A, Ribechini A, Fontanini G
Abstract
CONTEXT: - Patients with non-small cell lung cancer harboring ALK receptor tyrosine kinase ( ALK), ROS proto-oncogene 1 ( ROS1), and ret proto-oncogene ( RET) gene rearrangements can benefit from specific kinase inhibitors. Detection of fusion genes is critical for determining the best treatment. Assessing rearrangements in non-small cell lung cancer remains challenging, particularly for lung cytology.
OBJECTIVE: - To examine the possible application of the multiplex, transcript-based NanoString system (NanoString Technologies, Seattle, Washington) in the evaluation of fusion genes in lung adenocarcinoma samples.
DATA SOURCES: - This study is a narrative literature review. Studies about NanoString, gene fusions, and lung adenocarcinoma were collected from PubMed (National Center for Biotechnology Information, Bethesda, Maryland). We found 7 articles about the application of the NanoString system to detect fusion genes on formalin-fixed, paraffin-embedded tumor tissues and one article evaluating the adequacy of lung cytologic specimens for NanoString gene expression analysis.
CONCLUSIONS: - To maximize the yield of molecular tests on small lung biopsies, the NanoString nCounter system has been suggested to detect fusion genes. NanoString fusion gene assays have been successfully applied on formalin-fixed, paraffin-embedded tissues. Although there are only few studies available, the application of NanoString assays may also be feasible in lung cytology. According to available data, the NanoString system could strengthen the routine molecular characterization of lung adenocarcinoma.
PMID: 29372843 [PubMed - as supplied by publisher]
Aggressive ossifying fibroma of right ethmoidal sinus: A case report.
Int J Surg Case Rep. 2017 Dec 26;:
Authors: Alghonaim Y, ALRashed ALHumaid S, Arafat A
Abstract
BACKGROUND: Ossifying fibroma is a rare benign fibro-osseous lesion seen in the bones of the head and neck area. It is mostly found in the mandible followed by the maxilla and rarely in the paranasal sinuses along with the orbit and skull bones.
CASE PRESENTATION: A 30-year-old male patient presented with headache and incidental finding of a right ethmoidal sinus ossifying fibroma by paranasal-sinuses CT scan and MRI of the face. A flexible fiber-optic nasal endoscopy examination revealed a right side fullness. A non-contrasted CT scan of the paranasal sinus showed hyperdense lesion at the right ethmoid air cells. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed fibro-osseous lesion most consistent with aggressive ossifying fibroma. Later, a near total resection of skull base tumor by endoscopic surgery was done and patient was discharged next day in a good condition.
CONCLUSION: Ossifying fibroma is a rare lesion found in the head and neck area and it is unusual to be found in the paranasal sinuses. Thus crucial attention to the clinical, radiographical and histopathological examination should be taken for more accurate diagnosis and thus appropriate management.
PMID: 29373206 [PubMed - as supplied by publisher]
The transperiosteal "inside-out" occipital artery harvesting technique.
J Neurosurg. 2018 Jan 26;:1-6
Authors: Benet A, Tabani H, Ding X, Burkhardt JK, Rodriguez Rubio R, Tayebi Meybodi A, Nisson P, Kola O, Gandhi S, Yousef S, Lawton MT
Abstract
OBJECTIVE The occipital artery (OA) is a frequently used donor vessel for posterior circulation bypass procedures due to its proximity to the recipient vessels and its optimal caliber, length, and flow rate. However, its tortuous course through multiple layers of suboccipital muscles necessitates layer-by-layer dissection. The authors of this cadaveric study aimed to describe a landmark-based novel anterograde approach to harvest OA in a proximal-to-distal "inside-out" fashion, which avoids multilayer dissection. METHODS Sixteen cadaveric specimens were prepared for surgical simulation, and the OA was harvested using the classic (n = 2) and novel (n = 14) techniques. The specimens were positioned three-quarters prone, with 45° contralateral head rotation. An inverted hockey-stick incision was made from the spinous process of C-2 to the mastoid tip, and the distal part of the OA was divided to lift up a myocutaneous flap, including the nuchal muscles. The OA was identified using the occipital groove (OG), the digastric muscle (DM) and its groove (DG), and the superior oblique muscle (SOM) as key landmarks. The OA was harvested anterogradely from the OG and within the flap until the skin incision was reached (proximal-to-distal technique). In addition, 35 dry skulls were assessed bilaterally (n = 70) to study additional craniometric landmarks to infer the course of the OA in the OG. RESULTS The OA was consistently found running in the OG, which was found between the posterior belly of the DM and the SOM. The mean total length of the mobilized OA was 12.8 ± 1.2 cm, with a diameter of 1.3 ± 0.1 mm at the suboccipital segment and 1.1 ± 0.1 mm at the skin incision. On dry skulls, the occipitomastoid suture (OMS) was found to be medial to the OG in the majority of the cases (68.6%), making it a useful landmark to locate the OG and thus the proximal OA. CONCLUSIONS The anterograde transperiosteal inside-out approach for harvesting the OA is a fast and easy technique. It requires only superficial dissection because the OA is found directly under the periosteum throughout its course, obviating tedious layer-by-layer muscle dissection. This approach avoids critical neurovascular structures like the vertebral artery. The key landmarks needed to localize the OA using this technique include the OMS, OG, DM and DG, and SOM.
PMID: 29372878 [PubMed - as supplied by publisher]
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Isolated clival metastasis: a rare presentation of renal cell carcinoma.
BMJ Case Rep. 2017 Aug 11;2017:
Authors: Mani A, Yadav P, Paliwal VK, Lal H
Abstract
Renal cell carcinoma accounts for 3% of all adult malignancies. Usual sites of metastasis are lymph nodes, lungs, bone, liver and brain. We describe a patient who presented with complaints of holocranial headache and diplopia. MRI of the head showed a clival-based lesion with associated bony erosion. With suspicion of a metastatic lesion, an ultrasonogram of the abdomen was done which showed a left renal mass that enhanced on contrast-enhanced CT. There were no other metastatic foci. Patient underwent radiotherapy for the clival lesion. This case report emphasises on the evaluation of clival lesion with cranial neuropathies for a possibility of a renal primary tumour.
PMID: 28801336 [PubMed - indexed for MEDLINE]
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Microvascular Tissue Transfers for Midfacial and Anterior Cranial Base Reconstruction.
J Craniofac Surg. 2017 May;28(3):659-663
Authors: Aksu AE, Uzun H, Bitik O, Tunçbilek G, Şafak T
Abstract
Reconstruction of a midfacial defect can represent a difficult challenge for the plastic surgeon. Although many midfacial deformities have traumatic or congenital origins, the vast majority of head and neck defects occur after resection of malignant head and neck neoplasms. Autogenous reconstruction is now routinely performed for larger, complex defects resulting from surgical resection or trauma. In this study, the authors present 27 patients with midfacial defects reconstructed with free flaps. Twenty-two of the defects were created by surgical ablation of cancer (maxillectomy) and the others were traumatic. The maxillectomy defects were classified into 4 according to the classification proposed by Cordeiro. Eighteen of the patients were male and 9 were female. Twenty-nine free flaps were performed. Six different types of flaps including radial forearm flap, vertical rectus abdominis (VRAM) flap, anterolateral thigh (ALT) flap, tensor fasciae latae (TFL) flap, fibula osteocutaneous flap, and iliac osteocutaneous flap were accomplished. Types I and II defects were reconstructed with radial forearm flap. Type III defects were reconstructed with VRAM and ALT. Type IV defects were reconstructed with VRAM and TFL. Two patients underwent a second flap reconstruction due to recurrent disease (9.1%). Average patient age was 53.1 years. Free-flap survival was 100%. Free tissue transfer is the method of choice in midfacial reconstruction. Following a reconstructive algorithm is useful in the decision-making process for patient evaluation and treatment. Every reconstructive microsurgeon might have different experiences with different flaps. Therefore, the algorithm for flap choices is not universal among surgeons.
PMID: 28468144 [PubMed - indexed for MEDLINE]
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Endoscopic Transnasal Transpterygoid Excision of an Infratemporal Dermoid Cyst.
J Craniofac Surg. 2017 Jun;28(4):951-954
Authors: Kuran G, Yazici D
Abstract
OBJECTIVE: Intracranial dermoid cysts are rare, slow-growing masses of sellar, parasellar regions, and posterior cranial fossa. The symptomatology of these cysts depends on the localization and presence of rupture. The preoperative diagnosis of these cysts by imagining techniques is distinctive as they have characteristic appearances.
PATIENT: Endoscopic transnasal transpterygoid approach to infratemporal fossa for an extradural dermoid cyst of a 24 year-old woman is presented in this clinical report. Headache, dizziness, and retro orbital pain were her main complaints and diagnostic imagining studies designated an intracranial dermoid cyst preoperatively. The cyst was excised uneventfully with no recurrence 6 months after the operation.
CONCLUSION: Surgery of intracranial lesions neighboring critical vital neurovascular structures can be challenging to the surgeon. Alternative minimal invasive approaches should always be considered for averting life-threatening complications.
PMID: 28169904 [PubMed - indexed for MEDLINE]
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Teaching NeuroImages: Spontaneous resolution of a giant intracranial arachnoid cyst.
Neurology. 2016 05 03;86(18):e199-200
Authors: Liu Z, Li J, Xu J
PMID: 27164655 [PubMed - indexed for MEDLINE]
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Management of the cervico-petrous internal carotid artery in class C tympanojugular paragangliomas.
Head Neck. 2016 Jun;38(6):899-905
Authors: Bacciu A, Prasad SC, Sist N, Rossi G, Piazza P, Sanna M
Abstract
BACKGROUND: Management of the cervical and petrous internal carotid artery (ICA) is frequently required in Fisch class C tympanojugular paragangliomas (TJPs). The purpose of this study was to discuss the perioperative intervention of the ICA in patients who underwent surgical resection of a TJP.
METHODS: A retrospective study of 237 patients surgically treated for Fisch class C TJPs was done to identify cases that required ICA management.
RESULTS: Management of the ICA was required in 176 patients (74.2%). Forty-two patients required just an ICA decompression, 88 underwent a subperiosteal dissection, 19 underwent subadventitial dissection without intraluminal stenting, 17 underwent subadventitial dissection with intraluminal stenting, and 12 underwent arterial resection after permanent balloon occlusion. There were no complications associated with the endovascular procedures. Gross total tumor resection was achieved in 91.5% of the cases.
CONCLUSION: Preoperative endovascular intervention, in selected cases, facilitates gross total tumor removal and significantly reduces the risk of an intraoperative ICA injury. © 2015 Wiley Periodicals, Inc. Head Neck 38: 899-905, 2016.
PMID: 26614405 [PubMed - indexed for MEDLINE]
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The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss.
Int Arch Otorhinolaryngol. 2018 Jan;22(1):33-37
Authors: Bulğurcu S, Şahin B, Akgül G, Arslan İB, Çukurova İ
Abstract
Introduction Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.
PMID: 29371896 [PubMed]
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The Subjective Postural Vertical Determined in Patients with Pusher Behavior During Standing.
Top Stroke Rehabil. 2016 Jun;23(3):184-90
Authors: Bergmann J, Krewer C, Selge C, Müller F, Jahn K
Abstract
BACKGROUND: The subjective postural vertical (SPV), i.e., the perceived upright orientation of the body in relation to gravity, is disturbed in patients with pusher behavior. So far, the SPV has been measured only when these patients were sitting, and the results were contradictory as regards the side of the SPV deviation.
OBJECTIVE: The objective was to investigate the SPV in patients with different degrees of severity of pusher behavior while standing.
METHODS: Eight stroke patients with pusher behavior, ten age-matched stroke patients without pusher behavior, and ten age-matched healthy control subjects were included. The SPV (SPV error, SPV range) was assessed in the pitch and the roll planes. Pusher behavior was classified with the Burke Lateropulsion Scale (BLS).
RESULTS: In the pitch plane, the SPV range was significantly larger in pusher patients than in patients without pusher behavior or healthy controls. The SPV error was similar for groups. In the roll plane, the SPV error and the SPV range were significantly larger and more ipsilesionally tilted in the pusher group than in the other two groups. There was a significant correlation between the SPV error in the roll plane and the BLS score.
CONCLUSIONS: The study revealed that patients with pusher behavior had an ipsilesional SPV tilt that decreased with decreasing severity of the behavior. The large uncertainty in verticality estimation in both planes indicates that their sensitivity for the perception of verticality in space is generally disturbed. These findings emphasize the importance of specific rehabilitation approaches to recalibrate the impaired inner model of verticality.
PMID: 27077977 [PubMed - indexed for MEDLINE]
High frequency jet ventilation during endolaryngeal surgery: Risk factors for complications.
Auris Nasus Larynx. 2018 Jan 17;:
Authors: Altun D, Çamcı E, Orhan-Sungur M, Sivrikoz N, Başaran B, Özkan-Seyhan T
PMID: 29373164 [PubMed - as supplied by publisher]
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Otolaryngologic Manifestations of Klippel-Feil Syndrome in Children.
JAMA Otolaryngol Head Neck Surg. 2018 Jan 25;:
Authors: Kenna MA, Irace AL, Strychowsky JE, Kawai K, Barrett D, Manganella J, Cunningham MJ
Abstract
Importance: Children with Klippel-Feil syndrome (KFS), characterized principally by abnormal fusion of 2 or more cervical vertebrae, may have many additional congenital anomalies. The overall prevalence of otolaryngologic manifestations among patients with KFS has not been previously characterized.
Objective: To define the otolaryngologic diagnoses made and procedures performed in 95 patients with KFS, which, to our knowledge, is the largest series of this challenging patient population published to date.
Design, Setting, and Participants: For this retrospective review, all patients with KFS who underwent otolaryngology consultation at our institution over a 26-year period (January 1989 to December 2015) were included. Patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and were confirmed through individual medical record review. Relevant otolaryngologic diagnoses and procedures were extracted using ICD-9 and Current Procedural Terminology codes, respectively. Selected demographics included age, sex, number of clinic visits, and number of procedures.
Main Outcomes and Measures: The primary outcomes were the otolaryngologic diagnoses and procedures associated with the KFS patient population; the secondary outcome was Cormack-Lehane classification documented during airway procedures.
Results: Overall, 95 patients with KFS were included in this study (55 males [58%] and 40 females [42%]); mean (range) age at time of presentation to the otorhinolaryngology clinic was 5.8 (birth-23.0) years. Each patient with KFS averaged 8 visits to the otorhinolaryngology office and 5 otolaryngologic diagnoses. The most common diagnosis was conductive hearing loss (n = 49 [52%]), followed by sensorineural hearing loss (n = 38 [40%]), and dysphagia (n = 37 [39%]). Sixty-two (65%) patients underwent otolaryngologic procedures, with 44 (46%) undergoing multiple procedures. The most common procedure was tympanostomy tube placement (n = 36 [38%]), followed by office flexible endoscopy (n = 23 [24%]). Twelve of the 20 patients who underwent direct laryngoscopy had documented Cormack-Lehane classification; 5 of 12 patients (42%) had a compromised view (grade 2, 3, or 4) of the larynx. Three patients required tracheotomies at this institution for airway stabilization purposes; each had severe upper airway obstruction leading to respiratory failure.
Conclusions and Relevance: Patients with KFS require consultation for a variety of otolaryngologic conditions. Among these, hearing loss is the most common, but airway issues related to cervical spine fusion are the most challenging. Formulating an appropriate care plan in advance is paramount, even for routine otolaryngology procedures.
PMID: 29372238 [PubMed - as supplied by publisher]
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Impact of Smoking on the Ocular Surface, Tear Function, and Tear Osmolarity.
Curr Eye Res. 2017 Dec;42(12):1585-1589
Authors: Aktaş S, Tetikoğlu M, Koçak A, Kocacan M, Aktaş H, Sağdık HM, Özcura F
Abstract
PURPOSE: This study evaluated the effects of cigarette smoking on the ocular surface, tear function, and tear osmolarity.
MATERIALS AND METHODS: A total of 50 smokers with at least 5 years of heavy smoking (defined as 1 pack/day) and 51 nonsmoking, healthy individuals were enrolled. Tear osmolarity was measured with an osmometer (TearLab™ Osmolarity System). Ocular surface examinations involved corneal fluorescein staining, measurement of the tear film breakup time (TBUT), the Schirmer 1 test, measurement of corneal sensitivity with a Cochet-Bonnet esthesiometer, and conjunctival impression cytology. Dry eye symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. The results were compared with those from an age and sex-matched control group. The Chi-squared and independent sample t-tests were used for statistical analyses.
RESULTS: The smokers had significantly higher tear osmolarity values (305.38 ± 9.81 vs. 301.14 ± 7.04 mOsm/L; p = 0.014) and OSDI scores (34.13 ± 16.58 vs. 18.09 ± 9.61; p < 0.001) than the healthy controls. However, the TBUT, corneal sensitivity, and goblet cell density were significantly lower in smokers compared to healthy controls, but the fluorescein staining and Schirmer 1 test results were not statistically different between the smokers and controls.
CONCLUSION: Smoking results in increased osmolarity of the tear film, which can damage the ocular surface and tear function.
PMID: 28937831 [PubMed - indexed for MEDLINE]
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The vocal sac of Hylodidae (Amphibia, Anura): Phylogenetic and functional implications of a unique morphology.
J Morphol. 2017 Nov;278(11):1506-1516
Authors: Elias-Costa AJ, Montesinos R, Grant T, Faivovich J
Abstract
Anuran vocal sacs are elastic chambers that recycle exhaled air during vocalizations and are present in males of most species of frogs. Most knowledge of the diversity of vocal sacs relates to external morphology; detailed information on internal anatomy is available for few groups of frogs. Frogs of the family Hylodidae, which is endemic to the Atlantic Forest of Brazil and adjacent Argentina and Paraguay, have three patterns of vocal sac morphology-that is, single, subgular; paired, lateral; and absent. The submandibular musculature and structure of the vocal sac mucosa (the internal wall of the vocal sac) of exemplar species of this family and relatives were studied. In contrast to previous accounts, we found that all species of Crossodactylus and Hylodes possess paired, lateral vocal sacs, with the internal mucosa of each sac being separate from the contralateral one. Unlike all other frogs for which data are available, the mucosa of the vocal sacs in these genera is not supported externally by the mm. intermandibularis and interhyoideus. Rather, the vocal sac mucosa projects through the musculature and is free in the submandibular lymphatic sac. The presence of paired, lateral vocal sacs, the internal separation of the sac mucosae, and their projection through the m. interhyoideus are synapomorphies of the family. Furthermore, the specific configuration of the m. interhyoideus allows asymmetric inflation of paired vocal sacs, a feature only reported in species of these diurnal, stream-dwelling frogs.
PMID: 28744917 [PubMed - indexed for MEDLINE]
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Transoral laser microsurgery versus radiotherapy for T2 glottic squamous cell carcinoma: a systematic review of local control outcomes.
Clin Otolaryngol. 2017 Jun;42(3):629-636
Authors: Warner L, Lee K, Homer JJ
Abstract
BACKGROUND: Systematic reviews comparing treatment of early glottic cancer with transoral surgery or radiotherapy demonstrate similar oncological outcomes. Most studies of 'early-stage' laryngeal cancer include Tis, T1a, T1b and T2 cases. The data are dominated by patients with T1 and Tis tumours, although extrapolating these results and applying them for T2 cases may be inappropriate. No previous systematic reviews have focused on T2 cancers as a separate group.
OBJECTIVE OF REVIEW: This review compares local control outcomes for T2 glottic squamous cell carcinoma, treated with transoral microsurgery or external beam radiotherapy.
TYPE OF REVIEW: This is a systematic review of case series and comparison studies, focusing on oncological outcomes.
SEARCH STRATEGY: Independent searches of MEDLINE, EMBASE and the Cochrane Database were conducted by two authors, using the search terms: laryngeal/glottic/vocal cord combined with carcinoma/cancer/tumour and laser/microsurgery or radiotherapy. Studies of adult patients treated for primary T2N0 glottic squamous cell carcinoma (SCC) with laser surgery or curative radiotherapy were included.
EVALUATION METHOD: Full text of studies satisfying the inclusion criteria were reviewed with extraction of local control and survival data and laryngeal preservation rates. The primary endpoint is local control at 5 years.
RESULTS: Initial searches identified 3252 studies. Following full-text review of 183 papers, 59 studies met the inclusion criteria, all level IV evidence. A total of 48 studies specified 5-year local control for 1156 patients treated with transoral laser surgery and 3191 patients treated with radiotherapy. Weighted averages of local control at 5 years demonstrated similar results: 75.81% for radiotherapy versus 77.26% for transoral laser surgery.
CONCLUSIONS: The results of this review indicate no difference in 5-year local control between radiotherapy and transoral surgery for T2 glottic SCC. The data demonstrated higher rates of local failure for T2b compared with T2a cases, although outcomes were similar between laser excision and radiotherapy for each substage. Further research focusing upon functional outcomes for T2 glottic tumours is imperative to guide decision-making, ideally with subgroup analysis of T2a and T2b cases.
PMID: 27863075 [PubMed - indexed for MEDLINE]
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Effect of head position on laryngeal visualisation with the McGrath MAC videolaryngoscope in paediatric patients: A randomised controlled trial.
Eur J Anaesthesiol. 2016 07;33(7):528-34
Authors: Kim EH, Lee JH, Song IK, Kim JT, Kim BR, Kim HS
Abstract
BACKGROUND: The McGrath MAC video laryngoscope can improve visualisation of the glottis compared with the Macintosh direct laryngoscope. However, good visualisation of the glottis does not guarantee rapid or successful intubation because of difficulty in handling the McGrath device.
OBJECTIVE: We evaluated the effect of head elevation, aligning the positions of the external auditory meatus and sternal notch in the horizontal plane, on visualisation of the glottis and handling of the McGrath laryngoscope in paediatric patients.
DESIGN: A randomised controlled trial.
SETTING: The operating rooms of our tertiary care hospital.
PATIENTS: Forty-six children, American Society of Anaesthesiologists' physical status 1 or 2, aged 3 to 7 years.
INTERVENTION: Videolaryngoscopy using the McGrath device was performed with the head either flat or elevated.
MAIN OUTCOME MEASURES: The percentage of glottis opening score, the use of optimisation manoeuvre and time to successful tracheal intubation were recorded.
RESULTS: The median (IQR) percentage of glottis opening score was higher after head elevation than when the head was flat in all patients [100 (100 to 100)% vs. 100 (90 to 100)%, P = 0.0001). The need for use of optimisation procedures (50 vs. 9%, P = 0.004) and mean (SD) time to intubation (17 ± 4 s vs. 15 ± 3 s, P = 0.008) were lower in the head-elevated group.
CONCLUSION: Visualisation of the glottis and handling of the McGrath MAC video laryngoscope were significantly better when the external auditory meatus and sternal notch were aligned in the horizontal plane.
TRIAL REGISTRATION: http://cris.nih.go.kridentifier:KCT0001443.
PMID: 26986776 [PubMed - indexed for MEDLINE]
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Transcutaneous vocal cord ultrasonography after oral and maxillofacial surgery requiring intermaxillary fixation: A technical report.
Eur J Anaesthesiol. 2016 Aug;33(8):598-9
Authors: Sanuki T, Miura K, Watanabe T, Ayuse T
PMID: 26945153 [PubMed - indexed for MEDLINE]
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Upper airway trauma during general anaesthesia for major surgery: incidence and trends: A retrospective study.
Eur J Anaesthesiol. 2016 08;33(8):593-5
Authors: Elsharydah A, Benhardt AC, Minhajuddin A, Ogunnaike BO, Joshi GP
PMID: 26741460 [PubMed - indexed for MEDLINE]
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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DGE1Lg
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A Guerilla Guide to Common Problems in 'Neurostatistics': Essential Statistical Topics in Neuroscience.
J Undergrad Neurosci Educ. 2017;16(1):R1-R12
Authors: Smith PF
Abstract
Effective inferential statistical analysis is essential for high quality studies in neuroscience. However, recently, neuroscience has been criticised for the poor use of experimental design and statistical analysis. Many of the statistical issues confronting neuroscience are similar to other areas of biology; however, there are some that occur more regularly in neuroscience studies. This review attempts to provide a succinct overview of some of the major issues that arise commonly in the analyses of neuroscience data. These include: the non-normal distribution of the data; inequality of variance between groups; extensive correlation in data for repeated measurements across time or space; excessive multiple testing; inadequate statistical power due to small sample sizes; pseudo-replication; and an over-emphasis on binary conclusions about statistical significance as opposed to effect sizes. Statistical analysis should be viewed as just another neuroscience tool, which is critical to the final outcome of the study. Therefore, it needs to be done well and it is a good idea to be proactive and seek help early, preferably before the study even begins.
PMID: 29371855 [PubMed]
