Phacomatosis pigmentokeratotica: a case of HRAS mosaicism causing rhabdomyosarcoma

Abstract

A 17-year-old male presented with a large sebaceous naevus (SN) comprising part of his left face and scalp and a speckled lentiginous naevus (SLN) on his right trunk, hip, neck and scalp with a checkerboard pattern. His right oral hemimucosa showed extensive papillomatous lesions which were contiguous to the upper lip SN lesions. As for extracutaneous manifestations he suffered from cardiac, musculoskeletal and ocular alterations. On the other hand, he developed two primary rhabdomyosarcomas. DNA samples of the SN, SLN, the oral papillomatous hyperplasia and both rhabdomyosarcomas were analyzed by Sanger sequencing. A HRAS c.37G>C mutation was detected in all of them. Skin and blood DNA resulted wild type. PPK is characterized by the association of a sebaceous naevus with a papular naevus spilus and extracutaneous manifestations. Until not long ago, the etiopathogenetical hypothesis of didymosis was accepted. However, in 2013 Groesser et al. proved the existence of an activating HRAS mutation as the cause of this syndrome. A higher incidence of cancer has been observed in germline RASophaties. Furthermore, up to 30% of human cancers show dysregulation of the Ras-Raf-MEK-ERK pathways. In our patient, a HRAS mosaic mutation explains not only the cutaneous but also the extracutaneous manifestations. To our knowledge this is the first described case of PPK in which the existence of a HRAS mosaic mutation is the confirmed cause of rhabdomyosarcoma. Besides the HRAS 37G>C mutation has never been related to any type of rhabdomyosarcoma. Mosaicisms could be underdiagnosed causes of childhood tumours. As dermatologists we stand on a privileged position for the detection of these alterations.

This article is protected by copyright. All rights reserved.

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Tracking small sensory nerve action potentials in human axonal excitability studies

Publication date: Available online 11 February 2018
Source:Journal of Neuroscience Methods
Author(s): James Howells, Hugh Bostock, Susanna B. Park, Matthew C. Kiernan, David Burke
BackgroundExcitability studies on normal and diseased human axons in vivo have been greatly enhanced by fast non-invasive threshold-tracking techniques, using surface stimulation and recording. Although sensory axons are often more affected in disease, most studies to date have focussed on motor axons, because of technical difficulties in resolving pathologically small nerve volleys in the presence of noise and stimulus artefact.New MethodsThis paper describes techniques for tracking low-amplitude compound action potentials, using a battery-powered, isolated preamplifier of simple construction with high common mode rejection (>125 dB [balanced inputs]) and low noise (<0.4 μV referred to inputs [shorted]).ResultsWe demonstrate the preamplifier's capability by tracking targets as small as 2 μV for a full range of excitability measurements without the usual distortion due to residual stimulus artefact and without the need for clamping, additional filtering or ensemble averaging.Comparison with existing methodsIn practice, threshold-tracking studies have been unable to study sensory axons when the maximal compound sensory action potential was less than about 15 μV. The techniques and amplifier in the present study allow measurements to be made from nerve with maximal responses less than half that size, and we present three recordings in patients with pathologically small nerve action potentials ≤7 μV.ConclusionsBased on measurements of stimulus artefact distortion, noise and the performance in experiments, we conclude that the techniques described here will facilitate the study of diseased axons for which the sensory potentials have high thresholds and may be only a few microvolts in amplitude.



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Updated frequency analysis of spinocerebellar ataxia in China

Sir,

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Reply: Updated frequency analysis of spinocerebellar ataxia in China

Sir,

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The recurrent mutation in TMEM106B also causes hypomyelinating leukodystrophy in China and is a CpG hot spot

Sir,

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Reply: The recurrent mutation in TMEM106B also causes hypomyelinating leukodystrophy in China and is a CpG hotspot

Sir,

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Patient, Surgeon, and Anesthesiologist Satisfaction: Who has the Priority?

No abstract available

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Acquired Central Hypoventilation Syndrome Unmasked by Propofol Sedation

No abstract available

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Neurogenic Pulmonary Edema and Stunned Myocardium in a Patient With Meningioma: A Heart-Brain Cross Talk

No abstract available

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Targeting of glutamine transporter ASCT2 and glutamine synthetase suppresses gastric cancer cell growth

Abstract

Purpose

Glutamine (Gln) is essential for the proliferation of most cancer cells, making it an appealing target for cancer therapy. However, the role of Gln in gastric cancer (GC) metabolism is unknown and Gln-targeted therapy against GC remains scarce. The aim of this study was to investigate the relevance of Gln in GC growth and targeting.

Methods

Expression of Gln transporter ASCT2 and glutamine synthetase (GS) in the parental and molecularly engineered GC cells or in human GC specimens was determined by RT-PCR and western blot analysis or immunohistochemistry. Cell proliferation and survival was assessed by CCK-8 assay and colony formation assay. Intracellular Gln content was measured by a HPLC system. Effects of ASCT2 and/or GS inhibitor on tumor growth were investigated in xenograft models.

Results

A significant heterogeneity of GC cells was observed with respect to their response to the treatment of ASCT2 inhibitor benzylserine (BenSer). Gln deprivation did not affect the BenSer-resistant cell growth due to endogenous GS expression, whose inhibition remarkably reduced cell proliferation. The differential in vitro sensitivity correlated with overall intracellular Gln content. Combined therapy with both ASCT2 and GS inhibitors produced a greater therapeutic efficacy than the treatment of either inhibitor alone. Furthermore, 77% human GC tissues were found to express moderate and high levels of ASCT2, 12% of which also co-expressed relatively high levels of GS.

Conclusion

Gln mediates GC growth and the therapeutic efficacy of Gln-targeted treatment relies on distinct ASCT2 and GS expression pattern in specific gastric cancer groups.

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20Q: Teleaudiology - The Future is Now

An engaging Q & A discussion of teleaudiology applications and outcomes, with examples from the Veterans Administration.

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Predictive biomarkers and EGFR inhibitors in squamous cell carcinoma of head and neck (SCCHN)

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Phase IIa study of the CD19 antibody MOR208 in patients with relapsed or refractory B-cell non-Hodgkin’s lymphoma

Abstract

Background

This two-stage, phase IIa study (ClinicalTrials.gov: NCT01685008) investigated the antitumor activity and safety of MOR208, an Fc-engineered, humanized, CD19 antibody, in patients with relapsed or refractory (R-R) B-cell non-Hodgkin's lymphoma (NHL). CD19 is broadly expressed across the B-lymphocyte lineage, including in B-cell malignancies, but not by hematological stem cells.

Patients and methods

Patients aged ≥18 years, with R-R NHL progressing after ≥1 prior rituximab containing regimen were enrolled into subtype-specific cohorts: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), other indolent (i)NHL and mantle cell lymphoma (MCL). Treatment was MOR208, 12 mg/kg intravenously, weekly, for 8 weeks. Patients with at least stable disease could continue treatment for an additional 4 weeks. Those with a partial or complete response after 12 weeks could receive extended MOR208 treatment (12 mg/kg, either monthly or every second week) until progression. The primary endpoint was overall response rate.

Results

Ninety-two patients were enrolled: DLBCL (n=35), FL (n=34), other iNHL (n=11) and MCL (n=12). Responses were observed in DLBCL, FL and other iNHL cohorts (26%, 29% and 27%, respectively). They lasted ≥12 months in 5/9 responding patients with DLBCL, 4/9 with FL and 2/3 with other iNHL. Responses in nine patients are ongoing (>26 months in five instances). Patients with rituximab refractory disease showed a similar response rate and progression-free survival time to patients with non-refractory disease. The most common adverse events (any grade) were infusion-related reactions (IRRs; 12%) and neutropenia (12%). One patient experienced a grade 4 IRR and eight patients (9%) grade 3/4 neutropenia. No treatment-related deaths were reported.

Conclusions

MOR208 monotherapy demonstrated promising clinical activity in patients with R-R DLBCL and R-R FL, including in patients with rituximab refractory tumors. These efficacy data and the favorable safety profile support further investigation of MOR208 in phase II/III combination therapy trials in R-R DLBCL.

ClinicalTrials.gov number

NCT01685008

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Factors associated with romantic relationship formation difficulties in women with breast cancer

Abstract

Objective

Many un-partnered women report difficulty in forming romantic relationships after breast cancer, characterized by high dating-related anxiety and low perceived interpersonal competence. This study examined the relationship between poor body image (appearance investment and body dissatisfaction) and self-compassion, and women's ability to form romantic relationships post-breast cancer.

Methods

Women (N=152) diagnosed with breast cancer, who were either un-partnered and expressed interest in romantic dating, or who had commenced a relationship post-diagnosis, completed an online survey. Assessments included the Interpersonal Competence Questionnaire, Dating Anxiety Scale, Self-compassion Scale, Appearance Schemas Inventory-Revised, Body Image Scale, and Experiences in Close Relationships Scale. Multiple regression analyses assessed the relationships between these variables.

Results

Partnered and un-partnered women differed in levels of dating anxiety, interpersonal competence, anxious attachment and the self-evaluative salience facet of appearance investment. Analyses revealed a significant model for dating anxiety, with high self-evaluative salience, body image dissatisfaction, and attachment avoidance independently associated with this outcome. The model for interpersonal competence was also significant, with low attachment avoidance and high self-compassion independently associated with this outcome.

Conclusions

Un-partnered women who place high importance on appearance for their self-worth, and who report poor body image and low self-compassion are at risk of experiencing difficulties in forming new romantic relationships after breast cancer. Future interventions should target these variables to facilitate romantic dating during cancer survivorship.

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Sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors

Abstract

Background

Disrupted sexual function is a prevalent and sustained side effect of gynaecological cancer and its related treatment. This problem may pose challenges to the survivors in the process of illness adjustment, leading to elevated psychological distress and impaired quality of life. However, care and interventions in this area have been neglected in most countries.

Objectives

To investigate sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors in Hong Kong, and to explore their associations.

Methods

A cross-sectional design was adopted. Gynaecological cancer survivors were recruited from a gynaecological oncology out-patient clinic at a regional hospital in Hong Kong.

Results

A total of 225 Chinese gynaecological cancer survivors were recruited. Their sexual function was found to be impaired. They had satisfactory performance in psychosocial adjustment to illness, but the worst domain was sexual relationships. Their quality of life was fair, with physical and social functioning performing best. Path analysis demonstrated that psychosocial adjustment to illness played a significant mediating role in the relationship between sexual function and quality of life among those who were married or had a regular sex partner.

Conclusions

Impaired sexual function was prevalent among Chinese gynaecological cancer survivors and psychosocial adjustment to illness mediates the relationship between sexual function and quality of life. In Chinese clinical settings without routine sexuality assessments, early sexual function and psychosocial adjustment assessment should be integrated into routine nursing practice. In addition, a culturally appropriate practice model should be developed to guide sexuality care delivery.

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Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors

Abstract

Objective

Despite a generally good prognosis many prostate cancer survivors have poor quality of life (QOL). A greater understanding of how psychological appraisals influence QOL is merited given their potentially modifiable nature. In this study we considered how elements of survivors' retrospective and prospective appraisals relate to QOL.

Methods

1,229 prostate cancer survivors between 2-5 years post-diagnosis, identified from a population-based National Cancer Registry, were asked questions on their socio-demographics, health, treatment received and adverse-effects using a cross-sectional design. QOL was assessed using the EORTC QLQ-C30. Retrospective appraisals were assessed by asking survivors to reflect on their experience of treatment-related adverse-effects compared to their prior expectations. A Fear of Recurrence (FOR) scale assessed prospective appraisals of future disease course. A multiple regression model explored the impact of psychological appraisals on QOL, after controlling for socio-demographic, treatment and health-related factors.

Results

The model was significant explaining 37% of variance in QOL. The strongest associate with QOL was FOR (β=-.29; p<.001). Survivors who experienced side-effects that were worse than expected had significantly lower QOL (β=-.10; p=.002). Other significant correlates of lower QOL were: presence of comorbidities, having undergone a less invasive treatment, and having more advanced disease. Working at diagnosis and having a higher level of education were significantly associated with higher QOL.

Conclusions

Results suggest both retrospective and prospective appraisals are independently related to QOL in prostate cancer. Providing survivors with more information about possible adverse-effects of treatment, as well as providing appropriate information regarding future disease progression, may improve QOL.

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Prehospital stroke scales and large vessel occlusion: A systematic review

Background and purpose

Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate selection and identification of patients with high probability of a large vessel occlusion (LVO) in the prehospital setting improve the rationalization of the transport in the more suitable centers. Aim of this analysis was to determine the diagnostic accuracy of prehospital stroke scales detecting LVO.

Material and methods

Studies were searched into MEDLINE, EMBASE, and CINHAL databases between January 1990 and September 2017. Principal measurements of the meta-analysis were the overall accuracy level, sensitivity, and specificity of prehospital stroke scales.

Results

Nineteen scoring systems were included in the analysis coming from 13 studies. A total of 9824 patients were considered. Although a higher heterogeneity was observed in the analysis, three scores showed better results in predicting a LVO (the stroke Vision, Aphasia, Neglect assessment, the National Institute of Health Stroke scale and the Los Angeles Motor Scale). We observed significant differences of overall accuracy only for scores including hemineglect as cortical neurological sign (P < .05).

Conclusions

This meta-analysis suggests that some prehospital scoring systems including cortical signs showed better accuracy to predict stroke due to LVO. However, the assessment of these signs could be difficult to investigate by paramedics and personnel of Emergency Medical Services, and for this reason, further prospective evaluations are needed.

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The clinical value of HPV E6/E7 and STAT3 mRNA detection in cervical cancer screening

Publication date: Available online 11 February 2018
Source:Pathology - Research and Practice
Author(s): Yibing Fan, Zongji Shen
ObjectiveTo explore the value of human papillomavirus (HPV) E6/E7 and signal transducer and activator of transcription 3 (STAT3) mRNA detection in the screening of cervical lesions.Methods192 patients with abnormal ThinPrep cytology test (TCT) results and/or high-risk HPV infection were screened to identify possible cervical lesions in cases. Diagnoses were confirmed by histopathology. Fluorescence in situ hybridization (FISH) was performed to detect and qualify the mRNAs of HPV E6/E7, STAT3, and Survivin in cervical exfoliated cells. In addition, the performance of separate and combined mRNA detection methods were compared with TCT, HR-HPV DNA schemes respectively.Results1. Compared with HPVE6/E7 and STAT3 mRNA methods, Survivin mRNA assay had poor specificity (Sp), Youden index (YI) and concordance rate. 2. HPV E6/E7, STAT3, and STAT3 + HR-HPV methods had the best Sp, concordance rate and positive predictive value (PPV) for cervical lesions screening and atypical squamous cells of undetermined significance (ASCUS) triage. For screening of high grade squamous intraepithelial lesions or greater (HSILs + ), no difference was observed in the Se of mRNA detection methods in comparison with that of TCT, HR-HPV and TCT + HR-HPV, whereas the false positive rate (FPR) decreased by 41.48%/55.99%/17.19% and the colposcopy referral rate reduced by about 20.00%/25.00%/11.17%. For triage of women with ASCUS, no difference was observed in the Se of mRNA detection methods as compared to that of HR-HPV (χ² = 1.05, P> 0.75), while the FPR decreased by 45.83%/37.50%/41.66% and the colposcopy referral rate reduced by 32.42%/22.60%/25.28%, respectively. The Se, YI, and PPV of the combined methods increased in comparison to each method alone. 3. Compared with the TCT + HR-HPV method, HPV E6/E7 + STAT3 method had perfect Sp (95.92%) and PPV (95.40%) for screening HSILs+, the FPR and colposcopy referral rate decreased by 31.06% and 22.48% respectively.Conclusions1. The expression of HPV E6/E7 and STAT3 mRNA confirmed using FISH assay is expected to be a new method and molecular marker for cervical lesions screening. Survivin mRNA was excluded due to its poor performance. 2. HPV E6/E7, STAT3, and STAT3 +HR-HPV assays could be new approaches for cervical cancer screening and ASCUS triage, and the efficiency of combined screening program was better than that of a separate one. 3. HPV E6/E7 + STAT3 regimen is expected to be a diagnostic strategy for cervical lesions.



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Trajectories of income and social benefits for mothers and fathers of children with cancer: A national cohort study in Sweden

BACKGROUND

The contribution of different income sources from work and social benefits to trajectories of income for the parents of children with cancer has not been empirically investigated.

METHODS

Using Swedish registers, parents of children with an incidence cancer diagnosis between 2004 and 2009 were identified and matched with parents of children without cancer (reference parents). A total of 20,091 families were followed from the year before the diagnosis to a maximum of 8 years. Generalized linear models estimated the ratios of mean incomes from work and social benefits and of its total.

RESULTS

Around the time of the child's cancer diagnosis, the total income was on average up to 6% higher among the mothers of children with cancer compared with reference mothers, but no differences were noted among fathers. Income from work dropped to the lowest level around the time of a cancer diagnosis, with swift recovery noted for fathers but not for mothers. Sickness and childcare-related benefits were up to 6 times larger for the parents of children with cancer than reference parents. As social benefits diminished after approximately 3 years, the total income of mothers of children with cancer became lower than that of reference mothers, and the gap widened over time.

CONCLUSIONS

Social benefits appeared to ease the financial burden during the years around a cancer diagnosis. However, mothers experienced persistently lower income after benefits diminished. Experiences differed by single-parent versus dual-parent households, the survival of the child with cancer, and other relevant characteristics. Further investigation is needed for potential long-term consequences for mothers, including their career and future pension in retirement. Cancer 2018. © 2018 American Cancer Society.

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Spindle Cell Lipoma of the Thumb

Summary: We report the case of a 34-year-old man who presented with a 4-year history of a soft tissue on the palmar aspect of the thumb. Magnetic resonance imaging demonstrated the presence of a mass with heterogeneous high intensities on T1-weighted images and high intensities on T2-weighted images. We performed excisional biopsy. Histologically, the tumor was composed of mature adipocytes and spindle cells in a collagen background. Immunohistochemically, the tumor cells showed strong expression of CD34. Therefore, we diagnosed it as spindle cell lipoma. To the best of our knowledge, only 2 cases of spindle cell lipoma of the thumb have previously been reported. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 9 February 2018. Received for publication October 16, 2017; accepted December 15, 2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Shogo Ebisudani, MD, PhD, Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192 Japan, E-mail: ebisu@med.kawasaki-m.ac.jp Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase

Summary: Facial fillers are becoming increasingly popular as aesthetic procedures to temporarily reduce the depth of wrinkles or to contour faces. However, even in the hands of very experienced injectors, there is always a small possibility of vascular complications like intra-arterial injection of filler substance. We present a case report of a patient who developed features of vascular obstruction in right infraorbital artery and tell-tale signs of impending skin necrosis, after hyaluronic acid filler injection by an experienced injector. The diagnosis of a vascular complication was made quickly with the help of clinical features like blanching, livedo reticularis, and poor capillary refill. Patient was treated promptly with "high-dose pulsed hyaluronidase protocol" comprising three 1,000-unit pulses of hyaluronidase, administered hourly. There was no further increase in size of the involved area after the first dose of hyaluronidase. All of the involved area, along with 1 cm overlapping in uninvolved skin area, was injected during each injection pulse, using a combination of cannula and needle. Complete reperfusion and good capillary filling were achieved after completion of 3 pulses, and these were taken as the end-point of high-dose pulsed hyaluronidase treatment. Immediate skin changes after filler injections, as well as after hyaluronidase injections and during the 3-week recovery period, were documented with photographs and clinical notes. Involved skin was found to have been fully recovered from this vascular episode, thus indicating that complete recovery of the ischemic skin changes secondary to possible intra-arterial injection could be achieved using high-dose pulsed hyaluronidase protocol. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 9 February 2018. Received for publication October 16, 2017; accepted November 29, 2017. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Krishan Mohan Kapoor, MS, MCh, DNB, Anticlock Clinic, #1508, Sector 33 D, Chandigarh-160022, India, E-mail: kmkapoor@gmail.com Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Mentoring, Training, and Scholarly Productivity Experiences of Cancer-Related Health Disparities Research Trainees: Do Outcomes Differ for Underrepresented Scientists?

Abstract

The study aims to explore variation in scholarly productivity outcomes by underrepresented status among a diverse sample of researchers in a community-engaged training program. We identified 141 trainees from a web-based survey of researchers in the National Cancer Institute-funded, Community Networks Program Centers (CNPCs) (2011–2016). We conducted a series of multiple logistic regression models to estimate the effect of National Institutes of Health (NIH)-defined underrepresented status on four, self-reported, scholarly productivity outcomes in the previous 5 years: number of publications (first-authored and total) and funded grants (NIH and any agency). Sixty-five percent (n = 92) indicated NIH underrepresented status. In final adjusted models, non-NIH underrepresented (vs. underrepresented) trainees reported an increased odds of having more than the median number of total publications (> 9) (OR = 3.14, 95% CI 1.21–8.65) and any grant funding (OR = 5.10, 95% CI 1.77–14.65). Reporting ≥ 1 mentors (vs. none) was also positively associated (p < 0.05) with these outcomes. The CNPC underrepresented trainees had similar success in first-authored publications and NIH funding as non-underrepresented trainees, but not total publications and grants. Examining trainees' mentoring experiences over time in relation to scholarly productivity outcomes is needed.

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Issue Information

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Announcements

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Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions

Abstract

Purpose

To determine the value of non-enhanced MRI in combination with color Doppler flow imaging (CDFI) for differentiating malignant parotid tumors from benign ones.

Methods

This retrospective study analyzed 51 parotid gland lesions (39 benign and 12 malignant) in 51 patients who underwent preoperative CDFI as well as non-enhanced MRI including T₁-weighted, T₂-weighted, and diffusion-weighted imaging (DWI). Degrees of intratumor vascularity were categorized into four grades basing on CDFI findings. The relationships between the lesion and its adjacent external carotid artery and retromandibular vein were inspected on T₁-weighted and T₂-weighted images. Apparent diffusion coefficient (ADC) values were calculated from diffusion-weighted images, and were used to classify the parotid gland lesions with and without reference to the CDFI findings. The classification results were compared using the McNemar test. Sensitivity, specificity, and accuracy percentages were calculated when the non-enhanced MRI/CDFI findings were used to differentiate benign lesions from malignant ones.

Results

The diagnostic accuracy (96.1 vs 82.4%) was significantly improved when ADCs were used together with CDFI findings for classifying parotid gland lesions compared to when ADCs were used alone. Pleomorphic adenomas had the highest ADCs. The ADC thresholds were 1.425 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from carcinomas, 0.999 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from other benign lesions, and 0.590 × 10⁻³ mm²/s for differentiating benign lesions other than pleomorphic adenomas from lymphomas.

Conclusion

Combining CDFI with non-enhanced MRI can improve the diagnostic accuracy of MRI for classifying parotid gland lesions.

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Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions

Abstract

Purpose

To determine the value of non-enhanced MRI in combination with color Doppler flow imaging (CDFI) for differentiating malignant parotid tumors from benign ones.

Methods

This retrospective study analyzed 51 parotid gland lesions (39 benign and 12 malignant) in 51 patients who underwent preoperative CDFI as well as non-enhanced MRI including T₁-weighted, T₂-weighted, and diffusion-weighted imaging (DWI). Degrees of intratumor vascularity were categorized into four grades basing on CDFI findings. The relationships between the lesion and its adjacent external carotid artery and retromandibular vein were inspected on T₁-weighted and T₂-weighted images. Apparent diffusion coefficient (ADC) values were calculated from diffusion-weighted images, and were used to classify the parotid gland lesions with and without reference to the CDFI findings. The classification results were compared using the McNemar test. Sensitivity, specificity, and accuracy percentages were calculated when the non-enhanced MRI/CDFI findings were used to differentiate benign lesions from malignant ones.

Results

The diagnostic accuracy (96.1 vs 82.4%) was significantly improved when ADCs were used together with CDFI findings for classifying parotid gland lesions compared to when ADCs were used alone. Pleomorphic adenomas had the highest ADCs. The ADC thresholds were 1.425 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from carcinomas, 0.999 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from other benign lesions, and 0.590 × 10⁻³ mm²/s for differentiating benign lesions other than pleomorphic adenomas from lymphomas.

Conclusion

Combining CDFI with non-enhanced MRI can improve the diagnostic accuracy of MRI for classifying parotid gland lesions.

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Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions

Abstract

Purpose

To determine the value of non-enhanced MRI in combination with color Doppler flow imaging (CDFI) for differentiating malignant parotid tumors from benign ones.

Methods

This retrospective study analyzed 51 parotid gland lesions (39 benign and 12 malignant) in 51 patients who underwent preoperative CDFI as well as non-enhanced MRI including T₁-weighted, T₂-weighted, and diffusion-weighted imaging (DWI). Degrees of intratumor vascularity were categorized into four grades basing on CDFI findings. The relationships between the lesion and its adjacent external carotid artery and retromandibular vein were inspected on T₁-weighted and T₂-weighted images. Apparent diffusion coefficient (ADC) values were calculated from diffusion-weighted images, and were used to classify the parotid gland lesions with and without reference to the CDFI findings. The classification results were compared using the McNemar test. Sensitivity, specificity, and accuracy percentages were calculated when the non-enhanced MRI/CDFI findings were used to differentiate benign lesions from malignant ones.

Results

The diagnostic accuracy (96.1 vs 82.4%) was significantly improved when ADCs were used together with CDFI findings for classifying parotid gland lesions compared to when ADCs were used alone. Pleomorphic adenomas had the highest ADCs. The ADC thresholds were 1.425 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from carcinomas, 0.999 × 10⁻³ mm²/s for differentiating pleomorphic adenomas from other benign lesions, and 0.590 × 10⁻³ mm²/s for differentiating benign lesions other than pleomorphic adenomas from lymphomas.

Conclusion

Combining CDFI with non-enhanced MRI can improve the diagnostic accuracy of MRI for classifying parotid gland lesions.

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Shifting to Value-Based Principles in Sickness Insurance: Challenges in Changing Roles and Culture

Abstract

Purpose Management principles in insurance agencies influence how benefits are administered, and how return to work processes for clients are managed and supported. This study analyses a change in managerial principles within the Swedish Sickness Insurance Agency, and how this has influenced the role of insurance officials in relation to discretion and accountability, and their relationship to clients. Methods The study is based on a qualitative approach comprising 57 interviews with officials and managers in four insurance offices. Results The reforms have led to a change in how public and professional accountability is defined, where the focus is shifted from routines and performance measurements toward professional discretion and the quality of encounters. However, the results show how these changes are interpreted differently across different layers of the organization, where New Public Management principles prevail in how line managers give feedback on and reward the work of officials. Conclusions The study illustrates how the introduction of new principles to promote officials' discretion does not easily bypass longstanding management strategies, in this case managing accountability through top-down performance measures. The study points out the importance for public organizations to reconcile new organizational principles with the current organizational culture and how this is manifested through managerial styles, which may be resistant to change. Promoting client-oriented and value-driven approaches in client work hence needs to acknowledge the importance of organizational culture, and to secure that changes are reflected in organizational procedures and routines.

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Patterns and Predictors of Failed and Sustained Return-to-Work in Transport Injury Insurance Claimants

Abstract

Purpose To determine the incidence of employed people who try and fail to return-to-work (RTW) following a transport crash. To identify predictors of RTW failure. Methods: A historical cohort study was conducted in the state of Victoria, Australia. People insured through the state-based compulsory third party transport accident compensation scheme were included. Inclusion criteria included date of crash between 2003 and 2012 (inclusive), age 15–70 years at the time of crash, sustained a non-catastrophic injury and received at least 1 day of income replacement. A matrix was created from an administrative payments dataset that mapped their RTW pattern for each day up to 3 years' post-crash. A gap of 7 days of no payment followed by resumption of a payment was considered a RTW failure and was flagged. These event flags were then entered into a regression analysis to determine the odds of having a failed RTW attempt. Results: 17% of individuals had a RTW fail, with males having 20% lower odds of experiencing RTW failure. Those who were younger, had minor injuries (sprains, strains, contusions, abrasions, non-limb fractures), or were from more advantaged socio-economic group, were less likely to experience a RTW failure. Most likely to experience a RTW failure were individuals with whiplash, dislocations or particularly those admitted to hospital. Conclusions: Understanding the causes and predictors of failed RTW can help insurers, employers and health systems identify at-risk individuals. This can enable earlier and more targeted support and more effective employment outcomes.

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Layered Manufacturing of Dental Ceramics: Fracture Mechanics, Microstructure, and Elemental Composition of Lithography-Sintered Ceramic

Abstract

Purpose

To compare the fracture mechanics, microstructure, and elemental composition of lithography-based ceramic manufacturing with pressing and CAD/CAM.

Materials and Methods

Disc-shaped specimens (16 mm diameter, 1.2 mm thick) were used for mechanical testing (n = 10/group). Biaxial flexural strength of three groups (In-Ceram alumina [ICA], lithography-based alumina, ZirkonZahn) were determined using the "piston on 3-ball" technique as suggested in test Standard ISO-6872. Vickers hardness test was performed. Fracture toughness was calculated using fractography. Results were statistically analyzed using Kruskal-Wallis test followed by Dunnett T3 (α = 0.05). Weibull analysis was conducted. Polished and fracture surface characterization was made using scanning electron microscope (SEM). Energy dispersive spectroscopy (EDS) was used for elemental analysis.

Results

Biaxial flexural strength of ICA, LCM alumina (LCMA), and ZirkonZahn were 147 ± 43 MPa, 490 ± 44 MPa, and 709 ± 94 MPa, respectively, and were statistically different (P ≤ 0.05). The Vickers hardness number of ICA was 850 ± 41, whereas hardness values for LCMA and ZirkonZahn were 1581 ± 144 and 1249 ± 57, respectively, and were statistically different (P ≤ 0.05). A statistically significant difference was found between fracture toughness of ICA (2 ± 0.4 MPa⋅m^1/2), LCMA (6.5 ± 1.5 MPa⋅m^1/2), and ZirkonZahn (7.7 ± 1 MPa⋅m^1/2) (P ≤ 0.05). Weibull modulus was highest for LCMA (m = 11.43) followed by ZirkonZahn (m = 8.16) and ICA (m = 5.21). Unlike LCMA and ZirkonZahn groups, a homogeneous microstructure was not observed for ICA. EDS results supported the SEM images.

Conclusions

Within the limitations of this in vitro study, it can be concluded that LCM seems to be a promising technique for final ceramic object manufacturing in dental applications. Both the manufacturing method and the material used should be improved.

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Overdenture Prostheses with Metal Copings: A Retrospective Analysis of Survival and Prosthodontic Complications

Abstract

Purpose

To retrospectively evaluate complications associated with overdentures and abutment teeth restored with metal copings, including post-procedural and prosthetic problems; also to analyze the frequency and influencing factors associated with these problems.

Materials and Methods

A total of 80 subjects (48 females, 32 males, mean age 62 years) wearing root-supported overdentures were enrolled in the study. All participants were thoroughly examined by a single examiner, and appropriate maintenance care was performed. The 80 subjects had 270 abutments, which were endodontically treated teeth. All 80 subjects were carefully interviewed, inspected, and evaluated for post-procedural and clinical problems with their overdentures for an observation period of up to 5 years.

Results

Of the post-procedural problems evaluated, the most common problems were gingival inflammation (69%) and root caries (36%) because of poor oral hygiene (41%) and loss of metal copings (34%), followed by overdenture base fracture over abutment teeth (34%). Other post-procedural problems reported were loss of overdenture stability (23%), incidence of overdenture repair (20%), poor retention (18%), incidental finding of root fragments (unplanned) in the jaws (15%), and up to two grade net change in the mobility of overdenture abutments (8%). All prostheses were in use at the time of data collection and observation up to 5 years.

Conclusions

Overdenture therapy was satisfactory; however, post-procedural and prosthetic complications and aftercare maintenance must not be underestimated.

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Microtensile Bond Strength of CAD/CAM Resin Blocks to Dual-Cure Adhesive Cement: The Effect of Different Sandblasting Procedures

Abstract

Purpose

To investigate the effect of sandblasting powder particles on microtensile bond strength (μTBS) of dual-cure adhesive cement to CAD/CAM blocks.

Materials and Methods

CAD/CAM blocks (Cerasmart, VITA, and LAVA) were cut in slabs and divided into groups: group 1, no sandblasting; group 2, sandblasted with 27-μm Al₂O₃; group 3, sandblasted with 30-μm CoJet; group 4, sandblasted with 50-μm Al₂O₃. After sandblasting, all specimens were silanized and luted using dual-cure adhesive cement (G-CEM LinkForce). After 24 hours, bonded specimens were cut into 1 ± 0.2 mm² sticks, and μTBS values were obtained (N = 30). Additionally, 132 CAD/CAM block sections were prepared for surface roughness testing and scanning electron microscopy (SEM) evaluations. Results were analyzed using Kruskal-Wallis One-way ANOVA and Dunn's Post Hoc Test (p < 0.05).

Results

Group 1 exhibited significantly lower μTBS than the other groups (p < 0.05). The highest bond strength values were obtained from group 4 (p > 0.05). For LAVA, μTBS values of specimens that were sandblasted with 50-μm Al₂O₃ powder were significantly higher than 30-μm-SiO₂ and 27-μm Al₂O₃ (p < 0.05).

Conclusions

The sand particles investigated (27-μm Al₂O₃, 30-μm SiO₂, or 50-μm Al₂O₃) did not significantly affect μTBS results of CAD/CAM blocks for Cerasmart and VITA, although the results changed significantly for LAVA. The ideal bond protocol for CAD/CAM blocks is specific to the material used.

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Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia: Efficacy and foetal outcome a randomised double-blinded trial

BACKGROUND During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications. OBJECTIVE To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia. DESIGN A randomised, double-blind, controlled study. SETTING Single University Hospital. PATIENTS Sixty patients aged 18 to 45 years with pre-eclampsia receiving general anaesthesia for caesarean section. INTERVENTIONS The patients were randomly allocated to three groups. Groups D1and D2 received an infusion of dexmedetomidine 1 μg kg−1 over the 10 min before induction of general anaesthesia, then 0.4 and 0.6 μg kg−1 h−1 dexmedetomidine, respectively. Group C received equivalent volumes of 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was the effect of dexmedetomidine on mean arterial blood pressure measured before induction of general anaesthesia at 1 and 5 min after intubation, and then every 5 min until 10 min after extubation. The secondary outcomes were blood glucose and serum cortisol (measured before induction of general anaesthesia, and at 1 and 5 min after intubation), postoperative visual analogue pain scores, time to first request for analgesia, the total consumption of analgesia, Ramsay sedation score, maternal and placental vein blood serum levels of dexmedetomidine and neonatal Apgar score at 1 and 5 min. RESULTS At all assessment times, the mean arterial pressures were significantly lower in the dexmedetomidine groups than in the control group. Compared with group C, the heart rate was significantly lower in both groups D1 and D2. In group D2, the heart rate was lower than in group D1. Serum glucose and cortisol were significantly higher in the controls than in either group D1 or D2. Group D2 patients were significantly more sedated on arrival in the recovery room followed by D1. Time to first analgesia was significantly longer in groups D2 and D1 than in group C, and the visual analogue pain scores were significantly lower in groups D1 and D2 than in group C at 1, 2, 3 and 5 h. Total morphine consumption was significantly lower in groups D1 and D2 than in the control group. There was no difference in Apgar scores across the three groups despite significantly higher dexmedetomidine concentrations in group D2 (both maternal and placental vein) than in group D1. CONCLUSION Administration of dexmedetomidine in doses 0.4 and 0.6 μg kg−1 h−1 was associated with haemodynamic and hormonal stability, without causing significant adverse neonatal outcome. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org). Correspondence to Ashraf M. Eskandr, MD, Department of Anesthesia, ICU and Pain Therapy, Faculty of Medicine, Menoufiya University, 3 Yassin Abd-Elghafar Street, Shibin El-koom, Egypt E-mail: ameskandr@yahoo.com © 2018 European Society of Anaesthesiology

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Low anaesthetic waste gas concentrations in postanaesthesia care unit: A prospective observational study

BACKGROUND Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S) The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN A prospective observational study. SETTING Two different PACUs of the Hannover Medical School (Hannover, Germany) were evaluated in this study. The rooms differed in dimensions, patient numbers and room ventilation settings. PATIENTS During the observation period, sevoflurane anaesthesia was performed in 65 of 140 patients monitored in postanaesthesia unit one and in 42 of 70 patients monitored in postanaesthesia unit two. MAIN OUTCOME MEASURES Absolute trace gas room concentrations of sevoflurane measured with a compact, closed gas loop high-resolution ion mobility spectrometer. RESULTS Traces of sevoflurane could be detected in 805 out of 970 samples. Maximum concentrations were 0.96 ± 0.20 ppm in postanaesthesia unit one, 0.82 ± 0.07 ppm in postanaesthesia unit two. Median concentration was 0.12 (0.34) ppm in postanaesthesia unit one and 0.11 (0.28) ppm in postanaesthesia unit two. CONCLUSION Low trace amounts of sevoflurane were detected in both PACUs equipped with controlled air exchange systems. Occupational exposure limits were not exceeded. Correspondence to Dr. Sebastian Heiderich, MD, Clinic of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany E-mail: heiderich.sebastian@mh-hannover.de © 2018 European Society of Anaesthesiology

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Low perfusion pressure is associated with renal tubular injury in infants undergoing cardiac surgery with cardiopulmonary bypass: A secondary analysis of an observational study

BACKGROUND Earlier work on adults undergoing surgery with cardiopulmonary bypass suggests that there is a close relationship between the lower limit of the cerebral and renal autoregulation pressures. Although cerebral autoregulation during bypass in infants has been extensively investigated, the impact of bypass on kidney function is not well known. It is, nevertheless, acknowledged that the main pathophysiological process involved in cardiac surgery-related kidney damage is tubular injury, and that urine neutrophil gelatinase-associated lipocaline (uNGAL) is a reliable biomarker of injury. OBJECTIVE To identify the most predictive bypass variable for the measurement of renal injury, its threshold value and the most predictive time below that threshold. DESIGN Observational study linking electronically recorded bypass perfusion pressure and oxygen delivery rate with intra-operative uNGAL excretion. Variations in bypass variables were accounted for by their excursions below several thresholds. SETTING French tertiary referral paediatric cardiac centre. PATIENTS A total of 72 infants in whom uNGAL was measured within 1 h of bypass. INTERVENTIONS None. MAIN OUTCOME MEASURE Renal injury, identified by a high creatinine normalised uNGAL concentration (>21.2 μg mmol−1). RESULTS At the end of bypass, 43.75% of infants had high uNGAL. A more than 40% pressure drop below the normal age-standardised mean arterial pressure was associated with high uNGAL. Receiver operating curve [interquartile range] areas were 0.626 [0.501 to 0.752] for a more than 40% drop, and 0.679 [0.555 to 0.804] for a more than 50% drop. A more than 40% pressure drop for 19.5 min provided a 0.65 negative predictive value for high uNGAL, and a more than 50% pressure drop for 5.4 min provided a 0.67 negative predictive value. The link between uNGAL and oxygen delivery rate was negligible. CONCLUSION Maintaining the perfusion pressure above 60% of the normal age-standardised mean arterial pressure may provide an effective renal protective strategy. TRIAL REGISTRATION Registered on October 11, 2010, ClinicalTrials.gov Identifier: NCT01219998. Correspondence to Mirela Bojan, MD, PhD, Department of Anaesthesiology and Critical Care, Necker-Enfants Malades University Hospital, Assistance Publique – Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France Tel: +33 171396663; e-mail: mirela.bojan@nck.aphp.fr © 2018 European Society of Anaesthesiology

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Classification of Intensity in Team-Sport Activity

AbstractPurposeTo assess the efficacy of critical metabolic power derived from variable-speed movement for classifying intensity in team sport activity.MethodsElite male hockey players (n = 12) completed a series of time trials (100 yd, 400 yd, 1500 yd) and a 3-min all-out test to derive both critical speed (CS) and critical power (CP). Heart rate (HR), blood lactate (BLa) and rating of perceived exertion (RPE) were measured during each protocol. Participants (n = 10) then played 2 competitive hockey matches. Time spent >85% of HRmax was compared to time spent above CS (from the time trials) and CP (from the 3-min test).ResultsBetween protocols, there was a moderate and non-significant association for CS (r = 0.359, P = 0.252), and a very large association for CP (r = 0.754, P = 0.005); the association was very large for peak HR (r = 0.866, P 85% HRmax and time spent above both CS (r = 0.719, P 85% of HRmax was compared to time spent above CS (from the time trials) and CP (from the 3-min test). Results Between protocols, there was a moderate and non-significant association for CS (r = 0.359, P = 0.252), and a very large association for CP (r = 0.754, P = 0.005); the association was very large for peak HR (r = 0.866, P 85% HRmax and time spent above both CS (r = 0.719, P

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Let the Pleasure Guide Your Resistance Training Intensity

ABSTRACTPurposeThe purpose of this study was to evaluate the feasibility and reliability of the Feeling Scale (FS) to self-regulate resistance training (RT) intensity.MethodsSixteen sedentary men (39.7±7.5 years) performed 3 familiarization sessions, 2 one repetition maximum testing (1RM), and 16 RT sessions (4 sessions for each FS descriptor; randomized). The FS descriptors were "very good" (FS+5), "good" (FS+3), "fairly good" (FS+1), and "fairly bad" (FS-1). Resistance exercises were leg press, chest press, knee extension, and seated biceps curl. Participants were instructed to select a load associated with the verbal/numerical descriptor of the FS to perform 3 sets of 10 repetitions.ResultsParticipants lifted a significantly greater %1RM as the FS level decreased from FS+5 to FS-1 (P

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Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma

ABSTRACTIntroductionObese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated.ObjectiveTo assess the effects of exercise on DLPA, asthma symptoms and psychosocial comorbidities in obese adults with asthma.MethodsFifty-five grade II obese adults with asthma were randomly assigned to either a weight-loss program+exercise program (WL+E group, n=28) or a weight-loss program+sham (WL+S group, n=27). The WL+E group incorporated aerobic and resistance muscle training into the weight-loss program (nutrition and psychological therapies), while the WL+S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality and anxiety and depression symptoms were quantified before and after treatment.ResultsAfter 3 months, the WL+E group presented a significant increase in daily step counts (3,068 ± 2,325 vs. 729 ± 1,118 steps/day) and the number of asthma-symptom-free days (14.5 ± 9.6 vs. 8.6 ± 11.4 d/mo) compared with the WL+S group. The proportion of participants with improvements in depression symptoms (76.4 vs. 16.6 %) and a lower risk of developing obstructive sleep apnea (56.5 vs. 16.3%) was greater in the WL+E group than in the WL+S group (P

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Changes in Motor Coordination Induced by Local Fatigue during a Sprint Cycling Task

AbstractPurposeThis study investigated how muscle coordination is adjusted in response to a decrease in the force-generating capacity of one muscle group during a sprint cycling task.MethodsFifteen participants were tested during a sprint before and after a fatigue electromyostimulation protocol was conducted on the quadriceps of one leg. Motor coordination was assessed by measuring myoelectrical activity, pedal force and joint power.ResultsThe decrease in force-generating capacity of the quadriceps (-28.0±6.8%) resulted in a decrease in positive knee extension power during the pedaling task (-34.4±30.6 W; P=0.001). The activity of the main non-fatigued synergist and antagonist muscles (triceps surae, gluteus maximus and hamstrings) of the ipsilateral leg decreased, leading to a decrease in joint power at the hip (-30.1±37.8 W; P=0.008) and ankle (-20.8±18.7 W; P=0.001). However, both the net power around the knee and the ability to effectively orientate the pedal force were maintained during the extension by reducing the co-activation and the associated negative power produced by the hamstrings. Adaptations also occurred in flexion phases in both legs, exhibiting an increased power (+17.9±28.3 [P=0.004] and +19.5 ± 21.9 W [P=0.026]), associated with an improvement in mechanical effectiveness.ConclusionThese results demonstrate that the nervous system readily adapts coordination in response to peripheral fatigue by i) decreasing the activation of adjacent non-fatigued muscles to maintain an effective pedal force orientation (despite reducing pedal power) and ii) increasing the neural drive to muscles involved in the flexion phases such that the decrease in total pedal power is limited. Purpose This study investigated how muscle coordination is adjusted in response to a decrease in the force-generating capacity of one muscle group during a sprint cycling task. Methods Fifteen participants were tested during a sprint before and after a fatigue electromyostimulation protocol was conducted on the quadriceps of one leg. Motor coordination was assessed by measuring myoelectrical activity, pedal force and joint power. Results The decrease in force-generating capacity of the quadriceps (-28.0±6.8%) resulted in a decrease in positive knee extension power during the pedaling task (-34.4±30.6 W; P=0.001). The activity of the main non-fatigued synergist and antagonist muscles (triceps surae, gluteus maximus and hamstrings) of the ipsilateral leg decreased, leading to a decrease in joint power at the hip (-30.1±37.8 W; P=0.008) and ankle (-20.8±18.7 W; P=0.001). However, both the net power around the knee and the ability to effectively orientate the pedal force were maintained during the extension by reducing the co-activation and the associated negative power produced by the hamstrings. Adaptations also occurred in flexion phases in both legs, exhibiting an increased power (+17.9±28.3 [P=0.004] and +19.5 ± 21.9 W [P=0.026]), associated with an improvement in mechanical effectiveness. Conclusion These results demonstrate that the nervous system readily adapts coordination in response to peripheral fatigue by i) decreasing the activation of adjacent non-fatigued muscles to maintain an effective pedal force orientation (despite reducing pedal power) and ii) increasing the neural drive to muscles involved in the flexion phases such that the decrease in total pedal power is limited. Correspondence and reprints: Sylvain DOREL, PhD, University of Nantes, Laboratory "Motricité, Interactions, Performance" (EA4334), 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3, France. Email: sylvain.dorel@univ-nantes.fr Project support was provided by the Region Pays de la Loire (ANOPACy project) and the French Ministry of Sport (14-R-23). Francois Hug was supported by a fellowship from the Institut Universiatire de France (IUF). The authors report no conflict of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation Accepted for Publication: 6 February 2018 © 2018 American College of Sports Medicine

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10-10 Electrode Placement System

In a good overview of electrode nomenclature, Seeck et al. (2017) describe the methods for naming recording regions between the major 10-20 electrode nomenclature locations. This excellent presentation describes and illustrates current ideas about high density sampling sites.

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To warn or not to warn: A reappraisal of brainstem auditory evoked potential warning criteria during surgery

Neurophysiologic intraoperative monitoring (NIOM) is widely used to reduce neurologic morbidity in many types of surgeries where nervous tissue is at risk. Somatosensory and motor evoked potentials (SEP, MEP) have been shown to reduce the risk of paraplegia in spinal surgeries (Nuwer et al., 2012). Brainstem auditory evoked potentials (BAEP), similarly, have been shown to reduce the risk of hearing loss in surgeries involving the manipulation of the vestibulocochlear nerve, brainstem or cerebellum (Radtke et al., 1989).

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On the origin of epileptic High Frequency Oscillations observed on clinical electrodes

In drug-resistant partial epilepsies, resective surgery is the treatment of choice to suppress seizures, provided that the epileptogenic zone (EZ) is clearly identified and that it can be safely removed. In this context, the capacity to rely on objective biomarkers of the EZ is fundamental to define the optimal surgical approach in the specific context of each patient. Prior to surgery, patients may benefit from pre-surgical investigations, among which depth-EEG recordings which play a key role as the use of intracranial electrodes offer the unique opportunity to directly and locally record field potentials from brain areas with an excellent temporal resolution (sub-millisecond).

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Effect of comorbidities on the course of multiple sclerosis

Publication date: Available online 11 February 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Przemyslaw Puz, Anetta Lasek-Bal, Arkadiusz Steposz, Karina Bartoszek, Patrycja Radecka
ObjectiveThe clinical condition of multiple sclerosis (MS) patients depends not only on the course of MS but also on their lifestyle and comorbidities. This study aimed to assess the effect of selected comorbidities, lifestyle-related factors and clinical data available at the time of MS diagnosis, on the disease activity and the disability progression in patients with relapsing-remitting multiple sclerosis (RRMS).Patients and MethodsBased on clinical relapses over a period of 12 months of observation and the results of MRI scans, 138 patients with RRMS were qualified into two groups: 'active' or 'stable' course of the disease. Patients from both groups were compared regarding the clinical data determined at diagnosis, comorbidities and lifestyle-related factors. Similar comparisons were carried out between patients with EDSS < 3 vs, patients with EDSS≥3.ResultsNo significant differences in comorbidities and lifestyle-related data between the stable and active group were detected. Arterial hypertension, hyperlipidemia, higher BMI values, older age and a lower education level, were found more frequently in patients with EDSS≥3. Oligoclonal bands, multifocal clinical manifestation as the first relapse, higher EDSS score and many T2 MRI lesions at the diagnosis were detected significantly more often in the active group. Motor or brainstem/cerebellum damage symptoms as the first relapse were observed more frequently in patients with EDSS≥3.ConclusionsCardiovascular diseases may exacerbate disability progression in MS patients. Relapses and radiological activity do not depend on chronic comorbidities. Clinical data available at the diagnosis may be useful in forecasting a distant course of MS.



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Radiation Pneumonitis in Pediatric Hodgkin Lymphoma Patients receiving Radiotherapy to the Chest

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Gary D. Lewis, Jennifer E. Agrusa, Bin S. Teh, Maria M. Gramatges, Viral Kothari, Carl E. Allen, Arnold C. Paulino
PurposeThe purpose of this study is to determine the incidence of radiation pneumonitis (RP) in children receiving radiotherapy (RT) for Hodgkin lymphoma (HL).Patients/MethodsA retrospective chart review was conducted of pediatric HL patients who received multiagent chemotherapy followed by RT to any part of the chest. The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 was used to determine the RP grade. Parameters analyzed included gender, age, bleomycin dose, and RT dosimetric variables such as mean lung dose (MLD), mean individual (right versus left) lung dose or iMLD, V5 to V25 and individual (i) lung V5 to V25.ResultsFrom 2008-2016, 54 children with HL received RT to the chest and had follow-up and dosimetry information. All patients received induction chemotherapy; the most common regimen was ABVE-PC based chemotherapy (n = 48). All received a prescribed dose of 21 Gy in 14 fractions. Median follow-up from completion of RT was 39.5 months. Three of 54 patients (5.6%) or 3 of 108 (2.8%) lungs developed RP; two lungs had Grade 1 while one had Grade 2 RP. RP was seen only in patients with MLD > 12.4 Gy (p = 0.009), V5 > 66% (p = 0.033), V10 >55% (p = 0.015), V15 >45% (p = 0.005) and V20 > 32% (p = 0.007). Likewise, RP was only seen in lungs with iMLD > 13.8 Gy, iV5 > 75% (p =0.02), iV10 > 64% (p = 0.02), iV15 > 47% (< 0.005), and iV20 >34% (p = 0.003).ConclusionsRP in pediatric HL patients is an uncommon complication. MLD, iMLD, V5-V20 and iV5-iV20 correlated with RP.



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Design and Evaluation of a Safety-Centered User Interface for Radiation Therapy

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Ashleigh P. Shier, Plinio P. Morita, Colleen Dickie, Mohammad Islam, Catherine Burns, Joseph A Cafazzo
PurposeAs radiotherapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks due to use error. The radiotherapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and evaluated to improve treatment safety.Methods and MaterialsAn initial design concept was created based on previously completed analysis, and informally evaluated in focus groups with radiation therapists. Sixteen newly graduated radiation therapists used both the redesigned and current system in a usability test to determine if the redesigned system better supported detection of errors.ResultsThe redesigned system successfully improved the error detection rate of two errors, wrong treatment volume and wrong treatment site (p < 0.03 and p < 0.01, respectively). It also improved Level 2 and Level 3 situation awareness, i.e. comprehension of the meaning of the information and the projection of the behavior of the technology (p < 0.01 and p < 0.01 respectively), and achieved a higher user satisfaction.ConclusionsThe ecological interface design approach was found to be effective in redesigning a radiotherapy treatment delivery interface. Radiation therapists were able to deliver simulated radiation therapy with a higher rate of error detection, improved higher-level situation awareness, and participants preferred the redesigned interface to the current interface. Overall, the redesigned interface improved the radiation therapists' system understanding and ability to detect errors that affect patient safety.



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Impact of timing of radiotherapy on outcomes in atypical meningioma: a clinical audit

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Sidharth Pant, Raees Tonse, Sadhana Kannan, Aliasgar Moiyadi, Prakash Shetty, Sridhar Epari, Ayushi Sahay, Goda Jayant Sastri, Rakesh Jalali, Tejpal Gupta
BackgroundRole of early adjuvant radiotherapy (RT) in patients with atypical meningioma remains controversial.PurposeTo report the impact of timing of RT on outcomes in atypical meningioma.MethodsPatients of atypical meningioma were identified through electronic search of institutional database. Following surgery, RT was delivered either in upfront adjuvant setting (early adjuvant RT) or after recurrence/progression (salvage RT).ResultsThere were 51 patients in early adjuvant RT group and 30 patients in salvage RT group. Six of 51 (12%) patients in early adjuvant RT group recurred/progressed compared to 34 of 35 (97%) patients kept on observation after initial surgery. Thirty of these 34 patients received salvage RT, mostly after re-excision. Twelve of 30 (40%) patients recurred/progressed after salvage RT, compared to 6 of 51 (12%) patients after early adjuvant RT (p=0.003). Post-RT 5-year progression-free survival was significantly better for early adjuvant RT compared to salvage RT (69% vs 28%, log-rank p<0.001).ConclusionsWithin the limitations of any retrospective analysis, upfront early adjuvant RT can significantly reduce the risk of local recurrence/progression in atypical meningiomas compared to initial observation. A sizeable proportion of patients who are observed initially recur/progress over time necessitating salvage therapy. However, re-excision followed by salvage RT may not be as effective as early adjuvant RT.



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Management of Paranasal Sinus Metastasis by Percutaneous CT guided Permanent Seed Brachytherapy: Technical Report

Publication date: Available online 1 February 2018
Source:Practical Radiation Oncology
Author(s): Stephen Doggett, Shigeru Chino, Todd Lempert, Kunal Sidhar




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Pre-Operative Contralateral Radiation Lung Dose is Associated with Post-Operative Pulmonary Toxicity in Patients with Locally-Advanced Non-Small Cell Lung Cancer Treated with Trimodality Therapy

Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Wenji Guo, Xuan Hui, Salem Alfaifi, Lori Anderson, Scott Robertson, Russell Hales, Chen Hu, Todd McNutt, Stephen Broderick, Jarushka Naidoo, Richard Battafarano, Stephen Yang, K. Ranh Voong
PurposeIn patients with non-small cell lung cancer (NSCLC) who undergo trimodality therapy (chemoradiation followed by surgical resection), it is unknown whether limiting pre-operative radiation dose to the uninvolved lung reduces post-surgical morbidity. This study evaluated whether radiation fall-off dose parameters to the contralateral lung, that is unaffected by NSCLC, are associated with post-operative complications in NSCLC patients treated with trimodality therapy.Methods and materialsWe retrospectively reviewed NSCLC patients who underwent trimodality therapy between March 2008-October 2016, with available restored digital radiation plans. Fischer's exact test was used to assess associations between patient and treatment characteristics and the development of treatment-related toxicity. Spearman's rank correlation was used to measure the strength of association between dosimetric parameters.ResultsForty-six patients were identified who received trimodality therapy with intensity modulated radiation (median 59.4 Gy, range 45-70) and concurrent platinum doublet chemotherapy, followed by surgical resection. The median age was 64.9 years (range 45.6-81.6 years). The median follow-up time was 1.9 years (range 0.3-8.4 years). Twenty-four (52.2%) patients developed any grade pulmonary toxicity and 14 (30.4%) patients developed grade 2+ pulmonary toxicity. There was an increased incidence of any grade pulmonary toxicity in patients with contralateral lung V20≥7% compared to <7% (90%, n=9 versus 41.7%, n=15; p=0.01). Similarly, contralateral lung V10≥20% was associated with an increased rate of any grade pulmonary toxicity compared to V10<20% (80%, n=12 versus 38.7%, n=12; p=0.01). Pneumonectomy/bilobectomy was associated with grade 2+ pulmonary toxicity (p=0.04).ConclusionsPatients who received a higher radiation fall-off dose volume parameter (V20≥7% and V10≥20%) to the contralateral uninvolved lung had a higher incidence of any grade post-operative pulmonary toxicity. Limiting radiation fall-off dose to the uninvolved lung may be an important modifiable radiation parameter in limiting post-operative toxicity in trimodality patients.



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NRG Oncology Medical Physicists’ Manpower Survey Quantifying Support Demands for Multi-Institutional Clinical Trials

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): James I Monroe, Karan Boparai, Ying Xiao, David Followill, James M Galvin, Eric E Klein, Daniel Low, Jean M Moran, Haoyu Zhong, Jason W Sohn
PurposeA survey was created by XXXX to assess a medical physicists' percent Full Time Equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 ASTRO report, 'Safety Is No Accident', quantified medical physics staffing contributions in FTE Factors for clinical departments. No quantification of FTE effort associated with clinical trials was included.MethodsTo address this lack of information, the XXXX Medical Physics Subcommittee decided to obtain manpower data from the medical physics community to quantify the amount of time medical physicists spent supporting clinical trials. A survey, consisting of sixteen questions, was designed to obtain information regarding physicists' time spent supporting clinical trials. The survey was distributed to medical physicists at 1996 radiotherapy institutions included on the membership rosters of the five NCTN clinical trial groups.ResultsOf the 451 institutions who responded; fifty percent (226) of the respondents reported currently participating in radiotherapy trials. On average, the designated physicist at each institution spent 2.4 hours (SD: 5.5 hours) per week supervising or interacting with clinical trial staff. On average, 1.2 hours (SD: 3.1 hours), 1.8 hours (SD: 3.9 hours), and 0.6 hours (SD: 1.1 hours) per week were spent on trial patient simulations, treatment plan reviews, and maintaining a DICOM server, respectively. For all trial credentialing activities, physicists spent an average of 32 hours (SD: 57.2 hours) yearly. Reading protocols and supporting dosimetrists, clinicians, and therapists took an average of 2.1 hours (SD: 3.4 hours) per week. Physicists also attended clinical trial meetings, on average, 1.2 hours (SD: 1.9 hours) per month.ConclusionOn average, physicist spent a non-trivial total of 9 hours per week (0.21 FTE) supporting an average of 10 active clinical trials. This time commitment indicates the complexity of radiotherapy clinical trials and should be taken into account when staffing radiotherapy institutions.



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Utilizing 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) to define suspected non-enhancing tumor for radiotherapy planning of glioblastoma

Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Aimee R Hayes, Dasantha Jayamanne, Edward Hsiao, Geoffrey P Schembri, Dale L Bailey, Paul J Roach, Mustafa Khasraw, Allison Newey, Helen R Wheeler, Michael Back
AimTo evaluate the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and presence of suspected non-enhancing tumors compared with standard magnetic resonance imaging (MRI).MethodsPatients with GBM and contrast-enhancing MRI showing regions suspicious of non-enhancing tumor underwent post-operative FET-PET prior to commencing radiotherapy. Two Clinical Target Volumes (CTVs) were created using pre- and post-operative MRI; MRI-FLAIR sequences (CTVFLAIR) and MRI contrast sequences with an expansion on the surgical cavity (CTVSx). FET-PET was used to create Biological Tumor Volumes (BTVs) by encompassing FET avid regions, forming a BTVFLAIR and BTVSx. Volumetric analyses were conducted between CTVs and respective BTVs using Wilcoxon signed-rank tests. The volume increase with addition of FET was analyzed with respect to BTVFLAIR and BTVSx. Presence of focal gadolinium contrast enhancement within previously non-enhancing tumor or within the FET avid region was noted on MRI at one and three months after radiotherapy.ResultsTwenty-six patients were identified retrospectively from our database, of which 24 had demonstrable FET uptake. The median CTVFLAIR, CTVSx, BTVFLAIR and BTVSx was 57.1 cc (range 1.1-217.4), 83.6 cc (range 27.2-275.8), 62.8 cc (range 1.1-307.3) and 94.7 cc (range 27.2-285.5) respectively. When FET-PET was utilized, there was a mean increase in volume from CTVFLAIR to BTVFLAIR by 26.8% and CTVSx to BTVSx by 20.6%. A statistically significant difference was noted on Wilcoxon signed-rank test when assessing volumetric change between CTVFLAIR and BTVFLAIR (P<0.0001) and CTVSx and BTVSx (p<0.0001). Six out of 24 patients (25%), with FET avidity prior to radiotherapy, showed focal gadolinium enhancement within the radiotherapy portal.ConclusionFET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component. This may result in improved radiotherapy target delineation and reduce the risk of potential geographical miss.SummaryWe investigated the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and a suspected non-enhancing tumor compared with standard magnetic resonance imaging (MRI). We performed volumetric analyses between clinical target volumes and respective biological target volumes using Wilcoxon signed-rank tests. In conclusion, FET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component and reduce the risk of potential geographical miss.



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Development of a Virtual Radiation Oncology Clinic for training and simulation of errors in the radiation oncology workflow

Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): TR Willoughby, SL Meeks, P Kelly, T Dvorak, K. Muller, T. Dana, F Bova




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An interactive contouring module improves engagement and interest in radiation oncology among pre-clinical medical students: Results of a randomized trial

Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Pushpa Neppala, Michael Sherer, Grant Larson, Alex Bryant, Neil Panjwani, James D. Murphy, Erin F Gillespie
PurposeStudies have shown significant gaps in knowledge of radiation therapy among medical students and primary care providers. The goal of this study was to evaluate the impact of an interactive contouring module on knowledge and interest in radiation oncology among pre-clinical medical students.Methods and MaterialsSecond year medical students at *** were randomized to participate in an interactive contouring exercise or watch a traditional didactic lecture on radiation oncology. Participants completed knowledge tests and surveys at baseline, immediately following the exercise, and 3 months later. Statistical analysis included Wilcoxon signed-rank test for pre- and post-test comparisons and Wilcoxon rank sum test for comparison between groups.ResultsForty-three medical students participated in the trial (21 in the didactic group and 22 in the contouring group). Students completing the contouring module demonstrated similar overall knowledge improvement compared to the traditional didactic group (+8.6% vs. +6.6%, NS) but endorsed greater engagement on a 5-point Likert-type scale (3.10 vs 3.76, p=0.02). At 3-month follow-up, there was a non-significant trend toward improved overall knowledge in the contouring group (43% vs. 51%, p=0.10), with a significance difference in a subset of questions on knowledge of the process of radiation therapy as well as side effects (51% vs. 75%, p=0.002). Students in the contouring group demonstrated more interest in pursuing a clinical radiation oncology rotation (2.52 vs 3.27, p=0.01).ConclusionsUse of an interactive contouring module was an effective method to teach pre-clinical medical students about radiation oncology, with no significant difference in knowledge gained compared to a traditional didactic lecture. However, higher engagement among students completing the contouring module led to improved retention of knowledge of radiation side effects and greater interest in radiation oncology. These data suggest a potential benefit of integrating an interactive radiation oncology module into the pre-clinical medical school curriculum.



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Stereotactic body radiotherapy for high-risk prostate cancer: Not ready

Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Trevor J. Royce, Ronald C. Chen




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On the origin of epileptic High Frequency Oscillations observed on clinical electrodes

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Mohamad Shamas, Pascal Benquet, Isabelle Merlet, Mohamad Khalil, Wassim El Falou, Anca NICA, Fabrice Wendling
ObjectiveIn this study we aim to identify the key (patho)physiological mechanisms and biophysical factors which impact the observability and spectral features of High Frequency Oscillations (HFOs).MethodsIn order to accurately replicate HFOs we developed virtual-brain / virtual-electrode simulation environment combining novel neurophysiological models of neuronal populations with biophysical models for the source/sensor relationship. Both (patho)physiological mechanisms (synaptic transmission, depolarizing GABAA effect, hyperexcitability) and physical factors (geometry of extended cortical sources, size and position of electrodes) were taken into account. Simulated HFOs were compared to real HFOs extracted from intracerebral recordings of 2 patients.ResultsOur results revealed that HFO pathological activity is being generated by feed-forward activation of cortical interneurons that produce fast depolarizing GABAergic post-synaptic potentials (PSPs) onto pyramidal cells. Out of phase patterns of depolarizing GABAergic PSPs explained the shape, entropy and spatiotemporal features of real human HFOs.ConclusionsThe terminology "high-frequency oscillation" (HFO) might be misleading as the fast ripple component (200-600Hz) is more likely a "high-frequency activity" (HFA), the origin of which is independent from any oscillatory process.SignificanceNew insights regarding the origins and observability of HFOs along depth-EEG electrodes were gained in terms of spatial extent and 3D geometry of neuronal sources.



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10-10 Electrode Placement System

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Marc R. Nuwer




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To warn or not to warn: A reappraisal of brainstem auditory evoked potential warning criteria during surgery

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Aatif M. Husain




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Functional capacity in adults with cerebral palsy: Lower limb muscle strength matters.

Publication date: Available online 10 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jarred G. Gillett, Glen A. Lichtwark, Roslyn N. Boyd, Lee A. Barber
ObjectiveTo investigate the relationship between lower limb muscle strength, passive muscle properties and functional capacity outcomes in adults with cerebral palsy (CP).DesignCross-sectional study.SettingTertiary institution biomechanics laboratory.ParticipantsSample of 33 adults with spastic-type CP with a mean age of 25 (range, 15-51) years; mean ± SD body mass 70.15 ± 21.35 kg; Gross Motor Function Classification System (GMFCS) level I n=20, level II n=13.InterventionsNot applicable.Main Outcome MeasuresSix-minute walk test (6MWT) distance (m); lateral step-up (LSU) test performance (total repetitions); timed up-stairs (TUS) performance (s); maximum voluntary isometric strength of plantar flexors (PF) and dorsiflexors (DF) (Nm.kg^-1); and passive ankle joint and muscle stiffness.ResultsMaximum isometric PF strength independently explained 61% of variance in 6MWT performance; 57% of variance in LSU test performance; and 50% of variance in TUS test performance. GMFCS level was significantly and independently related to all three functional capacity outcomes, and age was retained as a significant independent predictor of LSU, and TUS test performance. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not significantly related to functional capacity measures in any of the multiple regression models.ConclusionsLow isometric PF strength was the most important independent variable related to distance walked on the 6MWT, fewer repetitions on the LSU test, and slower TUS test performance. These findings suggest lower isometric muscle strength contributes to the decline in functional capacity in adults with CP.



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What factors are associated with the recovery of autonomy after a hip fracture? A prospective multicentric cohort study

Publication date: Available online 10 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mattia Morri, Paolo Chiari, Cristiana Forni, Antonella Orlandi Magli, Domenica Gazineo, Natalia Franchini, Lorenzo Marconato, Tiziana Giamboi, Andrea Cotti
Objectiveto identify the factors associated with recovering autonomy in the activities of daily livingDesignA prospective cohort studySettingThe orthopedic and orthogeriatric departments of 2 regional hospitalsParticipantsPatients 65 years of age or older with a diagnosis of fragility hip fracture. There were 840 eligible patients. Forty-three patients were excluded and 55 were lost. Seven hundred and forty-two consecutive patients was enrolled at the time of hospitalization and 727 at follow-up.Main Outcome MeasuresThe level of autonomy at 4 months was assessed using the ADL scale.ResultsThe score of the ADL scale at 4 months had a median equal to 3 (IQR=5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B= 0.02; p<0.001), an elevated number of comorbidities (B=0.044; p=0.005); a lower level of prefracture autonomy (B=0.087; p<0.001); more frequent use of an anti-decubitus mattress (B=0.211; p<0.001), an increased number of days with disorientation (B=0.002; p=0.012); failure to recover deambulation (B=0.199; p<0.001); an increased number of days with diapers (B=0.003; p<0.001), with a urinary catheter (B=0.03; p<0.001) and with bed rails (B=0.001; p=0.014), and a non-intensive care pathway (B=0,199; p=0,014).ConclusionIn the initial phase, treatment of patients with hip fractures is significantly associated with the functional recovery of autonomy and should be activated starting from those factors which have the possibility of being modified in clinical practice: recovery of deambulation, treatment for disorientation and management of incontinence.



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Accuracy of frozen section in determining meningioma subtype and grade

Publication date: Available online 10 February 2018
Source:Annals of Diagnostic Pathology
Author(s): Richard A. Prayson
Frozen section intraoperative consultation is a well-established means of evaluating brain tumors at the time of surgery. Limitations to the procedure are also well recognized resulting in less than perfect specificity of diagnosis. This study retrospectively reviewed 424 consecutive meningioma cases (N = 310 females; mean age 57.3 years) to examine concordance between frozen section evaluation of meningioma subtype and grade as compared with the final diagnosis subtype and grade. A discrepancy between frozen section diagnosis and final diagnosis was observed in 114 (26.9%) of cases. Of the WHO grade I subtypes, the most common discrepancy involved transitional meningiomas (N = 31) which were most commonly diagnosed at frozen section as either fibrous (N = 18) or meningothelial (N = 13) meningiomas. None of the grade I tumors were diagnosed as higher grade lesions. Of the higher grade meningiomas (WHO grade II and III) (N = 145) reviewed, concordance between tumor type and grade was seen in only 26.2% of cases; most commonly, 73/98 atypical meningiomas were under-graded as some subtype of WHO grade I meningioma (71/73 cases). In conclusion, discrepancies at frozen section with respect to accurately identifying higher grade meningiomas and higher grade meningioma subtypes are common and are generally due to tumor sampling and heterogeneity.



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Incidence and morphometry of sellar bridges and related foramina in dry skulls: Their significance in middle cranial fossa surgery

Publication date: Available online 10 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Konstantinos Natsis, Maria Piagkou, Nikolaos Lazaridis, Trifon Totlis, Nikolaos Anastasopoulos, Jannis Constantinidis
PurposeThe current study investigated the incidence, morphology and morphometry of the ossified ligaments expanding between petrous bone and posterior clinoid processes and in between the anterior, middle and posterior clinoid processes. Side symmetry, gender dimorphism and age influence were also studied.Materials and MethodsA total of 123 adult Greek dry skulls were observed.ResultsA caroticoclinoid bar (CCB) was found in 60.2%. Partial CCBs appeared more commonly (36.6%) than complete (23.6%). The caroticoclinoid foramen (CCF) was symmetrical on both sides and genders. An anterior interclinoid, a posterior petroclinoid and a partial posterior interclinoid bar appeared in 19.5%, 6.5% and 2.4%, respectively. Osseous spurs posterolateral to the posterior clinoid process were present in 5.7%.ConclusionThe study highlights important morphometric details about osseous bars of the sella region and the related CCF in Greek skulls. Notable differences in the incidence of these bars in Greek individuals compared with findings from other populations highlight the growing awareness of ethnic differences in skull base landmarks. Variations and surgically oriented measurements provided by this study may benefit clinicians involved in the treatment of the middle cranial fossa pathology, enriching understanding of the complicated regional anatomy. Preoperative sellar area mapping is essential, by using computed tomography images, since modification of the surgical approach may be required in cases of severe ossification.



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Incidence and morphometry of sellar bridges and related foramina in dry skulls: Their significance in middle cranial fossa surgery

Publication date: Available online 10 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Konstantinos Natsis, Maria Piagkou, Nikolaos Lazaridis, Trifon Totlis, Nikolaos Anastasopoulos, Jannis Constantinidis
PurposeThe current study investigated the incidence, morphology and morphometry of the ossified ligaments expanding between petrous bone and posterior clinoid processes and in between the anterior, middle and posterior clinoid processes. Side symmetry, gender dimorphism and age influence were also studied.Materials and MethodsA total of 123 adult Greek dry skulls were observed.ResultsA caroticoclinoid bar (CCB) was found in 60.2%. Partial CCBs appeared more commonly (36.6%) than complete (23.6%). The caroticoclinoid foramen (CCF) was symmetrical on both sides and genders. An anterior interclinoid, a posterior petroclinoid and a partial posterior interclinoid bar appeared in 19.5%, 6.5% and 2.4%, respectively. Osseous spurs posterolateral to the posterior clinoid process were present in 5.7%.ConclusionThe study highlights important morphometric details about osseous bars of the sella region and the related CCF in Greek skulls. Notable differences in the incidence of these bars in Greek individuals compared with findings from other populations highlight the growing awareness of ethnic differences in skull base landmarks. Variations and surgically oriented measurements provided by this study may benefit clinicians involved in the treatment of the middle cranial fossa pathology, enriching understanding of the complicated regional anatomy. Preoperative sellar area mapping is essential, by using computed tomography images, since modification of the surgical approach may be required in cases of severe ossification.



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Dural recurrence among esthesioneuroblastoma patients presenting with intracranial extension.

Dural recurrence among esthesioneuroblastoma patients presenting with intracranial extension.

Laryngoscope. 2018 Feb 10;:

Authors: Yu Y, El-Sayed IH, McDermott MW, Theodosopoulos PV, van Zante A, Kased N, Glastonbury CM, Garsa AA, Yom SS

Abstract
OBJECTIVE: To quantify the rate of late intracranial recurrences among esthesioneuroblastoma patients treated with surgical resection and postoperative radiation.
STUDY DESIGN: Retrospective review.
METHODS: All patients receiving definitive-intent therapy for esthesioneuroblastoma between March 1995 and September 2015 were reviewed. Presenting disease extent was categorized based on radiologic, operative, and pathologic findings. Between-group survival differences were assessed using Kaplan-Meier method and log-rank test. Multivariate analyses were performed using Cox proportional hazards model.
RESULTS: Of 38 patients initially treated at our institution, 53% (20 of 38) presented with intracranial extension. At a median follow-up of 90 months (range, 6-199), 37% (14 of 38) recurred; 5- and 8-year disease-free survival rates were 69% and 54%; and overall survival rates were 81% and 72%, respectively. Among these patients, the dura was the most commonly involved site of relapse (8), followed by local (6), regional (5), and distant extracranial (3) sites; and five patients had ≥ two categories of failure. Eight-year dural disease-free survival was 57% versus 90% (P = 0.017) and 0% versus 87% (P < 0.0001), with and without intracranial extension and subtotal resection, respectively. Of six patients treated at recurrence, five (83%) experienced dural-based failure such that, among all 44 patients, 13 (65%) of 20 recurrences involved the dura. After dural recurrence, the median survival time was 42 months (range, 12-125); salvage treatments were effective in rare cases of isolated low-volume recurrence.
CONCLUSION: Esthesioneuroblastoma patients presenting with intracranial extension are at substantial and unique risk for long-term dural-based relapse.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2018.

PMID: 29427378 [PubMed - as supplied by publisher]

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Ideal Characteristics of a Laser-Protected Endotracheal Tube: ABEA and AHNS Member Survey and Biomechanical Testing.

Ideal Characteristics of a Laser-Protected Endotracheal Tube: ABEA and AHNS Member Survey and Biomechanical Testing.

Ann Otol Rhinol Laryngol. 2018 Feb 01;:3489418757549

Authors: Friedman AD, Gerber ME, Bhayani MK, Kuchta K, Kumar K, Ma A, Ren Y, Zhang LQ

Abstract
OBJECTIVES: To determine the characteristics of laser-protected endotracheal tubes (LPETs) valued by otolaryngologists performing transoral laser surgery in the head and neck and to measure LPET stiffness.
METHODS: An online questionnaire was completed by American Broncho-Esophagological Association (ABEA) and American Head and Neck Society (AHNS) members. LPET distal end compliance was measured in a biomechanics laboratory.
RESULTS: A total of 228 out of 2109 combined ABEA and AHNS members completed the survey. The following LPET characteristics, which were properties of the Medtronic Laser-Shield II tube (MLST), were highly valued: softness and flexibility, surface smoothness, and a tight-to-shaft balloon (all P < .01). Prior to industry-driven discontinuation of the MLST, 52% of surgeons (78% of fellowship-trained laryngologists [FTLs]) reported using it; afterward, 58% reported using the stainless steel, Mallinckrodt Laser-Flex tube (MLFT). Forty-six percent of all respondents (69% of FTLs) did not consider cost being a factor in LPET choice. Biomechanical testing revealed the distal end of the MLST to be 3.45 times more compliant than the MLFT ( P < .01).
CONCLUSION: Members of the ABEA and AHNS, particularly FTLs, highly value distinguishing properties of the now discontinued MLST. Manufacturers should consider this in the design of new LPETs.

PMID: 29426244 [PubMed - as supplied by publisher]

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External Auditory Canal Dimensions, Age, and Cerumen Retention or Impaction in Persons With Down Syndrome.

External Auditory Canal Dimensions, Age, and Cerumen Retention or Impaction in Persons With Down Syndrome.

Ann Otol Rhinol Laryngol. 2018 Feb 01;:3489418756678

Authors: Dy AES, Lapeña JFF

Abstract
OBJECTIVE: To investigate associations between age, external auditory canal (EAC) dimensions, and cerumen retention/impaction among persons with Down syndrome (DS).
METHODS: This cross-sectional study evaluated EAC dimensions, cerumen retention/impaction, and middle ear status with pneumatoscopy after extraction in 130 persons with DS. Descriptive and inferential statistics correlated age, presence of impacted/retained cerumen, and EAC diameter.
RESULTS: Of 260 ears in 67 males and 63 females with average age of 9.48 years, 72.3% (188) had EAC of ≤4 mm. Those ≤1 year were 4.97 times more likely to have cerumen problems than those >1 year (95% CI, 1.45-17.02, P = .011). The odds of having cerumen problems with an EAC diameter of ≤4 mm were 3.31 times higher than with a diameter of 5 mm (95% CI, 1.46-7.50, P = .004), and odds of having cerumen impaction were as much as 6.19 times higher (95% CI, 2.38-16.08, P < .001). Male gender and low-lying external ear were also associated with increased odds of cerumen problems.
CONCLUSION: There is a high prevalence of cerumen retention/impaction in persons with DS compared to the general Philippine population and a higher prevalence rate for EAC stenosis than elsewhere. A canal diameter of 4 mm and below and age 1 year or less are associated with a significantly higher likelihood of cerumen retention/impaction.

PMID: 29426243 [PubMed - as supplied by publisher]

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