Internal biliary stenting in liver transplantation

Abstract

Purpose

Internal biliary stenting (IBS) was reported to decrease biliary complications after liver transplantation (LT) but data in literature is scarce. The aim of the present study was to evaluate our experience with end-to-end choledoco-choledocostomy during liver transplantation with special focus on the influence of IBS on patient and biliary outcomes.

Methods

Between 2009 and 2013, 175 patients underwent deceased donor LT with end-to-end choledoco-choledocostomy and were included in the study. Supra-papillary silastic stent was inserted in 67 patients (38%) with small-size (< 5 mm) bile ducts (recipient or donor). Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for IBS removal, 6 months after LT. Operative outcomes and survival of patients who received internal stenting (IBS group) were compared with those of patients who did not (no-IBS group). Risk factors for biliary anastomotic complications were identified.

Results

Ten patients died (6%) and 104 (59%) experienced postoperative complications. Five-year patient and graft survival rates were 77 and 74%, respectively. Biliary complications were recorded in 61 patients (35%) and were significantly decreased by IBS insertion (p = 0.0003). Anastomotic fistulas occurred in 23 patients (13%) and stenoses in 44 patients (25%). On multivariate analysis, high preoperative MELD scores (p = 0.02) and hepatic artery thrombosis (p < 0.0001) were predictors of fistula; absence of IBS was associated with both fistula (p = 0.014) and stricture (p = 0.003) formation.

Conclusions

IBS insertion during LT decreases anastomotic complication.

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Parasite Tolerance and Host Competence in Avian Host Defense to West Nile Virus.

Related Articles

Parasite Tolerance and Host Competence in Avian Host Defense to West Nile Virus.

Ecohealth. 2018 Mar 22;:

Authors: Burgan SC, Gervasi SS, Martin LB

Abstract
Competence, or the propensity of a host to transmit parasites, is partly underlain by host strategies to cope with infection (e.g., resistance and tolerance). Resistance represents the ability of hosts to prevent or clear infections, whereas tolerance captures the ability of individuals to cope with a given parasite burden. Here, we investigated (1) whether one easy-to-measure form of tolerance described well the dynamic relationships between host health and parasite burden, and (2) whether individual resistance and tolerance to West Nile virus (WNV) were predictable from single cytokine measures. We exposed house sparrows (HOSP) to WNV and measured subsequent changes in host performance, viral burden, and cytokine expression. We then used two novel approaches (one complex, one simpler) to estimate tolerance within-individual HOSP using four separate host performance traits. We lastly investigated changes in the expression of pro-inflammatory cytokine interferon-γ (IFN-γ) and anti-inflammatory cytokine interleukin-10 (IL-10). Both approaches to estimating tolerance were equivalent among WNV-infected HOSP; thus, an easy-to-measure tolerance estimation may be successfully applied in field studies. Constitutive expression of IFN-γ and IL-10 were predictive of resistance and tolerance to WNV, implicating these cytokines as viable biomarkers of host competence to WNV.

PMID: 29569179 [PubMed - as supplied by publisher]

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Drug Treatment for Androgenetic Alopecia: First Italian Questionnaire Survey on What Dermatologists Think about Finasteride

Abstract

Introduction

Treatment with finasteride 1 mg/day represents the therapy of choice for androgenetic alopecia (AGA). We investigated how Italian dermatologists approach use of finasteride for treatment of AGA and common side effects reported by patients.

Methods

A tablet-based survey was conducted from February 2017 to January 2018 in Italy to investigating use of 1 mg/day finasteride in the treatment of AGA. Approximately 1153 Italian dermatologists were surveyed about prescription frequency, therapy duration, treatment practices, and side effects eventually reported.

Results

Dermatologists considered treatment with 1 mg/day finasteride to be the most efficacious treatment for AGA, as reflecting by its long-term (5 years) prescription. Data on sexual side effects from our survey are in line with previous scientific evidence, especially regarding loss of libido, erectile dysfunction, and problems with ejaculation, but also in the psychological sphere and regarding physical impairments such as myalgia and loss of muscle tone.

Conclusions

This is the first preliminary observational study on how Italian dermatologists approach use of finasteride to treat AGA. Although side effects have been reported, especially in the sexual sphere, lack of alternative treatments with the same efficacy leads dermatologists to prescribe 1 mg/day finasteride with a tendency to prolong therapy in the long term.

Funding

Giuliani S.p.A.

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Mercury Methylation Capacity and Removal of Hg Species from Aqueous Medium by Cyanobacteria

Abstract

Most technologies used for decontamination presents good results for high concentrations, but limitations for lower ones. The desirable Hg concentration in the water is extremely low because of its toxicity. The aims of this study were to evaluate inorganic mercury (Hg²⁺) and methylmercury (CH₃Hg⁺) toxicity in Nostoc paludosum, to assess the potential of this cyanobacteria strain to remove these Hg species from aqueous medium and also to investigate Hg methylation by the cyanobacteria. CH₃Hg⁺ determination was performed by gas chromatography-pyrolysis-atomic fluorescence spectrometry in cultures exposed to a concentration of 20 μg L⁻¹ for 30 days. Both Hg species were removed from the supernatant, ranging from 73 to 96% of Hg²⁺ and from 73 to 95% of CH₃Hg⁺. Ultrastructural Hg²⁺ effects in the cyanobacteria cells investigated by transmission electron microscopy revealed higher production of glycogen, cyanophycin, and intrathylacoidal spaces than the control group. When Hg was added to the culture in the form of CH₃Hg⁺, a decrease corresponding to approximately 60% of the initial concentration due to Hg volatilization was observed. The production of CH₃Hg⁺ by the cyanobacteria was detected in concentrations near the limit of detection (0.0025%) of the bioaccumulated THg. This is an advantage for biotechnological decontamination applications, as CH₃Hg⁺ is a very toxic specie and can be bioaccumulated and biomagnified. The results demonstrated that cyanobacteria cells are an efficient alternative to retain and/or remove Hg at low concentrations and they constitute a potential tool for a "final cleaning" of contaminated waste water.

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Boosting the LTP-like plasticity effect of intermittent theta-burst stimulation using gamma transcranial alternating current stimulation

Publication date: Available online 24 March 2018
Source:Brain Stimulation
Author(s): Andrea Guerra, Antonio Suppa, Matteo Bologna, Valentina D'Onofrio, Edoardo Bianchini, Peter Brown, Vincenzo Di Lazzaro, Alfredo Berardelli
BackgroundTranscranial Alternating Current Stimulation (tACS) consists in delivering electric current to the brain using an oscillatory pattern that may entrain the rhythmic activity of cortical neurons. When delivered at gamma frequency, tACS modulates motor performance and GABA-A-ergic interneuron activity.ObjectiveSince interneuronal discharges play a crucial role in brain plasticity phenomena, here we co-stimulated the primary motor cortex (M1) in healthy subjects by means of tACS during intermittent theta-burst stimulation (iTBS), a transcranial magnetic stimulation paradigm known to induce long-term potentiation (LTP)-like plasticity.MethodsWe measured and compared motor evoked potentials before and after gamma, beta and sham tACS-iTBS. While we delivered gamma-tACS, we also measured short-interval intracortical inhibition (SICI) to detect any changes in GABA-A-ergic neurotransmission.ResultsGamma, but not beta and sham tACS, significantly boosted and prolonged the iTBS-induced after-effects. Interestingly, the extent of the gamma tACS-iTBS after-effects correlated directly with SICI changes.ConclusionsOverall, our findings point to a link between gamma oscillations, interneuronal GABA-A-ergic activity and LTP-like plasticity in the human M1. Gamma tACS-iTBS co-stimulation might represent a new strategy to enhance and prolong responses to plasticity-inducing protocols, thereby lending itself to future applications in the neurorehabilitation setting.



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The role of myeloid derived suppressor cells in mycosis fungoides

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Remote sensing of on-road vehicle emissions: Mechanism, applications and a case study from Hong Kong

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Yuhan Huang, Bruce Organ, John L. Zhou, Nic C. Surawski, Guang Hong, Edward F.C. Chan, Yat Shing Yam
Vehicle emissions are a major contributor to air pollution in cities and have serious health impacts to their inhabitants. On-road remote sensing is an effective and economic tool to monitor and control vehicle emissions. In this review, the mechanism, accuracy, advantages and limitations of remote sensing were introduced. Then the applications and major findings of remote sensing were critically reviewed. It was revealed that the emission distribution of on-road vehicles was highly skewed so that the dirtiest 10% vehicles accounted for over half of the total fleet emissions. Such findings highlighted the importance and effectiveness of using remote sensing for in situ identification of high-emitting vehicles for further inspection and maintenance programs. However, the accuracy and number of vehicles affected by screening programs were greatly dependent on the screening criteria. Remote sensing studies showed that the emissions of gasoline and diesel vehicles were significantly reduced in recent years, with the exception of NOx emissions of diesel vehicles in spite of greatly tightened automotive emission regulations. Thirdly, the experience and issues of using remote sensing for identifying high-emitting vehicles in Hong Kong (where remote sensing is a legislative instrument for enforcement purposes) were reported. That was followed by the first time ever identification and discussion of the issue of frequent false detection of diesel high-emitters using remote sensing. Finally, the challenges and future research directions of on-road remote sensing were elaborated.



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Determination of respirable-sized crystalline silica in different ambient environments in the United Kingdom with a mobile high flow rate sampler utilising porous foams to achieve the required particle size selection

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Peter Stacey, Andrew Thorpe, Paul Roberts, Owen Butler
Inhalation of respirable crystalline silica (RCS) can cause diseases including silicosis and cancer. Levels of RCS close to an emission source are measured but little is known about the wider ambient exposure from industry emissions or natural sources. The aim of this work is to report the RCS concentrations obtained from a variety of ambient environments using a new mobile respirable (PM4) sampler. A mobile battery powered high flow rate (52 L min⁻¹) sampler was developed and evaluated for particulate aerosol sampling employing foams to select the respirable particle size fraction. Sampling was conducted in the United Kingdom at site boundaries surrounding seven urban construction and demolition and five sand quarry sites. These are compared with data from twelve urban aerosol samples and from repeat measurements from a base line study at a single rural site. The 50% particle size penetration (d50) through the foam was 4.3 μm. Over 85% of predict bias values were with ±10% of the respirable convention, which is based on a log normal curve. Results for RCS from all construction and quarry activities are generally low with a 95 th percentile of 11 μg m⁻³. Eighty percent of results were less than the health benchmark value of 3 μg m⁻³ used in some states in America for ambient concentrations. The power cutting of brick and the largest demolition activities gave the highest construction levels. Measured urban background RCS levels were typically below 0.3 μg m⁻³ and the median RCS level, at a rural background location, was 0.02 μg m⁻³. These reported ambient RCS concentrations may provide useful baseline values to assess the wider impact of fugitive, RCS containing, dust emissions into the wider environment.



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Nitrogen deposition in precipitation to a monsoon-affected eutrophic embayment: Fluxes, sources, and processes

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Yunchao Wu, Jingping Zhang, Songlin Liu, Zhijian Jiang, Iman Arbi, Xiaoping Huang, Peter Ian Macreadie
Daya Bay in the South China Sea (SCS) has experienced rapid nitrogen pollution and intensified eutrophication in the past decade due to economic development. Here, we estimated the deposition fluxes of nitrogenous species, clarified the contribution of nitrogen from precipitation and measured ions and isotopic composition (δ¹⁵N and δ¹⁸O) of nitrate in precipitation in one year period to trace its sources and formation processes among different seasons. We found that the deposition fluxes of total dissolved nitrogen (TDN), NO3⁻, NH4⁺, NO2⁻, and dissolved organic nitrogen (DON) to Daya Bay were 132.5, 64.4 17.5, 1.0, 49.6 mmol m⁻²∙yr⁻¹, respectively. DON was a significant contributor to nitrogen deposition (37% of TDN), and NO3⁻ accounted for 78% of the DIN in precipitation. The nitrogen deposition fluxes were higher in spring and summer, and lower in winter. Nitrogen from precipitation contributed nearly 38% of the total input of nitrogen (point sources input and dry and wet deposition) in Daya Bay. The δ¹⁵N-NO3^- abundance, ion compositions, and air mass backward trajectories implicated that coal combustion, vehicle exhausts, and dust from mainland China delivered by northeast monsoon were the main sources in winter, while fossil fuel combustion (coal combustion and vehicle exhausts) and dust from PRD and southeast Asia transported by southwest monsoon were the main sources in spring; marine sources, vehicle exhausts and lightning could be the potential sources in summer. δ¹⁸O results showed that OH pathway was dominant in the chemical formation process of nitrate in summer, while N2O5+ DMS/HC pathways in winter and spring.



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Evaluation of cellular effects of fine particulate matter from combustion of solid fuels used for indoor heating on the Navajo Nation using a stratified oxidative stress response model

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Ning Li, Wyatt M. Champion, Jemal Imam, Damansher Sidhu, Joseph R. Salazar, Brian J. Majestic, Lupita D. Montoya
Communities in the Navajo Nation face public health burdens caused in part by the combustion of wood and coal for indoor heating using stoves that are old or in disrepair. Wood and coal combustion emits particulate matter (PM) with aerodynamic diameter < 2.5 μm (PM2.5), which can reach deep in the lung and cause injuries. Currently, there is little information about the health effects of wood and coal combustion-derived PM2.5 on Navajo Nation residents. This study tested the hypothesis that PM2.5 generated from solid fuel combustion in stoves commonly used by Navajo residents would induce stratified oxidative stress responses ranging from activation of antioxidant defense to inflammation and cell death in mouse macrophages (RAW 264.7). PM2.5 emitted from burning Ponderosa Pine (PP) and Utah Juniper (UJ) wood and Black Mesa (BM) and Fruitland (FR) coal in a stove representative of those widely used by Navajo residents were collected, and their aqueous suspensions used for cellular exposure. PM from combustion of wood had significantly more elemental carbon (EC) (15%) and soluble Ni (0.0029%) than the samples from coal combustion (EC: 3%; Ni: 0.0019%) and was also a stronger activator of antioxidant enzyme heme oxygenase-1 (11-fold increase vs. control) than that from coal (5-fold increase). Only PM from PP-wood (12-fold) and BM-coal (3-fold) increased the release of inflammatory cytokine tumor necrosis factor alpha. Among all samples, PP-wood consistently had the strongest oxidative stress and inflammatory effects. PM components, i.e. low-volatility organic carbon, EC, Cu, Ni and K were positively correlated with the cellular responses. Results showed that, at the concentrations tested, emissions from all fuels did not have significant cytotoxicity. These findings suggest that PM2.5 emitted from combustion of wood and coal commonly used by Navajo residents may negatively impact the health of this community.

Graphical abstract

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Characteristics of atmospheric ammonia and its relationship with vehicle emissions in a megacity in China

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Ruyu Wang, Xingnan Ye, Yuxuan Liu, Haowen Li, Xin Yang, Jianmin Chen, Wei Gao, Zi Yin
Atmospheric ammonia plays an important role in haze formation in East China. In this study, long-term measurements of NH3 concentrations were implemented at urban, suburban, and tunnel sites in Shanghai, the largest city in East China. The average monthly ammonia concentrations at the urban site varied from 3.7 ppb to 14.5 ppb and exhibited the highest levels in summer and lowest levels in winter, indicating that the biological emissions and agriculture in the surrounding areas are important contributors. The suburban NH3 levels were significantly higher in autumn compared to those at the urban site, indicating the important contribution of agricultural activities. Regardless of the season, the difference of NH3 concentrations between the tunnel and urban sites remained almost constant. On average, the tunnel NH3 level was three times higher than that of the nearby urban site, indicating strong vehicle NH3 emissions in the tunnel. The tunnel NH3 levels on weekdays were comparable to those on weekends, a result that was in agreement with the daily average traffic volume. It was estimated that the vehicle emissions contributed 12.6–24.6% of the atmospheric NH3 in the urban area and 3.8–7.5% for the whole area of Shanghai. Our results suggest that vehicle NH3 emissions should be considered, although agricultural emissions are still more important for mitigating severe haze pollution during wintertime in the megacities of China.

Graphical abstract

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Texas Hill Country ENT Symposium Scheduled for April 2018

Mark your calendars for the McGovern Medical School Department of Otorhinolaryngology-Head and Neck Surgery's two-day CME meeting in the Texas... Read the full article...

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Branchial Cleft Cyst Resection: A Pediatric Patient Benefits from Texas Medical Center Expertise and the Convenience of Follow-up ENT Care in Southeast Houston

When J. Caleb Simmons, MD, started medical school, he thought he might be a pediatrician. Today as an otolaryngologist, nearly... Read the full article...

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Dr. Michael Byrd Named 2017 Physician of the Year at Memorial Hermann Southeast Hospital

Otolaryngologist Michael Byrd, MD, has been recognized as 2017 Physician of the Year at Memorial Hermann Southeast Hospital, a 274-bed... Read the full article...

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Effect of the masseter muscle injection of botulinum toxin A on the mandibular bone growth of developmental rats

Abstract

Background

The objective of this study was to evaluate the influence of masticatory muscle injection of botulinum toxin type A (BTX-A) on the growth of the mandibular bone in vivo.

Methods

Eleven Sprague-Dawley rats were used, and BTX-A (n = 6) or saline (n = 5) was injected at 13 days of age. All injections were given to the right masseter muscle, and the BTX-A dose was 0.5 units. All of the rats were euthanized at 60 days of age. The skulls of the rats were separated and fixed with 10% formalin for micro-computed tomography (micro-CT) analysis.

Results

The anthropometric analysis found that the ramus heights and bigonial widths of the BTX-A-injected group were significantly smaller than those of the saline-injected group (P < 0.05), and the mandibular plane angle of the BTX-A-injected group was significantly greater than in the saline-injected group (P < 0.001). In the BTX-A-injected group, the ramus heights II and III and the mandibular plane angles I and II showed significant differences between the injected and non-injected sides (P < 0.05). The BTX-A-injected side of the mandible in the masseter group showed significantly lower mandibular bone growth compared with the non-injected side.

Conclusion

BTX-A injection into the masseter muscle influences mandibular bone growth.

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Letter to the Editor referring to the retracted publication entitled “Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment” by Hwang et al.

After our article entitled "Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment" [1] was published in Oral Oncology, we responded to a reader's query and provided our data at the Editor-in-Chief's request. In reviewing the data, we discovered that a calculation error had occurred which changed the sensitivity from 71% to 48% and negative predictive value from 60% to 36% for the Straticyte assay in the high-risk vs. non-high-risk subgroups.

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“Tumulus” stabilization of a total ossicular replacement prosthesis

Publication date: Available online 24 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): T. Mom, C. Caburet, N. Saroul, L. Gilain, M. Gersdorff
Functional failure of total ossicular replacement prostheses (TORP) is often due to secondary displacement, ranging from simple subluxation to prosthesis extrusion following recurrence of severe tympanic membrane retraction. Several surgical techniques have been proposed to stabilize a TORP, mostly using superimposed non-organic or resorbable heterologous materials. We describe a simple so-called "tumulus" surgical technique that limits prosthesis displacement and extrusion, regardless of the type of TORP, by using a few fragments of autologous cartilage that are always available and perfectly tolerated at no cost. Review of 31 cases treated by this technique did not reveal any cases of prosthesis displacement and only one case (3.2%) of prosthesis extrusion with audiometric results comparable to the best results reported in the literature.



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In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees

Publication date: Available online 24 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Ricci, G. Riva, F. Dagna, E. Seglie, A.L. Cavalot
Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure.



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International Journal of Experimental Pathology, Ahead of Print.

International Journal of Experimental Pathology, Ahead of Print.


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Editorial Board/Reviewing Committee

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Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation

The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old).

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Letter to the Editor referring to the retracted publication entitled “Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment” by Hwang et al.

After our article entitled "Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment" [1] was published in Oral Oncology, we responded to a reader's query and provided our data at the Editor-in-Chief's request. In reviewing the data, we discovered that a calculation error had occurred which changed the sensitivity from 71% to 48% and negative predictive value from 60% to 36% for the Straticyte assay in the high-risk vs. non-high-risk subgroups.

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Management update of potentially premalignant oral epithelial lesions

Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael Awadallah, Matthew Idle, Ketan Patel, Deepak Kademani
The term oral potentially malignant disorders (OPMD) previously defined at the World Health Organisation (W.H.O) workshop in 2005 has now been redefined as potentially premalignant oral epithelial lesions (PPOELs). It is important to differentiate PPOEL's which are a broad term to define a wide variety of clinical lesions from oral epithelial dysplasia which should be reserved specifically for lesions with biopsy proven foci of dysplasia. Unfortunately, the nomenclature is not consistent and many times both terms PPOEL and dysplasia are used interchangeably which adds to confusion in the literature. PPOEL's encompass lesions that include leukoplakia, erythroplakia, erythroleukoplakia, lichen planus, and submucosal fibrosis. The World Health Organization (W.H.O). definition of a histologically proven oral premalignant lesion that is associated with a significantly increased risk of malignant transformation. The primary goal of management of dysplasia includes the prevention, early detection and treatment prior to malignant transformation. The aim of this paper is to inform the clinician about management of PPOELs.



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Loss of PD-L1 (SP-142) expression characterizes renal vein tumor thrombus microenvironment in clear cell renal cell carcinoma

Publication date: Available online 24 March 2018
Source:Annals of Diagnostic Pathology
Author(s): José I. López, Rafael Pulido, Charles H. Lawrie, Javier C. Angulo
Immunotherapy is a promising tool in the treatment of patients with advancer renal cancer, in particular the blockage of immune checkpoint inhibitors. Clear cell renal cell carcinoma is an example of heterogeneous neoplasm and this particular characteristic is responsible of many therapeutic failures so far. Since variations in the local microenvironment across a tumor may conditionate the effect of this new therapy, a deeper knowledge of this issue seems advisable for any treatment success. We have analyzed the PD-L1 (SP142) expression in three different areas in the tumor and in two areas in the renal vein/caval thrombi in 39 advanced clear cell renal cell carcinomas to determine the extent and potential clinical significance of this regional variability. A statistically significant decrease in PD-L1 expression has been detected between the main tumor and its thrombus faction (p < 0.0001). Also, we have observed a high variability in the PD-L1 positivity across the three different areas of the main tumor tested, with only three cases being uniformly positive in all tested areas. In conclusion, PD-L1 expression display a highly variable distribution in clear cell renal cell carcinomas and this particularity should be kept in mind when selecting the tumor samples to be tested for immunotherapy.



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Cutaneous metastases of infantile choriocarcinoma can mimic infantile hemangioma both clinically and radiographically

Abstract

Infantile metastatic choriocarcinoma is a rare tumor of placental origin that can be observed with or without maternal metastases. A single cutaneous mass may be the only clinically observed sign. Reports of imaging findings are scarce given the extreme rarity of the tumor, and the disease can be rapidly fatal in the absence of prompt diagnosis. In order to promote timely consideration for this malignancy as a differential consideration in the approach to skin lesions in infancy, we present the findings of this neoplasm in an infant. While imaging and clinical characteristics similar to infantile hemangioma were demonstrated at presentation, biopsy and further radiologic investigation revealed multifocal metastatic choriocarcinoma. This case also highlights important differences between these entities, as the T2 hyperintensity and contrast enhancement observed with this choriocarcinoma were predominantly peripheral in location.

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Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation

Publication date: Available online 23 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Sugiura, S. Sarukawa, J. Hayasaka, H. Kamochi, T. Noguchi, Y. Mori
The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n=6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.



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"B-ENT"[jour]; +42 new citations

42 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"B-ENT"[jour]

These pubmed results were generated on 2018/03/24

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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History of plastic surgery: art, philosophy, and rhinoplasty

Publication date: Available online 23 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Valdas Macionis
The two-hundredth anniversary of K. F. Graefe's "Rhinoplasty", E. Zeis' naming of the specialty of plastic surgery in 1838, and the continuing discussion on what is plastic surgery have prompted this historical-conceptual review with an analytic semantic insight into the meaning of the word "plastic". A literature search has revealed that this term has a dual content composed of an artistic and a philosophic aspect. Progressive development of these two connotations can be traced from their birth in the ceramics and myths of the ancient Greece to their metamorphoses in the fine arts, science, and plasticity philosophy of our days. Although the names of plastic procedures and the title of the specialty carry both features, the philosophical notion is less evident. This article underlines the importance of etymological history in interpretation of the concept of plastic surgery.



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A bony defect of the sphenoid air sinus found in male cadaver: a case report

Abstract

The sphenoid sinus one of the posterior group of sinus, considered one of the most difficult sinuses due to its deep location in the skull. The interest in the understanding of the anatomy of the sphenoid sinus increased markedly during the last decades due to the development of endoscopic transsphenoidal approaches to the intracranial structures. The important anatomical relations of the sphenoid sinus make it one of the difficult and challenging structures for the surgeons. In this case report, we present one of the anatomical variations that was found during cadaveric dissection of the head. In this case we found abnormal bony defect in the lateral wall of the sinus, the defect closed just by the lining mucosa of the sinus and the dura from its intracranial side. A point may be of clinical importance to the related nearby structures.

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Association between impaired IL-10 production following exposure to Staphylococcus aureus enterotoxin B and disease severity in eosinophilic chronic rhinosinusitis

Publication date: Available online 23 March 2018
Source:Allergology International
Author(s): Takenori Haruna, Shin Kariya, Tazuko Fujiwara, Takaya Higaki, Seiichiro Makihara, Kengo Kanai, Rumi Fujiwara, Satoshi Iwasaki, Yoshihiro Noguchi, Kazunori Nishizaki, Mitsuhiro Okano
BackgroundIL-10 is a major anti-inflammatory cytokine that prevents inflammation-mediated tissue damage. We characterized the production of IL-10 by sinonasal tissue cells following exposure to Staphylococcus aureus enterotoxin B (SEB), which elicits cellular responses and is associated with the pathogenesis of eosinophilic chronic rhinosinusitis (ECRS).MethodsDispersed nasal polyp (NP) cells and uncinate tissue (UT) cells were prepared from patients with CRS with and without NP, respectively. Cells were incubated with SEB, and then the levels of IL-10 in the cell supernatants were determined. The effect of neutralizing IL-10 on SEB-induced IL-5, IL-13, IFN-γ, and IL-17A production was examined. Expression of IL-10 in NPs was also determined.ResultsIL-10 was expressed in infiltrating inflammatory cells in NPs. NP cells, especially non-adherent NP cells, produced substantial amounts of IL-10 in response to SEB. Although baseline production of IL-10 was significantly higher in NP cells than UT cells, the degree of IL-10 response to SEB was not significantly different between the cell types. The degree of IL-10 production was negatively correlated with the degree of eosinophilia both in tissues and peripheral blood whereas positively correlated with the 1-s forced expiratory volume/forced vital capacity ratio. Patients with severe ECRS displayed a significant decrease in IL-10 production compared with those with non-ECRS. IL-10 neutralization significantly augmented SEB-induced IL-13 and IFN-γ production by NP cells.ConclusionsImpaired IL-10 production in response to SEB in NP may exacerbate the pathophysiology of ECRS including eosinophilia and lower airway obstruction.



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Disseminated cutaneous histoplasmosis with laryngeal involvement in a setting of immune reconstitution inflammatory syndrome.

Disseminated cutaneous histoplasmosis with laryngeal involvement in a setting of immune reconstitution inflammatory syndrome.

South Afr J HIV Med. 2017;18(1):693

Authors: Sacoor MF

Abstract
Introduction: Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. We report a case of disseminated cutaneous histoplasmosis with mucocutaneous involvement in an AIDS patient paradigmatic of the multifaceted nature of the disease, which is an expression of the immune reconstitution inflammatory syndrome (IRIS).
Patient presentation: A 39-year-old man presented with a three month history of asymptomatic papules and nodules with necrotic centres involving the centrofacial region. The patient was diagnosed as being HIV-positive a month earlier and was commenced on antiretroviral treatment. Two weeks after the development of skin lesions, the patient complained of a sore throat and hoarseness of his voice. A fibre-optic laryngoscopy and biopsies of the skin, larynx and liver were performed.
Management and outcome: The CD4 counts increased from 2 cells/µL to 124 cells/µL, whereas the viral load decreased from one million to less than 20 copies/mL. A fibre-optic laryngoscopy revealed a supraglottitis with ulceration on the epiglottis. Histology of the liver, larynx and sections of the skin demonstrated pandermal necrotising granulomatous inflammation. Grocott-Gomori methenamine silver and Periodic acid-Schiff (PAS) stains revealed a relative paucity of intracellular, narrow-neck budding fungal organisms. Culture findings confirmed the diagnosis of histoplasmosis. The patient was treated with intravenous amphotericin B for two weeks followed by oral itraconazole 100 mg twice a day, with an excellent response to treatment.
Conclusion: We present this case to remind clinicians that disseminated histoplasmosis in AIDS patients may occur as an expression of IRIS. A sudden onset of hoarseness with cutaneous lesions in a patient with disseminated disease should alert one to possible laryngeal histoplasmosis. Prompt recognition and treatment will avert the potential fatal complications of this disease.

PMID: 29568629 [PubMed]

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An alternative digital workflow for fabricating a mandibular implant-supported complete fixed dental prosthesis with limited restorative space: A clinical report

Publication date: Available online 23 March 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Druthil Belur, William W. Nagy
This clinical report describes the prosthetic rehabilitation of a patient with a mandibular implant-supported complete fixed dental prosthesis with limited interocclusal restorative space. The problem was manifested by repeated fractures of the acrylic resin teeth and distortion of the supporting framework. The definitive restoration included a custom computer-aided design and computer-aided manufacturing (CAD-CAM) titanium framework with the lingual cusps and most of the occlusal table of the mandibular posterior teeth milled in titanium as part of the framework. An esthetic CAD-CAM milled denture base along with teeth was bonded over this framework.



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Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan.

Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan.

Auris Nasus Larynx. 2018 Mar 19;:

Authors: Matsuyama H, Yamazaki K, Okabe R, Ueki Y, Shodo R, Omata J, Sato Y, Ota H, Takahashi T, Tomita M, Yokoyama Y, Togashi T, Aoyama H, Abe E, Saijo Y, Katsura K, Soga M, Sugita T, Matsumoto Y, Tsuchida E, Horii A

Abstract
OBJECTIVE: Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese.
METHODS: Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events.
RESULTS: A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event.
CONCLUSION: The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).

PMID: 29567334 [PubMed - as supplied by publisher]

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A bony defect of the sphenoid air sinus found in male cadaver: a case report

Abstract

The sphenoid sinus one of the posterior group of sinus, considered one of the most difficult sinuses due to its deep location in the skull. The interest in the understanding of the anatomy of the sphenoid sinus increased markedly during the last decades due to the development of endoscopic transsphenoidal approaches to the intracranial structures. The important anatomical relations of the sphenoid sinus make it one of the difficult and challenging structures for the surgeons. In this case report, we present one of the anatomical variations that was found during cadaveric dissection of the head. In this case we found abnormal bony defect in the lateral wall of the sinus, the defect closed just by the lining mucosa of the sinus and the dura from its intracranial side. A point may be of clinical importance to the related nearby structures.

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The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice.

The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice.

J Voice. 2018 Mar 19;:

Authors: Behlau M

Abstract
This Paul Moore Lecture honors the contributions made by authors to the Journal of Voice during a period of 30 years, from 1987. Fifty articles were selected and included under the following five topics: (1) normalcy of the larynx and voice; (2) the clinical speech-language pathologist's evaluation; (3) the patient's perspective; (4) the core of vocal rehabilitation; and (5) behavioral versus organic dysphonias. The analysis reflects a vivid landscape of the specific area and significant advances in knowledge. It also shows the valuable interdependence between science and clinical practice. The topics highlight the following information: (1) The physical appearance of a healthy larynx varies across individuals with normal voices. (2) The voice is not a binary descriptor (normal versus abnormal) but a variable measure, with many cultural influences on the perceptual auditory analysis of a voice. (3) The clinical speech-language pathologist assessment is multidimensional and multiparametric, with both subjective and objective analyses. The patients' opinion about the impact of a voice problem on his or her quality of life is significant when proposing a treatment. Therefore, it is also included in the initial assessment. (4) Vocal rehabilitation is a nonlinear process that combines direct and indirect approaches. Evidence of the positive effect of voice therapy is now well established. (5) Behavioral dysphonias may be linked to self-regulation of the use of voice and this needs to be taken into consideration. Although organic dysphonias are not necessarily the result of harmful vocal behaviors, they too can benefit from vocal rehabilitation.

PMID: 29567050 [PubMed - as supplied by publisher]

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Cochlear Gifts $10 Million to Build Academic Center on Hearing Loss

​Cochlear (https://ift.tt/2oVevGx) has pledged a gift of $10 million to the Johns Hopkins Bloomberg School of Public Health to establish the Cochlear Center for Hearing and Public Health in honor of World Hearing Day this year. The Cochlear Center will focus on addressing the global impact of hearing loss by conducting research to determine the gravity of hearing loss as a public health issue, developing and testing interventions to mitigate the effects of hearing loss, and helping craft policies and strategies to ensure successful implementation of those interventions at the local, national, and global levels. The Center will also recruit and train researchers and public health experts to advance these goals.
 
The gift of $10 million will be made over a period of 10 years. Cochlear will collaborate with the Center and have representation on the Center's advisory board to provide feedback and help identify opportunities for continued industry-academic collaborations. Since Cochlear's headquarters are based on the campus of Macquarie University in Sydney and is next to the Australian Hearing Hub, the company is hoping that this gift will facilitate closer industry, academic, and clinical engagement to spur future training and research partnerships, including shared postdoctoral fellowships, a shared masters of public health program, shared PhD programs, and faculty exchanges. Cochlear and Johns Hopkins Bloomberg School of Public Health celebrated the official opening of the Cochlear Center for Hearing and Public Health on World Hearing Day, March 3.​

Published: 3/23/2018 9:36:00 AM

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iHear and Atlazo to Develop Audio-Centric Digital Platform for Hearing Devices

​iHear Medical (https://ift.tt/1pm5Mpw) is partnering with Atlazo to develop an advanced digital hardware platform, System on Chip (SoC), which will power a new operating system designed to shift devices from relying on visual displays to voice commands and the auditory domain for hearing aids and hearables. With the Hearing of Things (HoT) operating system, users can selectively listen to and send communications to their social media accounts and text messages with hearing devices instead of their cell phone or computer, eliminating the need to be tethered to traditional computing devices for sending and receiving information. The HoT standard will offer bi-directional wireless connectivity to everyday devices, from mobile phones to home appliances. Hearing devices powered by the HoT operating system will streamline the user experience for mobile phones, including phone calling and control of home appliances with a voice user interface. These devices will also offer real-time health tracking and relay personal and health information into the ear privately and discreetly. 

Published: 3/23/2018 9:18:00 AM

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Reduced heart rate variability and increased saliva cortisol in patients with TMD

Publication date: Available online 23 March 2018
Source:Archives of Oral Biology
Author(s): Suruedee Chinthakanan, Kittipong Laosuwan, Pattriyaporn Boonyawong, Sirinart Kumfu, Nipon Chattipakorn, Siriporn C. Chattipakorn
Temporomandibular disorders (TMD) are the most common source of non-dental pain. The pathogenesis of TMD is multifactorial, involving biological, psychological and behavioral factors. Those factors are involved with alterations of the autonomic nervous system (ANS) and stressful conditions. Heart rate variability (HRV) has been used as a marker of ANS function. Increased cortisol level (a stress indicator), has been found in chronic pain. Therefore, the present study aimed to compare pain intensity, HRV, psychological factors, and salivary cortisol level between TMD patients and a control group. Twenty-one TMD patients and twenty-three healthy control subjects participated in the study. All participants underwent 24-hour-Holter monitoring to record HRV. Morning unstimulated saliva samples were collected from each participant for cortisol analysis. The pain intensity was assessed using a visual analog scale. The participants were evaluated for anxiety and depression via the Hospital Anxiety and Depression Scales. We found that pain intensity and psychological distress in the TMD group were significantly greater than those of the control (p < 0.01). Pain intensity showed a positive correlation with psychological distress (p < 0.01). HRV parameters in the TMD group were significantly lower than those in the control, suggesting reduced HRV in TMD patients. Pain intensity was negatively associated with HRV. Salivary cortisol level of the TMD group was greater than that of control. Our findings indicate that reduced HRV with higher psychological distress and increased salivary cortisol levels were observed in the TMD group. Therefore, TMD patients may benefit from interventions that can restore ANS function and stress balance.



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Occupational exposure and asthma

Publication date: Available online 23 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anh Dao, David I. Bernstein




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Barriers to medication adherence in asthma: the importance of culture and context

Publication date: Available online 23 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Elizabeth L. McQuaid
ObjectiveSignificant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.Data SourcesData were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials.Study Selection. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.ResultsThere is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.ConclusionDisparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.



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Optimization of treatment planning workflow and tumor coverage during daily adaptive magnetic resonance image guided radiation therapy (MR-IGRT) of pancreatic cancer

Abstract

Background

To simplify the adaptive treatment planning workflow while achieving the optimal tumor-dose coverage in pancreatic cancer patients undergoing daily adaptive magnetic resonance image guided radiation therapy (MR-IGRT).

Methods

In daily adaptive MR-IGRT, the plan objective function constructed during simulation is used for plan re-optimization throughout the course of treatment. In this study, we have constructed the initial objective functions using two methods for 16 pancreatic cancer patients treated with the ViewRay™ MR-IGRT system: 1) the conventional method that handles the stomach, duodenum, small bowel, and large bowel as separate organs at risk (OARs) and 2) the OAR grouping method. Using OAR grouping, a combined OAR structure that encompasses the portions of these four primary OARs within 3 cm of the planning target volume (PTV) is created. OAR grouping simulation plans were optimized such that the target coverage was comparable to the clinical simulation plan constructed in the conventional manner. In both cases, the initial objective function was then applied to each successive treatment fraction and the plan was re-optimized based on the patient's daily anatomy. OAR grouping plans were compared to conventional plans at each fraction in terms of coverage of the PTV and the optimized PTV (PTV OPT), which is the result of the subtraction of overlapping OAR volumes with an additional margin from the PTV.

Results

Plan performance was enhanced across a majority of fractions using OAR grouping. The percentage of the volume of the PTV covered by 95% of the prescribed dose (D₉₅) was improved by an average of 3.87 ± 4.29% while D₉₅ coverage of the PTV OPT increased by 3.98 ± 4.97%. Finally, D₁₀₀ coverage of the PTV demonstrated an average increase of 6.47 ± 7.16% and a maximum improvement of 20.19%.

Conclusions

In this study, our proposed OAR grouping plans generally outperformed conventional plans, especially when the conventional simulation plan favored or disregarded an OAR through the assignment of distinct weighting parameters relative to the other critical structures. OAR grouping simplifies the MR-IGRT adaptive treatment planning workflow at simulation while demonstrating improved coverage compared to delivered pancreatic cancer treatment plans in daily adaptive radiation therapy.

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Altruistic decisions following penetrating traumatic brain injury

Abstract

The cerebral correlates of altruistic decisions have increasingly attracted the interest of neuroscientists. To date, investigations on the neural underpinnings of altruistic decisions have primarily been conducted in healthy adults undergoing functional neuroimaging as they engaged in decisions to punish third parties. The chief purpose of the present study was to investigate altruistic decisions following focal brain damage with a novel altruistic decision task. In contrast to studies that have focused either on altruistic punishment or donation, the Altruistic Decision Task allows players to anonymously punish or donate to 30 charitable organizations involved with salient societal issues such as abortion, nuclear energy and civil rights. Ninety-four Vietnam War veterans with variable patterns of penetrating traumatic brain injury and 28 healthy veterans who also served in combat participated in the study as normal controls. Participants were asked to invest $1 to punish or reward real societal organizations, or keep the money for themselves. Associations between lesion distribution and performance on the task were analysed with multivariate support vector regression, which enables the assessment of the joint contribution of multiple regions in the determination of a given behaviour of interest. Our main findings were: (i) bilateral dorsomedial prefrontal lesions increased altruistic punishment, whereas lesions of the right perisylvian region and left temporo-insular cortex decreased punishment; (ii) altruistic donations were increased by bilateral lesions of the dorsomedial parietal cortex, whereas lesions of the right posterior superior temporal sulcus and middle temporal gyri decreased donations; (iii) altruistic punishment and donation were only weakly correlated, emphasizing their dissociable neuroanatomical associations; and (iv) altruistic decisions were not related to post-traumatic personality changes. These findings indicate that altruistic punishment and donation are determined by largely non-overlapping cerebral regions, which have previously been implicated in social cognition and moral experience such as evaluations of intentionality and intuitions of justice and morality.

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The Impact of Suprarenal Fixation on Renal Function Following Endovascular Abdominal Aortic Aneurysm Repair: Meta-analysis Based on Estimated Glomerular Filtration Rate

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): T. Calderbank, M. Bown, A. Saratzis
BackgroundEndovascular abdominal aortic aneurysm (AAA) repair (EVAR) is currently used routinely to treat AAA. Suprarenal fixation (SRF) of EVAR grafts can lead to renal dysfunction. A meta-analysis of studies using estimated glomerular filtration rate (eGFR) as a measure of renal injury to assess the effect of SRF on renal function was performed.MethodsAn electronic search was carried out to identify all articles that reported on renal injury following SRF versus infrarenal fixation (IRF) EVAR, and 24 studies were identified. Formal meta-analysis was used to assess eGFR drop at 1 and 5 years. The primary outcome measure was a drop in eGFR >20% at 1 year; secondary measures included eGFR drop >20% at 5 years and "renal dysfunction" based on the definition used in each publication.ResultsFive series reported eGFR reduction >20% at 1 year. The weighted odds ratio (OR) was 1.53 (95% CI 0.67–3.51, p = .31, I² = 53.2%); 9.3% for SRF versus 7.4% for IRF. One study reported eGFR based renal dysfunction at 5 years: OR 1.77 (95% CI 1.04–3.02, p = .03); 16.9% for SRF versus 10.3% for IRF. Nineteen series reported some form of renal dysfunction (5287 SRF vs. 4386 IRF patients, mean follow up: 20.5 months, range 72 h to 5 years). The weighted OR was 1.32 (95% CI 1.01–1.71, p = .03, I² = 28.4%); 5.1% for SRF versus 4.6% for IRF. "Renal dysfunction" definitions varied greatly and were based on creatinine or other inaccurate methods.ConclusionEVAR using SRF does not lead to a significant drop in renal function at 1 year, based on eGFR. Long-term results are limited. Authors should report long-term renal injury using eGFR and not inaccurate arbitrary measures, which are currently common in the literature.



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Commentary on “A Feasibility Study of a New Unibody Branched Stent Graft Applied to Reconstruct the Canine Aortic Arch”

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Adeline Schwein, Yannick Georg, Nabil Chakfé




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Response to Commentary on “Five-year Results of Great Saphenous Vein Treatment: A Meta-analysis”

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Sterre A.S. Hamann




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Limited Adherence to Peripheral Arterial Disease Guidelines and Suboptimal Ankle Brachial Index Reliability in Dutch Primary Care

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): David Hageman, Niels Pesser, Lindy N.M. Gommans, Edith M. Willigendael, Marc R.H.M. van Sambeek, Ellen Huijbers, Aafke Snoeijen, Marc R.M. Scheltinga, Joep A.W. Teijink
Objective/BackgroundThe Dutch College of General Practitioners' guideline on peripheral arterial disease (PAD) provides clear recommendations on the management of PAD. An ankle brachial index (ABI) measurement, prescription of antiplatelet drugs and statins, and supervised exercise therapy (SET) for intermittent claudication (IC) are advised. The aims of this study were to determine the adherence of general practitioners (GPs) to their own guideline on PAD and to evaluate the reliability of primary care ABI measurements.MethodsThis was a cross-sectional study. All patients suspected of having symptomatic PAD who were referred by GPs to a large hospital in 2015 were evaluated regarding three of the guideline criteria: (i) ABI measurement; (ii) prescription of secondary prevention; (iii) initiation of SET. ABI values obtained in primary care and the hospital's vascular laboratory were compared using correlation coefficients and regression analysis. An abnormal ABI was defined as a value <.9 (normal ABI ≥.9).ResultsOf 308 potential patients with new onset PAD, 58% (n = 178) had undergone ABI measurement prior to referral. A modest correlation between ABI values obtained in primary care and the vascular laboratory was found (r = .63, p < .001). Furthermore, a moderate reliability was calculated (intraclass correlation coefficient 0.60, 95% confidence interval 0.49–0.69, p < .001). Of the new patients with an abnormal ABI, 59% used antiplatelet drugs and 55% used statins. A referral for SET was initiated by a GP in 10% of new PAD patients with IC symptoms.ConclusionsAdherence by Dutch GPs to their own society's PAD guideline has room for improvement. The reliability of ABI measurements is suboptimal, whereas rates of prescription of secondary prevention and initiation of SET as primary treatment for IC need upgrading.



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Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Jacek Górka, Kamil Polok, Jakub Fronczek, Karolina Górka, Mateusz Kózka, Paweł Iwaszczuk, Marzena Frołow, P.J. Devereaux, Bruce Biccard, Jacek Musiał, Wojciech Szczeklik
Objective/backgroundVenous thromboembolism (VTE) has been considered the dominant major life threatening vascular complication after non-cardiac surgery, but recent studies have shifted the emphasis toward myocardial injury after non-cardiac surgery (MINS) as a common adverse event in the peri-operative setting. The aim of the present study was to compare the incidence and influence on mortality of two dominant venous and arterial events in the peri-operative period by prospectively screening a consecutive cohort of patients undergoing vascular surgery.MethodsThis was a sub-study of Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION), the main objective of which was to evaluate major peri-operative complications after non-cardiac surgery. Patients undergoing vascular surgery had their blood collected to measure the Roche fifth generation high sensitivity troponin T (hsTnT) assay before and four times after surgery (6–12 h post-operatively, on the first, second, and third day following the procedure). MINS was defined as an elevated post-operative hsTnT ≥65 ng/L or an hsTnT ≥20 to <65 ng/L with an absolute change of ≥5 ng/L that was judged to be due to ischaemia. All patients underwent ultrasound venous compression testing for deep vein thrombosis (DVT) before, 4, and 7 days after surgery and follow-up was performed by telephone 30 days and 1 year after surgery.ResultsIn total, 164 consecutive patients were included in this sub-study. MINS was diagnosed in 39 patients (23.8%) and DVT in four patients (2.4%). The 1 year mortality was higher in MINS (9/39 [23.1%]) than non-MINS patients (9/125 [7.2%]; p = .006). None of the patients who developed DVT died in the first year after surgery.ConclusionMINS is a common complication after vascular surgery. It occurs more frequently than DVT and is associated with high 1 year mortality.



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Association between physical activity and walking capacity with cognitive function in peripheral artery disease patients

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Bruno Remigio Cavalcante, Antonio H. Germano-Soares, Aline M. Gerage, Anthony Leicht, Rafael M. Tassitano, Henrique Bortolotti, Fábio Gazelato de Mello Franco, Nelson Wolosker, Gabriel G. Cucato, Raphael M. Ritti-Dias
ObjectiveTo identify the association between objectively measured physical activity and walking capacity with cognitive function in patients with symptomatic peripheral artery disease.MethodsThis was an observational, cross sectional study. One hundred and thirty patients (age 67 ± 8 years) were recruited at a tertiary centre specializing in vascular disease. Cognitive function (global, memory, executive function and attention) was evaluated using the Montreal Cognitive Assessment tool. Physical activity levels (total, light, and moderate-vigorous) were obtained using an accelerometer. A 6 min and 4 m walk test were undertaken to assess walking capacity. Crude and covariate adjusted, linear regression analyses confirmed significant associations between physical activity levels and walking capacity with cognitive function.ResultsPositive and significant associations were observed between moderate to vigorous physical activity (p = .039) and walking capacity (p = .030) with memory after adjusting for covariates. No significant association was identified between light physical activity and usual gait speed with any cognitive function outcome.ConclusionGreater memory performance was associated with greater moderate to vigorous physical activity levels and walking capacity in patients with symptomatic peripheral artery disease. Clinical interventions focused on improving moderate to vigorous physical activity levels and walking capacity may provide important therapies to potentially enhance cognitive health in patients with peripheral artery disease.



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A Feasibility Study of a New Unibody Branched Stent Graft Applied to Reconstruct the Canine Aortic Arch

Publication date: Available online 23 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): W. Li, S. Zhai, K. Xu, Q. Li, H. Zhong, T. Li, Z. Zhang
ObjectivesThe aim was to evaluate the feasibility and safety of a new unibody branched stent graft for the reconstruction of the canine aortic arch.MethodsThe unibody branched stent grafts included single branched stent grafts and double branched stent grafts. The main stent graft and branched limbs were sutured together. The branched stent grafts were folded into the introducer system, which consisted of a double channel catheter, a detachable sleeve, and an introducer sheath. The branched stent grafts were introduced and deployed into the aortic arch by the delivery system. Twenty adult mongrel dogs were used for the experiments. Ten dogs were implanted with single branched stent grafts; the other 10 were implanted with double branched stent grafts. The surviving animals were followed up for 3 months. Computed tomography angiography (CTA) was performed to observe the status of the branched stent grafts.ResultsAll the unibody branched stent grafts were successfully implanted into the canine aortic arches. The technical success rate was 100%. There was no cerebral infarction, paraplegia or incision infection. CTA showed that all the branched stent grafts were patent; there was no endoleak or stent migration.ConclusionsThe unibody branched stent graft system could be used to reconstruct the aortic arch. The animal experimental procedures demonstrated the safety and feasibility of the unibody branched stent graft system.



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Correction to: From IB2 to IIIB locally advanced cervical cancers: report of a ten-year experience

In the original publication [1] one author name was spelled incorrect.

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Malnutrition and refeeding syndrome prevention in head and neck cancer patients: from theory to clinical application.

Malnutrition and refeeding syndrome prevention in head and neck cancer patients: from theory to clinical application.

Eur Arch Otorhinolaryngol. 2018 Mar 22;:

Authors: Kaderbay A, Atallah I, Fontaine E, Chobert-Bakouline M, Schmitt S, Mitariu P, Righini CA

Abstract
PURPOSE: The goal of this review is to raise awareness about refeeding syndrome (RFS) and to give a comprehensive presentation of recent guidelines and latest scientific data about nutritional management among head and neck cancer (HNC) patients while focusing on RFS prevention.
METHODS: A review of literature for nutritional assessment and RFS management was conducted. Electronic searches of Medline, Cochrane, PubMed and Embase databases for articles published in peer-reviewed journals were conducted from February to September 2017 using the keywords: "nutrition assessment", "head and neck cancer", "refeeding syndrome" and "guidelines". Articles, reviews, book references as well as national and international guidelines in English and French were included.
RESULTS: The prevalence of malnutrition is high in HNC patients and a large number of them will need artificial nutritional support or refeeding intervention. RFS is characterized by fluid and electrolyte imbalance associated with clinical manifestations induced by rapid refeeding after a period of malnutrition or starvation. Regarding risk factors for malnutrition and RFS, HNC patients are particularly vulnerable. However, RFS remains unrecognized among head and neck surgeons and medical teams. Practical data are summarized to help organizing nutritional assessment and refeeding interventions. It also summarizes preventive measures to reduce RFS incidence and morbidity in HNC population.
CONCLUSION: Nutritional assessment and early refeeding interventions are crucial for HNC patients care. As prevention is the key for RFS management, early identification of patients with high risks is crucial and successful nutritional management requires a multidisciplinary approach.

PMID: 29569135 [PubMed - as supplied by publisher]

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The microbiology of chronic rhinosinusitis with and without nasal polyps.

The microbiology of chronic rhinosinusitis with and without nasal polyps.

Eur Arch Otorhinolaryngol. 2018 Mar 22;:

Authors: Wei HZ, Li YC, Wang XD, Lu XX, Hu CH, He S, Liu X

Abstract
OBJECTIVE: To compare the microbiological features in middle meatus samples from chronic rhinosinusitis (CRS) patients with nasal polyps (CRSwNP) and those without nasal polyps (CRSsNP), and control subjects.
METHODS: A total of 136 CRSwNP patients, 66 CRSsNP patients, and 49 control subjects who underwent endoscopic surgery in Beijing TongRen Hospital were enrolled between January 2014 and January 2016. Swab samples were obtained from the middle meatus during surgery and processed for the presence of aerobic and non-aerobic bacteria and fungi. Information on the allergic rhinitis, asthma, the percentage of eosinophils in peripheral blood, and the history of smoking and surgery was collected.
RESULTS: The overall isolation rate for bacteria was 81.3% for the three groups, with the lowest in the CRSsNP group (77.3%) and the highest in the CRSwNP group (88.4%). There were no significant differences in isolation rates among the three groups (P = 0.349). The three most common bacterial species were: Coagulase-negative Staphylococcus (24.3%), Corynebacterium (19.9%), and Staphylococcus epidermidis (19.1%) in the CRSwNP group; S. epidermidis (21.2%), Corynebacterium (21.2%), Coagulase-negative staphylococcus (18.2%), and Staphylococcus aureus (13.6%) in the CRSsNP group; S. epidermidis (30.6%), Coagulase-negative Staphylococcus (28.6%), and S. aureus (14.3%) in the control group. For the bacterial species with high isolation rates, no significant difference in the microbial cultures was observed among the three groups; whereas in the CRSwNP group, a relatively high proportion of Citrobacter (5.9%, a bacterium with low isolation rate) was observed compared with the CRSsNP and control groups (all 0.0%). Furthermore, when samples were categorized into subgroups according to the percentage of eosinophils, some bacterial species showed different rates in the CRSwNP group (e.g., S. aureus, 3.3% in the subgroup with normal percentage of eosinophils, 17.2% in the subgroup with increased percentage of eosinophils, P = 0.011).
CONCLUSIONS: There were no significant differences in the microbiological features (except Citrobacter) in middle meatus samples from CRSwNP patients, CRSsNP patients, and control subjects. S. aureus may promote eosinophilic inflammatory response, while S. epidermidis may promote non-eosinophilic inflammatory response.

PMID: 29569134 [PubMed - as supplied by publisher]

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Benefits of upgrading to the Nucleus® 6 sound processor for a wider clinical population.

Benefits of upgrading to the Nucleus® 6 sound processor for a wider clinical population.

Cochlear Implants Int. 2018 Mar 22;:1-6

Authors: Todorov MJ, Galvin KL

Abstract
OBJECTIVES: To determine whether a large clinical group of cochlear implant (CI) recipients demonstrated a difference in sentence recognition in noise when using their pre-upgrade sound processor compared to when using the Nucleus 6 processor, and to examine the impact of the following factors: implant type, sound processor type, age, or onset of hearing loss.
METHODS: A file review of 154 CI recipients (aged 7-92 years old) who requested an upgrade to the Nucleus 6 sound processor at the Cochlear Care Centre Melbourne was conducted. 105 recipients had complete data collected according to the protocol. A repeated measures, single subject design was used. Performance of CI recipients was compared with their pre-upgrade sound processor versus the Nucleus 6 processor using the Australian Sentence Test in Noise.
RESULTS: Group performance of CI recipients improved by 4.7 dB with the Nucleus 6 compared with the pre-upgrade sound processor. The benefit was not affected by pre-upgrade sound processor type or implant type (including older implant types and sound processors), age or onset of hearing loss (pre-lingual versus post-lingual).
CONCLUSION: This study confirmed that a clinical group of CI recipients obtained a significant benefit when upgrading to the Nucleus 6 sound processor.

PMID: 29566583 [PubMed - as supplied by publisher]

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Climate Change and the Impact on Respiratory and Allergic Disease: 2018

Abstract

Purpose of Review

The purpose of this paper is to review allergic respiratory disease related to indoor and outdoor exposures and to examine the impact of known and projected changes in climate. The global burden of disease directly attributed to climate change is very difficult to measure and becomes more challenging when the capacity of humans to adapt to these changes is taken into consideration. Allergic respiratory disease, such as asthma, is quite heterogenous, though closely associated with environmental and consequently immunologic interaction. Where is the tipping point?

Recent Findings

Our climate has been measurably changing for the past 100 years. It may indeed be the most significant health threat of the twenty-first century, and consequently tackling climate change may be the greatest health opportunity. The impacts of climate change on human health are varied and coming more into focus. Direct effects, such as heatwaves, severe weather, drought, and flooding, are apparent and frequently in the news. Indirect or secondary effects, such as changes in ecosystems and the impact on health, are less obvious. It is these changes in ecosystems that may have the greatest impact on allergic and respiratory diseases.

Summary

This review will explore some ways that climate change, current and predicted, influences respiratory disease. Discussion will focus on changing pollen patterns, damp buildings with increased mold exposure, air pollution, and heat stress.

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Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma

Abstract

Purpose of Review

To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.

Recent Findings

AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.

Summary

Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.

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Immigrant Respiratory Health: a Diverse Perspective in Environmental Influences on Respiratory Health

Abstract

Purpose of Review

The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA.

Recent Findings

Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations.

Summary

Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.

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How Do Storms Affect Asthma?

Abstract

Purpose of Review

There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients.

Recent Findings

An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20–30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids.

Summary

The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.

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Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management

Abstract

Purpose of Study

Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Recent Findings

There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN.

Summary

The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.

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Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps

Abstract

Purpose of Review

Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition.

Recent Findings

This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment.

Summary

This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.

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High serum levels of caspase-cleaved cytokeratin-18 are associated with malignant middle cerebral artery infarction patient mortality

There have been found apoptotic changes in brain tissue samples from humans after cerebral ischemia. Caspase-cleaved cytokeratin (CCCK)-18 could appears in blood during apoptosis. High circulating levels of CC...

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Phase I study of combined indomethacin and platinum-based chemotherapy to reduce platinum-induced fatty acids

Abstract

Purpose

Chemotherapy-resistance remains a major obstacle to effective anti-cancer treatment. We previously showed that platinum analogs cause the release of two fatty acids. These platinum-induced fatty acids (PIFAs) induced complete chemoresistance in mice, whereas co-administration of a COX-1 inhibitor, indomethacin, prevented PIFA release and significantly enhanced chemosensitivity. To assess the safety of combining indomethacin with platinum-based chemotherapy, and to explore its efficacy and associated PIFA levels, a multi-center phase I trial was conducted.

Methods

The study was comprised of two arms: oxaliplatin plus capecitabine (CAPOX, arm I) and cisplatin plus gemcitabine, capecitabine or 5FU (arm II) in patients for whom these regimens were indicated as standard care. Indomethacin was escalated from 25 to 75 mg TID, using a standard 3 × 3 design per arm, and was administered orally 8 days around chemo-infusion from cycle two onwards. PIFA levels were measured before and after treatment initiation, with and without indomethacin.

Results

Thirteen patients were enrolled, of which ten were evaluable for safety analyses. In arm I, no dose-limiting toxicities were observed, and all indomethacin dose levels were well-tolerated. Partial responses were observed in three patients (30%). Indomethacin lowered plasma levels of 12-S-hydroxy-5,8,10-heptadecatrienoic acid (12-S-HHT), whereas 4,7,10,13-hexadecatetraenoic acid (16:4(n-3)) levels were not affected. Only one patient was included in arm II; renal toxicity led to closure of this cohort.

Conclusions

Combined indomethacin and CAPOX treatment is safe and reduces the concentrations of 12-S-HHT, which may be associated with improved chemosensitivity. The recommended phase II dose is 75 mg indomethacin TID given 8 days surrounding standard dosed CAPOX.

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Comparisons of tumor-infiltrating lymphocyte levels and the 21-gene recurrence score in ER-positive/HER2-negative breast cancer

Abstract

Background

Recent studies have shown that tumors with extensive tumor-infiltrating lymphocytes (TILs) have a higher probability of pathologic complete response, even in luminal/human epidermal growth factor 2 (HER2)-negative breast cancer. We compared TIL levels and the 21-gene recurrence score (RS) in estrogen receptor (ER)-positive/HER2-negative breast cancer.

Methods

We evaluated the percentage of stromal TILs in 198 ER-positive/HER2-negative patients in whom RS was obtained by examining slides of surgical specimens by standardized methodology proposed by the international TIL Working Group. TIL levels were categorized as high (≥ 60%), intermediate (11–59%), or low (≤ 10%). All tumors were treatment-naïve.

Results

Ninety-seven (49.0%), 88 (44.4%), and 13 patients (6.6%) had low, intermediate, and high TIL levels, respectively. There was a significant but weak correlation between continuous RS and continuous TIL levels (Pearson's R = 0.201, p = 0.004). The mean RS was significantly highest in high TIL tumors (17.8 ± 10.7 in low TIL tumors, 19.4 ± 8.7 in intermediate TIL tumors, and 26.2 ± 8.2 in high TIL tumors; p = 0.014). However, when we compared categorized RS and TIL levels, we found that tumors with high TIL levels tended to have higher RS (≥ 26) but it was not significant (p = 0.155). Furthermore, multivariate analysis revealed that high RS was not an independent factor associated with high TIL levels. Chemo-endocrine therapy was more frequently performed among patients with high TILs and less frequently among those with low or intermediate TILs (p <  0.001).

Conclusions

Despite of a weak correlation between continuous TIL levels and RS, we found that tumors with high TIL levels tended to have a higher RS in ER-positive/HER2-negative breast cancer. Further study is warranted considering the clinical outcomes.

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Phase I study of combined indomethacin and platinum-based chemotherapy to reduce platinum-induced fatty acids

Abstract

Purpose

Chemotherapy-resistance remains a major obstacle to effective anti-cancer treatment. We previously showed that platinum analogs cause the release of two fatty acids. These platinum-induced fatty acids (PIFAs) induced complete chemoresistance in mice, whereas co-administration of a COX-1 inhibitor, indomethacin, prevented PIFA release and significantly enhanced chemosensitivity. To assess the safety of combining indomethacin with platinum-based chemotherapy, and to explore its efficacy and associated PIFA levels, a multi-center phase I trial was conducted.

Methods

The study was comprised of two arms: oxaliplatin plus capecitabine (CAPOX, arm I) and cisplatin plus gemcitabine, capecitabine or 5FU (arm II) in patients for whom these regimens were indicated as standard care. Indomethacin was escalated from 25 to 75 mg TID, using a standard 3 × 3 design per arm, and was administered orally 8 days around chemo-infusion from cycle two onwards. PIFA levels were measured before and after treatment initiation, with and without indomethacin.

Results

Thirteen patients were enrolled, of which ten were evaluable for safety analyses. In arm I, no dose-limiting toxicities were observed, and all indomethacin dose levels were well-tolerated. Partial responses were observed in three patients (30%). Indomethacin lowered plasma levels of 12-S-hydroxy-5,8,10-heptadecatrienoic acid (12-S-HHT), whereas 4,7,10,13-hexadecatetraenoic acid (16:4(n-3)) levels were not affected. Only one patient was included in arm II; renal toxicity led to closure of this cohort.

Conclusions

Combined indomethacin and CAPOX treatment is safe and reduces the concentrations of 12-S-HHT, which may be associated with improved chemosensitivity. The recommended phase II dose is 75 mg indomethacin TID given 8 days surrounding standard dosed CAPOX.

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Behavioral evaluation of auditory stream segregation in rats

Publication date: Available online 23 March 2018
Source:Neuroscience Research
Author(s): Takahiro Noda, Hirokazu Takahashi
Perceptual organization of sound sequences into separate sound sources or streams is called auditory stream segregation. Neural substrates for this process in both the spectral and temporal domains remain to be elucidated. Despite abundant knowledge about their auditory physiology, behavioral evidence for auditory streaming in rodents is still limited. We provided behavioral evidence for auditory streaming in the go/no-go discrimination task, but not in the two-alternative choice task. In the go/no-go discrimination phase, rats were able to discriminate different rhythms corresponding to segregated or integrated tone sequences in both short inter-tone interval (ITI) and long ITI conditions. Nevertheless, performance was poorer in the long ITI group. In probe testing, which assessed the ability to discriminate one of the segregated tone sequences from ABA- tone sequences, the detection rate increased with the difference in frequency (ΔF) for short (100 ms), but not long (200 ms) ITIs. Our results indicate that auditory streaming in rats on both the spectral and temporal features in the ABA- tone paradigm is qualitatively analogous to that observed in human psychophysics studies. This suggests that rodents are a valuable model for investigating the neural substrates of auditory streaming.



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Neuroimaging correlates of narcolepsy with cataplexy: A systematic review

Publication date: Available online 23 March 2018
Source:Neuroscience Research
Author(s): Masataka Wada, Masaru Mimura, Yoshihiro Noda, Shotaro Takasu, Eric Plitman, Makoto Honda, Akiyo Natsubori, Kamiyu Ogyu, Ryosuke Taurmi, Ariel Graff-Guerrero, Shinichiro Nakajima
Recent developments in neuroimaging techniques have advanced our understanding of biological mechanisms underpinning narcolepsy. We used MEDLINE to retrieve neuroimaging studies to compare patients with narcolepsy and healthy controls. Thirty-seven studies were identified and demonstrated several replicated abnormalities: (1) gray matter reductions in superior frontal, superior and inferior temporal, and middle occipital gyri, hypothalamus, amygdala, insula, hippocampus, cingulate cortex, thalamus, and nucleus accumbens, (2) decreased fractional anisotropy in white matter of fronto-orbital and cingulate area, (3) reduced brain metabolism or cerebral blood flow in middle and superior frontal, and cingulate cortex (4) increased activity in inferior frontal gyri, insula, amygdala, and nucleus accumbens, and (5) N-acetylaspartate/creatine-phosphocreatine level reduction in hypothalamus. In conclusion, all the replicated findings are still controversial due to the limitations such as heterogeneity or size of the samples and lack of multimodal imaging or follow-up. Thus, future neuroimaging studies should employ multimodal imaging methods in a large sample size of patients with narcolepsy and consider age, duration of disease, age at onset, severity, human leukocyte antigen type, cerebrospinal fluid hypocretin levels, and medication intake in order to elucidate possible neuroimaging characteristic of narcolepsy and identify therapeutic targets.



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CHARACTERIZATION OF MOUSE CHORDA TYMPANI RESPONSES EVOKED BY STIMULATION OF ANTERIOR OR POSTERIOR FUNGIFORM TASTE PAPILLAE

Publication date: Available online 23 March 2018
Source:Neuroscience Research
Author(s): Stuart A. McCaughey
Different gustatory papilla types vary in their locations on the tongue. Distinctions have often made between types, but variation within fungiform papillae has seldom been explored. Here, regional differences in fungiform papillae were investigated by flowing solutions selectively over either an anterior fungiform (AF, tongue tip) or a posterior fungiform (PF, middle third) region as taste-evoked activity was measured in the chorda tympani nerve of C57BL/6J (B6) mice. Significantly larger responses were evoked by NaCl applied to the AF than PF region, and the ENaC blocker amiloride reduced the NaCl response size only for the former. Umami synergy, based on co-presenting MSG and IMP, was larger for the AF than PF region. The regions did not differ in response size to sour chemicals, but responses to L-lysine, L-arginine, sucrose, and tetrasodium pyrophosphate were larger for the AF than PF region. Thus, fungiform papillae on the tongue tip differed from those found further back in their transduction mechanisms for salty and umami compounds. Gustatory sensitivity also showed regional variation, albeit with a complex relationship to palatability and taste quality. Overall, the data support a regional organization for the mouse tongue, with different functional zones for the anterior, middle, and posterior thirds.



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