OtoRhinoLaryngology News: 03/27/18

Τρίτη 27 Μαρτίου 2018

The combination of cardiorespiratory fitness and muscle strength, and mortality risk

Abstract

Little is known about the combined associations of cardiorespiratory fitness (CRF) and hand grip strength (GS) with mortality in general adult populations. The purpose of this study was to compare the relative risk of mortality for CRF, GS, and their combination. In UK Biobank, a prospective cohort of > 0.5 million adults aged 40–69 years, CRF was measured through submaximal bike tests; GS was measured using a hand-dynamometer. This analysis is based on data from 70,913 men and women (832 all-cause, 177 cardiovascular and 503 cancer deaths over 5.7-year follow-up) who provided valid CRF and GS data, and with no history of heart attack/stroke/cancer at baseline. Compared with the lowest CRF category, the hazard ratio (HR) for all-cause mortality was 0.76 [95% confidence interval (CI) 0.64–0.89] and 0.65 (95% CI 0.55–0.78) for the middle and highest CRF categories, respectively, after adjustment for confounders and GS. The highest GS category had an HR of 0.79 (95% CI 0.66–0.95) for all-cause mortality compared with the lowest, after adjustment for confounders and CRF. Similar results were found for cardiovascular and cancer mortality. The HRs for the combination of highest CRF and GS were 0.53 (95% CI 0.39–0.72) for all-cause mortality and 0.31 (95% CI 0.14–0.67) for cardiovascular mortality, compared with the reference category of lowest CRF and GS: no significant association for cancer mortality (HR 0.70; 95% CI 0.48–1.02). CRF and GS are both independent predictors of mortality. Improving both CRF and muscle strength, as opposed to either of the two alone, may be the most effective behavioral strategy to reduce all-cause and cardiovascular mortality risk.

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Calcifying Odontogenic Cyst Showing a Varied Epithelial Lining: An Additional Case with Implications for the Divergent Differentiation Capacity of the Cyst Epithelium

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Seromucinous Hamartoma of the Nasal Cavity

Abstract

Seromucinous hamartoma (SMH) is a rare benign epithelial proliferation occurring in the sinonasal tract. The clinical, radiographic, and histologic appearance of SMH may mimic several benign and malignant entities. Presented is a novel case, with a review of the literature focused on potential histologic diagnostic pitfalls.

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Operative time and length of stay is similar between robotic assisted and laparoscopic colon and rectal resections

Abstract

Robotic-assisted surgery is increasingly being utilized for colorectal surgery. Data are scarce and contradictory when outcomes are compared between robotic and laparoscopic surgery. All patients undergoing minimally invasive colorectal surgery were compared from 2011 to 2016. Outcomes between the two groups were statistically analyzed. p < 0.05 was considered statistically significant. 185 patients underwent laparoscopic resection and 70 underwent robotic resection. Demographics, ASA score, and BMI were similar between the two groups (p > 0.05). There was no statistical difference in median length of stay between laparoscopic and robotic colon (both 4 days; p = 0.5) and rectal (6 vs 4.5 days; p = 0.2) resections. Median operative times were also similar between the two approaches for colon (150.5 vs 169.5 min, p = 0.2) and rectal (197.0 vs 231.5 min, p = 0.9) resections. There was also no difference in operative time between the two approaches for right (median = 137 vs 130.5 min; p = 0.9) and left (median = 162.0 vs 170.5 min; p = 0.6) colectomies. Robotic surgery results in similar operative times and length of stay as laparoscopic surgery for patients undergoing colon and rectal resections.

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Cancers, Vol. 10, Pages 93: The Role of Activator Protein-1 (AP-1) Family Members in CD30-Positive Lymphomas

Cancers, Vol. 10, Pages 93: The Role of Activator Protein-1 (AP-1) Family Members in CD30-Positive Lymphomas

Cancers doi: 10.3390/cancers10040093

Authors: Ines Garces de los Fayos Alonso Huan-Chang Liang Suzanne D. Turner Sabine Lagger Olaf Merkel Lukas Kenner

The Activator Protein-1 (AP-1) transcription factor (TF) family, composed of a variety of members including c-JUN, c-FOS and ATF, is involved in mediating many biological processes such as proliferation, differentiation and cell death. Since their discovery, the role of AP-1 TFs in cancer development has been extensively analysed. Multiple in vitro and in vivo studies have highlighted the complexity of these TFs, mainly due to their cell-type specific homo- or hetero-dimerization resulting in diverse transcriptional response profiles. However, as a result of the increasing knowledge of the role of AP-1 TFs in disease, these TFs are being recognized as promising therapeutic targets for various malignancies. In this review, we focus on the impact of deregulated expression of AP-1 TFs in CD30-positive lymphomas including Classical Hodgkin Lymphoma and Anaplastic Large Cell Lymphoma.

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A phase II, multicenter, single-arm trial of eribulin as first- or second-line chemotherapy for HER2-negative advanced or metastatic breast cancer: evaluation of efficacy, safety, and patient-reported outcomes

Abstract

Purpose

Although eribulin is a suitable option for early-line treatment of metastatic breast cancer (MBC), data on first- or second-line use of eribulin for human epidermal growth factor receptor 2 (HER2)-negative MBC are still limited. Therefore, we conducted a phase II trial to investigate the efficacy and safety of eribulin for first- or second-line chemotherapy for HER2-negative MBC.

Materials and methods

We performed a phase II, open-label, single-arm, multicenter study in Japan. Eligible patients were women with histologically confirmed HER2-negative MBC without chemotherapy or only one chemotherapy line for MBC. The primary endpoint was the overall response rate (ORR) and the secondary endpoints included the clinical benefit rate (ORR + stable disease for 6 months; CBR), progression-free survival (PFS), overall survival (OS), duration of response (DOR), safety, and health-related quality of life (HRQoL).

Results

A total of 35 patients with HER2-negative MBC were enrolled between March 2013 and February 2017 (data cut-off July 31, 2017). The ORR was 37.1% (95% CI 21.1–53.2%). The CBR was 54.3% (95% CI 37.8–70.8%). The median PFS was 6.2 months (95% CI 2.7–9.4 months) and median OS was 21.4 months (95% CI 11.5–32.9 months). Common grade 3/4 adverse events were neutropenia (42.9%) but febrile neutropenia (2.9%). Although the majority of non-hematological adverse events were mild in severity, one patient died of pneumonitis. In HRQoL analysis, eribulin appeared to maintain HRQoL of many patients.

Conclusions

Eribulin as first- or second-line chemotherapy is effective and has manageable toxicity for patients with HER2-negative MBC.

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The combination of cardiorespiratory fitness and muscle strength, and mortality risk

Abstract

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A phase II, multicenter, single-arm trial of eribulin as first- or second-line chemotherapy for HER2-negative advanced or metastatic breast cancer: evaluation of efficacy, safety, and patient-reported outcomes

Abstract

Purpose

Materials and methods

Results

Conclusions

Eribulin as first- or second-line chemotherapy is effective and has manageable toxicity for patients with HER2-negative MBC.

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Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis

Abstract

Purpose: To estimate the strength and shape of the dose–response relationship between sedentary behaviour and all-cause, cardiovascular disease (CVD) and cancer mortality, and incident type 2 diabetes (T2D), adjusted for physical activity (PA). Data Sources: Pubmed, Web of Knowledge, Medline, Embase, Cochrane Library and Google Scholar (through September-2016); reference lists. Study Selection: Prospective studies reporting associations between total daily sedentary time or TV viewing time, and ≥ one outcome of interest. Data Extraction: Two independent reviewers extracted data, study quality was assessed; corresponding authors were approached where needed. Data Synthesis: Thirty-four studies (1,331,468 unique participants; good study quality) covering 8 exposure-outcome combinations were included. For total sedentary behaviour, the PA-adjusted relationship was non-linear for all-cause mortality (RR per 1 h/day: were 1.01 (1.00–1.01) ≤ 8 h/day; 1.04 (1.03–1.05) > 8 h/day of exposure), and for CVD mortality (1.01 (0.99–1.02) ≤ 6 h/day; 1.04 (1.03–1.04) > 6 h/day). The association was linear (1.01 (1.00–1.01)) with T2D and non-significant with cancer mortality. Stronger PA-adjusted associations were found for TV viewing (h/day); non-linear for all-cause mortality (1.03 (1.01–1.04) ≤ 3.5 h/day; 1.06 (1.05–1.08) > 3.5 h/day) and for CVD mortality (1.02 (0.99–1.04) ≤ 4 h/day; 1.08 (1.05–1.12) > 4 h/day). Associations with cancer mortality (1.03 (1.02–1.04)) and T2D were linear (1.09 (1.07–1.12)). Conclusions: Independent of PA, total sitting and TV viewing time are associated with greater risk for several major chronic disease outcomes. For all-cause and CVD mortality, a threshold of 6–8 h/day of total sitting and 3–4 h/day of TV viewing was identified, above which the risk is increased.

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Maternal Thyroid Function in Early Pregnancy and Child Neurodevelopmental Disorders: A Danish Nationwide Case-Cohort Study

Thyroid, Ahead of Print.

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The Effects of Sex Differences and Hormonal Contraception on Outcomes after Collegiate Sports-Related Concussion

Journal of Neurotrauma, Ahead of Print.

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The Danger Zone in the Anterior Neck

Find out about the 'danger zone' in the anterior neck region that surgeons should be aware of when performing face-lifts and neck-lifts.
ePlasty, Open Access Journal of Plastic Surgery

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Mild Jugular Compression Collar Ameliorated Changes in Brain Activation of Working Memory after One Soccer Season in Female High School Athletes

Journal of Neurotrauma, Ahead of Print.

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The Effects of Sex Differences and Hormonal Contraception on Outcomes after Collegiate Sports-Related Concussion

Journal of Neurotrauma, Ahead of Print.

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Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis

Abstract

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Avelumab (anti-PD-L1) in platinum-resistant/refractory ovarian cancer: JAVELIN Ovarian 200 Phase III study design

Future Oncology, Ahead of Print.

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Avelumab (anti-PD-L1) in platinum-resistant/refractory ovarian cancer: JAVELIN Ovarian 200 Phase III study design

Future Oncology, Ahead of Print.

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IMGN779, a Novel CD33-Targeting Antibody-Drug Conjugate with DNA Alkylating Activity, Exhibits Potent Antitumor Activity in Models of AML

The myeloid differentiation antigen CD33 has long been exploited as a target for antibody-based therapeutic approaches in acute myeloid leukemia (AML). Validation of this strategy was provided with the approval of the CD33-targeting antibody-drug conjugate (ADC) gemtuzumab ozogamicin in 2000; the clinical utility of this agent has however been hampered by safety concerns. Thus, the full potential of CD33-directed therapy in AML remains to be realized, and considerable interest exists in the design and development of more effective ADCs that confer high therapeutic indices and favorable tolerability profiles. Here we describe the preclinical characterization of a novel CD33-targeting ADC, IMGN779, which utilizes a unique DNA alkylating payload to achieve potent antitumor effects with good tolerability. The payload, DGN462, is prototypical of a novel class of purpose-created indolinobenzodiazeprine pseudodimers, termed IGNs. With low picomolar potency, IMGN779 reduced viability in a panel of AML cell lines in vitro. Mechanistically, the cytotoxic activity of IMGN779 involved DNA damage, cell cycle arrest, and apoptosis consistent with the mode of action of DGN462. Moreover, IMGN779 was highly active against patient-derived AML cells, including those with adverse molecular abnormalities, and sensitivity correlated to CD33 expression levels. In vivo, IMGN779 displayed robust antitumor efficacy in multiple AML xenograft and disseminated disease models, as evidenced by durable tumor regressions and prolonged survival. Taken together, these findings identify IMGN779 as a promising new candidate for evaluation as a novel therapeutic in AML.

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Tumor infiltrating lymphocytes and PD-L1 expression in pre- and post-treatment breast cancers in the SWOG S0800 Phase II neoadjuvant chemotherapy trial

Our aim was to examine the association of pre-treatment tumor infiltrating lymphocyte (TIL) count and PD-L1 levels with pathologic complete response (pCR) and assess immune marker changes following treatment in tumor specimens from the S0800 clinical trial which randomized patients to bevacizumab+nab-paclitaxel followed by doxorubicin/cyclophosphamide (AC) versus two control arms without bevacizumab (varying sequence of AC and nab-paclitaxel). TILs were assessed in 124 pre- and 62 post-treatment tissues (including 59 pairs). PD-L1 was assessed in 120 pre- and 43 post-treatment tissues (including 39 pairs) using the 22C3 antibody. Baseline and treatment-induced immune changes were correlated with pCR and survival using estrogen receptor (ER) and treatment adjusted logistic and Cox regressions, respectively. At baseline, the mean TIL count was 17.4% (17% had zero TIL, 9% had >50% TILs). Post-treatment, mean TIL count decreased to 11% (5% had no TIL, 2% had > 50% TILs). In paired samples, the mean TILs change was 15% decrease. Baseline PD-L1 was detected in 43% of cases (n=5 in tumor cells, n=29 stroma, n=18 tumor+stroma). Post-treatment, PD-L1 expression was not significantly lower, 33%. Higher baseline TIL count and PD-L1 positivity rate were associated with higher pCR rate even after adjustment for treatment and ER status (p=0.018). There was no association between TIL counts, PD-L1 expression and survival due to few events. In conclusion, TIL counts, but not PD-L1 expression, decreased significantly after treatment. Continued PD-L1 expression in some residual cancers raises the possibility that adjuvant immune checkpoint inhibitor therapy could improve survival in this patient population.

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Sources of variance in BC mass measurements from a small marine engine: Influence of the instruments, fuels and loads

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Yu Jiang, Jiacheng Yang, Stéphanie Gagné, Tak W. Chan, Kevin Thomson, Emmanuel Fofie, Robert A. Cary, Dan Rutherford, Bryan Comer, Jacob Swanson, Yue Lin, Paul Van Rooy, Akua Asa-Awuku, Heejung Jung, Kelley Barsanti, Georgios Karavalakis, David Cocker, Thomas D. Durbin, J. Wayne Miller, Kent C. Johnson
Knowledge of black carbon (BC) emission factors from ships is important from human health and environmental perspectives. A study of instruments measuring BC and fuels typically used in marine operation was carried out on a small marine engine. Six analytical methods measured the BC emissions in the exhaust of the marine engine operated at two load points (25% and 75%) while burning one of three fuels: a distillate marine (DMA), a low sulfur, residual marine (RMB-30) and a high-sulfur residual marine (RMG-380). The average emission factors with all instruments increased from 0.08 to 1.88 gBC/kg fuel in going from 25 to 75% load. An analysis of variance (ANOVA) tested BC emissions against instrument, load, and combined fuel properties and showed that both engine load and fuels had a statistically significant impact on BC emission factors. While BC emissions were impacted by the fuels used, none of the fuel properties investigated (sulfur content, viscosity, carbon residue and CCAI) was a primary driver for BC emissions. Of the two residual fuels, RMB-30 with the lower sulfur content, lower viscosity and lower residual carbon, had the highest BC emission factors. BC emission factors determined with the different instruments showed a good correlation with the PAS values with correlation coefficients R2 >0.95. A key finding of this research is the relative BC measured values were mostly independent of load and fuel, except for some instruments in certain fuel and load combinations.

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Editorial Board

Publication date: May 2018
Source:Atmospheric Environment, Volume 181

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Loss of PTEN in High Grade Advanced Stage Triple Negative Breast Ductal Cancers in African American Women

Publication date: Available online 27 March 2018
Source:Pathology - Research and Practice
Author(s): Farhan Khan, Ashwini Esnakula, Luisel J Ricks-Santi, Rabia Zafar, Yasmine Kanaan, Tammey Naab
IntroductionPTEN is a tumor suppressor gene that inhibits cell proliferation by inhibiting the phosphoinositide 3- kinase (PI3 K) signaling pathway. The significance of PTEN mutations resulting in variable PTEN expression and their impact on prognosis of breast cancer is not well established. The objective of our study was to correlate the immunohistochemical expression of PTEN in the four major subtypes of breast carcinoma (Luminal A, Luminal B, HER2 positive, and Triple Negative) in a population of 202 African-American (AA) females with other clinicopathological factors.Materials and MethodsTissue microarrays (TMAs) were constructed from FFPE tumor blocks from primary ductal breast carcinomas in 202 African-American females. Five micrometer sections were stained with a mouse monoclonal antibody against PTEN. The sections were evaluated for the intensity of cytoplasmic and nuclear reactivity. Bivariate analysis was done via χ2 analysis and survivability data was calculated via the generation of Kaplan-Meier curves (SPSS v19).ResultsLoss of PTEN expression was associated with ER negative (p = 0.021), PR negative (p = 0.024) and triple negative (p = 0.0024) breast ductal cancers. It was marginally associated with distant metastasis (p = 0.074). There was no association between PTEN loss and recurrence-free survival or overall survival.ConclusionIn our study, a statistically significant association between PTEN loss and the triple negative breast cancers (TNBC) was found in AA women. PTEN inhibits PI3 K resulting in decreased activation of downstream effector, mammalian target of rapamycin (mTOR). Loss of PTEN results in cell proliferation through activation of mTOR. Targeted therapy with mTOR inhibitors might be useful in the treatment of TNBC.

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Hematologic Markers of Lung Metastasis in Stage IV Colorectal Cancer

Abstract

Background

Many studies showed an association between absolute neutrophil count (ANC), absolute monocyte count (AMC), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) with poor overall survival (OS) in patients with cancer. However, only a few studies were conducted to further investigate this association in colorectal cancer (CRC).

Methods

Clinical data from 299 stage IV CRC patients treated at King Hussein Cancer Center from 2004 to 2012 have been retrospectively reviewed. We examined the association between ANC, AMC, MLR, PLR, and NLR with lung metastasis in stage IV CRC. Receiver Operating Characteristic (ROC) curve analysis was operated to determine the optimal NLR cutoff value. Univariate and multivariate analysis were performed.

Results

The ROC value of 3.4 was determined as the cutoff value of NLR to study the association. Univariate and multivariate analysis showed that patients with high baseline NLR (≥ 3.4) had more baseline lung metastasis than patients with low NLR (< 3.4) (p = 0.0001, p = 0.0151, respectively). Also, baseline NLR correlated significantly with the presence of lymphovascular invasion (p = 0.001). In patients with no baseline lung metastasis, high post-treatment NLR was associated with consequent development of lung metastasis (p = 0.0227). Other markers including ANC, AMC, MLR, and PLR were significantly associated with lung metastasis at time of diagnosis (p = 0.0006, p = 0.0006, p = 0.0187, and p = 0.001, respectively).

Conclusion

Results are suggesting that different hematologic markers obtained from a cheap test (CBC) could potentially be used to predict the likelihood of lung metastasis in stage IV CRC. Prospective studies are needed to further assess the immune cells' role in tumor metastasis promotion.

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Study of Pre and Post Operative Videostroboscopic Evaluation of Benign Vocal Cord Lesions

Abstract

To determine pre and postoperative vocal fold vibratory changes using videostroboscopy (VS) and effect of surgery on functional, physical and emotional levels of voice using voice handicap index (VHI). To determine correlation between VHI and VS in patients with benign vocal fold pathology. This is a prospective study done at Pushpagiri Medical College. 40 patients in the age group of 14–75 years who presented with complaints of voice change were included. VS and VHI of patients done preoperatively in 40 patients. Patients were re-evaluated postoperatively at 1 month by VHI and VS. All patients underwent microlaryngoscopic excision of the benign vocal cord lesion with biopsy under GA in the conventional manner. One month postoperatively, these patients were evaluated by VS and VHI and the findings noted. There was statistically significant improvement in the stroboscopy ratings and VHI scores post operatively (p < 0.0001). The mucosal wave was diminished or absent in 100% of the studied TVC cysts and present in approximately 60% of vocal polyps. There was no significant correlation found between preoperative VHI scores and stroboscopy ratings except for mucosal waves. Whereas there was significant correlation noted between the VHI subscales and total scores with stroboscopic scores postoperatively except for symmetry. All but 6 patients in this study benefitted from surgery and 85% had a normal voice post-operatively. Pre and post operative assessment of patients with benign vocal fold lesions by stroboscopy and VHI is a useful way to determine the degree of improvement following surgery.

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Study of Pre and Post Operative Videostroboscopic Evaluation of Benign Vocal Cord Lesions

Abstract

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A G3BP1-interacting lncRNA promotes ferroptosis and apoptosis in cancer via nuclear sequestration of p53

Long non-coding RNAs (lncRNA) have been associated with various types of cancer, however, the precise role of many lncRNAs in tumorigenesis remains elusive. Here we demonstrate that the cytosolic lncRNA P53RRA is downregulated in cancers and functions as a tumor suppressor by inhibiting cancer progression. Chromatin remodeling proteins LSH and Cfp1 silenced or increased P53RRA expression respectively. P53RRA bound Ras GTPase-activating protein-binding protein 1 (G3BP1) using nucleotides 1 and 871 of P53RRA and the RRM interaction domain of G3BP1 (aa 177-466). The cytosolic P53RRA-G3BP1 interaction displaced p53 from a G3BP1 complex resulting in greater p53 retention in the nucleus which led to cell cycle arrest, apoptosis, and ferroptosis. P53RRA promoted ferroptosis and apoptosis by affecting transcription of several metabolic genes. Low P53RRA expression significantly correlated with poor survival in patients with breast and lung cancers harboring wild-type p53. These data show that lncRNAs can directly interact with the functional domain of signaling proteins in the cytoplasm, thus regulating p53 modulators to suppress cancer progression.

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The circular RNA circPRKCI promotes tumor growth in lung adenocarcinoma

Somatic copy-number variations (CNV) may drive cancer progression through both coding and noncoding transcripts. However, noncoding transcripts resulting from CNV are largely unknown, especially for circular RNAs. By integrating bioinformatics analyses of alerted circRNAs and focal CNV in lung adenocarcinoma (LAC), we identify a proto-oncogenic circular RNA (circPRKCI) from the 3q26.2 amplicon, one of the most frequent genomic aberrations in multiple cancers. circPRKCI was overexpressed in LAC tissues, in part due to amplification of the 3q26.2 locus, and promoted proliferation and tumorigenesis of LAC. circPRKCI functioned as a sponge for both miR-545 and miR-589 and abrogated their suppression of the pro-tumorigenic transcription factor E2F7. Intra-tumor injection of cholesterol-conjugated siRNA specifically targeting circPRKCI inhibited tumor growth in a patient-derived LAC xenograft model. In summary, circPRKCI is crucial for tumorigenesis and may serve as a potential therapeutic target in LAC patients.

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I{kappa}B kinase {alpha} is required for development and progression of KRAS-mutant lung adenocarcinoma.

Although oncogenic activation of nuclear factor (NF)-κΒ has been identified in various tumors, the NF-κΒ-activating kinases (inhibitor of NF-κΒ kinases, IKK) responsible for this are elusive. In this study, we determined the role of IKKα and IKKβ in KRAS-mutant lung adenocarcinomas induced by the carcinogen urethane and by respiratory epithelial expression of oncogenic KRASG12D. Using NF-κB reporter mice and conditional deletions of IKKα and IKKβ, we identified two distinct early and late activation phases of NF-κΒ during chemical and genetic lung adenocarcinoma development, which were characterized by nuclear translocation of RelB, ΙκΒβ, and IKKα in tumor-initiated cells. IKKα was a cardinal tumor promoter in chemical and genetic KRAS-mutant lung adenocarcinoma, and respiratory epithelial IKKα-deficient mice were markedly protected from the disease. IKKα specifically cooperated with mutant KRAS for tumor induction in a cell-autonomous fashion, providing mutant cells with a survival advantage in vitro and in vivo. IKKα was highly expressed in human lung adenocarcinoma, and a heat shock protein 90 inhibitor that blocks IKK function delivered superior effects against KRAS-mutant lung adenocarcinoma compared with a specific IKKβ inhibitor. These results demonstrate an actionable requirement for IKKα in KRAS-mutant lung adenocarcinoma, marking the kinase as a therapeutic target against this disease.

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Intratumoral CpG-B promotes anti-tumoral neutrophil, cDC, and T cell cooperation without reprograming tolerogenic pDC

Cancer immunotherapies utilize distinct mechanisms to harness the power of the immune system to eradicate cancer cells. Therapeutic vaccines, aimed at inducing active immune responses against an existing cancer, are highly dependent on the immunological microenvironment, where many immune cell types display high levels of plasticity and, depending on the context, promote very different immunological outcomes. Among them, plasmacytoid dendritic cells (pDC), known to be highly immunogenic upon inflammation, are maintained in a tolerogenic state by the tumor microenvironment. Here we report that intratumoral (i.t.) injection of established solid tumors with CpG oligonucleotides-B (CpG-B) inhibits tumor growth. Interestingly, control of tumor growth was independent of tumor-associated (TA) pDC, which remained refractory to CpG-B stimulation and whose depletion did not alter the efficacy of the treatment. Instead, tumor growth inhibition subsequent to i.t. CpG-B injection depended on the recruitment of neutrophils into the milieu, resulting in the activation of conventional dendritic cells (cDC), subsequent increased anti-tumor T cell priming in draining lymph nodes, and enhanced effector T cell infiltration in the tumor microenvironment. These results reinforce the concept that intratumoral delivery of TLR9 agonists alters the tumor microenvironment by improving the anti-tumor activity of both innate and adaptive immune cells.

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Exome sequencing of plasma DNA portrays the mutation landscape of colorectal cancer and discovers mutated VEGFR2 receptors as modulators of anti-angiogenic therapies

Background:Despite the wide use of antiangiogenic drugs in the clinical setting, predictive biomarkers of response to these drugs are still unknown.Experimental design: We applied whole-exome sequencing of matched germline and basal plasma cell-free DNA samples (WES-cfDNA) on a RAS/BRAF/PIK3CA wild-type metastatic colorectal cancer patient with primary resistance to standard treatment regimens, including inhibitors to the VEGF:VEGFR2 pathway. We performed extensive functional experiments, including ectopic expression of VEGFR2 mutants in different cell lines, kinase and drug sensitivity assays, and cell- and patient-derived xenografts. Results: WES-cfDNA yielded a 77% concordance rate with tumor exome sequencing and enabled the identification of the KDR/VEGFR2 L840F clonal, somatic mutation as the cause of therapy refractoriness in our patient. Additionally, we found that 1-3% of samples from cancer sequencing projects harbor KDR somatic mutations located in protein residues frequently mutated in other cancer-relevant kinases, such as EGFR, ABL1, and ALK. Our in vitro and in vivo functional assays confirmed that L840F causes strong resistance to anti-angiogenic drugs, whereas the KDR hot-spot mutant R1032Q confers sensitivity to strong VEGFR2 inhibitors. Moreover, we showed that the D717V, G800D, G800R, L840F, G843D, S925F, R1022Q, R1032Q, and S1100F VEGFR2 mutants promote tumor growth in mice. Conclusions: Our study supports WES-cfDNA as a powerful platform for portraying the somatic mutation landscape of cancer and discovery of new resistance mechanisms to cancer therapies. Importantly, we discovered that VEGFR2 is somatically mutated across tumor types and that VEGFR2 mutants can be oncogenic and control sensitivity/resistance to antiangiogenic drugs.

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Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes

Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes

Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes, Published online: 28 March 2018; doi:10.1038/s41416-018-0041-x

Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes

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Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer

Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer

Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer, Published online: 28 March 2018; doi:10.1038/s41416-018-0027-8

Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer

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Incidence of Radiographically Occult Nodal Metastases in HPV+ Oropharyngeal Carcinoma: Implications for Reducing Elective Nodal Coverage

Publication date: Available online 27 March 2018
Source:Practical Radiation Oncology
Author(s): Gokoulakrichenane Loganadane, Jacqueline R. Kelly, Nicholas C. Lee, Benjamin Kann, Amit Mahajan, James E. Hansen, Yazid Belkacémi, Wendell Yarbrough, Zain Husain
PurposeInitial de-escalation studies for HPV-driven oropharyngeal squamous cell carcinomas (HPV+ OPSCC) altered radiotherapy dose or the systemic agent used. Newer trials examine the disease control achieved with a reduced elective nodal field. We examined patterns of nodal involvement in patients with HPV+ OPSCC with a focus on implications for radiation field design for treatment de-escalation.Methods and materialsRecords of patients with HPV+ OPSCC with preoperative imaging (CT or FDG-PET/CT) who underwent neck dissection without neoadjuvant therapy from 2010 to 2017 were retrospectively reviewed. The number and location of clinically positive lymph nodes on preoperative imaging were compared with those documented on pathology. These data were then used to establish the probability of missing nodal disease in three modified radiation field designs.ResultsOne hundred patients were included. The median time between imaging and surgery was 22 days. The most common clinical N stage was cN2a (35%), while the most common pathologic N stage was pN2b (45%). The median number of radiographically and pathologically involved nodes was 1 (range 0-6) and 2 (range 0-11), respectively. 43% of patients had more pathologically involved nodes than predicted on imaging, while 21% had pathologic involvement at an additional nodal level not predicted on imaging. Of the 21 patients with additional pathologically involved nodal levels, 14 had involvement of a directly adjacent station, four were patients with a cN0 hemineck with pathologically positive level II disease, and three had pathologic involvement of a level two echelons removed from that predicted on imaging.ConclusionOur study suggests that radiation fields encompassing only clinically involved nodes or levels has an unacceptably high likelihood of missing subclinical disease. Alternatively, treating the first uninvolved echelon nodes in addition would cover pathologic sites of disease in 97% of patients. This approach merits further study in prospective trials.

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Anosmia and nasal obstruction

Publication date: Available online 26 March 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J.J. Braun, S. Riehm

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A New Method for Monitoring Abnormal Muscle Response in Hemifacial Spasm: A Prospective Study

Hemifacial spasm (HFS) is a neurovascular compression syndrome and microvascular decompression (MVD) is the only curative treatment. An intraoperative abnormal muscle response (AMR) has been a reliable diagnostic tool and indicator of complete facial nerve decompression. An AMR is elicited by stimulation of a facial nerve branch and is recorded from facial muscles innervated by other nerve branches. Typically, it is instantly eliminated on intraoperative facial nerve electromyography (EMG) when the facial nerve is decompressed.

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Correlation between body mass index and obstructive sleep apnea severity indexes — A retrospective study

To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA).

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Phenotypic presentation of adolescents with overt primary hypothyroidism

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Metabolic and genetic markers’ associations with elevated levels of alanine aminotransferase in adolescents

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes

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Multivariable clinical-genetic risk model for predicting venous thromboembolic events in patients with cancer

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Trend in otolaryngological surgeries in an era of super-aging: Descriptive statistics using a Japanese inpatient database

To reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging.

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Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial

The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period.

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Microcystic adnexal carcinoma—diagnostic criteria and therapeutic methods: case report and review of the literature

Microcystic adnexal carcinoma (MAC) is a rare, infiltrating, locally aggressive cutaneous neoplasm of combined follicular and eccrine/apocrine histogenesis, usually presenting on the upper lip or face. Differentiation from other adnexal tumours is very important because the clinical management of these tumours is radically different, and misdiagnosis may lead to incorrect treatment. A case of recurrent MAC in the upper lip, treated with multiple excisions and postoperative radiation therapy (PORT), is presented herein.

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The forgotten aspects of the quality of life of significant others of patients with a peripheral facial palsy

A peripheral facial palsy (PFP) has a significant impact on the health related quality of life (HRQoL), psychosocial distress, communication and social interaction. Even after several treatment modalities the HRQoL increases, but comes nowhere near the pre-disease levels. 1 It is hypothesized and studied that there might be differences between cosmetic appreciation of patients with a left and right PFP, and that this might lead to altered social interactions between patients and their significant others (including partners, family members and close friends) (SO's).

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Correlation between body mass index and obstructive sleep apnea severity indexes — A retrospective study

Publication date: Available online 27 March 2018
Source:American Journal of Otolaryngology
Author(s): Domenico Ciavarella, Michele Tepedino, Claudio Chimenti, Giuseppe Troiano, Manuela Mazzotta, Maria Pia Foschino Barbaro, Lorenzo Lo Muzio, Michele Cassano
PurposeTo evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA).Materials and methodsSeventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025.ResultsNo correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r² = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2.ConclusionsHigher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.

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Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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Anke Beck to leave De Gruyter

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The Impact of Lexical Characteristics and Noise on Intelligibility of Parkinsonian Speech

Purpose

This study investigated the impact of lexical characteristics on the intelligibility of speakers with Parkinson's disease (PD). Intelligibility was compared for listening in a quiet versus a noisy environment.

Method

A total of 192 young listeners participated in the study, with 96 listeners listening in quiet and 96 listening in noise in which the spoken sentences were mixed with 10-talker babble. The listeners transcribed spoken sentences with target words controlled for word frequency and neighborhood density. The sentences were produced by 12 speakers with PD and 12 healthy control (HC) speakers. Transcription accuracy was compared across lexical categories between PD and HC and between the two listening conditions.

Results

Transcription accuracy was higher for high-frequency words than low-frequency words for both speaker groups in quiet and in noise. The neighborhood density effect was evident only in the noise condition with better intelligibility for words from sparse neighborhoods than from dense neighborhoods. Regardless of listening condition, the PD group was less intelligible with a significant decrease in intelligibility in noise relative to quiet.

Conclusions

The lexical properties of the words affected listeners' understanding of Parkinsonian speech. Frequent words in sparse neighborhood enhanced intelligibility, especially under adverse listening conditions. Babble noise had a detrimental impact on the intelligibility of Parkinsonian speech. The extent of the lexical effect on intelligibility increased in noise.

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Vocal Emotion Identification by Children Using Cochlear Implants, Relations to Voice Quality, and Musical Interests

Purpose

Listening tests for emotion identification were conducted with 8–17-year-old children with hearing impairment (HI; N = 25) using cochlear implants, and their 12-year-old peers with normal hearing (N = 18). The study examined the impact of musical interests and acoustics of the stimuli on correct emotion identification.

Method

The children completed a questionnaire with their background information and noting musical interests. They then listened to vocal stimuli produced by actors (N = 5) and consisting of nonsense sentences and prolonged vowels ([a:], [i:], and [u:]; N = 32) expressing excitement, anger, contentment, and fear. The children's task was to identify the emotions they heard in the sample by choosing from the provided options. Acoustics of the samples were studied using Praat software, and statistics were examined using SPSS 24 software.

Results

The children with HI identified the emotions with 57% accuracy and the normal hearing children with 75% accuracy. Female listeners were more accurate than male listeners in both groups. Those who were implanted before age of 3 years identified emotions more accurately than others (p < .05). No connection between the child's audiogram and correct identification was observed. Musical interests and voice quality parameters were found to be related to correct identification.

Conclusions

Implantation age, musical interests, and voice quality tended to have an impact on correct emotion identification. Thus, in developing the cochlear implants, it may be worth paying attention to the acoustic structures of vocal emotional expressions, especially the formant frequency of F3. Supporting the musical interests of children with HI may help their emotional development and improve their social lives.

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The Effects of Parent Training on Vocabulary Scores of Young Children With Hearing Loss

Purpose

The purpose of this study is to evaluate the effects of short-term parent training on maternal use of language stimulation strategies and vocabulary scores in children with hearing loss.

Method

Six mother–child dyads participated in the multiple-baseline study. During baseline and maintenance, children engaged in a business-as-usual model of clinician-only therapy. During intervention, mothers and children participated in parent training focused on transparent labeling and linguistic mapping strategies. Parent strategy use was measured via weekly play-based probe assessments. Child vocabulary growth was measured via parent report.

Results

A relation between parent training and use of transparent labeling was established for all mothers, and a relation between parent training and use of linguistic mapping was established for 3 of 6 mothers. Child vocabulary growth rate increased from baseline to intervention in 4 of 6 children.

Conclusions

Short-term parent training can change parent behavior. However, parents may not maintain these skills without support. Further research is needed to characterize the extent to which short-term training can make long-term changes in parent and child outcomes.

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Measuring the Diagnostic Features of Social (Pragmatic) Communication Disorder: An Exploratory Study

Purpose

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition introduced a new neurodevelopmental disorder, social (pragmatic) communication disorder (SPCD), that is characterized by deficits in 4 areas of communication. Although descriptions of these areas are provided, no assessment tools for SPCD are recommended. The purpose of this study was to examine the extent to which items from measurement tools commonly used in assessing pragmatic language impairment and related disorders might be useful in assessing the characteristics of social communication that define SPCD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Method

Based on a literature search, 594 items from assessment tools commonly used to measure social communication abilities in people with pragmatic language impairment were identified. The first author judged whether each item reflected 1, more than 1, or none of the 4 SPCD diagnostic characteristics. After a brief training process, 5 second raters independently mapped subsets of items to the 6 categories. We calculated the percentage of agreement and Cohen's kappa for each pair of raters in assigning items to categories.

Results

Percentages of agreement ranged from 76% to 82%, and Cohen's kappa values ranged from .69 to .76, indicating substantial agreement. Sources and item numbers for the 206 items that both raters assigned to the same SPCD feature are provided.

Conclusions

These items may provide guidance in assessing SPCD and in designing standardized screening and diagnostic measures for SPCD.

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Overexpression of Lox in triple-negative breast cancer

Publication date: Available online 27 March 2018
Source:Annals of Diagnostic Pathology
Author(s): Cornelia Leo, Christine Cotic, Victoria Pomp, Daniel Fink, Zsuzsanna Varga
BackgroundTriple negative breast cancer (TNBC) accounts for approximately 15% of breast cancers. It is associated with a poor prognosis and typically earlier onset of metastasis in comparison with other breast cancer subtypes. Since TNBC lacks the expression of estrogen and progesterone receptors and Her2 status is also negative, there is currently no target that can be used for systemic therapy. Epithelial-mesenchymal transition (EMT) plays an important role in tumor progression and metastasis. In this study, we examined a subset of EMT markers consisting of Snail, Twist-1 and Lox in TNBC and non-TNBC breast cancer subtypes and analyzed their expression pattern in regard to subtype, clinico-pathological parameters and prognosis.Experimental designWe analyzed 659 breast cancer samples from two tissue microarrays. Breast cancer samples were categorized into two groups according to hormone receptor expression and Her2 status (n = 146 were triple negative, n = 513 were non triple-negative). Immunohistochemical expression of Snail, Twist-1 and Lox was semi-quantitatively analyzed using a three-tiered (weak-moderate-strong) scoring system. Results were statistically analyzed and correlated to clinico-pathological parameters and overall survival.ResultsStrong overexpression of Lox was significantly higher in triple negative breast cancers when compared to non triple-negative breast cancers (p < 0.001). No difference was seen between the groups regarding Snail and Twist expression (p > 0.05). In addition, Lox expression was significantly stronger in poorly differentiated (G3) breast cancers (p < 0.001 for Lox).ConclusionsThe EMT marker Lox has a differential expression pattern in breast cancer, being significantly overexpressed in triple negative breast cancers. We could not link this expression to prognosis, however, this marker might be explored in future studies as possible target for systemic therapy of TNBC.

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Track-structure simulations of energy deposition patterns to mitochondria and damage to their DNA

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Matrix Metalloproteinase 8: Could it Benefit the CAR-T Cell Therapy of Solid Tumors?- a- Commentary on Therapeutic Potential

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Cochlear Implantation in Adults With Asymmetric Hearing Loss: Speech Recognition in Quiet and in Noise, and Health Related Quality of Life

Objective: To examine the possible speech recognition and health related quality of life (HRQoL) benefits of cochlear implantation among adults with asymmetric sensorineural hearing loss. Study Design: Retrospective chart review, single-subject design. Methods: A total of 45 adult cochlear implant recipients with asymmetric sensorineural hearing loss where performance for the best-aided condition exceeded 60% correct open set sentence recognition in quiet, and the implanted ear met traditional candidacy criteria. End point testing of the implanted ear was evaluated with use of the Consonant-Vowel Nucleus-Consonant (CNC) word test and AzBio sentence test materials in quiet, and bimodally with the AzBio sentence test materials in noise at +5 dB signal-to-noise ratio (SNR). HRQoL was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Results: Measured in quiet, with the non-implanted ear plugged, the average CNC word scores increased from 9.1% preoperatively to 55.7% (p

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Efficacy of Testosterone plus NASA Exercise Countermeasures during Head-Down Bed Rest

Introduction Prolonged confinement to head-down bed rest (HDBR) results in musculoskeletal losses similar to those observed during long duration space flight. Exercise countermeasures by themselves have not completely prevented the deleterious losses in muscle mass or function in HDBR or space flight. Purpose The objective was to investigate the safety and efficacy of intermittent, low-dose testosterone treatment in conjunction with NASA exercise (SPRINT) countermeasures during 70 days of 6° HDBR. Method Healthy men (35 ± 8 yrs) were randomized into one of three groups that remained inactive (CON) or performed exercise 6 days per week in addition to receiving either placebo (PEX) or testosterone treatment (TEX, 100mg/week). Testosterone/placebo injections were administered once a week for 2 weeks, followed by two weeks off, etc. during HDBR. Results Total, leg, and trunk LBM consistently decreased in CON, increased in TEX, with little or no changes in PEX. Total, leg, and trunk FM consistently increased in CON and PEX and decreased in TEX. Leg strength decreased in CON while PEX and TEX were protected against loss in strength. Changes in leg LBM correlated positively with changes in leg muscle strength. Conclusion Addition of a testosterone countermeasure enhanced the preventative actions of exercise against body composition changes during long-term HDBR in healthy eugonadal men. This is the first report to demonstrate that cycled, low dose testosterone treatment increases LBM under conditions of strict exercise control. These results are clinically relevant to the development of safe and effective therapies against muscle atrophy during long-term bed rest, aging, and disease where loss of muscle mass and strength is a risk. The potential space flight applications of such countermeasure combinations deserve further investigations. Correspondence: Edgar L. Dillon, Ph.D. Assistant Professor, The University of Texas Medical Branch, 301 University Blvd. Galveston, Texas 77555, Phone 409-772-8701, eldillon@utmb.edu This study was funded by the National Aeronautics and Space Administration (#NNX10AP86G, RJU/MSM) and conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences, National Institutes of Health. Authors have no conflicts of interest. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 5 February 2018 © 2018 American College of Sports Medicine

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Exercise Training Mitigates Multi-System Deconditioning during Bed Rest

Introduction This study investigated the safety and effectiveness of a new integrated aerobic and resistance exercise training prescription (SPRINT) using two different sets of exercise equipment: a suite of large ISS-like exercise equipment similar to what is found on the International Space Station (ISS) and a single device with aerobic and resistance exercise capability in the spaceflight analog of bed rest (BR). Methods: Subjects (n=34) completed 70 days of 6° head down tilt BR: 9 were randomized to remain sedentary (CONT), 9 to exercise training using traditional equipment (EX), 8 to exercise using traditional equipment and low dose testosterone supplementation (ExT), and 8 to exercise using a combined resistance and aerobic flywheel device (FLY). Peak aerobic capacity (VO2peak), ventilatory threshold (VT), cardiac morphology and function (echocardiography), muscle mass (magnetic resonance imaging (MRI)) and strength/power (isokinetic, leg press, and vertical jump), and bone health (bone mineral density (BMD), blood and urine bone markers) were assessed before and after bed rest. Results The SPRINT protocol mitigated bed rest-induced muscle and cardiac deconditioning regardless of the exercise device used. Molecular markers of bone did not change in CONT or EX groups. VO2peak was maintained from pre to post bed rest in all exercise groups similarly whereas significant declines were observed in CONT (~10%). Significant interaction effects between CONT and all EX groups were observed for muscle performance including leg press total work, isokinetic upper and lower leg strength, vertical jump power and maximal jump height as well as muscle size. Conclusions This is the first trial to evaluate multi-system deconditioning and the role of an integrated exercise countermeasure. These findings have important implications for the design and implementation of exercise-based countermeasures on future long duration spaceflight missions. Correspondence: Lori Ploutz-Snyder, School of Kinesiology, University of Michigan, Ann Arbor, MI. 4170 Observatory Lodge, 1402 Washington Heights, Ann Arbor, MI 48109-2013. (734) 764-5210. lorips@umich.edu Funding: This study was supported by a research grant from NASA Human Research Program and the National Space Biomedical Research Institute (NSBRI) Conflicts of Interest: The authors declare no conflicts of interest. Accepted for Publication: 5 February 2018 © 2018 American College of Sports Medicine

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Computer tomographic assessment of postoperative peripancreatic collections after distal pancreatectomy

Abstract

Background

Peripancreatic collections occur frequently after distal pancreatectomy. However, the sequelae of peripancreatic collections vary from case to case, and their clinical impact is uncertain. In this study, the correlations between CT findings of peripancreatic collections and complications after distal pancreatectomy were investigated.

Methods

Ninety-six consecutive patients who had undergone distal pancreatectomy between 2010 and 2015 were retrospectively investigated. The extent and heterogeneity of peripancreatic collections and background clinicopathological characteristics were analyzed. The extent of peripancreatic collections was calculated based on three-dimensional computed tomography images, and the degree of heterogeneity of peripancreatic collections was assessed based on the standard deviation of their density on computed tomography.

Results

Of 85 patients who underwent postoperative computed tomography imaging, a peripancreatic collection was detected in 77 (91%). Patients with either a large extent or a high degree of heterogeneity of peripancreatic collection had a significantly higher rate of clinically relevant pancreatic fistula than those without (odds ratio 5.95, 95% confidence interval 2.12–19.72, p = 0.001; odds ratio 8.0, 95% confidence interval 2.87–24.19, p = 0.0001, respectively).

Conclusions

A large and heterogeneous peripancreatic collection was significantly associated with postoperative complications, especially clinically relevant postoperative pancreatic fistula. A small and homogenous peripancreatic collection could be safely observed.

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Running at submaximal speeds, the role of the intact and prosthetic limbs for trans-tibial amputees

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Siobhan C. Strike, Daniela Acrone, Michael Orendurff
BackgroundDynamic Elastic Response prostheses are designed absorb and return strain energy in running. Past research has focused on running prostheses with a single toe spring designed for high speeds.Research QuestionTo determine how runners with amputation modulate the ground reaction force of each limb to run at different speeds using a general-purpose dynamic prosthesis which has a heel spring.MethodsOverground running data were collected in 16 recreational runners (8 transtibial amputee using their own BladeXT prosthesis and 8 controls) using Vicon Nexus V.2.5 with Kistler force plates. Participants ran at self-selected running pace, 70% and 130% of that pace. Vertical, braking and propulsion peak ground reaction forces and impulses and vertical loading and decay rates were analysed between limbs at each speed (ANOVA) and their association with speed assessed (simple linear regression).ResultsThe vertical, braking forces and impulses and propulsive force were significantly less (p < 0.05) on the prosthetic limb than controls at the faster speed, but there was no difference in the propulsive impulse. The intact limb did not evidence increased vertical force at any speed, but experienced increased braking (p < 0.05) compared to both prosthetic limb and controls at the slow speed. For all limbs, braking and propulsive peak forces, decay rate, step length and step frequency were strongly (r > 0.6) and significantly (p < 0.05) associated with speed. On the prosthetic limb vertical impulse was strongly and significantly negatively associated with speed and control's braking impulse was associated with speed.SignificanceA leg-specific response was found at different speeds. On the prosthetic limb the technique was to brake less not propel more at higher speeds with reduced vertical drive. Running at self-selected speed could be used for fitness without inducing detrimental ground reaction forces on the intact limb or evoking asymmetry in step length and frequency.

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Energy expenditure in people with transtibial amputation walking with crossover and energy storing prosthetic feet: A randomized within-subject study

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Cody L. McDonald, Patricia Kramer, Sara J. Morgan, Elizabeth G. Halsne, Sarah M. Cheever, Brian J. Hafner
BackgroundEnergy storing feet are unable to reduce the energy required for normal locomotion among people with transtibial amputation. Crossover feet, which incorporate aspects of energy storing and running specific feet, are designed to maximize energy return while providing stability for everyday activities.Research questionDo crossover prosthetic feet reduce the energy expenditure of walking across a range of speeds, when compared with energy storing feet among people with transtibial amputation due to non-dysvascular causes?MethodsA randomized within-subject study was conducted with a volunteer sample of twenty-seven adults with unilateral transtibial amputation due to non-dysvascular causes. Participants were fit with two prostheses. One had an energy storing foot (Össur Variflex) and the other a crossover foot (Össur Cheetah Xplore). Other components, including sockets, suspension, and interface were standardized. Energy expenditure was measured with a portable respirometer (Cosmed K4b2) while participants walked on a treadmill at self-selected slow, comfortable, and fast speeds with each prosthesis. Gross oxygen consumption rates (VO2 ml/min) were compared between foot conditions. Energy storing feet were used as the baseline condition because they are used by most people with a lower limb prosthesis. Analyses were performed to identify people who may benefit from transition to crossover feet.ResultsOn average, participants had lower oxygen consumption in the crossover foot condition compared to the energy storing foot condition at each self-selected walking speed, but this difference was not statistically significant. Participants with farther six-minute walk test distances, higher daily step counts, and higher Medicare Functional Classification Levels at baseline were more likely to use less energy in the crossover foot.SignificanceCrossover feet may be most beneficial for people with higher activity levels and physical fitness. Further research is needed to examine the effect of crossover feet on energy expenditure during high-level activities.

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Is Symmetry of Loading Improved for injured runners during Novice Barefoot Running?

Publication date: Available online 27 March 2018
Source:Gait & Posture
Author(s): Adam S. Tenforde, Matthew C. Ruder, Steve T. Jamison, Pratham P. Singh, Irene S. Davis
BackgroundAs barefoot (BF) running provides important sensory information that influence landing patterns, it may also affect loading symmetry.Research questionThe purpose of this investigation was to examine whether symmetry of loading in a group of injured runners would be improved in a novice, barefoot condition.MethodsCross-sectional design evaluating 67 injured RFS runners. Each subject ran on an instrumented treadmill, first with their habitual shod pattern and then in a BF condition with a FFS pattern, both at the same self-selected speed. Data were averaged over 10 footstrikes. Variables of interest included vertical average load rate, vertical instantaneous load rate, and resultant instantaneous load rate. Symmetry indices (SI) for full population and within quartiles were compared for each loadrate variable (P≤.05) to evaluate changes between conditions.ResultsOn average, symmetry of loading was similar in a novice BF condition of injured runners compared with their habitual RFS shod condition. However, a subanalysis of quartiles revealed that the injured runners with the highest asymmetry (greatest SI values) displayed significantly lower asymmetry when running BF for all three loadrate measures.SignificanceThe addition of sensory input during barefoot running only improves symmetry of loading when habitual loading is highly asymmetric.

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Enhancement of Solubility and Biohydrogen Production from Sewage Sludge with Lime Mud Filtrate

Abstract

This work has been performed to investigate the use of lime mud filtrate (LMF) pretreatment to enhance hydrogen (H₂) evolution from sewage sludge (SS). The SS samples were pretreated with LMF (pH 8.0–11.0) at 55 °C for 48 h, prior to the H₂ fermentation. The maximum H₂ yield of 38.30 ml/g-VS (volatile solid) was obtained from the SS pretreated by LMF pH of 10.0, with the corresponding lag time of 3.10 h, which was well described by the modified Gompertz model. Adequate pH of LMF facilitated the solubilization of SS and the release of organic matters, providing adequate substrates for subsequent bio-H₂ evolution. The soluble chemical oxygen demand was increased from 25.0 to 91.7%, as compared with the control test without LMF soak. However, further increase in pH of LMF could decrease the concentration of available substrate, thus reducing the H₂ yield. This technique revealed sustainable waste management and energy recovery.

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Cochlear Implantation in Adults With Asymmetric Hearing Loss: Speech Recognition in Quiet and in Noise, and Health Related Quality of Life

Ossifying Fibromyxoid tumor of soft parts in head and neck: case report and literature review

Ossifying fibromyxoid tumor of soft parts (OFMT), is a rare but morphologically distinctive neoplasm of uncertain histogenesis that most frequently affects middle-aged male adults. Clinically, it usually prese...

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Proceedings of the Annual Meeting of the Austrian Society of Haematology and Medical Oncology

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Microcystic adnexal carcinoma—diagnostic criteria and therapeutic methods: case report and review of the literature

Publication date: Available online 27 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Mamic, L. Manojlovic, P. Suton, I. Luksic
Microcystic adnexal carcinoma (MAC) is a rare, infiltrating, locally aggressive cutaneous neoplasm of combined follicular and eccrine/apocrine histogenesis, usually presenting on the upper lip or face. Differentiation from other adnexal tumours is very important because the clinical management of these tumours is radically different, and misdiagnosis may lead to incorrect treatment. A case of recurrent MAC in the upper lip, treated with multiple excisions and postoperative radiation therapy (PORT), is presented herein. There have been no signs or symptoms of recurrence since the subsequent reconstructive surgery and PORT. Based on reports in the literature it appears that although immunohistochemistry can be helpful in distinguishing between MAC and other adnexal tumours, careful histopathological examination is essential for an accurate diagnosis. Perineural and intramuscular invasion strongly suggest the diagnosis of MAC. Its predilection for the facial area often limits the width of surgical excision. In such cases, PORT may be considered.

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Intra-alveolar epsilon-aminocaproic acid for the control of post-extraction bleeding in anticoagulated patients: randomized clinical trial

Publication date: Available online 27 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.V. da Silva, T.B. Gadelha, R.R. Luiz, S.R. Torres
The aim of this study was to compare the effectiveness of the intra-alveolar administration of epsilon-aminocaproic acid (EACA) and daily gentle rinsing with EACA mouthwash with that of routine postoperative procedures for the control of bleeding after tooth extraction in anticoagulated patients. A randomized clinical trial was conducted involving 52 patients submitted to 140 tooth extractions, assigned randomly to two groups. The intervention group was treated with intra-alveolar administration of EACA immediately after surgery and gentle rinsing with EACA mouthwash during the postoperative period. The control group received routine postoperative recommendations. A single episode of immediate bleeding occurred in the intervention group. Late bleeding episodes occurred in 23 procedures (16.4%): 11 (15.7%) in the intervention group and 12 (17.1%) in the control group. Among the patients with late bleeding, 18 (78.3%) events were classified as moderate and were controlled by the patient applying pressure to a gauze pack placed over the extraction socket. The remaining five cases (21.7%) required re-intervention. No statistically significant difference in the frequency of postoperative bleeding was observed between the groups. Thus, routine measures were as effective for the control of bleeding after simple tooth extractions in anticoagulated patients as the topical administration of EACA.

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The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study

Background and Objectives Major ankle surgery causes intense postoperative pain, and whereas the importance of a sciatic nerve block is well established, the clinical significance of a supplemental saphenous nerve block has never been determined in a prospective, randomized, double-blind, placebo-controlled trial. We hypothesized that a saphenous nerve block reduces the proportion of patients experiencing significant clinical pain after major ankle surgery. Methods Eighteen patients were enrolled and received a popliteal sciatic nerve block. Patients were randomized to single-injection saphenous nerve block with 10 mL 0.5% bupivacaine with 1:200,000 epinephrine or 10 mL saline (Fig. 1). Primary outcome was the proportion of patients reporting significant clinical pain, defined as a score greater than 3 on the numerical rating scale. Secondary outcomes were maximal pain and analgesia of the cutaneous territory of the infrapatellar branch of the saphenous nerve. Results Eight of 9 patients in the placebo group reported significant clinical pain versus 1 of 9 patients in the bupivacaine-epinephrine group (P = 0.003). Maximal pain was significantly lower in the active compared with the placebo group (median, 0 [0–0] vs 5 [4–6]; P = 0.001). Breakthrough pain from the saphenous territory began within 30 minutes after surgery in all cases. Sensory testing of the cutaneous territory of the infrapatellar branch of the saphenous nerve showed correlation between pain reported in the anteromedial ankle region and the intensity of cutaneous sensory block in the anteromedial knee region. Conclusions The saphenous nerve is an important contributor to postoperative pain after major ankle surgery, with significant clinical pain appearing within 30 minutes after surgery. Clinical Trials Registration This study has been registered at ClinicalTrials.gov, identifier NCT02697955. Accepted for publication November 20, 2017. Address correspondence to: Thomas Fichtner Bendtsen, MD, PhD, Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus, Denmark (e-mail: tfb@dadlnet.dk). Funding was received from the A. P. Møller and Chastine Mc-Kinney Møller Foundation. The content is solely the responsibility of the authors. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Too Deep or Not Too Deep?: A Propensity-Matched Comparison of the Analgesic Effects of a Superficial Versus Deep Serratus Fascial Plane Block for Ambulatory Breast Cancer Surgery

Background and Objectives Serratus fascial plane block can reduce pain following breast surgery, but the question of whether to inject the local anesthetic superficial or deep to the serratus muscle has not been answered. This cohort study compares the analgesic benefits of superficial versus deep serratus plane blocks in ambulatory breast cancer surgery patients at Women's College Hospital between February 2014 and December 2016. We tested the joint hypothesis that deep serratus block is noninferior to superficial serratus block for postoperative in-hospital (pre-discharge) opioid consumption and pain severity. Methods One hundred sixty-six patients were propensity matched among 2 groups (83/group): superficial and deep serratus blocks. The cohort was used to evaluate the effect of blocks on postoperative oral morphine equivalent consumption and area under the curve for rest pain scores. We considered deep serratus block to be noninferior to superficial serratus block if it were noninferior for both outcomes, within 15 mg morphine and 4 cm·h units margins. Other outcomes included intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and incidence of postoperative nausea and vomiting. Results Deep serratus block was associated with postoperative morphine consumption and pain scores area under the curve that were noninferior to those of the superficial serratus block. Intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and postoperative nausea and vomiting were not different between blocks. Conclusions The postoperative in-hospital analgesia associated with deep serratus block is as effective (within an acceptable margin) as superficial serratus block following ambulatory breast cancer surgery. These new findings are important to inform both current clinical practices and future prospective studies. Accepted for publication November 27, 2017. Address correspondence to: Faraj W. Abdallah, MD, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, Ontario, Canada K1H 8L6 (e-mail: FAbdallah@toh.ca). This work was supported by departmental funding. F.W.A. and R.B. are supported by the Merit Award Program, Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. R.B. also receives research support from the Evelyn Bateman Cara Operations Endowed Chair in Ambulatory Anesthesia and Women's Health, Women's College Hospital, Toronto. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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The multiforme of glioblastoma

See article by Mahlokozera et al, pp. 472–483

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Highlights from the Literature

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Forthcoming Meetings

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Drug discovery in neuro-oncology: challenges in the path forward

It is an honor to have been asked to write an editorial for Neuro-Oncology, the highly ranked journal of the Society for Neuro-Oncology (SNO). My goal is to enunciate my vision for what I believe we, as a group dedicated to curing central nervous system (CNS) malignancies, need to achieve.

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Quality improvement in neurology: Neuro-Oncology Quality Measurement Set

[213] All Oncology[120] MRI[109] All Health Services Research[334] All Practice ManagementQuality Measurement

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What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the litera...

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The clinical relevance of advanced artificial feedback in the control of a multi-functional myoelectric prosthesis

To effectively replace the human hand, a prosthesis should seamlessly respond to user intentions but also convey sensory information back to the user. Restoration of sensory feedback is rated highly by the pro...

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Continuous Infusion of Phenelzine, Cyclosporine A, or their Combination: Evaluation of Mitochondrial Bioenergetics, Oxidative Damage, and Cytoskeletal Degradation following Severe Controlled Cortical Impact Traumatic Brain Injury in Rats

Journal of Neurotrauma, Ahead of Print.

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Modelling Movement Energetics Using Global Positioning System Devices in Contact Team Sports: Limitations and Solutions

Abstract

Quantifying the training and competition loads of players in contact team sports can be performed in a variety of ways, including kinematic, perceptual, heart rate or biochemical monitoring methods. Whilst these approaches provide data relevant for team sports practitioners and athletes, their application to a contact team sport setting can sometimes be challenging or illogical. Furthermore, these methods can generate large fragmented datasets, do not provide a single global measure of training load and cannot adequately quantify all key elements of performance in contact team sports. A previous attempt to address these limitations via the estimation of metabolic energy demand (global energy measurement) has been criticised for its inability to fully quantify the energetic costs of team sports, particularly during collisions. This is despite the seemingly unintentional misapplication of the model's principles to settings outside of its intended use. There are other hindrances to the application of such models, which are discussed herein, such as the data-handling procedures of Global Position System manufacturers and the unrealistic expectations of end users. Nevertheless, we propose an alternative energetic approach, based on Global Positioning System-derived data, to improve the assessment of mechanical load in contact team sports. We present a framework for the estimation of mechanical work performed during locomotor and contact events with the capacity to globally quantify the work done during training and matches.

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Hearing Loss is Higher in Children with Post-Cardiac Surgery

Researchers at the Children's Hospital of Philadelphia found out that hearing loss in preschoolers who have undergone cardiac surgery during infancy could be 20 times more than in the one percent incidence in the general population.

Three hundred forty-eight children, who had surgery for their congenital heart disease (CHD), underwent audiologic and neurodevelopmental evaluations as part of a prospective study on neurodevelopmental progress at the age of 4. Researchers looked into the possible contributing factors of hearing loss and the impact of the hearing impairment on neurodevelopmental outcomes.

Senior author Nancy B. Burnham, RN, MSN, CRNP explained that the parent study was inspired by the increasing evidence of impaired neurodevelopmental outcomes in children with CHD who require surgery as infants. These outcomes have so many inter-individual variations.

"Audiological testing at the time of the National Institutes of Health (NIH) funded evaluation was primarily done because of the cognitive and speech evaluation to make sure they did not have associated hearing loss," Burnham told The Hearing Journal. "I don't know if we knew we would discover such a high prevalence of hearing loss."

The study reported that the prevalence of hearing loss was 21.6 percent. Specifically, the prevalence of conductive hearing loss was 12.4 percent; the incidence of sensorineural hearing loss was 6.9 percent, and the indeterminate hearing loss was 2.3 percent. Only 18 preschoolers out of the 348 subjects were tested for hearing loss prior to the study. Ten subjects were already using hearing aids. The study suggested that hearing loss was associated with longer postoperative duration of stay, the presence of a genetic anomaly, and younger gestational age. Effects of the hearing loss included worse neurodevelopmental outcomes in language, cognition, and attention.

Burnham said that the impact of the findings of the study is "without a doubt, the importance of early screening and early testing."

When asked about possible measures to prevent the unintended hearing loss from cardiac surgery in infancy, given that younger gestational age, genetic anomaly, and longer postoperative duration of stay are the risk factors, Burnham explained: "There might be modifiable factors but additional research would be required. Duration of stay is a potential area of research. What about the longer length of stay increases the risk for hearing impairment? Perhaps the many ototoxic drugs they receive during their hospital stay (a potential mechanism for future study). Research has shown babies with CHD brains are more immature than their associated GA at birth. If there were measures that would reduce preterm or near-term births that might have an impact."

Published: 3/27/2018 9:00:00 AM

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Continuous Infusion of Phenelzine, Cyclosporine A, or their Combination: Evaluation of Mitochondrial Bioenergetics, Oxidative Damage, and Cytoskeletal Degradation following Severe Controlled Cortical Impact Traumatic Brain Injury in Rats

Journal of Neurotrauma, Ahead of Print.

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Retrograde Snare-Assisted Rescue via Anterior Communicating Artery for Lost Access During Multiple Overlapping Pipeline Embolization Device Placement

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Wonsoo Son, Dong-Hun Kang, Byung Moon Kim, Jaechan Park, Yong-Sun Kim
BackgroundThe Pipeline embolization device (PED; ev3, Irvine, California, USA) has been used to divert flow away from an aneurysm sac. The risk of complications may increase for flow diversion with giant aneurysms because these cases may require multiple overlapping PEDs, which makes the technique highly complex.Case DescriptionWe report a rescue technical strategy for lost access during multiple overlapping PED placement for a giant, fusiform cavernous aneurysm.ConclusionsBy using the collateral circulation as an alternative rescue route, intraprocedural loss of distal access may be salvaged.

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Percutaneous Endoscopic Spine Minimally Invasive Technique for Decompression Therapy of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Xinxin Miao, Dingwen He, Tianlong Wu, Xigao Cheng
BackgroundThe percutaneous endoscopic technique through an interlaminar approach is a commonly used minimally invasive procedure in the treatment of lumbar disc herniation, even lumbar spinal stenosis. This report describes complete decompression with the percutaneous endoscopic technique for patients with thoracic ossification of the ligamentum flavum (OLF).Case DescriptionWe performed surgical decompression in of 2 patients with thoracic myelopathy caused by OLF using percutaneous endoscopic surgery through an interlaminar approach. After surgery, the patients described significant improvement in their preoperative neurologic symptoms. Postoperative thoracic computed tomography showed that the ossification of ligaments was completely removed.ConclusionWe applied the percutaneous endoscopic technique for the treatment of thoracic OLF accomplished direct decompression of the ossified ligaments with minimal trauma and instability. This technique could be used as an alternative choice. However, the fused types should be performed prudently because of the difficulties of the operation.

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Pediatric Case of Xanthogranuloma in the Sellar Region Presenting a Visual Disturbance Successfully Treated with Endoscopic Endonasal Surgery

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Fumihiko Nishimura, Young-Soo Park, Yasushi Motoyama, Ichiro Nakagawa, Shuichi Yamada, Hiroyuki Nakase
BackgroundXanthomatous pituitary diseases rarely occur in childhood. We report a rare pediatric case of a xanthogranuloma that developed in the sellar region, resulting in a visual disturbance that was treated successfully with endoscopic endonasal surgery.Case DescriptionA 13-year-old boy came to us with a headache and visual disturbance that occurred 1 month prior. Clinical examination findings showed that he was alert with signs of bitemporal hemianopsia. An endocrinologic examination showed partial hypopituitarism, and brain magnetic resonance imaging revealed a cystic mass in the sellar turcica compressing the optic apparatus. Endoscopic endonasal surgery was performed to decompress the optic apparatus, and the mass was removed. Histopathologic analysis of the tumor demonstrated granulomatous tissue with cholesterol clefts, foamy macrophages, and multinucleated giant cells, with no epithelial component. The diagnosis was xanthogranuloma of the sellar region. The patient gradually recovered from the visual disturbance and was free from any neurologic signs or symptoms 6 months after surgery.ConclusionsXanthogranuloma, although rare, should be considered as a differential diagnosis of a sellar or suprasellar lesion, even in children.

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Ethmoid Meningoencephalocele in a Patient with Cerebrofacial Arteriovenous Metameric Syndrome

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Rodrigo Fernández-Gajardo, Joao Paulo Almeida, Suganth Suppiah, Ian Witterick, Gelareh Zadeh
BackgroundSkull base meningoencephaloceles are a rare condition, frequently secondary to traumatic or iatrogenic causes. Cerebrofacial arteriovenous metameric syndrome (CAMS) is characterized by the presence of retinal, facial, and cerebral arteriovenous malformations (AVMs) with metameric distribution. To our knowledge, this is the first reported case associating these 2 conditions.Case DescriptionA 45-year-old woman previously diagnosed with CAMS type 2 presented with a long history of cerebrospinal fluid (CSF) rhinorrhea. Magnetic resonance imaging and digital subtraction angiography demonstrated a right-sided facial and orbital AVM extending posteriorly along the optic tract into the suprasellar cistern, and a right-sided meningoencephalocele protruding into the olfactory recess and ethmoid sinus. An extended endoscopic endonasal approach was performed to resect the meningoencephalocele and to repair the CSF leak without complications.ConclusionsWe report the unusual association between the development of a meningoencephalocele and a metameric syndrome, and comment on clinical implications in the management of this patient.

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Re: “A Follow-Up Strategy for Patients with Excellent Response to Initial Therapy for Differentiated Thyroid Carcinoma” by Jeon et al. (Thyroid 2018;28:187–192)

Thyroid, Ahead of Print.

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Anterior robotic approach in en-bloc sacrectomy: a preliminary experience

Abstract

En-bloc sacrectomy is a highly demanding surgical procedure necessary to obtain wide margin in sacral tumor. The double approach, anterior and posterior approach, is usually preferred for tumors extending proximally to S3 level where iliac internal vessels are at a higher risk for damage during posterior surgery. It can be justified also in selected cases to decrease the risk of posterior approach as in local recurrence or in patients who already underwent laparotomy. Our intent was to apply robotic-assisted techniques for performing anterior preparatory approach for sacrectomy surgery. Between December 2010 and December 2014, three cases of sacrectomies were performed in a previous robotic-assisted preparatory approach to separate the rectum from the tumor. Dissections were successfully performed in all cases close to the pelvic floor. The surgeon was able to position a Gore-Tex spacer between the anterior tumor surface and the rectum in all cases. The anterior dissections were performed with a perfect control of bleeding. No complications related to the anterior approach were reported. Robot-assisted surgery can be considered a valid and minimally invasive technique which allows a safe anterior dissection of the pelvic structures dividing tumors from surrounding tissues. It allows to place a spacer to protect organs during posterior sacral resection performed on the same day or at a later time. Further experiences are advocated to evaluate its efficiency in sacral tumors of greater size.

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Αρχειοθήκη ιστολογίου

Τρίτη 27 Μαρτίου 2018

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