Morphological and morphometric evaluation of intertendinous connections among extensor tendons in fetal hands

Abstract

Purpose

The purpose of this study was to determine morphometry and morphology of intertendinous connection on fetal cadavers and perform an evidence on tendon relationships.

Methods

Thirty dorsal fetal cadaveric hands were dissected. Morphometric measurements (length, width, beginning-ending angles and areas) of intertendinous connections were performed. The intertendinous connections were typed morphologically according to their shape and direction. Measurement values were obtained for the second, third and fourth intermetacarpal spaces. The measurement results were compared between right–left hand and male–female fetuses.

Results

No intertendinous connections were present in the first intermetacarpal space in any dissected hands. Statistical differences were observed between the sides in terms of width, and beginning and end angles.

Conclusion

Anatomical results of this study would be helpful in identifying intertendinous connection types, dimensions and their relationships to the extensor tendons, and would assist surgeons when choosing intertendinous connection as an additional structural resource for tendon repair especially pediatric cases.

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Reply to “ESMO-MCBS v1.1: Statistical and Patient Relevant Shortcomings” by R. Emprechtinger et al

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Methodology of clinical trials evaluating the incorporation of new drugs in the first line treatment of patients with diffuse large B-cell lymphoma (DLBCL): a critical review

Abstract

Purpose

The first line treatment of diffuse large B-cell lymphoma (DLBCL) is the combination of rituximab with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy, curing approximately 60% of patients. Many clinical trials have been performed over the last 10 years trying to improve the results of this treatment, but the appropriateness of their planning strategies could be rediscussed.

Patients and Methods

Reports of phase 3 trials evaluating the addition of molecularly targeted agents (MTA) or new monoclonal antibodies to the classic R-CHOP backbone in first-line induction or maintenance treatment were reviewed. The trial design, primary end point, number of patients enrolled, patient selection criteria, treatment schedule and results were registered for each one. In addition, the phase1 and 2 trials which preceded these phase 3 trials were also reviewed.

Results

Among six phase 3 trials with results, only one trial evaluating lenalidomide maintenance after response to R-CHOP induction was positive and reached its primary endpoint. The other 5 trials did not show an improved outcome with the addition of the new agent. The preceding phase 1 and 2 trials were very heterogeneous in their endpoints and design. Even though most of these trials were considered positive, thus encouraging further investigation, so far they failed to predict the results of the subsequent phase 3 trials.

Conclusion

The standard of care for DLBCL is still R-CHOP. Phase 1/2 trials failed to predict the results of subsequent phase 3 trials evaluating non-chemotherapeutic agents added to R-CHOP. The methodology of phase 2 trials evaluating new agents in DLBCL needs to be better defined in the future.

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ADI-PEG 20 Plus Best Supportive Care versus Placebo Plus Best Supportive Care in Patients with Advanced Hepatocellular Carcinoma

Abstract

Background

Arginine depletion is a putative target in hepatocellular carcinoma (HCC). HCC often lacks argininosuccinate synthetase, a citrulline to arginine-repleting enzyme. ADI-PEG 20 is a cloned arginine degrading enzyme – arginine deiminase – conjugated with polyethylene glycol. The goal of this study was to evaluate this agent as a potential novel therapeutic for HCC after first line systemic therapy.

Methods and Patients

Patients with histologically proven advanced HCC and Child-Pugh up to B7 with prior systemic therapy, were randomized 2:1 to ADI-PEG 20 18 mg/m² vs. placebo intramuscular (IM) injection weekly. The primary endpoint was overall survival (OS), with 93% power to detect a 4 to 5.6 months increase in median OS (1-sided α = 0.025). Secondary endpoints included progression-free survival (PFS), safety, and arginine correlatives.

Results

635 patients were enrolled: median age 61, 82% male, 60% Asian, 52% hepatitis B, 26% hepatitis C, 76% stage IV, 91% Child-Pugh A, 70% progressed on sorafenib and 16% were intolerant. Median OS was 7.8 months for ADI-PEG 20 vs 7.4 for placebo (p = 0.88, HR = 1.02) and median PFS 2.6 months vs. 2.6 (p = 0.07, HR = 1.17). Grade 3 fatigue and decreased appetite occurred in less than 5% of patients. Two patients on ADI-PEG 20 had ≥ grade 3 anaphylactic reaction. Death rate within 30 days of end of treatment was 15.2% on ADI-PEG 20 vs. 10.4% on placebo, none related to therapy. Post-hoc analyses of arginine assessment at 4, 8, 12 and 16 weeks, demonstrated a trend of improved OS for those with more prolonged arginine depletion.

Conclusion

ADI-PEG 20 monotherapy did not demonstrate an OS benefit in second line setting for HCC. It was well tolerated. Strategies to enhance prolonged arginine depletion and synergize the effect of ADI-PEG 20 are underway.

Clinical Trial number

www.clinicaltrials (NCT 01287585)

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Biological function of UCA1 in hepatocellular carcinoma and its clinical significance: Investigation with in vitro and meta-analysis

Publication date: Available online 4 April 2018
Source:Pathology - Research and Practice
Author(s): Li-ting Qin, Rui-xue Tang, Peng Lin, Qing Li, Hong Yang, Dian-zhong Luo, Gang Chen, Yun He, Ping Li
Urothelial cancer associated 1 (UCA1) was upregulated in hepatocellular carcinoma (HCC) tissues and cell lines, and the expression of UCA1 was associated with several clinical features and malignant behaviours in HCC. However, none of these findings completely interpreted the role of UCA1 in HCC. We conducted this investigation to validate the expression of UCA1 and its relationship with Tumor Node Metastasis (TNM) stage in 41 HCC tissues and their paired noncancerous adjacent tissues by real-time qPCR. Furthermore, we also explored the biological functions of UCA1 in vitro with HCC cell lines. Most importantly, we conducted a comprehensive meta-analysis and bioinformatics investigation based on peer-reviewed literature and in silico approaches to further summarise the clinical value and functions of UCA1 in HCC. UCA1 expression was remarkably upregulated in HCC tissues, and its expression was profoundly higher in advanced stages than in early stages. Reducing the expression levels of UCA1 suppressed the proliferation and induced apoptosis of HCC cells. Furthermore, the present meta-analysis validated that up-regulated UCA1 was closely related to larger tumour size and advanced TNM stages, and the overexpression of UCA1 was significantly correlated with a shorter OS. Additionally, according to GO analysis, the target genes were found concentrated in the following biological processes: extracellular matrix organisation, cilium assembly and cilium morphogenesis. KEGG pathway analysis showed that the UCA1-related genes were significantly enriched in the following pathways: hippo signalling pathway, bile secretion and gastric acid secretion. This evidence hinted that UCA1 could play an indispensable proliferation-related key role in HCC via the hippo signalling pathway. However, the exact molecular mechanism needs to be verified with future functional experiments.



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A New Proof of a Contrast Function for Bounded Component Analysis and Further Analysis

Publication date: Available online 4 April 2018
Source:Computer Speech & Language
Author(s): Wei Gao, Shen Fan, Roberto Togneri, Victor Sreeram
Bounded Component Analysis (BCA) solves the Blind Source Separation (BSS) problem based on geometric assumptions. This paper introduces a new proof of a BCA contrast function, derived from elementary matrices, Gauss-Jordan elimination and convex geometry. The new proof and further analysis provide additional insight into a key assumption of BCA. In addition, an interpretation is presented to clarify one of the limitations of the instantaneous BCA algorithm. Experiments on audio sources support our analysis.



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Prevalent Homozygous Deletions of Type I Interferon and Defensin Genes in Human Cancers Associate with Immunotherapy Resistance

Purpose: Homozygous deletions play important roles in carcinogenesis. The genome-wide screening for homozygously deleted genes in many different cancer types with a large number of patient specimens representing the tumor heterogeneity has not been done. Experimental Design: We performed integrative analyses of the copy number profiles of 10,759 patients across 31 cancer types from The Cancer Genome Atlas project. Results: We found that the Type-I interferon, α- and β-defensin genes were homozygously deleted in 19 cancer types with high frequencies (7%-31%, median = 12%; interquartile range = 10-16.5%). Patients with homozygous deletion of interferons exhibited significantly shortened overall or disease-free survival time in a number of cancer types, whereas patients with homozygous deletion of defensins did not significantly associate with worse overall or disease-free survival. Gene expression analyses suggested that homozygous deletion of interferon and defensin genes could activate genes involved in oncogenic and cell cycle pathways but repress other genes involved in immune response pathways, suggesting their roles in promoting tumorigenesis and helping cancer cells evade immune surveillance. Further analysis of the whole exomes of 109 melanoma patients demonstrated that the homozygous deletion of interferon (P = 0.0029, OR = 11.8) and defensin (P = 0.06, OR = 2.79) genes are significantly associated with resistance to anti-CTLA-4 (Cytotoxic T-Lymphocyte Associated protein 4) immunotherapy. Conclusions: Our analysis reveals that the homozygous deletion of interferon and defensin genes are prevalent in human cancers, and importantly this feature can be used as a novel prognostic biomarker for immunotherapy resistance.

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Inositol trisphosphate receptor type 3-mediated enhancement of EGFR and MET co-targeting efficacy in non-small cell lung cancer detected by 18F-fluorothymidine

Purpose: Our aim was to test whether imaging with ¹⁸F-fluorothymidine (¹⁸F-FLT) PET/CT was able to detect the combined effects of EGFR and MET inhibitors in oncogene-driven non-small lung cancer (NSCLC) and to elucidate the mechanisms underlying the enhanced efficacy of drug combination. Experimental Design: NSCLC cells bearing MET amplification (H1993 and H820) were treated with EGFR and MET inhibitors either alone or in combination and then tested for cell viability and inhibition of signaling. Nude mice bearing H1993 tumors underwent ¹⁸F-FLT PET/CT scan before and after treatment with erlotinib and crizotinib alone or in combination (1:1 ratio) and post-treatment changes of ¹⁸F-FLT uptake in tumors were determined. The role of inositol trisphosphate receptor type 3 (IP3R3) in mediating the combined action of EGFR and MET inhibitors was tested by transfecting NSCLC cells with IP3R3-targeted siRNA. Results: Imaging studies showed a significant reduction of ¹⁸F-FLT uptake in response to combined treatment with EGFR and MET inhibitors that was higher than that obtained with single agents (ANOVA, F ratio= 6.215, p=0.001). Imaging findings were confirmed by analysis of surgically excised tumors. Levels of IP3R3 were significantly reduced in both cells and tumors after treatment with crizotinib whereas EGFR inhibitors caused a reduction of IP3R3 interaction with K-Ras mainly through dephosphorylation of serine residues of K-Ras. Conclusions: Our findings indicate that ¹⁸F-FLT PET/CT is able to detect the enhanced efficacy of EGFR and MET inhibitors in oncogene-driven NSCLC and that such enhancement is mediated by IP3R3 through its interaction with K-Ras.

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Risk assessment after neoadjuvant chemotherapy in luminal breast cancer using a clinico-molecular predictor

Purpose: This study aimed to evaluate a modified EPclin test (mEPclin), a combination of EndoPredict (EP) score, post-neoadjuvant pathological tumor size and nodal status, for predicting the risk of distance recurrence after neoadjuvant chemotherapy (NACT) in patients with residual estrogen-receptor (ER)-positive/HER2-negative breast cancer (BC). We also compared the prognostic power of the mEPclin with that of the CPS-EG score. Experimental Design: 428 formalin-fixed, paraffin-embedded tumor samples from GeparTrio and GeparQuattro studies were evaluated for mRNA expression of eight cancer-related and three reference genes. The mEPclin score was computed using a modified algorithm and predefined cutoff values were used to classify each patient at low or high risk. Primary endpoint was disease-free survival (DFS). Results: A higher continuous mEPclin score was significantly associated with increased risk of relapse (HR=2.16 [95%CI 1.86-2.51]; p<0.001) and death (HR=2.28 [95% CI 1.90-2.75]; p<0.001). Similarly, patients classified at high risk by dichotomous mEPclin showed significantly poorer disease-free and overall survival compared to those at low risk. In contrast to CPS-EG, the mEPclin remained significantly prognostic for DFS in multivariate analysis (HR=2.13 [1.73-2.63]; p<0.001). Combining CPS-EG and other clinicopathological variables with mEPclin yielded a significant improvement of the prognostic power for DFS versus without mEPclin (c-indices: 0.748 vs. 0.660; p<0.001). Conclusions: The mEPclin score independently predicted the risk of distance recurrence and provided additional prognostic information to the CPS-EG score to assess more accurately the prognosis after NACT in the luminal non-pCR patient population. Therefore, this approach can be used to select patients for additional post-neoadjuvant therapies.

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Orthoxenografts of testicular germ cell tumors demonstrate genomic changes associated with cisplatin resistance and identify PDMP as a re-sensitizing agent

Purpose: To investigate the genetic basis of cisplatin resistance. Efficacy of cisplatin chemotherapy in the treatment of distinct malignancies is often hampered by intrinsic/ acquired drug resistance of tumors. Experimental design: We produced 14 orthoxenograft transplanting human nonseminomatous (NSE) testicular germ cell tumors (TGCTs) to mice, keeping the primary tumor features (genotype, phenotype and sensitivity to cisplatin). Chromosomal and genetic alterations were evaluated in matched cisplatin-sensitive and their counterpart orthoxenografts that developed resistance to cisplatin in vivo. Results: Comparative genomic hybridization analyses of four matched orthoxenografts identified recurrent chromosomal rearrangements across cisplatin-resistant tumors in three of them, showing gains at 9q32-q33.1 region. We found a clinical correlation between the presence of 9q32-q33.1 gains in cisplatin refractory patients and poorer overall survival in metastatic TGCTs. We study the expression profile of the sixty genes located at that genomic region. POLE3 and AKNA were the only two genes deregulated in resistant tumors harboring the 9q32-q33.1 gain. Other four genes (GCS, ZNF883, CTR1 and FLJ31713) were deregulated in all five resistant tumors independently of the 9q32-q33.1 amplification. RT-PCRs in tumors and functional analyses in C. elegans indicate that the influence of 9q32-q33.1 genes in cisplatin resistance can be driven by either up- or down-regulation. We focused on glucosylceramide synthase (GCS) to demonstrate that the GCS inhibitor DL-threo-PDMP re-sensitizes cisplatin-resistant germline-derived orthoxenografts to cisplatin. Conclusions: Orthoxenografts can be used preclinically to test the efficiency of drugs and also to identify prognosis markers and gene alterations acting as drivers of the acquired cisplatin resistance.

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Change in topoisomerase 1 (Top1) positive circulating tumor cells impacts overall survival in patients with advanced breast cancer after treatment with etirinotecan pegol

Purpose: Preplanned exploratory analyses were performed to identify biomarkers in circulating tumor cells (CTCs) predictive of response to the topoisomerase 1 inhibitor etirinotecan pegol (EP). Experimental Design: The BEACON trial treated patients with metastatic breast cancer (MBC) with EP or treatment of physician's choice (TPC). Blood from 656/852 (77%) of patients was processed with ApoStream® to enrich for CTCs. A multiplex immunofluorescence assay measured expression of candidate response biomarkers (Top1, Top2, Ki67, RAD51, ABCG2, H2AX, TUNEL) in CTCs. Patients were classified as Top1 low (Top1Lo) or Top1 high (Top1Hi) based on median CTC Top1 expression. Correlation of CTC biomarker expression at baseline, cycle 2 day 1 (C2D1), and cycle 4 day 1 with overall survival (OS) was investigated using Cox regression and Kaplan-Meier analyses. Results: Overall, 98% of samples were successfully processed, of which 97% had detectable CTCs (median 47-63 CTCs/ml; range 0-2020 CTCs/ml). Top1, Top2, and TUNEL expression was detected in 52%-90% of samples; no significant associations with OS were observed in pre-treatment samples for either group. EP-treated patients with low C2D1Top1+ CTCs had improved OS compared to those with higher positivity (14.1 months vs. 11.0 months, respectively, HR 0.7, P=0.02); this difference was not seen in TPC-treated patients (HR 1.12, P=0.48). Patients whose CTCs decreased from Top1Hi to Top1Lo at C2D1 had the greatest OS benefit from EP (HR 0.57, P=0.01). Conclusions: CTC Top1 expression following EP treatment may identify patients with MBC most likely to have an OS benefit.

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Lessons from the Crypt: HMGA1—Amping up Wnt for Stem Cells and Tumor Progression

High mobility group A1 (HMGA1) chromatin remodeling proteins are enriched in aggressive cancers and stem cells, although their common function in these settings has remained elusive until now. Recent work in murine intestinal stem cells (ISC) revealed a novel role for Hmga1 in enhancing self-renewal by amplifying Wnt signaling, both by inducing genes expressing Wnt agonist receptors and Wnt effectors. Surprisingly, Hmga1 also "builds" a stem cell niche by upregulating Sox9, a factor required for differentiation to Paneth cells; these cells constitute an epithelial niche by secreting Wnt and other factors to support ISCs. HMGA1 is also highly upregulated in colon cancer compared with nonmalignant epithelium and SOX9 becomes overexpressed during colon carcinogenesis. Intriguingly, HMGA1 is overexpressed in diverse cancers with poor outcomes, where it regulates developmental genes. Similarly, HMGA1 induces genes responsible for pluripotency and self-renewal in embryonic stem cells. These findings demonstrate that HMGA1 maintains Wnt and other developmental transcriptional networks and suggest that HMGA1 overexpression fosters carcinogenesis and tumor progression through dysregulation of these pathways. Studies are now needed to determine more precisely how HMGA1 modulates chromatin structure to amplify developmental genes and how to disrupt this process in cancer therapy. Cancer Res; 78(8); 1–8. ©2018 AACR.

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Ces « spins » qui twistent les articles

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): O. Laccourreye, H. Maisonneuve




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Lésions de l’œsophage provoquées par l’ingestion de pile bouton chez l’enfant : analyse des causes et proposition de mesures préventives

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): J.J. Lahmar, C. Célérier, E.N. Garabédian, V. Couloigner, N. Leboulanger, F. Denoyelle
ButsÉtudier les cas récents de lésion œsophagienne chez l'enfant par ingestion de piles boutons pris en charge aux urgences ORL pédiatriques d'Île-de-France, pour proposer des mesures préventives adaptées.Matériel et méthodesNous avons réalisé une étude descriptive, rétrospective et monocentrique. Les patients inclus étaient tous les enfants, âgés de moins de 15 ans, pris en charge aux urgences d'ORL pédiatrique entre janvier 2008 et avril 2014 pour l'ingestion et le blocage dans l'œsophage de pile bouton ayant nécessité une extraction en urgence.RésultatsVingt-deux garçons et 4 filles ont été inclus. L'âge médian était de 25 mois. Vingt-cinq piles sur 26 avaient un diamètre de 20mm ou plus. La durée médiane de présence des piles dans l'œsophage était de 7 heures 30 (2 à 72h). Le taux de complications était de 23 %. Le coût d'hospitalisation allait de 10 260 à 110 520€, avec un coût moyen de 38 751€. La provenance des piles était connue dans 23 cas sur 26 : télécommande sans compartiment vissé (42,3 %), paquet neuf ouvert (15,4 %), jouet pour enfant (15,3 %), appareil photo (7,7 %), montre (un cas) et appareil auditif sans compartiment vissé (un cas).ConclusionLes lésions œsophagiennes par ingestion de piles bouton chez l'enfant sont dues presque toujours à des piles de plus de 20mm provenant en majorité d'appareils au compartiment mal protégé ou de piles non conditionnées individuellement. Ces lésions sont sources de complications graves une fois sur 4 et leur prise en charge a un coût de santé élevé. Une législation imposant des compartiments vissés pour les appareils concernés et des emballages blisters individuels des piles aurait évité plus de 76,9 % des ingestions.



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Myringoplastie avec utilisation de colle au cyanoacrylate et sans comblement d’oreille moyenne par Gelfoam©

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L. Yang, L. JianMin, C. Yan, Z. Qing, R. XiaoYong, S. Ying
ObjectifsBien que de nombreuses méthodes aient été décrites pour essayer de stabiliser le greffon lors d'une myringoplastie, on ne peut éviter de placer du Gelfoam^© dans la caisse ; ceci peut entraîner une obstruction tubaire voire une atteinte de l'oreille interne. L'usage d'une colle tissulaire lors d'une myringoplastie connaît un regain d'intérêt car elle permet de stabiliser le greffon et d'améliorer sa prise. Le but de cette étude prospective était d'étudier les résultats des myringoplasties réalisées pour perforation tympanique subtotale, avec utilisation de colle au cyanoacrylate et sans mise en place d'un produit de comblement dans l'oreille moyenne.MéthodesEntre mars 2014 et novembre 2015, 71 patients présentant une perforation tympanique subtotale ont été opérés, aléatoirement et prospectivement répartis en deux groupes : le groupe colle et le groupe témoin. Deux techniques de stabilisation du greffon ont été utilisées : soit par colle au cyanoacrylate (groupe colle), soit par comblement de l'oreille moyenne au Gelfoam^© (groupe témoin). Toutes les interventions ont été réalisées par le même opérateur.RésultatsÀ 6 mois de l'intervention, la prise de greffe était de 87 % dans le groupe colle et de 89 % dans le groupe témoin. Dans les deux groupes, une amélioration significative de l'audition par rapport au préopératoire a été mise en évidence (p<0,05 dans les deux cas). Il n'y avait pas de différence entre le taux de prise de greffe, celui de complications, et les résultats audiométriques entre les deux groupes.ConclusionLa colle au cyanoacrylate est un outil utile pour stabiliser le greffon dans les myringoplasties pour perforation subtotale, et peut se substituer au comblement de la caisse par Gelfoam^©.



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Facteurs pronostiques des métastases intra-parotidiennes des carcinomes épidermoïdes cutanés de la face

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Bobin, P. Ingrand, B. Dréno, E. Rio, O. Malard, F. Espitalier
ContexteLes carcinomes épidermoïdes cutanés (CEC) se développent sur l'extrémité céphalique dans 80 % des cas. Les métastases intra-parotidiennes (MIP) sont rares, mais leur traitement associant chirurgie et radiothérapie est lourd et leur pronostic est sombre.Matériel et méthodesLes cas de parotidectomies pour MIP d'un CEC de la face entre 2005 et 2015 ont été rétrospectivement étudiés. Les données épidémiologiques, carcinologiques et thérapeutiques ont été évaluées. Les survies globale et spécifique ont été calculées suivant la méthode de Kaplan–Meier. Le test du Logrank et le modèle de Cox ont été utilisés pour rechercher les facteurs pronostiques des MIP.ObjectifsL'objectif principal était d'identifier les facteurs influençant la survie des patients présentant une MIP d'un CEC de la face.RésultatsTrente-cinq patients ont été inclus. Le délai d'apparition des MIP était en moyenne de 13 mois. La survie globale à 1 an, 2 ans et 5 ans était respectivement de 57 %, 50 % et 35 %, la survie spécifique respectivement de 70 %, 66 % et 59 %. Les facteurs pronostiques indépendants des MIP étaient l'immunodépression, l'âge au traitement, les marges non saines de la tumeur cutanée, l'envahissement macroscopique du nerf facial et la présence d'adénopathies cervicales métastatiques.ConclusionCette étude confirme l'association de nombreux facteurs pronostiques indépendants au stade métastatique ganglionnaire intra-parotidien, liés à la population, à la tumeur cutanée primitive et à la MIP. L'obtention d'une exérèse complète de la tumeur cutanée initiale est une règle absolue, afin de diminuer le risque de survenue des MIP. Une surveillance radioclinique accrue doit permettre le diagnostic précoce de ces métastases.



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Évaluation à moyen terme de la fonction de la trompe auditive après dilatation par ballonnet

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): D. Schmitt, M. Akkari, T. Mura, M. Mondain, A. Uziel, F. Venail
Il n'existe à ce jour aucun traitement consensuel des dysfonctions tubaires par obstruction. En cas d'échec de traitements médicamenteux et pressionnels bien conduits, certains auteurs proposent la dilatation tubaire par ballonnet comme alternative thérapeutique. Le but était d'évaluer l'efficacité et l'innocuité de la dilatation tubaire par ballonnet dans cette population.Materiels et méthodesCette étude rétrospective monocentrique rapporte les résultats évalués cliniquement et par tubomanométrie, ainsi que les complications et la satisfaction des sujets traités consécutivement par dilatation tubaire de juin 2012 à février 2015. L'indication opératoire était portée sur des signes cliniques et paracliniques de dysfonction tubaire obstructive en échec de traitement médical bien conduit.RésultatsQuarante-cinq gestes ont été réalisés chez 38 sujets. L'amélioration des symptômes cliniques a été évaluée à 88 %, 80 % et 80 % à respectivement 2 mois, 6 mois, et à plus d'un an. On observait également une amélioration de la fonction évaluée par tubomanométrie dans 81 % des cas. Le geste était bien toléré, et uniquement 4 % de complications mineures ont été retrouvées.ConclusionsL'efficacité, la tolérance et la sécurité retrouvées sont comparables à celles observées dans la littérature, bien qu'il s'agisse de patients étant tous en échec de 1^re ligne de traitement. On note une normalisation de la fonction tubaire dans un peu plus d'un tiers des cas. Malgré ces résultats encourageants, la place et l'efficacité réelle de ce traitement reste à évaluer dans le cadre d'études prospectives de plus fort niveau de preuve.



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Editorial Board

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2





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La chirurgie de rattrapage dans les récidives de carcinomes épidermoïdes du larynx et de l’hypopharynx : étude rétrospective de 2005 à 2013

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectifLa chirurgie en terrain irradié, dite de rattrapage, est l'option thérapeutique de référence en cas de récidive locorégionale des cancers du larynx et de l'hypopharynx. Néanmoins ses résultats carcinologiques et fonctionnels modérés nécessitent de pouvoir sélectionner les patients candidats à cette chirurgie. L'objectif principal de ce travail était de déterminer les facteurs pronostiques préopératoires associés à la survie. Les objectifs secondaires étaient l'étude de la survie globale et sans récidive à 5 ans, du taux de complications locorégionales et générales et des résultats fonctionnels en termes d'alimentation et de sevrage de trachéotomie.Patients et méthodeIl s'agit d'une étude rétrospective multicentrique sur 52 patients ayant présenté une récidive de carcinome épidermoïde laryngé ou hypopharyngé en terrain irradié et ayant eu une chirurgie de rattrapage entre 2005 et 2013.RésultatsLes facteurs associés à une meilleure survie globale à 3 ans en analyse univariée étaient la localisation laryngée de la tumeur initiale (p=0,001), la localisation laryngée de la récidive (p=0,026), les tumeurs classées rT1, rT2, rT3 par rapport aux tumeurs rT4 (p=0,007), un antécédent de chimiothérapie (p=0,036) et la réalisation d'un curage cervical au cours de la chirurgie de rattrapage (p=0,005). Ce dernier est confirmé à l'analyse multivariée. La survie globale à 5 ans était de 36,0 % [27,6 %–44,4 %]. La durée médiane de survie globale estimée était de 23,04 mois (IC 95 % [19,44–26,64]). La survie sans récidive à 5 ans était de 23,5 % [16,0 %–31,0 %]. La durée médiane de survie sans récidive estimée était de 8,04 mois (IC 95 % [2,04–14,04]).ConclusionLa chirurgie de rattrapage des cancers du larynx et de l'hypopharynx est difficile avec des survies modestes. La localisation laryngée de la tumeur initiale et de la récidive, son volume et son extension modérés (inférieure à T4), un traitement préalable par chimiothérapie, ainsi que la possibilité de réaliser un curage lors de la chirurgie de rattrapage sont corrélés à une meilleure survie globale et sans récidive, permettant une meilleure sélection des patients pouvant en bénéficier.



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Facteurs de risque cardiovasculaire et facteurs de gravité chez les patients hospitalisés pour épistaxis spontanée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectifsÉvaluer le rôle des facteurs de risque « cardiovasculaire », de la prise de médicaments altérant la crase sanguine et les signes de gravité chez des patients hospitalisés pour épistaxis spontanée.Matériel et méthodesIl s'agissait d'une étude monocentrique, rétrospective, réalisée sur 7 ans dans un centre hospitalier universitaire, ayant inclus 205 patients hospitalisés pour épistaxis spontanée. Ont été notés par patient : les facteurs de « risque cardiovasculaire » (maladie ou antécédent « cardiovasculaire » à risque hémorragique ou thromboembolique, hypertension artérielle, diabète sucré, dyslipidémie), la prise de médicaments modifiant la crase sanguine ; les mesure de la pression artérielle et le taux minimal d'hémoglobinémie au cours de l'hospitalisation. Les patients ont été séparés en deux groupes : épistaxis « graves » et « non graves ».RésultatsIl n'existait pas de différence significative entre les groupes de patients concernant l'âge moyen, le sex-ratio, la présence d'un antécédent d'hypertension artérielle et le nombre de facteurs de « risque cardiovasculaire ». Les patients avec une épistaxis grave avaient des mesures de pression artérielle significativement plus basse que dans le groupe non grave. L'hémoglobinémie était significativement inférieure dans le groupe des épistaxis graves. Il existait un lien entre le nombre de facteurs de risque « cardiovasculaire » par patient et la probabilité d'une transfusion sanguine.ConclusionsLes rôles réels de ces différents facteurs présumés dans la survenue d'une épistaxis spontanée restent encore à élucider, de même que les facteurs de gravité.



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Localisation intra-labyrinthique d’une tumeur sporadique du sac endolymphatique

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): C. Lucas, J.-C. Leclère, E. Mornet, R. Marianowski
IntroductionLes tumeurs du sac endolymphatique sont des tumeurs bénignes, invasives d'évolution lente, envahissant l'os temporal, se manifestant par une surdité unilatérale. Elles peuvent être sporadiques ou s'intégrer dans un syndrome de von Hippel-Lindau (VHL).Résumé du casNous rapportons le cas d'une tumeur développée dans l'utricule dont l'aspect histologique et immunohistochimique correspond à une tumeur du sac endolymphatique, chez un patient indemne de VHL.DiscussionLes tumeurs du sac endolymphatique sont des lésions lysant l'os temporal, situées dans la partie postérieure de l'os pétreux. D'après deux études concernant des patients atteints de von Hippel-Lindau, les tumeurs du sac endolymphatique seraient développées aux dépens du canal endolymphatique. Notre observation d'un développement intra-labyrinthique d'une tumeur du sac endolymphatique sporadique est en faveur de cette hypothèse pour les formes sporadiques et plaide pour une labyrinthectomie associée au geste d'exérèse tumorale afin d'éviter les récidives.



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La pharyngo-laryngoplastie par voie endoscopique : à propos d’un cas

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Baguan, C.A. Righini, P.F. Castellanos, I. Atallah
IntroductionToute thérapeutique permettant la décanulation des malades trachéotomisés et dépendants de leur canule leur apporte un confort et permet pour ceux-ci et permet en outre de réduire les coûts de santé publique.Résumé du cas cliniqueNous exposons le cas d'un patient de 70 ans trachéotomisé dans les suites d'une radiothérapie pour un cancer du larynx en rémission depuis 13 ans avec des échecs de décanulation. Il présentait une sténose pharyngolaryngée. Une pharyngo-laryngoplastie par voie endoscopique a été réalisée en adoptant les techniques reconnues de la microchirurgie reconstructrice au laser par voie transorale. Des sutures par voie endoscopique ont été réalisées et sécurisées par des clips afin de remodeler le pharyngo-larynx et d'éviter la récidive des synéchies. La chirurgie a permis la décanulation définitive de ce patient.DiscussionLa chirurgie endoscopique pharyngo-laryngée a été initialement développée pour la résection des tumeurs à des stades localisés. Plus récemment, la microchirurgie reconstructrice au laser par voie transorale a été développée. Elle présente un intérêt fonctionnel permettant une reconstruction pharyngolaryngée destinée à traiter les séquelles de la chirurgie ou/et de la radiothérapie des cancers des voies aérodigestives supérieures. Elle permet de reconstruire les voies aériennes supérieures restaurant une respiration buccale chez les patients trachéotomisés favorisant leur décanulation.



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Lymphome de la zone marginale de localisation méningée : le piège du méningiome

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Villeneuve, F. Rubin, P. Bonfils
ObjectifPrésenter un cas de lymphome de la zone marginale de type MALT de la méninge temporale dans lequel un diagnostic initial de méningiome temporal avait été initialement porté.ObservationPatiente de 60 ans immunocompétente suivie depuis plus de 10 ans pour un méningiome en plaque temporal (ou ostéoméningiome) responsable de vertiges et d'hypoacousie mixte. L'apparition d'une adénopathie cervicale a conduit à mettre en évidence une progression importante de la lésion intracrânienne et à poser le diagnostic de lymphome de la zone marginale grâce à l'examen histologique de l'adénopathie cervicale. Le traitement par 6 cures de Rituximab et Bendamustine a permis une rémission complète de l'atteinte cervicale et de l'atteinte intracrânienne, confirmant qu'il s'agissait d'un lymphome dural temporal.ConclusionLe lymphome dural primitif doit faire partie du diagnostic différentiel du méningiome, la surveillance au long terme permettant de redresser le diagnostic.



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Comment utiliser à moindre coût l’impression 3D comme aide à la reconstruction mandibulaire ?

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Dupret-Bories, S. Vergez, T. Meresse, F. Brouillet, G. Bertrand
L'impression en 3 dimensions est en plein essor dans le domaine médical. Cette technologie accroît les possibilités de traitement personnalisé pour les patients tout en abaissant les coûts de fabrication. Dans le cadre des reconstructions de mandibule par lambeau libre de fibula, des sociétés proposent, à l'heure actuelle, des guides de coupe obtenus par moulage à partir de scanner. Outre les délais de réalisation importants i.e. minimum 21jours, ces guides sont vendus à des coûts prohibitifs (2000 à 6000 euros). Conjointement avec le CNRS, des étudiants ingénieurs, une société biomédicale, les auteurs ont mis au point des guides de coupe et des fantômes de mandibule imprimés en 3 dimensions, livrables en 7jours et à moindre coût. La nouveauté de ce projet réside dans la rapidité d'élaboration des produits et la réduction importante de leur prix. Les auteurs proposent de décrire dans cette note technique la chaîne logistique de réalisation des fantômes et des guides de coupe ainsi que les résultats apportés. L'objectif est de permettre dans un avenir proche l'accès à cette technologie pour tous les patients.



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La chirurgie endoscopique de la fente olfactive

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau, P. Gallet, D.T. Nguyen, A. Russel, B. Toussaint
La fente olfactive est le siège électif de tumeurs spécifiques (hamartome épithélial respiratoire adénomatoïde, adénocarcinome intestinal, neuroblastome olfactif, papillome inversé, glomangiopéricytome, …). Elle est aussi le site de rhinoliquorrhées particulières appelées cribri-liquorrhées. En conséquence la chirurgie de la fente olfactive se doit d'être pensée en tant que chirurgie spécifique, complémentaire de la chirurgie des masses latérales de l'ethmoïde et de celle de la fosse cérébrale antérieure. Les tumeurs développées à partir de la fente olfactive peuvent être réséquées selon cinq procédés chirurgicaux différents : mucosectomie de fente olfactive, résection partielle de fente olfactive, résection totale de fente olfactive, résection cranio-ethmoïdale endoscopique unilatérale, et résection cranio-ethmoïdale endoscopique bilatérale. Le diagnostic et la fermeture des cribri-liquorrhées (rhinoliquorrhée prouvée dont l'origine au niveau de la lame criblée est affirmée au cours d'une endoscopie des fentes olfactives sous anesthésie générale chez un patient dont l'imagerie n'a pas permis de localiser le site de la brèche) complète ce nouvel arsenal chirurgical.



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L’organe oublié

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): L.-M. Roussel, C. Escalard, M. Hitier




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Une tumeur cervicale inusitée

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): A. Gaudreau, A. Belisle, T. Ayad




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Physiologie de l’ostium des sinus paranasaux : observations endoscopiques

Publication date: April 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 2
Author(s): R. Jankowski, C. Rumeau




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Reconstruction of large oroantral defects using a pedicled buccal fat pad

Abstract

Background

Oroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction.

Case presentation

This report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort.

Conclusion

In conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.

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Editorial Board

Publication date: 1 May 2018
Source:Journal of Neuroscience Methods, Volume 301





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Multifocal nitrous oxide cryoballoon ablation with or without EMR for treatment of neoplastic Barrett’s esophagus

Endoscopic cryotherapy can eradicate neoplastic Barrett's esophagus (BE). A new contact cryoballoon focal ablation system (CbFAS)) freezes esophageal mucosa with nitrous oxide. We studied the safety and efficacy of CbFAS for complete eradication of neoplastic Barrett's esophagus.

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Ten 'One Stop Shop' Cancer Diagnosis Centers Announced in UK

The new centers will have multidisciplinary teams under one roof for rapid -- and early -- diagnosis and assessment of cancer.
Medscape Medical News

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The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: a literature review

To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (10-19 years).

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Palliative thoracic radiation therapy for non-small cell lung cancer: 2018 Update of an American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline

Publication date: Available online 4 April 2018
Source:Practical Radiation Oncology
Author(s): Benjamin Moeller, Ehsan H. Balagamwala, Aileen Chen, Kimberly M. Creach, Giuseppe Giaccone, Matthew Koshy, Sandra Zaky, George Rodrigues
PurposeTo revise the recommendation on the use of concurrent chemotherapy (CC) with palliative thoracic external beam radiation therapy (EBRT) made in the original 2011 American Society for Radiation Oncology guideline on palliative thoracic radiation for lung cancer.Methods and materialsBased on a systematic PubMed search showing new evidence for this key question, the task force felt an update was merited. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology–approved tools for grading evidence quality and recommendation strength.ResultsAlthough few randomized clinical trials address the question of CC combined with palliative thoracic EBRT for non-small cell lung cancer (NSCLC), a strong consensus was reached among the task force on recommendations for incurable stage III and IV NSCLC. For patients with stage III NSCLC deemed unsuitable for curative therapy but who are (1) candidates for chemotherapy, (2) have an Eastern Cooperative Oncology Group PS of 0 to 2, and (3) have a life expectancy of at least 3 months, administration of a platinum-containing chemotherapy doublet concurrently with moderately hypofractionated palliative thoracic radiation therapy is recommended over treatment with either modality alone. For patients with stage IV NSCLC, routine use of concurrent thoracic chemoradiation is not recommended.ConclusionsOptimal palliation of patients with incurable NSCLC requires coordinated interdisciplinary care. Recent data establish a rationale for CC with palliative thoracic EBRT for a well-defined subset of patients with incurable stage III NSCLC. For all other patients with incurable NSCLC, data remain insufficient to support this treatment approach.



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Comparative Sonographic and Magnetic Resonance Images of an Acute Pronator Teres Full-Thickness Tear

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Benefits of hippotherapy and horse riding simulation exercise on healthy older adults: a systematic review

To provide an up-to-date research analysis on equine-assisted therapies and horse riding simulation exercise in older adults, and to suggest future directions in clinical practice and research.

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Effects of whole body vibration on tibia strength and structure of competitive adolescent swimmers: A randomized controlled trial

Swimming has no effect on bone mass or structure. Therefore, adolescent swimmers present similar bone strength values when compared to normo-active controls, and lower values when compared to weight-bearing athletes. It thus seems necessary to try to improve bone structure and strength of adolescent swimmers through a weight-bearing intervention in order to reduce the risk of suffering osteoporosis later in life.

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Comparing the Effects of Dual-task Gait Testing in New and Established Ambulators with Lower Extremity Amputations

Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm.

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Genicular Radiofrequency Ablation for the Treatment of Post-Traumatic Knee Pain: A Case Presentation

This is the first reported case presentation utilizing cooled genicular radiofrequency ablation (C-RFA) for the treatment of post-traumatic knee pain. The patient is a 29 year old male who sustained open right femoral and tibial fractures following two motor vehicle collisions. He was deemed too young to undergo TKA by Orthopedic Surgery. It was recommended he trial diagnostic genicular nerve blocks followed by C-RFA. The procedure provided a >50% reduction in average pain with an increase in activity tolerance lasting 9 months.

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Dynamic sonographic visualization of an occult posterior lateral meniscocapsular separation: A case report

Meniscocapsular separation describes detachment of the meniscus from the knee joint capsule. Diagnosis is challenging with conventional examination and imaging methods. We report a case of an 18-year-old female softball catcher with unrevealing MRI despite continued left knee locking and discomfort with deep squatting. Meniscocapsular separation was revealed only on dynamic sonographic exam, where knee flexion revealed a 3.1 mm gap that developed between the capsule and peripheral meniscus. Arthroscopy confirmed the sonographic findings, and repair resulted in complete resolution of symptoms.

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Effect of changing postoperative pain management on bleeding rates in tonsillectomy patients

To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management.

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A boy presenting with chronic ear drainage and associated middle ear mass

11-year old male presented to the clinic with a chronically draining ear and associated hearing loss. He was treated two months ago by his pediatrician for otitis media with amoxicillin but continued to have drainage. He underwent an audiogram which showed a left sided maximal conductive hearing loss. He had no history of ear tubes or surgery. He passed his newborn hearing screen and subsequent audiograms until recently.

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In whom does horizontal canal BPPV recur?

The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.

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Warthin’s tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population

There is little information in the English-language literature regarding Warthin's tumour (WT) in the eastern-Chinese population. A large retrospective study (1084 primary tumours over a period of 18years) was carried out to investigate the clinicopathological features (patients' gender, age and tumour location) of these tumours in this population. A total of 994 (91.7%) patients were male and 90 (8.3%) were female, with a male/female ratio of 11:1. The mean age was 56.48years (range 20–89years), with a peak incidence in the fifth to seventh decade (82.1%).

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Three-dimensional radiographic evaluation of root migration patterns 4–8.5 years after lower third molar coronectomy: a cone beam computed tomography study

This prospective study in patients with a follow-up of 4–8.5years aimed to describe the long-term, three-dimensional changes of coronectomized lower third molar roots. Pre- and postoperative cone beam computed tomography (CBCT) scans were compared. The distance of root migration, the direction of root translation and rotation, and the amount of bone regeneration at the adjacent second molar and superficially to the third molar root were recorded. Age, gender, time elapsed following surgery, the status of the retained root including, impaction pattern and depth of impaction were tested to check if they were influencing factors for the above outcomes.

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Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: a systematic review and meta-analysis

Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban; DOACs) have been introduced to improve safety and superior therapeutic value compared to their predecessors such as warfarin or enoxaparin. The aim of this systematic review and meta-analysis was to assess the postoperative bleeding risk of DOACs during oral surgery procedures. Systematic searches were performed in electronic databases including PubMed, Scopus, Web of Science and Cochrane Library. Thirteen studies were included in the qualitative synthesis: two retrospective case–control studies, five prospective case–control studies, three cross-sectional studies, two case series and a case report; while only six studies were statistically analysed.

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Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours

This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery.

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Wear measurement of dental tissues and materials in clinical studies: A systematic review

Publication date: Available online 4 April 2018
Source:Dental Materials
Author(s): C. Wulfman, V. Koenig, A.K. Mainjot
ObjectivesThis study aims to systematically review the different methods used for wear measurement of dental tissues and materials in clinical studies, their relevance and reliability in terms of accuracy and precision, and the performance of the different steps of the workflow taken independently.MethodsAn exhaustive search of clinical studies related to wear of dental tissues and materials reporting a quantitative measurement method was conducted. MedLine, Embase, Scopus, Cochrane Library and Web of Science databases were used. Prospective studies, pilot studies and case series (>10 patients), as long as they contained a description of wear measurement methodology. Only studies published after 1995 were considered.ResultsAfter duplicates' removal, 495 studies were identified, and 41 remained for quantitative analysis. Thirty-four described wear-measurement protocols, using digital profilometry and superimposition, whereas 7 used alternative protocols. A specific form was designed to analyze the risk of bias. The methods were described in terms of material analyzed; study design; device used for surface acquisition; matching software details and settings; type of analysis (vertical height-loss measurement vs volume loss measurement); type of area investigated (entire occlusal area or selective areas); and results.SinificanceThere is a need of standardization of clinical wear measurement. Current methods exhibit accuracy, which is not sufficient to monitor wear of restorative materials and tooth tissues. Their performance could be improved, notably limiting the use of replicas, using standardized calibration procedures and positive controls, optimizing the settings of scanners and matching softwares, and taking into account unusable data.



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Clinical features and presentation of oral potentially malignant disorders

Publication date: Available online 4 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Saman Warnakulasuriya
Oral potentially malignant disorders (OPMDs) are conditions that precede the appearance of invasive cancers of the oral cavity. The term embraces both precancerous lesions and conditions referred to in the earlier WHO definitions. Leukoplakia is the most common OPMD; erythroplakia though rare is more serious. Several variants of leukoplakia are recognized and clinical subtyping could help in predicting the prognosis to a limited extent. Biopsy is essential to confirm the provisional clinical diagnosis and timely referral to a specialist is indicated. Certain OPMDs such as oral submucous fibrosis are encountered particularly in population groups from Asia with specific life-style habits. This review provides clinical descriptions of the wide range of PMDs encountered in the oral cavity as a prelude to the topics discussed in this focus issue.



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Molecular markers associated with development and progression of potentially premalignant oral epithelial lesions: current knowledge and future implications

Publication date: Available online 4 April 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis, Monica Pentenero, Maria Georgaki, Catherine F. Poh, Douglas E. Peterson, Paul Edwards, Mark Lingen, John J. Sauk
Identification and management of potentially premalignant oral epithelial lesions (PPOELs) at highest risk of malignant transformation (MT) holds great promise for successful secondary prevention of oral squamous cell carcinoma (OSCC), potentially reducing oral cancer morbidity and mortality. However, to date, neither clinical nor histopathologic validated risk predictors have been identified that can reliably predict which PPOELs will definitively progress to malignancy. In addition, the management of PPOELs remains a major challenge. Arguably, progress in the prevention and treatment of oral premalignancy and cancer will require improved understanding of the underlying molecular mechanisms, facilitating the discovery of diagnostic, prognostic and predictive markers, as well as the identification of novel targeted therapeutics.This review provides a synopsis of the molecular biomarkers that have been studied in PPOELs and have been correlated with the presence and grade of dysplasia and/or their propensity to undergo MT to OSCC. The emphasis is on highlighting new emerging research fields, particularly epigenetic events, including methylation and miRNA regulation. Several promising biomarkers are highlighted. Current limitations and challenges are discussed. Recommendations for future focused research areas, in order to validate and promote clinically useful applications, are offered.



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Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T.-C. Lu, S. Filson, C.-F. Yao, P.K.-T. Chen
Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.



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Endocytoscopy for in situ real-time histology of oral mucosal lesions

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I. Miyamoto, N. Yada, K. Osawa, I. Yoshioka
This study investigated the utility of endocytoscopy, a novel emerging endoscopic system, for in situ real-time histology of oral mucosal lesions. Endocytoscopy involves the use of a contact light microscopy system with 380-fold magnification. With the development of endoscopic instruments, it has become possible to observe the abnormal microvascular and capillary patterns of tumour cells. The resolution of the endoscopic image is improved in situ, and a more detailed diagnosis is possible. In this study, endocytoscopy along with other diagnostic modalities was used in nine patients. Normal mucous membranes and oral malignant lesions were observed. Endocytoscopy enabled the pathological diagnosis of oral malignancies in situ and the observation of both structural and cytological atypia. In the future, it is expected that pathological diagnoses will be made in situ by direct viewing of living cells. This technique has the potential to allow an 'optical biopsy'.



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Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible following salvage surgery for recurrent head and neck tumours

Publication date: Available online 4 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): W.-l. Chen, Z.-q. Huang, B. Zhou, Y. Wang, R. Chen
This study was performed to evaluate the outcomes of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for the restoration of through-and-through defects of the mandible. The subjects were six patients with recurrent malignant tumours who underwent salvage surgeries and reconstruction with combined flaps based on the transverse cervical vessels (TCVs). All patients had combined bone (four type H, one type LCL, and one type C) and extensive soft tissue defects (through-and-through defects) following salvage surgery. All tumours were removed and the complex defects restored successfully. Two patients experienced minor complications: one minor intraoral flap failure and one case of wound dehiscence at the donor site. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion of the upper limb. The patients were followed up for 10 to 18months. One patient was living with no evidence of disease. The use of combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps based on the TCVs may be an effective approach for the restoration of through-and-through defects of the mandible and may provide satisfactory or acceptable functional and aesthetic outcomes following salvage surgery for advanced head and neck tumours.



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A boy presenting with chronic ear drainage and associated middle ear mass

Publication date: Available online 4 April 2018
Source:American Journal of Otolaryngology
Author(s): Kaelen Black, Jonathan Murnick, Brian K. Reilly




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Rectal ulcer and pseudomalignant epithelial changes after prostate seed brachytherapy: A rare complication with a diagnostic pitfall

Publication date: Available online 4 April 2018
Source:Annals of Diagnostic Pathology
Author(s): Hwajeong Lee, Natallia Sheuka, Osama El-kadi, Brian P. Murray, Hugh A. Fisher, Bhaskar V.S. Kallakury, Edward C. Lee, Ann Boguniewicz, Timothy A. Jennings
BackgroundImplant brachytherapy (IBT) is a well-recognized treatment modality for early stage prostate cancer. Rectal ulcer and rectourethral fistula complicating IBT may cause an alteration of the normal anatomic landmarks. In this context, pseudomalignant radiation-induced changes within prostatic epithelium may be misinterpreted as a primary rectal malignancy. Such challenging and misleading findings have not been described, and may not be recognized as such.Materials and methodsWe present the clinical and pathologic aspects of two patients who underwent IBT for low stage prostate cancer that was complicated by deep rectal ulcer. Both patients underwent extensive palliative surgical resection for disease control.ResultsThe histologic changes in both cases were noteworthy for extensive necrosis and inflammation of the prostate, associated with loss of recto-prostatic anatomical landmarks. Prostatic glands showed striking radiation-induced atypia and pseudomalignant epithelial changes extending to the rectal ulcer bed, with no residual viable tumor. The first patient had undergone a biopsy of the rectal ulcer bed that was misinterpreted as a rectal adenocarcinoma prior to surgery. The similarity between atypical glands of the biopsy and the benign prostatic tissue with radiation-induced atypia in resection specimen confirmed their benign nature.ConclusionsDeep rectal ulcer complicating IBT may lead to distortion of the normal recto-prostatic anatomical landmarks, resulting in detection of pseudo-malignant prostatic glands at the ulcer base. Such findings may be mistaken for a primary rectal malignancy in limited biopsy material if not familiar to the pathologist.



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Primary breast carcinomas with neuroendocrine features: Clinicopathological features and analysis of tumor growth patterns in 36 cases

Publication date: Available online 4 April 2018
Source:Annals of Diagnostic Pathology
Author(s): Canan Kelten Talu, Cem Leblebici, Tulin Kilicaslan Ozturk, Ezgi Hacihasanoglu, Sevim Baykal Koca, Zuhal Gucin
Primary breast carcinoma with neuroendocrine features (NEBC) is an uncommon tumor. In the classification of WHO 2012, these tumors were categorized as: 1- neuroendocrine tumor, well-differentiated; 2- neuroendocrine carcinoma, poorly differentiated/small cell carcinoma; and 3- invasive breast carcinoma with neuroendocrine differentiation. In this study, we reviewed NEBC except poorly differentiated/small cell carcinoma variant in order to define the morphological growth patterns and cytonuclear details of these tumors. All breast surgical excision materials between 2007 and 2016 were re-evaluated in terms of neuroendocrine differentiation. Thirty-six cases showing positive staining for synaptophysin and/or chromogranin A in ≥50% of tumor cells were included in the study. All cases were female with a mean age of 67.4. Mean tumor diameter was 26 mm. Multifocality was noted in 5 cases. Grossly, they were mostly infiltrative mass lesions. T stages, identified in 34 cases, were as follows: 13 cases with pT1; 19 pT2 and 2 pT3. We described schematically 4 types of patterns depending on predominant growth pattern, except one case: 1) Large-sized solid cohesive groups (6 cases), 2) Small- to medium-sized solid cohesive groups with trabeculae/ribbons and glandular structures (6 cases), 3) Mixed growth patterns (20 cases), 4) Invasive tumor with prominent extracellular and/or intracellular mucin (3 cases). The tumor cells were mostly polygonal-oval with eosinophilic/eosinophilic-granular cytoplasm. The nuclei of tumor cells were mostly round to oval with evenly distributed chromatin. Only 5 cases showed high grade nuclear and histological features. Molecular subtypes of the cases were as follows: 33 luminal A, 2 luminal B, and 1 triple negative. NEBC should come to mind when a tumor display one of the morphological patterns described above, composed of monotonous cells with mild to moderate nuclear pleomorphism and abundant eosinophilic/eosinophilic granular or clear cytoplasm, especially in elderly patients.



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PD-L1 immuno-expression assay in thymomas: Study of 84 cases and review of literature

Publication date: Available online 4 April 2018
Source:Annals of Diagnostic Pathology
Author(s): Prerna Guleria, Nuzhat Husain, Saumya Shukla, Sunil Kumar, Rajinder Parshad, Deepali Jain
Background and aimsProgrammed death ligand 1 (PD-L1), an immune check point inhibitor, is known to be expressed in several malignancies and is being considered as a prognostic factor and a potential immunotherapeutic target. The aim of this study was to characterize PD-L1 expression in thymomas and to determine correlation with clinicopathological features and previously published studies in the literature.MethodsTissue microarrays were prepared from selected blocks of thymomas and immunohistochemistry (IHC) for PD-L1 was performed. Cases were considered as PD-L1 positive or negative depending on whether the percentage of stained thymic epithelial cells were <25 or >25%. Results were compared clinically and with previously published studies using Google and Pubmed search engines.ResultsOf 84 cases of thymoma, 69 (82.1%) revealed PD-L1 positivity in >25% cells. 94.23% of type B thymoma subtypes (B1/B2/B3) were PD-L1 positive (P < 0.001). There was no correlation of PD-L1 with age, gender, myasthenia gravis, the tumor size or stage of disease. Nine studies were available in the literature; most of which showed PD-L1 expression in higher stage and B subtype however percentage positivity varied from 53.7% to over 90%.ConclusionsPD-L1 expression is frequent in type B (B1/B2/B3) thymomas. It can be easily evaluated by IHC even on small biopsies in unresectable cases, thereby enabling improved clinical evaluation as well as prognostic stratification of patients. It will serve as a potential indicator for benefit from anti-PD-L1 antibody immunotherapy in thymomas.



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Safe zone for the posterior interosseous nerve with regard to the lateral and posterior approaches to the proximal radius

Abstract

Purpose

The posterior interosseous nerve (PIN) is at risk during the posterior and lateral approaches to the proximal radius. We aimed to define a safe zone for these approaches to avoid injury of the PIN and to evaluate their close and changing relationship to the nerve during forearm rotation.

Methods

The study collective consisted of 50 upper limbs. After performance of the lateral approach, the distance between the tip of the radial head and the PIN's exit point from the supinator (= distance 1) and the shortest interval between the nerve's exit to the radial margin of the ulna (= distance 2) were measured in maximum pronation and supination. Then, the dorsal approach was conducted and again distance 1 and the interval between the distal margin of the anconeus and the nerve's exit point (distance 2) were evaluated (pronation and supination).

Results

There were significantly shorter distances during supination in comparison to pronation. Regarding the lateral approach, distance 1 changed from a mean of 60.3 mm (supination) to 62.7 mm in pronation (p < 0.001). For the dorsal approach, distance 1 decreased significantly (p < 0.001) from 62.9 mm (pronation) to 60.2 mm (supination).

Conclusion

Supination during the lateral and dorsal approaches to the proximal radius needs to be avoided to protect the PIN. Furthermore, the nerve appeared at an interval between 45 and 84.1 mm (lateral approach) and 47.5–93.8 mm (dorsal approach), respectively. Therefore, care must be taken at this height during extension of the approaches in a distal direction.

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A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia

Abstract

Background

Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity.

Methods

Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tool was used to collect data at all survey sites. Descriptive data analyses were completed using Excel. Studies of association were completed using Stata. All reported percentages are of the hospitals outside of the capital (n = 21).

Results

All provincial hospitals have general surgeons; seven (33.3%) of them have pediatric surgeon(s). One facility has no anesthesiologist. All facilities perform basic procedures and provide anesthesia. Four (19%) can treat common congenital anomalies. All facilities have basic operating room equipment. Nine hospitals do not have pulse oximetry available. Twelve hospitals do not have pediatric surgical instruments always available. Pediatric supplies are lacking.

Conclusions

Provincial hospitals in Mongolia can perform basic procedures. However, essential pediatric supplies are lacking. Consequently, certain life-saving procedures are not available to children outside of the capital. Only a few improvements would be amendable to low-cost process improvement adjustment, and the majority of needs require resource additions. Procedure, equipment, and supply availability should be further explored to develop a comprehensive nationwide pediatric surgical program.

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A case report of atypical Spitz tumor harboring a novel MLPH-ALK gene fusion with discordant ALK immunohistochemistry results

Publication date: Available online 4 April 2018
Source:Human Pathology
Author(s): Masakazu Fujimoto, Yuki Togashi, Ibu Matsuzaki, Satoko Baba, Kengo Takeuchi, Yutaka Inaba, Masatoshi Jinnin, Shin-ichi Murata
Frequent kinase fusions have been reported in spitzoid neoplasms, approximately 10% of which involve ALK rearrangements. Herein, we report a case of atypical Spitz tumor with a novel MLPH-ALK fusion, which has not been previously reported to contribute to cancer development. The tumor was detected in the right arm of a 40-year-old woman. The novel ALK fusion was identified by a 5′-rapid amplification of cDNA ends-based system optimized for formalin-fixed, paraffin-embedded tissue. Initially, ALK expression was detected by immunohistochemistry using 5A4 antibodies for both sensitive and conventional polymer detection methods. However, the anti-ALK1 antibody, which is commonly used for the diagnosis of ALK-positive anaplastic large cell lymphoma, failed to confirm ALK expression. These results indicated that ALK immunohistochemistry results in ALK-rearranged atypical Spitz tumor may differ based on the type of primary antibody clone, which can be a potential diagnostic pitfall.



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Renal histology in a patient with TAFRO Syndrome: A case report

Publication date: Available online 4 April 2018
Source:Human Pathology
Author(s): Hiroki Mizuno, Akinari Sekine, Masahiko Oguro, Yoichi Oshima, Masahiro Kawada, Keiichi Sumida, Masayuki Yamanouchi, Noriko Hayami, Tatsuya Suwabe, Rikako Hiramatsu, Eiko Hasegawa, Junichi Hoshino, Naoki Sawa, Takashi Fujii, Kenmei Takaichi, Kenichi Ohashi, Yoshifumi Ubara
An 84-year-old Japanese man was admitted due to anasarca, thrombocytopenia, systemic inflammation, and progressive renal insufficiency, resistant to diuretics, glucocorticoid therapy and plasma exchange. Renal biopsy showed diffuse endocapillary proliferation and mesangiolysis without any immune deposits. Tocilizumab suppressed systemic inflammation, resulting in improvement of anasarca and renal dysfunction, but thrombocytopenia persisted and platelet-associated IgG antibody was elevated. Though romiplostim was effective for thrombocytopenia, the patient died of aspiration pneumonia after cerebral hemorrhage. Autopsy showed the hyaline vascular type Castleman's disease-like lymphadenopathy and reticulin myelofibrosis with an increase of megakaryocytes. Renal finding showed that endocapillary injury improved, and collapsed glomeruli was noted. This patient fitted the criteria of TAFRO (thrombocytopenia (T), anasarca (A), fever (F), reticulin myelofibrosis (R), and organomegaly (O)) syndrome. The clinical course suggests that two factors, including overproduction of interleukin-6 and autoimmune-mediated thrombocytopenia via thrombopoietin receptor, may have contributed to the pathogenesis of TAFRO syndrome in this patient.



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EWSR1-NFATC2 Gene Fusion in a Soft Tissue Tumor with Epithelioid Round Cell Morphology and Abundant Stroma: A Case Report and Review of the Literature

Publication date: Available online 4 April 2018
Source:Human Pathology
Author(s): Jarish N. Cohen, Amit J. Sabnis, Gregor Krings, Soo-Jin Cho, Andrew E. Horvai, Jessica L. Davis
SummaryMesenchymal round cell tumors are a diverse group of neoplasms defined by primitive, often high-grade cytomorphology. The most common molecular alterations detected in these tumors are gene rearrangements involving EWSR1 to one of many fusion partners. Rare EWSR1-NFATC2 gene rearrangements, corresponding to a t(20;22) gene translocation, have been described in mesenchymal tumors with clear round cell morphology and a predilection for the skeleton. We present a case of a tumor harboring the EWSR1-NFATC2 gene fusion arising in the subcutaneous tissue of a young woman. The tumor exhibited corded and trabecular architecture of epithelioid cells within abundant myxoid and fibrous stroma. The cells showed strong immunoreactivity for NKX2.2, variable CD99, keratin, and EMA, but were negative for S100 and myoepithelial markers. Importantly, similar to previously reported cases the clinical course was more indolent than that of Ewing sarcoma. This case highlights the distinctive clinicopathologic characteristics of EWSR1-NFATC2 gene fusion-associated neoplasms that distinguish them from Ewing sarcoma.



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Expanding the Histomorphologic Spectrum of TFE3 Rearranged PEComas

Publication date: Available online 4 April 2018
Source:Human Pathology
Author(s): Nolan Maloney, Krinio Giannikou, Joel Lefferts, Julia A. Bridge, Konstantinos Linos
Perivascular epithelioid tumors (PEComas) are a family of mesenchymal neoplasms that have smooth muscle and melanocytic differentiation. They can be sporadic or associated with Tuberous Sclerosis Complex and commonly present in the kidney as angiomyolipoma or in the lung as pulmonary clear cell sugar tumors or lymphangioleiomyomatosis. However, they can present at any visceral or soft tissue site. They usually have a benign clinical course, but rarely can behave in a malignant fashion. Most PEComas demonstrate abnormalities of TSC2, but a recently described subset harbor TFE3 rearrangements that appear to be mutually exclusive of TSC2 alterations. TFE3 rearranged PEComas demonstrate a distinct alveolar morphology that lacks spindle cells and smooth muscle differentiation. Distinction between these may have important therapeutic consequences. Herein, we present a case of a TFE3 rearranged PEComa without the customary morphology that required ancillary investigation with TFE3 immunohistochemistry and break-apart fluorescence in-situ hybridization (FISH) for proper categorization.



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Placentas from women with pregnancy-associated venous insufficiency show villi damage with evidence of hypoxic cellular stress

Publication date: Available online 4 April 2018
Source:Human Pathology
Author(s): Natalio García-Honduvilla, Miguel A Ortega, Ángel Asúnsolo, María J Álvarez-Rocha, Beatriz Romero, Juan De León-Luis, Melchor Álvarez- Mon, Julia Buján
Lower extremity venous insufficiency (VI) is a complication of pregnancy. The potential association of this venous disease with structural damage of the placenta has not been described. We analyzed the pattern of histopathological lesions and the gene and protein expression of HIF1-α and apoptosis regulatory proteins. A prospective study was carried out on placenta samples from 43 women with pregnancy-associated VI and 24 age-matched pregnant healthy controls (HC). Women with VI showed a significant increase in the number of villi (150.77±42.55 VI versus 122.13±27.74 HC) and in syncytial knots compared to those found in placentas from HC (67.15±31.08 VI versus 42.49±17.36 HC), and an increase in the number of bridges (32.40±2.67 VI versus 22.73±2.37 HC) (P<.05). The mean number of syncytial nodes per villus is 1.37±0.90 in the VI group and 0.49±0.58 in the HC group (P<.001). Significant increases in the expression of Bax and Caspase-3 and 9 in the placentas from women with VI were observed compared to those found in HC. The expression of HIF-1α at both the mRNA and protein levels was also significantly increased in placentas from women with VI. Our study demonstrates that placentas from women with pregnancy-associated VI show structural remodeling, with an increase in the number of villi and syncytial knots and enhanced apoptotic cellular death. Interestingly, this placental damage is associated with an increased expression of hypoxia-triggered molecular pathways, such as HIF-1α.



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Surgical Indication for Advanced Intrahepatic Cholangiocarcinoma According to the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value

Abstract

Background

The indication of surgery in intrahepatic cholangiocarcinoma (ICC) patients with lymph node metastasis (LNM), macroscopic periductal infiltration (PI), and intrahepatic metastasis (IM) remains unclear.

Methods

Patients who underwent resection for mass-forming (MF) dominant ICC and unresected patients caused by LNM, IM, or locally advanced tumors (UR group) were enrolled. The significance of CA19-9 was investigated in advanced ICC.

Results

Seventy-three patients who underwent resection and 20 UR patients were analyzed. Using the minimum p value approach based on the overall survival, the optimal CA19-9 cutoff value was 300 U/mL. The OS of the patients with CA19-9 < 37 U/mL (n = 26; MST, 49.6 months) and 37–300 U/mL (n = 28; MST, 45.1 months) was comparable (P = 0.842); however, the OS of the patients with CA19-9 = 37–300 U/mL was significantly better than that with CA19-9 ≥ 300 U/mL (n = 19; MST, 15.3 months; P < 0.001). CA19-9 > 300 U/mL, MF + PI, and IM were independently associated with OS. The OS of the patients with CA19-9 < 300 U/mL who developed LNM (MST, 34.0 months), MF + PI (MST, 32.9 months), or IM (MST, 35.2 months), or who required major vascular resection (MST, 45.1 months) was better than those with CA19-9 ≥ 300 U/mL who developed LNM (MST, 8.7 months; P = 0.005), MF + PI (MST, 7.5 months; P = 0.040), or IM (MST, 8.7 months; P = 0.001), or who required major vascular resection (MST, 14.8 months; P = 0.015); their prognosis was similar with the UR group.

Conclusions

Even if patients had ICC developing LNM, PI, or IM, or require major vascular resection, surgical resection can be indicated for patients with CA19-9 < 300 U/mL. However, the indications for either adjuvant therapy or resection should be carefully determined in patients with CA19-9 ≥ 300 U/mL.

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Letter to the Editor: Risk Factors for Mortality and Morbidity in Elderly Patients Presenting with Digestive Surgical Emergencies

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Results of Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease

Abstract

Background

Magnetic sphincter augmentation (MSA) is a modern treatment option for gastroesophageal reflux disease (GERD); however, laparoscopic fundoplication remains the gold standard. The aim of the study was to evaluate outcomes of MSA patients at a reflux center.

Methods

A retrospective review was performed of all patients that underwent MSA between March 2012 and November 2017. Out of 110 patients, 68 with a follow-up >3 months were included. Postoperative gastrointestinal symptoms, proton pump inhibitor (PPI) intake, GERD-Health-related Quality of Life (GERD-HRQL) and alimentary satisfaction (AS) were assessed. Postoperative esophageal functioning tests were performed in 50% of patients.

Results

Sixty-eight patients underwent MSA; hiatal repair was performed in 31 cases. The median OR time was 27 min, and no intraoperative complications occurred. The median follow-up was 13 months (IQR 4.2–45). Endoscopic dilatation was performed in 2 patients (3%) and device removal in another 2 cases. The postoperative GERD-HRQL score was significantly reduced (3 vs. 24; p < 0.001) and the median AS was 8/10. Preoperative experienced heartburn, regurgitations and dysphagia were eliminated in 92, 96 and 100%. Postoperative new-onset difficulties swallowing with solids only were reported to occur occasionally by 16% and rarely by 21% of patients. Satisfaction with heartburn relief was 95%, and the overall outcome was rated excellent/good in 89%. PPI dependency was eliminated in 87%. The median total percentage pH < 4 and number of reflux episodes were significantly reduced. Postoperative pH results were negative or slightly above the norm in 79% and 12%, respectively.

Conclusion

Sphincter augmentation results in significantly reduced reflux symptoms, increased GERD-specific Quality of Life and excellent alimentary satisfaction with low perioperative morbidity. This procedure should be considered an excellent alternative to fundoplication in the treatment of GERD.

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Pollen and spore monitoring in the world

Ambient air quality monitoring is a governmental duty that is widely carried out in order to detect non-biological ("chemical") components in ambient air, such as particles of 

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Safe zone for the posterior interosseous nerve with regard to the lateral and posterior approaches to the proximal radius

Abstract

Purpose

The posterior interosseous nerve (PIN) is at risk during the posterior and lateral approaches to the proximal radius. We aimed to define a safe zone for these approaches to avoid injury of the PIN and to evaluate their close and changing relationship to the nerve during forearm rotation.

Methods

The study collective consisted of 50 upper limbs. After performance of the lateral approach, the distance between the tip of the radial head and the PIN's exit point from the supinator (= distance 1) and the shortest interval between the nerve's exit to the radial margin of the ulna (= distance 2) were measured in maximum pronation and supination. Then, the dorsal approach was conducted and again distance 1 and the interval between the distal margin of the anconeus and the nerve's exit point (distance 2) were evaluated (pronation and supination).

Results

There were significantly shorter distances during supination in comparison to pronation. Regarding the lateral approach, distance 1 changed from a mean of 60.3 mm (supination) to 62.7 mm in pronation (p < 0.001). For the dorsal approach, distance 1 decreased significantly (p < 0.001) from 62.9 mm (pronation) to 60.2 mm (supination).

Conclusion

Supination during the lateral and dorsal approaches to the proximal radius needs to be avoided to protect the PIN. Furthermore, the nerve appeared at an interval between 45 and 84.1 mm (lateral approach) and 47.5–93.8 mm (dorsal approach), respectively. Therefore, care must be taken at this height during extension of the approaches in a distal direction.

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Introduction: Food as Medicine, Medicine as Food

The history of food is "well and truly out of the academic wilderness."1¹ Long a marginalized area of inquiry in both food studies programs and history departments, food history has moved into the historical mainstream since the early 2000s, and found institutionalization in conferences, journals, anthologies, and programs of study.2² The publication of companion guides to food history perhaps signaled this move most of all.3³ In addition to being at the center of an increasingly well-demarcated field, food has also become a useful category of analysis in political, social, and environmental histories. Food has been recognized, for example, as a particularly illuminating way of examining empire and globalization.4⁴ At the opposite end of the scale, food forms part of local and national history.5⁵ Changing technologies of food production in the home have been linked to shifts in gender roles and particularly to increasingly housebound women.6⁶ Environmental historians have used food to raise issues around resource management, economic development, and the configurations of notions such as purity and the natural.7⁷

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Invalid Cookery, Nursing and Domestic Medicine in Ireland, c. 1900

Abstract

This article uses a 1903 text by the Irish cookery instructress Kathleen Ferguson to examine the intersections between food, medicine and domestic work. Sick Room Cookery, and numerous texts like it, drew on traditions of domestic medicine and Anglo-Irish gastronomy while also seeking to establish female expertise informed by modern science and medicine. Placing the text in its broader cultural context, the article examines how it fit into the tradition of domestic medicine and the emerging profession of domestic science. Giving equal weight to the history of food and of medicine, and seeing each as shaped by historical context, help us to see the practice of feeding the sick in a different way.

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Unpalatable Truths: Food and Drink as Medicine in Colonial British India

Abstract

This article considers the significance of eating and drinking within a series of diaries and journals produced in British colonial India during the Indian Rebellion of 1857. The discussion of food and drink in this context was not simply a means to add color or compelling detail to these accounts, but was instead a vital ingredient of the authors' understanding of health and medical treatment. These texts suggest a broader colonial medical understanding of the importance of regulating diet to maintain physical health. Concern with food, and the lack thereof, was understandably a key element in diaries, and in the eyewitness accounts kept by British soldiers, doctors, and civilians during the rebellion. At a narrative level, mention of food also functioned as a trope serving to increase dramatic tension and to capture an imagery of fortitude. In references to drink, by contrast, these sources reveal a conflict between professional and lay opinions regarding the use of alcohol as part of medical treatment. The accounts show the persistent use of alcohol both for medicinal and restorative purposes, despite growing social and medical anxieties over its ill-effects on the body. Close examination of these references to food and drink reflect the quotidian habits, social composition, and the extent of professional and lay knowledge of health and medicine in colonial British India.

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Comparison of the computer–aided articulation therapy application with printed material in children with speech sound disorders

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Rana Dural, Özlem Ünal–Logacev
ObjectivesThe aim of the present study was to develop an iPad application for computer–aided articulation therapy called the Turkish Articulation Therapy Application (TARTU), and make comparisons between the efficacy of TARTU and printed material.MethodA single subject research design, adapted alternating treatments model, was used for this purpose. The study was carried out with 2 children, at the age of 5; 1 and 5; 11, both of whom have a speech sound disorder. The comparison between TARTU and printed material effectiveness was compared for three target sounds (/k/, /ʃ/ and /l/). 12 therapy sessions were carried out three times a week using the behavioural approach. One participant received therapy targeting the sound /k/ using TARTU, while printed material used for the sound /ʃ/. The targeted sounds were switched for the second participant. Sound /l/ was left without any intervention.ResultThe target sound met the criterion with TARTU in one participant, and with printed material in the other participant.ConclusionThe presentation type of the materials did not play an important role in the success of the therapy on the participants.



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Domain-General and Domain-Specific Patterns of Activity Supporting Metacognition in Human Prefrontal Cortex

Metacognition is the capacity to evaluate the success of one's own cognitive processes in various domains; for example, memory and perception. It remains controversial whether metacognition relies on a domain-general resource that is applied to different tasks or if self-evaluative processes are domain specific. Here, we investigated this issue directly by examining the neural substrates engaged when metacognitive judgments were made by human participants of both sexes during perceptual and memory tasks matched for stimulus and performance characteristics. By comparing patterns of fMRI activity while subjects evaluated their performance, we revealed both domain-specific and domain-general metacognitive representations. Multivoxel activity patterns in anterior prefrontal cortex predicted levels of confidence in a domain-specific fashion, whereas domain-general signals predicting confidence and accuracy were found in a widespread network in the frontal and posterior midline. The demonstration of domain-specific metacognitive representations suggests the presence of a content-rich mechanism available to introspection and cognitive control.

SIGNIFICANCE STATEMENT We used human neuroimaging to investigate processes supporting memory and perceptual metacognition. It remains controversial whether metacognition relies on a global resource that is applied to different tasks or if self-evaluative processes are specific to particular tasks. Using multivariate decoding methods, we provide evidence that perceptual- and memory-specific metacognitive representations coexist with generic confidence signals. Our findings reconcile previously conflicting results on the domain specificity/generality of metacognition and lay the groundwork for a mechanistic understanding of metacognitive judgments.

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Analytical Transparency and Reproducibility in Human Neuroimaging Studies

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{beta}-Secretase BACE1 Promotes Surface Expression and Function of Kv3.4 at Hippocampal Mossy Fiber Synapses

The β-secretase β-site APP-cleaving enzyme 1 (BACE1) is deemed a major culprit in Alzheimer's disease, but accumulating evidence indicates that there is more to the enzyme than driving the amyloidogenic processing of the amyloid precursor protein. For example, BACE1 has emerged as an important regulator of neuronal activity through proteolytic and, most unexpectedly, also through nonproteolytic interactions with several ion channels. Here, we identify and characterize the voltage-gated K⁺ channel 3.4 (Kv3.4) as a new and functionally relevant interaction partner of BACE1. Kv3.4 gives rise to A-type current with fast activating and inactivating kinetics and serves to repolarize the presynaptic action potential. We found that BACE1 and Kv3.4 are highly enriched and remarkably colocalized in hippocampal mossy fibers (MFs). In BACE1^–/– mice of either sex, Kv3.4 surface expression was significantly reduced in the hippocampus and, in synaptic fractions thereof, Kv3.4 was specifically diminished, whereas protein levels of other presynaptic K⁺ channels such as K_Ca1.1 and K_Ca2.3 remained unchanged. The apparent loss of presynaptic Kv3.4 affected the strength of excitatory transmission at the MF–CA3 synapse in hippocampal slices of BACE1^–/– mice when probed with the Kv3 channel blocker BDS-I. The effect of BACE1 on Kv3.4 expression and function should be bidirectional, as predicted from a heterologous expression system, in which BACE1 cotransfection produced a concomitant upregulation of Kv3.4 surface level and current based on a physical interaction between the two proteins. Our data show that, by targeting Kv3.4 to presynaptic sites, BACE1 endows the terminal with a powerful means to regulate the strength of transmitter release.

SIGNIFICANCE STATEMENT The β-secretase β-site APP-cleaving enzyme 1 (BACE1) is infamous for its crucial role in the pathogenesis of Alzheimer's disease, but its physiological functions in the intact nervous system are only gradually being unveiled. Here, we extend previous work implicating BACE1 in the expression and function of voltage-gated Na⁺ and K⁺ channels. Specifically, we characterize voltage-gated K⁺ channel 3.4 (Kv3.4), a presynaptic K⁺ channel required for action potential repolarization, as a novel interaction partner of BACE1 at the mossy fiber (MF)–CA3 synapse of the hippocampus. BACE1 promotes surface expression of Kv3.4 at MF terminals, most likely by physically associating with the channel protein in a nonenzymatic fashion. We advance the BACE1–Kv3.4 interaction as a mechanism to strengthen the temporal control over transmitter release from MF terminals.

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Excreted Steroids in Vertebrate Social Communication

Steroids play vital roles in animal physiology across species, and the production of specific steroids is associated with particular internal biological functions. The internal functions of steroids are, in most cases, quite clear. However, an important feature of many steroids (their chemical stability) allows these molecules to play secondary, external roles as chemical messengers after their excretion via urine, feces, or other shed substances. The presence of steroids in animal excretions has long been appreciated, but their capacity to serve as chemosignals has not received as much attention. In theory, the blend of steroids excreted by an animal contains a readout of its own biological state. Initial mechanistic evidence for external steroid chemosensation arose from studies of many species of fish. In sea lampreys and ray-finned fishes, bile salts were identified as potent olfactory cues and later found to serve as pheromones. Recently, we and others have discovered that neurons in amphibian and mammalian olfactory systems are also highly sensitive to excreted glucocorticoids, sex steroids, and bile acids, and some of these molecules have been confirmed as mammalian pheromones. Steroid chemosensation in olfactory systems, unlike steroid detection in most tissues, is performed by plasma membrane receptors, but the details remain largely unclear. In this review, we present a broad view of steroid detection by vertebrate olfactory systems, focusing on recent research in fishes, amphibians, and mammals. We review confirmed and hypothesized mechanisms of steroid chemosensation in each group and discuss potential impacts on vertebrate social communication.

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Role of Rostral Fastigial Neurons in Encoding a Body-Centered Representation of Translation in Three Dimensions

Many daily behaviors rely critically on estimates of our body motion. Such estimates must be computed by combining neck proprioceptive signals with vestibular signals that have been transformed from a head- to a body-centered reference frame. Recent studies showed that deep cerebellar neurons in the rostral fastigial nucleus (rFN) reflect these computations, but whether they explicitly encode estimates of body motion remains unclear. A key limitation in addressing this question is that, to date, cell tuning properties have only been characterized for a restricted set of motions across head-re-body orientations in the horizontal plane. Here we examined, for the first time, how 3D spatiotemporal tuning for translational motion varies with head-re-body orientation in both horizontal and vertical planes in the rFN of male macaques. While vestibular coding was profoundly influenced by head-re-body position in both planes, neurons typically reflected at most a partial transformation. However, their tuning shifts were not random but followed the specific spatial trajectories predicted for a 3D transformation. We show that these properties facilitate the linear decoding of fully body-centered motion representations in 3D with a broad range of temporal characteristics from small groups of 5–7 cells. These results demonstrate that the vestibular reference frame transformation required to compute body motion is indeed encoded by cerebellar neurons. We propose that maintaining partially transformed rFN responses with different spatiotemporal properties facilitates the creation of downstream body motion representations with a range of dynamic characteristics, consistent with the functional requirements for tasks such as postural control and reaching.

SIGNIFICANCE STATEMENT Estimates of body motion are essential for many daily activities. Vestibular signals are important contributors to such estimates but must be transformed from a head- to a body-centered reference frame. Here, we provide the first direct demonstration that the cerebellum computes this transformation fully in 3D. We show that the output of these computations is reflected in the tuning properties of deep cerebellar rostral fastigial nucleus neurons in a specific distributed fashion that facilitates the efficient creation of body-centered translation estimates with a broad range of temporal properties (i.e., from acceleration to position). These findings support an important role for the rostral fastigial nucleus as a source of body translation estimates functionally relevant for behaviors ranging from postural control to perception.

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