Psychophysical measurement of the effects and non-effects of TMS on contrast perception

Publication date: Available online 7 April 2018
Source:Brain Stimulation
Author(s): Greta Vilidaite, Daniel H. Baker




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Endocrine outcomes of endoscopic versus transcranial resection of craniopharyngiomas: a system review and meta-analysis

Publication date: Available online 7 April 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Qiao Nidan
It is unclear whether the endoscopic technique has any advantages over transcranial approach in the aspect of endocrine outcomes in patients with craniopharyngiomas, thus, we conducted a systematic review and meta-analysis. We conducted a comprehensive search of PubMed to identify relevant studies. Pituitary, hypothalamus functions and recurrence were used as outcome measures. A total of 39 cohort studies involving 3,079 adult patients were included in the comparison. Among these studies, 752 patients across 17 studies underwent endoscopic transsphenoidal resection, and 2,327 patients across 23 studies underwent transcranial resection. More patients in the endoscopic group (75.7%) had visual symptoms and endocrine symptoms (60.2%) than did patients in the transcranial group (67.0%, p = 0.038 and 42.0%, p = 0.016). There was no significant difference in hypopituitarism and pan-hypopituitarism after surgery between the two groups: 72.2% and 43.7% of the patients in endoscopic group compared to 80.7% and 48.3% in the transcranial group (p = 0.140 and p = 0.713). We observed same proportions of transient and permanent diabetes insipidus in both groups. Similar recurrence was observed in both groups (p = 0.131). Pooled analysis showed that neither weight gain (p = 0.406) nor memory impairment (p = 0.995) differed between the two groups. Meta-regression analysis revealed that gross total resection contributed to the heterogeneity of recurrence proportion (p < 0.001). We observed similar proportions of endocrine outcomes and recurrence in both endoscopic and transcranial groups. More recurrences were observed in studies with lower proportions of gross total resection.



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Characterization of distinct Arctic aerosol accumulation modes and their sources

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): R. Lange, M. Dall'Osto, H. Skov, J.K. Nøjgaard, I.E. Nielsen, D.C.S. Beddows, R. Simo, R.M. Harrison, A. Massling
In this work we use cluster analysis of long term particle size distribution data to expand an array of different shorter term atmospheric measurements, thereby gaining insights into longer term patterns and properties of Arctic aerosol. Measurements of aerosol number size distributions (9–915 nm) were conducted at Villum Research Station (VRS), Station Nord in North Greenland during a 5 year record (2012–2016). Alongside this, measurements of aerosol composition, meteorological parameters, gaseous compounds and cloud condensation nuclei (CCN) activity were performed during different shorter occasions. K-means clustering analysis of particle number size distributions on daily basis identified several clusters. Clusters of accumulation mode aerosols (main size modes > 100 nm) accounted for 56% of the total aerosol during the sampling period (89–91% during February–April, 1–3% during June–August). By association to chemical composition, cloud condensation nuclei properties, and meteorological variables, three typical accumulation mode aerosol clusters were identified: Haze (32% of the time), Bimodal (14%) and Aged (6%). In brief: (1) Haze accumulation mode aerosol shows a single mode at 150 nm, peaking in February–April, with highest loadings of sulfate and black carbon concentrations. (2) Accumulation mode Bimodal aerosol shows two modes, at 38 nm and 150 nm, peaking in June–August, with the highest ratio of organics to sulfate concentrations. (3) Aged accumulation mode aerosol shows a single mode at 213 nm, peaking in September–October and is associated with cloudy and humid weather conditions during autumn. The three aerosol clusters were considered alongside CCN concentrations. We suggest that organic compounds, that are likely marine biogenic in nature, greatly influence the Bimodal cluster and contribute significantly to its CCN activity. This stresses the importance of better characterizing the marine ecosystem and the aerosol-mediated climate effects in the Arctic.



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Four years of highly time resolved measurements of elemental and organic carbon at a rural background site in Central Europe

Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Saliou Mbengue, Michal Fusek, Jaroslav Schwarz, Petr Vodička, Adéla Holubová Šmejkalová, Ivan Holoubek
Elemental carbon (EC) and organic carbon (OC) in fine atmospheric aerosols (PM2.5: aerodynamic diameter smaller than 2.5 μm) have been measured with a semi-automatic instrument during a 4-year survey at the National Atmospheric Observatory Košetice (NAOK), Czech Republic. Ground based measurements were performed from March 2013 to December 2016 with a field Semi-Continuous OCEC Aerosol Analyzer (Sunset Laboratory Inc., USA). The variation of EC and OC concentrations and the OC/EC ratio was characterized for different seasons and days of the week. During our survey, higher concentrations of EC and OC were observed in winter (0.83 ± 0.67 and 3.33 ± 2.28 μg m⁻³, respectively), and lower concentrations were recorded in summer (0.34 ± 0.18 and 2.30 ± 1.15 μg m⁻³, respectively). Inversely, the OC/EC ratio with mean value (5.1 ± 2.6) characteristic to rural background area was higher in summer (7.33 ± 3.23) in comparison to the other seasons. Since the data contain values below detection and quantification limits of the measuring device (i.e., censored values), statistical methods for censored data have been used in order to compare mean EC and OC concentrations between various seasons. It was found out that there is a significant difference between summer and the other seasons with the exception of mean OC concentrations at noon. In most cases, there was also a significant difference between winter and the other seasons. Moreover, it was found out that when dealing with OC concentrations, it is possible to replace censored values by a constant and still obtain reasonable results. In case of EC concentrations, the method based on censored distributions should be preferred when the sample size is small and the proportion of censored values is high. The diurnal variation of EC and OC is less pronounced in summer. During working days, the EC diurnal pattern displays a morning (between 6:00 and 10:00) and an afternoon/evening (between 18:00 and 22:00) peaks, while for OC, only the afternoon/evening peak is observed. These seasonal, diurnal and weekly variations of EC and OC concentrations and OC/EC ratio are probably related to variability in terms of emission sources (residential heating, traffic), transport characteristic and meteorological conditions. A weaker correlation between EC and OC in summer (r = 0.56) suggests additional sources and/or transport processes during other seasons. The elevated OC/EC ratio, the higher correlation between OC and O3, and the temperature and solar radiation during summer confirmed an increasing contribution of OC from secondary organic carbon (SOC) estimated as at least 59 ± 11% of total carbon in the PM2.5 using the EC tracer method. Backward trajectories of air masses arriving at 100 m AGL calculated in winter and summer show that higher pollution episodes of EC and OC are predominantly associated with continental air masses confined over Central Europe (about 79%), while lower EC and OC levels are mainly associated with episodes of long-range transport of marine air masses. Interestingly, the results reveal that in winter pollutants emitted during workdays could be accumulated above the region and influence the rural background air quality during some prolonged time of the weekend, especially on Saturday.



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Comparison of Two Music Training Approaches on Music and Speech Perception in Cochlear Implant Users.

Related Articles

Comparison of Two Music Training Approaches on Music and Speech Perception in Cochlear Implant Users.

Trends Hear. 2018 Jan-Dec;22:2331216518765379

Authors: Fuller CD, Galvin JJ, Maat B, Başkent D, Free RH

Abstract
In normal-hearing (NH) adults, long-term music training may benefit music and speech perception, even when listening to spectro-temporally degraded signals as experienced by cochlear implant (CI) users. In this study, we compared two different music training approaches in CI users and their effects on speech and music perception, as it remains unclear which approach to music training might be best. The approaches differed in terms of music exercises and social interaction. For the pitch/timbre group, melodic contour identification (MCI) training was performed using computer software. For the music therapy group, training involved face-to-face group exercises (rhythm perception, musical speech perception, music perception, singing, vocal emotion identification, and music improvisation). For the control group, training involved group nonmusic activities (e.g., writing, cooking, and woodworking). Training consisted of weekly 2-hr sessions over a 6-week period. Speech intelligibility in quiet and noise, vocal emotion identification, MCI, and quality of life (QoL) were measured before and after training. The different training approaches appeared to offer different benefits for music and speech perception. Training effects were observed within-domain (better MCI performance for the pitch/timbre group), with little cross-domain transfer of music training (emotion identification significantly improved for the music therapy group). While training had no significant effect on QoL, the music therapy group reported better perceptual skills across training sessions. These results suggest that more extensive and intensive training approaches that combine pitch training with the social aspects of music therapy may further benefit CI users.

PMID: 29621947 [PubMed - in process]

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Glioblastoma Metastatic to the Ovary, a Very Different Krukenberg Tumor?

Publication date: Available online 7 April 2018
Source:Practical Radiation Oncology
Author(s): Robin E. Bonomi, Josh Kovoor, Mark Zaki, Mark Szlaczky, Michael Christensen, William Kupsky, Geoffrey Barger, Steven Miller, Michael M. Dominello




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Gastric metastasis from pancreatic neuroendocrine tumor

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Secondary gastric involvement of follicular lymphoma

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Linitis plastica in excluded stomach after Roux-en-Y gastric bypass

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Differences between manual and automatic analysis in determining the severity of Obstructive Sleep Apnea using home sleep apnea testing

Home sleep apnea testing (HSAT) is a diagnostic measure for obstructive sleep apnea hypopnea syndrome (OSAHS) in moderate/high risk patients. Some HSAT companies contain automatic analysis (AA). However, guidelines recommend manual analysis (MA) despite the weak evidence for this recommendation.

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Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT

Publication date: Available online 7 April 2018
Source:Dental Materials
Author(s): Katrin Heck, Juergen Manhart, Reinhard Hickel, Christian Diegritz
ObjectiveThe objective of this RCT was to compare the 10-year clinical performance of QuiXfil with that of Tetric Ceram in posterior single- or multi-surface cavities.Methods46 QuiXfil (Xeno III) and 50 Tetric Ceram (Syntac classic) composite restorations were placed in 14 stress bearing class I and 82 class II cavities in first or second molars. Clinical evaluation was performed at baseline and after up to 10 years by using modified US Public Health Service criteria. At the last recall period, 26 QuiXfil and 30 Tetric Ceram restorations in 11 stress bearing class I and 45 class II cavities, were assessed.ResultsTen failed restorations were observed during the follow-up period, four Tetric Ceram restorations failed due to secondary caries (2), tooth fracture (1) and bulk fracture combined with secondary caries (1) whereas six QuiXfil restorations failed due to secondary caries (1), tooth fracture (2), secondary caries combined with restoration fracture (1), restoration fracture (1) and postoperative sensitivity (1). Fisher's exact test yielded no significant difference between both materials (p=0.487).SignificanceBoth materials, bulk fill QuiXfil restorations and Tetric Ceram restorations, showed highly clinical effectiveness during the 10-year follow-up.



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Geometrical accuracy of metallic objects produced with additive or subtractive manufacturing: A comparative in vitro study

Publication date: Available online 7 April 2018
Source:Dental Materials
Author(s): Michael Braian, David Jönsson, Mir Kevci, Ann Wennerberg
ObjectiveTo evaluate the accuracy and precision of objects produced by additive manufacturing systems (AM) for use in dentistry and to compare with subtractive manufacturing systems (SM).MethodsTen specimens of two geometrical objects were produced by five different AM machines and one SM machine. Object A mimics an inlay-shaped object, while object B imitates a four-unit bridge model. All the objects were sorted into different measurement dimensions (x, y, z), linear distances, angles and corner radius.ResultsNone of the additive manufacturing or subtractive manufacturing groups presented a perfect match to the CAD file with regard to all parameters included in the present study. Considering linear measurements, the precision for subtractive manufacturing group was consistent in all axes for object A, presenting results of <0.050mm. The additive manufacturing groups had consistent precision in the x-axis and y-axis but not in the z-axis. With regard to corner radius measurements, the SM group had the best overall accuracy and precision for both objects A and B when compared to the AM groups.SignificanceWithin the limitations of this in vitro study, the conclusion can be made that subtractive manufacturing presented overall precision on all measurements below 0.050mm. The AM machines also presented fairly good precision, <0.150mm, on all axes except for the z-axis. Knowledge regarding accuracy and precision for different production techniques utilized in dentistry is of great clinical importance. The dental community has moved from casting to milling and additive techniques are now being implemented. Thus all these production techniques need to be tested, compared and validated.



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A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy

Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation.

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Towards circuit optogenetics

Publication date: June 2018
Source:Current Opinion in Neurobiology, Volume 50
Author(s): I-Wen Chen, Eirini Papagiakoumou, Valentina Emiliani
Optogenetics neuronal targeting combined with single-photon wide-field illumination has already proved its enormous potential in neuroscience, enabling the optical control of entire neuronal networks and disentangling their role in the control of specific behaviors. However, establishing how a single or a sub-set of neurons controls a specific behavior, or how functionally identical neurons are connected in a particular task, or yet how behaviors can be modified in real-time by the complex wiring diagram of neuronal connections requires more sophisticated approaches enabling to drive neuronal circuits activity with single-cell precision and millisecond temporal resolution. This has motivated on one side the development of flexible optical methods for two-photon (2P) optogenetic activation using either, or a hybrid of two approaches: scanning and parallel illumination. On the other side, it has stimulated the engineering of new opsins with modified spectral characteristics, channel kinetics and spatial distribution of expression, offering the necessary flexibility of choosing the appropriate opsin for each application. The need for optical manipulation of multiple targets with millisecond temporal resolution has imposed three-dimension (3D) parallel holographic illumination as the technique of choice for optical control of neuronal circuits organized in 3D. Today 3D parallel illumination exists in several complementary variants, each with a different degree of simplicity, light uniformity, temporal precision and axial resolution. In parallel, the possibility to reach hundreds of targets in 3D volumes has prompted the development of low-repetition rate amplified laser sources enabling high peak power, while keeping low average power for stimulating each cell.All together those progresses open the way for a precise optical manipulation of neuronal circuits with unprecedented precision and flexibility.

Graphical abstract

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Importance of the subcellular location of protein deposits in neurodegenerative diseases

Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Anne Bertolotti
Alzheimer's disease, Parkinson's, Huntington's, amyotrophic lateral sclerosis (ALS) and prion disorders are devastating neurodegenerative diseases of increasing prevalence in aging populations. Although clinically different, they share similar molecular features: the accumulation of one or two proteins in abnormal conformations inside or outside neurons. Enhancing protein quality control systems could be a useful strategy to neutralize the abnormal proteins causing neurodegenerative diseases. This review emphasizes the subcellular location of protein deposits in neurodegenerative diseases and the need to tailor strategies aimed at boosting protein quality control systems to the affected subcellular compartment. Inhibition of a protein phosphatase terminating the unfolded protein response will be discussed as a strategy to protect from diseases associated with misfolded proteins in the endoplasmic reticulum.



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DOES fixation METHOD EFFECTS temporomandibular joints after mandibular advancement?

Sagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ).

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Female Surgical Researchers Show Gender Biases Similar to Men’s

Women researchers include more females in their surgical research than male researchers do, but their studies are equally gender-biased, according to new findings.
Reuters Health Information

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The Nasal Musculature as a Control Panel for Singing—Why Classical Singers Use a Special Facial Expression?

Publication date: Available online 7 April 2018
Source:Journal of Voice
Author(s): Maarit Aura, Ahmed Geneid, Kåre Bjørkøy, Marita Rantanen, Anne-Maria Laukkanen
ObjectivesThis study aimed to explain the possible reason why classical singers seem to spread their nostrils and raise their cheeks before starting to sing.Study DesignThis is an experimental study.MethodsFive subjects (three classical singers, two nonsingers) were investigated with nasofiberoscopy holding their breath after inhalation. The subjects were instructed to have a neutral expression first and then to take the singers' expression characterized by nostril flaring. In case of nonsingers, the special expression was rehearsed beforehand, guided by a classical singer. The following measurements were made: (1) height of soft palate, (2) area of the hypopharynx, (3) area of the epilaryngeal tube inlet (Aditus laryngis), and (4) dimensions of the (visible) glottis (length, width, and length-to-width ratio).ResultsAll subjects raised the palate and widened the pharyngeal inlet, epilaryngeal inlet, and the glottis during "singer's expression."ConclusionsThe results suggest that classical singers may take advantage of breathing- and smelling-related connections between nasal and facial muscles and the larynx to avoid a hard glottal attack and pressed phonation and possibly also to assist the production of mixed register (head voice), characterized by a relatively low adduction between the vocal folds.



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The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Nicola Bizzaro, Ignazio Brusca, Giulia Previtali, Maria Grazia Alessio, Massimo Daves, Stefan Platzgummer, Luigi Cinquanta, Giusy Paura, Maria Infantino, Mariangela Manfredi, Raffaella Faricelli, Danila Bassetti, Maura Musso, Gaia Deleonardi, Maria Teresa Trevisan, Antonella Radice, Marco Liguori, Tiziana Imbastaro, Fiorenza Pesente, Martina Fabris, Elio Tonutti




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The role of ophthalmic imaging in central nervous system degeneration in systemic lupus erythematosus

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Arnaldo Dias-Santos, Rita Pinto Proença, Joana Tavares Ferreira, Sofia Pinheiro, João Paulo Cunha, Rui Proença, Maria Francisca Moraes-Fontes
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that can involve any organ system. Central nervous system involvement can be a severe life threatening complication, ultimately resulting in severe neurodegenerative changes. Magnetic resonance imaging suggests that neurodegeneration, which may have deleterious effects on brain function, may occur early in SLE and experimental models suggest that neuroprotection may be feasible and beneficial.The retina is an extension of the brain. Recent ophthalmic imaging technologies are capable of identifying early changes in retinal and choroidal morphology and circulation that may reflect CNS degeneration. However, their utility in monitoring CNS involvement in SLE has been poorly studied as these have only been performed in small cohorts, in a cross-sectional design, non-quantitatively and without correlation to disease activity.The authors aim to review the current understanding of neurodegeneration associated with SLE, with particular focus on the visual pathway. We describe the neuropathology of the visual system in SLE and the evidence for retinal and choroidal neurodegenerative and microvascular changes using optical coherence tomography technology. We aim to describe the potential role of optical imaging modalities in NPSLE diagnosis and their likely impact on the study of neuronal function.



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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Franziska Sotzny, Julià Blanco, Enrica Capelli, Jesús Castro-Marrero, Sophie Steiner, Modra Murovska, Carmen Scheibenbogen
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent and severe chronic disease drastically impairing life quality. The underlying pathomechanism is incompletely understood yet but there is convincing evidence that in at least a subset of patients ME/CFS has an autoimmune etiology. In this review, we will discuss current autoimmune aspects for ME/CFS. Immune dysregulation in ME/CFS has been frequently described including changes in cytokine profiles and immunoglobulin levels, T- and B-cell phenotype and a decrease of natural killer cell cytotoxicity. Moreover, autoantibodies against various antigens including neurotransmitter receptors have been recently identified in ME/CFS individuals by several groups. Consistently, clinical trials from Norway have shown that B-cell depletion with rituximab results in clinical benefits in about half of ME/CFS patients. Furthermore, recent studies have provided evidence for severe metabolic disturbances presumably mediated by serum autoantibodies in ME/CFS. Therefore, further efforts are required to delineate the role of autoantibodies in the onset and pathomechanisms of ME/CFS in order to better understand and properly treat this disease.



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Systemic lupus erythematosus and systemic sclerosis: All roads lead to platelets

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Marc Scherlinger, Vivien Guillotin, Marie-Elise Truchetet, Cécile Contin-Bordes, Vanja Sisirak, Pierre Duffau, Estibaliz Lazaro, Christophe Richez, Patrick Blanco
Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are two phenotypically distincts inflammatory systemic diseases. However, SLE and SSc share pathogenic features such as interferon signature, loss of tolerance against self-nuclear antigens and increased tissue damage such as fibrosis. Recently, platelets have emerged as a major actor in immunity including auto-immune diseases. Both SLE and SSc are characterized by strong platelet system activation, which is likely to be both the witness and culprit in their pathogenesis. Platelet activation pathways are multiple and sometimes redundant. They include immune complexes, Toll-like receptors activation, antiphospholipid antibodies and ischemia-reperfusion associated with Raynaud phenomenon. Once activated, platelet promote immune dysregulation by priming interferon production by immune cells, providing CD40L supporting B lymphocyte functions and providing a source of autoantigens. Platelets are actively implicated in SLE and SSc end-organ damage such as cardiovascular and renal disease and in the promotion of tissue fibrosis. Finally, after understanding the main pathogenic implications of platelet activation in both diseases, we discuss potential therapeutics targeting platelets.



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From HSV infection to erythema multiforme through autoimmune crossreactivity

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Alberta Lucchese
Scientific and clinical data indicate that human herpes simplex virus 1 (HSV1) and, at a lesser extent, human herpes simplex virus 2 (HSV2) are factor(s) implicated in the development of erythema multiforme (EM). With a focus on oral EM, the present structured review of proteomic and epitope databases searched for the molecular basis that might link HSV1 and HSV2 infections to EM. It was found that a high number of peptides are shared between the two HSVs and human proteins related to the oral mucosa. Moreover, a great number of the shared peptides are also present in epitopes that have been experimentally validated as immunopositive in the human host. The results suggest the involvement of HSV infections in the induction of oral EM via a mechanism of autoimmune cross-reactivity and, in particular, highlight a potential major role for 180 kDa bullous pemphigoid antigen and HSV1 infection in the genesis of crossreactions potentially conducive to EM.



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Autoimmune phenomena and disease in cancer patients treated with immune checkpoint inhibitors

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Milena Tocut, Ronen Brenner, Gisele Zandman-Goddard
The discovery and approved treatment with immune checkpoint inhibitors (ICIs) for a variety of cancers has changed dramatically morbidity and mortality for these patients.Despite the obvious benefits, their use is associated with unique immune-related adverse effects (irAEs), including autoimmune conditions such as: inflammatory arthritis, myositis, vasculitis and Sicca syndrome.The appearance of ICIs-induced autoimmune irAE requires from oncologists and rheumatologists a different approach to the identification and treatment of these conditions, which may differ from the classic and traditional approach to rheumatologic diseases. It should be taken into consideration that ICIs therapy in patients with preexisting autoimmunity could be possible, but with a cost of causing disease exacerbation.In this extensive review, we present the autoimmune irAEs, mostly as phenomena, but also as classic autoimmune diseases as well as therapeutic options for the side effects.



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Antinuclear antibodies: Is the indirect immunofluorescence still the gold standard or should be replaced by solid phase assays?

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Dolores Pérez, Boris Gilburd, Danielle Azoulay, Ora Shovman, Nicola Bizzaro, Yehuda Shoenfeld




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Efficacy and safety of rituximab in systemic sclerosis: French retrospective study and literature review

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Mathilde Thiebaut, David Launay, Sébastien Rivière, Thibaut Mahévas, Syrine Bellakhal, Eric Hachulla, Olivier Fain, Arsène Mekinian
ObjectiveTo describe safety and efficacy of rituximab in patients with systemic sclerosis.MethodsWe included 13 patients with systemic sclerosis treated with rituximab and pooled with 40 additional patients from the literature. SSc rituximab untreated patients were matched to rituximab treated ones.ResultsThirteen patients who received rituximab and 26 rituximab-untreated patients were included. In comparison to 26 patients who did not received rituximab, FVC changes were not significantly different, whereas DLCO improved in 13 patients who received rituximab (0 [−4; 4] vs loss of −7 [−19; 0]; p = 0.05). Considering 7 rituximab treated and 14 untreated diffuse SSc, FVC was improved during the 24 [12; 46] months of follow up in dSSc who received rituximab (gain of 12 [7.5:14] % vs loss of 1.5 [−16.8; 2.5], (p = 0.003)). Pooled analysis of 53 patients (40 literature patients and 13 from personal series) showed significant improvement of median mRSS from 18 [8; 32] at baseline to 9 [4; 18] at M6 (p = 0.007), 13 [8; 18] at M12 (p = 0.008) and 10 [4; 16] at the last follow-up (p = 0.0002). FVC increased from 71% [66; 80] at baseline to 84% [75; 90] at M12 (p = 0.001). DLCO increased from 58% [39; 65] at M0 to 63% [53; 78] at M12 (p = 0.04).ConclusionOur personal data and pooled literature analysis suggest the efficacy of rituximab in the subset of diffuse SSc in particular in skin and interstitial disease involvements. The safety of rituximab seems to be reasonable and similar to previous data in other autoimmune diseases.



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Behçet's disease: New insights into pathophysiology, clinical features and treatment options

Publication date: Available online 6 April 2018
Source:Autoimmunity Reviews
Author(s): Antonio Greco, Armando De Virgilio, Massimo Ralli, Andrea Ciofalo, Patrizia Mancini, Giuseppe Attanasio, Marco de Vincentiis, Alessandro Lambiase
Behçet's disease (BD) is a rare systemic vasculitis characterized by oral aphthous ulcers, genital ulcers, ocular lesions and other systemic manifestations. BD occurs most frequently in Eurasian populations along the ancient trading route known as the "Silk Road" which extends from eastern Asia to the Mediterranean basin. The causes of BD are unknown: it is believed to be due to an autoimmune process triggered by an infectious or environmental agent in a genetically predisposed individual. HLA-B51 allele located in the MHC locus, on chromosome 6p has been the most strongly associated risk factor for BD in areas along the Old Silk Route. Herpes simplex virus-1 and Streptococcus have been postulated as possible environmental triggers of BD. T cell homeostasis perturbation, especially Th1 and Th17 expansions and decrease regulation by Tregs are now supposed to be the cornerstone of BD pathogenesis. The histology shows vasculitis that involves both arteries and veins, and vessels of any size. BD is a systemic vasculitis with significant neutrophil infiltration, endothelial cell swelling, and fibrinoid necrosis. The diagnosis of BD is only supported by clinical criteria and requires the exclusion of other diagnoses based on clinical presentation. There are no pathognomonic laboratorial findings of BD. This rare disease often leads to blindness and fatal systemic involvement. Main causes of death include major vessel disease and central nervous system involvement (Neuro-Behcet). Corticosteroids are commonly used to treat clinical manifestations of BD in combination with immunosuppressant drugs. Tumor necrosis factor (TNF)-blocking agents such as Infliximab, Etanercept, and Adalimumab have been reported to have success in patients with BD.



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Genomic Profile of Appendiceal Goblet Cell Carcinoid Is Distinct Compared to Appendiceal Neuroendocrine Tumor and Conventional Adenocarcinoma

Publication date: Available online 7 April 2018
Source:Human Pathology
Author(s): Kwun Wah Wen, James P. Grenert, Nancy M. Joseph, Nafis Shafizadeh, Anne Huang, Mojgan Hosseini, Sanjay Kakar
Goblet cell carcinoid (GCC) is a rare appendiceal tumor with unique morphologic features that shows glandular and neuroendocrine differentiation on immunohistochemistry. An additional component of adenocarcinoma (AC) can be present (GCC-AC). Both GCC and GCC-AC are staged and treated like AC. The histogenesis and genetic alterations underlying GCC and GCC-AC are unclear. Capture-based next-generation DNA sequencing targeting 479 cancer genes was performed on 19 appendiceal tumors: 4 GCC, 9 GCC-AC, 3 neuroendocrine tumors (NET), and 3AC (2 conventional, 1 mucinous). Somatic coding mutations were not seen in any NET. Pathogenic (P)/likely pathogenic (LP) mutations were present in 1 GCC, 8 GCC-AC and all 3AC cases. P/LP mutations in chromatin remodeling genes were seen in 4 (44.4%) GCC-AC cases, but not in NET, GCC or AC. In GCC-AC, P/LP mutations in ARID1A and RHOA were each present in 3 cases, and KDM6A and SOX9 mutations were each seen in 2 cases. APC and KRAS mutations were present in 1 conventional AC case, but were not observed in any GCC or GCC-AC. This limited series reveals mutations in SOX9, RHOA, and chromatin-modifier genes in goblet cell tumors, and shows that the mutational profile of GCC/GCC-AC is distinct from NET and conventional appendiceal AC.



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High expression of synthesis of cytochrome c oxidase 2 and TP53-induced glycolysis and apoptosis regulator can predict poor prognosis in human lung adenocarcinoma

Publication date: Available online 7 April 2018
Source:Human Pathology
Author(s): Jiabin Liu, Funian Lu, Yan Gong, Chen Zhao, Qi Pan, Stephanie Ballantyne, Xianda Zhao, Sufang Tian, Honglei Chen
Synthesis of cytochrome c oxidase 2 (SCO2) and TP53-induced glycolysis and apoptosis regulator (TIGAR) are two p53-mediated proteins that can play a regulatory role in cancer energy metabolism. However, no study has examined the association of SCO2 and TIGAR with the prognosis of patients with lung adenocarcinoma (AC). In our study, the expression of SCO2 and TIGAR proteins in lung AC was detected, and the potential relation to prognosis was evaluated, aiming to take a further view of lung AC progression. Quantum dots–based immunofluorescence histochemistry staining was performed to observe the expression of p53, SCO2, and TIGAR in 75 specimens of lung AC. Of these, 51 (68.0%) showed high expression of SCO2, and 59 (78.7%) showed high expression of TIGAR. High TIGAR expression was significantly associated with a history of smoking (P = .017) and being male (P = .006). The correlation between high SCO2 expression and age also was significant (P = .042). Moreover, high TIGAR expression was positively correlated with high SCO2 expression (P = .019; rs = 0.271). High expression of the SCO2 and TIGAR proteins predicted poorer survival and a higher mortality rate (P = .024 and .030, respectively). High expression of SCO2 and TIGAR proteins is significantly associated with lung AC progression, suggesting their potential use as prognostic markers and therapeutic targets.



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Somatic polymerase epsilon mutations as another route leading to loss of DNA MMR protein expression in endometrial carcinoma

Publication date: Available online 7 April 2018
Source:Human Pathology
Author(s): Pieter J. Westenend, Winand N. Dinjens




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Investigational agents to enhance the efficacy of chemotherapy or radiation in pancreatic cancer

Publication date: Available online 7 April 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Myrna Hurtado, Umesh T. Sankpal, Amalendu Ranjan, Rajasekhar Maram, Jamboor K. Vishwanatha, Ganji Purnachandra Nagaraju, Bassel F. El-Rayes, Riyaz Basha
Pancreatic cancer (PC) continues to be a fatal malignancy. With standard treatments having modest impact, alternative courses of actions are being investigated such as enhancing the efficacy of standard treatment through sensitization of PC cells to chemotherapy or radiation. This review emphasizes investigational agents that increase the responses to chemotherapy or radiation in PC models. Our group has extensively investigated on Curcumin (Cur), analogs (EF31, UBS109, and L49H37), nanoparticles and a small molecule Tolfenamic acid (TA) for enhancing therapeutic efficacy in both in vitro and in vivo assays. Cur has a low level of toxicity and promising anti-cancer activity, however, its clinical development has been limited by low bioavailability. Cur analogs and nanoparticles were synthesized to improve Cur's efficacy and bioavailability. These compounds were found to be effective in enhancing the therapeutic effects of chemotherapy in pre-clinical models. Small molecules such as NSAIDs have also been tested for the anti-cancer activity and induction of response of chemotherapy and radiation. Interest in TA, a NSAID, has recently increased due to promising preclinical data demonstrating its anti-cancer properties with minimum toxicity. TA also synergistically increased the response of XRT in PC cells and in an orthotropic mouse model. With strong preclinical evidence, research aimed at developing less toxic therapies for PC using Cur analogues or TA is ready for translation into clinical testing.



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The role of heme iron molecules derived from red and processed meat in the pathogenesis of colorectal carcinoma

Publication date: Available online 7 April 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): S.M.K. Gamage, Lakal Dissabandara, Alfred King-Yin Lam, Vinod Gopalan
Emerging evidence that heme iron in red meat is a risk factor for colorectal carcinogenesis is a topic that has received recent scrutiny. This review aims to summarise the mechanism of colorectal carcinogenesis by heme contained in red and processed meat. Heme iron can induce cytotoxicity by 'cytotoxic heme factor' and promote surface epithelial cell apoptosis and compensatory epithelial hyperplasia. Heme, induces peroxidation of lipids, leading to free radical formation and generation of DNA adducts in colorectal epithelial cells. In addition, heme catalyses the formation of N-nitroso-compounds, which in turn results in the initiation of colorectal carcinogenesis. Emerging data suggest that intestinal dysbiosis can promote carcinogenic properties of heme. Heme induces multiple genetic alterations by regulating WNT signalling pathway and causing mutations in major colon cancer genes such as APC, TP53 and KRAS. However, a balanced diet containing green vegetables, olive oil and calcium may reduce the carcinogenic effects of heme.



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Radiological Evaluation of Response to Immunotherapy in Brain Tumors: Where Are We Now and Where Are We Going?

Publication date: Available online 7 April 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Michele Porcu, Cinzia Solinas, Paolo Garofalo, Evandro de Azambuja, Mario Scartozzi, Karen Willard-Gallo, Matthias Preusser, Luca Saba




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The identification and isolation of CTCs: a Biological Rubik’s Cube

Publication date: Available online 7 April 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Cristina Mansilla, Elena Soria, Natalia Ramírez
Liquid biopsy represents an alternative to conventional biopsies for the evaluation of tumors mainly due to its easy sampling. One of the main applications is the enumeration of Circulating Tumor Cells (CTCs) to evaluate tumor progression or response to treatment. The analysis of the functional characteristics of CTCs could give us much more information about their role in order to establish a more personalized treatment for the patients. The major issue that has to be solved is the isolation of the CTC population. Multiple protocols have been developed, however none of them has demonstrated to be the definitive one. In fact, a combination of these techniques has often been performed in order to obtain a purer and viable population of CTCs. In this review we have summarized for the first time the different combinatorial approaches used in the last years to optimize the isolation of CTCs and their limitations.



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Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We...

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Clinical outcome of Guillain-Barre syndrome after prolonged mechanical ventilation

Background

Patients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV).

Methods

Prospectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint.

Results

In the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2–44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62–261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis.

Conclusions

Prolonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently.

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Collateral status as the fifth dimension: warping the time clock for endovascular treatment in acute ischaemic stroke

Endovascular treatment (EVT) has radically transformed the treatment of acute ischaemic stroke during the last few years. A meta-analysis of individual data pooled from five randomised controlled trials (RCTs) of 1287 patients, the Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration, showed no heterogeneity across subgroups of patients with different characteristics in the benefit of EVT over standard medical treatment, with up to 7.3 hours of onset-to-puncture time.1 However, the odds of achieving a good 3-month outcome after EVT significantly declined with longer onset-to-treatment time intervals.2

Four of the five RCTs in the HERMES collaboration had to some extent taken into account the infarct core, evidence of salvageable tissue or the collateral status in patient eligibility criteria.1 2 Data from earlier studies also demonstrated that patients with good pretreatment collaterals, and hence a smaller infarct core and favourable penumbra pattern, would...

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Altered cerebral blood flow in the anterior cingulate cortex is associated with neuropathic pain

Objective

To assess the cerebral blood flow (CBF) in patients with diabetic neuropathic pain, and its changes after duloxetine therapy.

Methods

Using iodine-123-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (IMP-SPECT), we performed a cross-sectional study of 44 patients with diabetes, and compared CBF in those with (n = 24) and without neuropathic pain (n = 20). In patients with neuropathic pain, we also longitudinally assessed changes in CBF 3 months after treatment with duloxetine.

Results

IMP-SPECT with voxel-based analyses showed a significant increase in cerebral blood flow in the right anterior cingulate cortex and a decrease in the left ventral striatum in patients with neuropathic pain, compared with those without pain. After duloxetine treatment, volume of interest analyses revealed a decrease in cerebral blood flow in the anterior cingulate cortex in patients with significant pain relief but not in non-responders. Furthermore, voxel-based whole brain correlation analyses demonstrated that greater baseline CBF in the anterior cingulate cortex was associated with better pain relief on the numerical rating scale.

Conclusions

Our results suggest that the development of neuropathic pain is associated with increased activity in the anterior cingulate cortex, and greater baseline activation of this region may predict treatment responsiveness to pharmacological intervention.

Trial registration number

UMIN000017130;Results.

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Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in an individual from the Teramo Sant’Anna archaeological site (7th–12th centuries of the Common Era, Italy)

Publication date: Available online 6 April 2018
Source:Archives of Oral Biology
Author(s): Joan Viciano, Ruggero D'Anastasio
BackgroundThis study is based in an analysis of the skeletal remains of an adult male from the Teramo Sant'Anna archaeological site (7th–12th centuries of the Common Era, Teramo, Italy).Results and DiscussionThe individual shows distinct abnormalities that principally involve asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. The combination of these findings and the absence of abnormalities of the spine strongly suggest diagnosis of the congenital malformation known as hemifacial microsomia. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development. Despite the lack of clinical information and the absence of soft tissue, it was possible to perform a differential diagnosis for this palaeopathological case. Mastication was probably altered considering that the mandible is extremely asymmetric and lacks true condyles. The temporomandibular joints are present, but the right one is hypoplastic and abnormal in shape. There is evidence of bilateral dislocation, and the facial muscles are hypertrophic.ConclusionsThis case represents an important contribution to the palaeopathological literature because this is an uncommon condition that has not been widely documented in ancient skeletal remains.



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Hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on Streptococcus mutans biofilm and tooth demineralization

Publication date: Available online 6 April 2018
Source:Archives of Oral Biology
Author(s): Juliana Gonçalves Pires, Sara Salustiano Zabini, Aline Silva Braga, Rita de Cássia Fabris, Flaviana Bombarda de Andrade, Rodrigo Cardoso de Oliveira, Ana Carolina Magalhães
ObjectivesThis study evaluated the effect of the hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (alone or combined) on the viability of Streptococcus mutans biofilm and on the prevention of enamel demineralization.MethodsStrain of S. mutans (ATCC 21175) was reactivated in BHI broth. Minimum inhibitory concentration, minimum bactericidal concentration, minimum inhibition biofilm concentration and minimum eradication biofilm concentration were determined in order to choose the concentrations to be tested under biofilm model. S. mutans biofilm (5 × 10⁵ CFU/ml) was produced on bovine enamel, using McBain saliva under 0.2% sucrose exposure, for 3 days. The biofilm was daily treated with the extracts for 1 min. The biofilm viability was tested by fluorescence and the enamel demineralization was measured using TMR.ResultsMyracrodruon urundeuva All. (Isolated or combined) at the concentrations ≥ 0.625 mg/ml was able to reduce bacteria viability, while Qualea Grandflora Mart. alone had antimicrobial effect at 5 mg/ml only (p < 0.05). On the other hand, none of the extracts were able to reduce enamel demineralization.ConclusionsThe hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (isolated or combined) have antimicrobial action; however, they do not prevent enamel caries under S. mutans biofilm model.



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Vagal Nerve Stimulator Malfunction with Change in Neck Position: Case Report and Literature Review

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Erin D'Agostino, Vyacheslav Makler, David F. Bauer
BackgroundVagal nerve stimulation is a safe and well-tolerated treatment for drug-resistant epilepsy. Complications and failure of the device can result from lead fracture, device malfunction, disconnection, or battery displacement and can result in a variety of symptoms. We present an interesting case of stimulator malfunction with increased impedance change seen only with a change in head position.Case DescriptionThe patient is a 25-year-old male with a vagal nerve stimulator (VNs) placed for medically refractory epilepsy who presented with neck pain and an electrical pulling sensation in his neck whenever he turned his head to the right.Initial interrogation of the VNs showed normal impedance. Subsequent interrogation with the patient's head turned found increased impedance only when the head was turned to the right. The patient had successful removal and replacement of the device with resolution of his preoperative complaints. Partial lead fracture was seen at explant.ConclusionVNs malfunction can present in atypical ways. Positional maneuvers may help with its timely diagnosis.



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Spinal Sclerosing Epithelioid Fibrosarcoma at the Cervicothoracic Junction

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Jing Zhang, Dean Chou
BackgroundSclerosing epithelioid fibrosarcoma (SEF) is an unusual variant of fibrosarcoma that was previously considered to be a low-grade tumor with an indolent course. To our knowledge, the spine is a rare primary site for SEF, with only a few cases reported to date.Case DescriptionWe report a case of SEF occurring in the cervicothoracic spine of a 64-year-old man with complaints of neck pain and right hand tingling for 6 months before clinical presentation. Imaging revealed a large mass that extended from C5 to T1 in the right posterior paraspinal soft tissues, with involvement of the posterior elements from C6 to T1 and infiltration of the T1 vertebral body. We performed an en bloc spondylectomy and gross total resection of the tumor. Pathologic and immunohistochemical characteristics confirmed the diagnosis of SEF.ConclusionsBecause of the anatomic nature of the cervicothoracic spine and critical neurovascular structures that the tumor involves, a true en bloc resection might not be possible, but an oncologically sound excision is ideal.



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Orbital Lymphaticovenous Malformation with Intradural Extension: Rare Case

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Mohamad Abbass, Michael K. Tso, Ezekiel Weis, Alim P. Mitha
BackgroundOrbital lymphaticovenous malformations (LVMs) are congenital vascular lesions that are typically infiltrative in nature. There have been reports of orbital LVMs extending intracranially through orbital fissures, but there have been no reports of intradural extension.Case DescriptionWe report the first case of orbital LVM extending intradurally through a bony defect in the medial orbital roof. A modified orbitozygomatic approach was used to successfully obliterate this lesion. Neurosurgical and ophthalmologic collaboration was used in the surgical management of this case.ConclusionsThis case highlights the importance of an interdisciplinary approach when managing infiltrative orbital LVMs, as both ophthalmologic and neurosurgical expertise were critical in the success of the surgery.



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Craniocervical Junction Meningiomas without Hydrocephalus Presenting Solely with Syncope: Report of 2 Cases

Publication date: June 2018
Source:World Neurosurgery, Volume 114
Author(s): Pierre-Olivier Champagne, Michel W. Bojanowski
ObjectiveTo our knowledge, there have not been any reported cases of a meningioma of the craniocervical region presenting solely with syncope as its initial symptom. Only 1 case of meningioma presenting with syncope has been published, but it was associated with hydrocephalus. We report 2 cases of syncope caused by a craniocervical junction meningioma, with syncope being the sole presenting symptom and without hydrocephalus. We discuss the possible pathophysiology, as well as the clinical relevance of this type of presentation.MethodsWe reviewed the charts, operative details, and imagery of 2 cases of meningioma in the region of the craniocervical junction, with syncope as their sole presenting feature. We also reviewed the literature.ResultsIn 1 case the syncope occurred spontaneously. In the other, it occurred during a Valsalva maneuver. Both meningiomas were surgically removed via a retromastoid approach. There was no recurrence of syncope following surgery. Following a literature review, we found 1 case of posterior fossa meningioma presenting with syncope, but hydrocephalus was also present.ConclusionSyncope can be the sole manifestation of a meningioma of the craniocervical junction. Such syncopes are a consequence of transient dysfunction of the autonomous pathways in the medulla and/or of the medulla's output. In the absence of other causes of syncope, a meningioma in this region, even in the absence of hydrocephalus, should not be considered as fortuitous, but rather as the actual cause of syncope. Recognizing this possibility offers the potential for proper diagnosis and appropriate treatment of the syncope.



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Subarachnoid hemorrhage after transient global amnesia caused by cerebral venous congestion: case report

Transient global amnesia is reported to be caused by cerebral venous congestion. Internal jugular venous flow reversal in particular with the Valsalva maneuver leads to cerebral venous congestion. In addition,...

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Early Response Assessment on Mid-Treatment CT Predicts Loco-Regional Recurrence in Oropharyngeal Cancer Patients Treated with Definitive Radiation Therapy

Publication date: Available online 6 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rafi Kabarriti, N. Patrik Brodin, George Lundgren, Nitin Ohri, Wolfgang A. Tomé, Shalom Kalnicki, Madhur K. Garg
Purpose/Objective(s)To evaluate if response assessment based on mid-treatment computed tomography (CT) scans during definitive radiation therapy (RT) for oropharyngeal head and neck cancer (HNC) can predict for loco-regional recurrence (LRR).Materials/MethodsHNC patients treated at our institution with RT undergo CT rescans at 15^th fraction and are replanned in case of inadequate dose to gross disease or increased dose to organs-at-risk. A retrospective cohort analysis was performed on 96 consecutive patients with oropharyngeal cancer treated in 2007-2015 with mid-treatment rescans. The volume of primary disease and involved lymph nodes were delineated on pre- and mid-treatment CT. Univariable and multivariable Cox proportional hazards regression analysis were used to evaluate the efficacy of mid-treatment reduction in tumor volume as a predictor of LRR. Risk-stratification was performed by dichotomizing patients into high- and low-risk groups based on mid-treatment response as well as p-16 status and smoking history.ResultsWith a median follow-up of 34 months, 14 patients experienced LRR. The median reduction in total tumor volume was 18.7% (IQR: 8.4%-30.9%). Reduction in total tumor volume > median is an independent predictor of LRR (HR: 0.22; 95%CI: 0.05–0.89; p=0.020), and the reduction in primary tumor volume is an even stronger predictor (HR: 0.11; 95%CI: 0.02–0.57; p=0.002). Stratifying patients into a high-risk group with reduction in total tumor volume at mid-treatment ≤ median, p-16 negative status, and smoking status >10 pack years, and a low-risk group without these factors, there was a clear separation in Kaplan-Meier curves with actuarial 3-year loco-regional control, progression-free survival and overall survival rates for the high-risk patients of 45.7%, 38.2%, 71.8% compared to 90.7%, 70.6%, 89.8% for low-risk patients, respectively (p≤0.021 for all).ConclusionOur study shows that early response assessment based on mid-treatment CT is an independent predictor of LRR and can be used to effectively distinguish high-risk and low-risk patients, allowing for risk-adaptive treatment stratification at the midway point.

Teaser

In a cohort study of 96 oropharyngeal cancer patients undergoing definitive radiation therapy, we identified early response assessment based on mid-treatment CT at the 15^th RT fraction as an independent predictor of locoregional recurrence. Combining this with p-16 and smoking status, we were able to effectively distinguish high-risk and low-risk patients, potentially allowing for more precise risk-adaptive treatment stratification.


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Methodological Characteristics and Future Directions for Plyometric Jump Training Research: A Scoping Review

Abstract

Recently, there has been a proliferation of published articles on the effect of plyometric jump training, including several review articles and meta-analyses. However, these types of research articles are generally of narrow scope. Furthermore, methodological limitations among studies (e.g., a lack of active/passive control groups) prevent the generalization of results, and these factors need to be addressed by researchers. On that basis, the aims of this scoping review were to (1) characterize the main elements of plyometric jump training studies (e.g., training protocols) and (2) provide future directions for research. From 648 potentially relevant articles, 242 were eligible for inclusion in this review. The main issues identified related to an insufficient number of studies conducted in females, youths, and individual sports (~ 24.0, ~ 37.0, and ~ 12.0% of overall studies, respectively); insufficient reporting of effect size values and training prescription (~ 34.0 and ~ 55.0% of overall studies, respectively); and studies missing an active/passive control group and randomization (~ 40.0 and ~ 20.0% of overall studies, respectively). Furthermore, plyometric jump training was often combined with other training methods and added to participants' daily training routines (~ 47.0 and ~ 39.0% of overall studies, respectively), thus distorting conclusions on its independent effects. Additionally, most studies lasted no longer than 7 weeks. In future, researchers are advised to conduct plyometric training studies of high methodological quality (e.g., randomized controlled trials). More research is needed in females, youth, and individual sports. Finally, the identification of specific dose-response relationships following plyometric training is needed to specifically tailor intervention programs, particularly in the long term.

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Fuel for the Work Required: A Theoretical Framework for Carbohydrate Periodization and the Glycogen Threshold Hypothesis

Abstract

Deliberately training with reduced carbohydrate (CHO) availability to enhance endurance-training-induced metabolic adaptations of skeletal muscle (i.e. the 'train low, compete high' paradigm) is a hot topic within sport nutrition. Train-low studies involve periodically training (e.g., 30–50% of training sessions) with reduced CHO availability, where train-low models include twice per day training, fasted training, post-exercise CHO restriction and 'sleep low, train low'. When compared with high CHO availability, data suggest that augmented cell signalling (73% of 11 studies), gene expression (75% of 12 studies) and training-induced increases in oxidative enzyme activity/protein content (78% of 9 studies) associated with 'train low' are especially apparent when training sessions are commenced within a specific range of muscle glycogen concentrations. Nonetheless, such muscle adaptations do not always translate to improved exercise performance (e.g. 37 and 63% of 11 studies show improvements or no change, respectively). Herein, we present our rationale for the glycogen threshold hypothesis, a window of muscle glycogen concentrations that simultaneously permits completion of required training workloads and activation of the molecular machinery regulating training adaptations. We also present the 'fuel for the work required' paradigm (representative of an amalgamation of train-low models) whereby CHO availability is adjusted in accordance with the demands of the upcoming training session(s). In order to strategically implement train-low sessions, our challenge now is to quantify the glycogen cost of habitual training sessions (so as to inform the attainment of any potential threshold) and ensure absolute training intensity is not compromised, while also creating a metabolic milieu conducive to facilitating the endurance phenotype.

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A New Direction to Athletic Performance: Understanding the Acute and Longitudinal Responses to Backward Running

Abstract

Backward running (BR) is a form of locomotion that occurs in short bursts during many overground field and court sports. It has also traditionally been used in clinical settings as a method to rehabilitate lower body injuries. Comparisons between BR and forward running (FR) have led to the discovery that both may be generated by the same neural circuitry. Comparisons of the acute responses to FR reveal that BR is characterised by a smaller ratio of braking to propulsive forces, increased step frequency, decreased step length, increased muscle activity and reliance on isometric and concentric muscle actions. These biomechanical differences have been critical in informing recent scientific explorations which have discovered that BR can be used as a method for reducing injury and improving a variety of physical attributes deemed advantageous to sports performance. This includes improved lower body strength and power, decreased injury prevalence and improvements in change of direction performance following BR training. The current findings from research help improve our understanding of BR biomechanics and provide evidence which supports BR as a useful method to improve athlete performance. However, further acute and longitudinal research is needed to better understand the utility of BR in athletic performance programs.

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Test-Retest Reliability and Interpretation of Common Concussion Assessment Tools: Findings from the NCAA-DoD CARE Consortium

Abstract

Background

Concussion diagnosis is typically made through clinical examination and supported by performance on clinical assessment tools. Performance on commonly implemented and emerging assessment tools is known to vary between administrations, in the absence of concussion.

Objective

To evaluate the test-retest reliability of commonly implemented and emerging concussion assessment tools across a large nationally representative sample of student-athletes.

Methods

Participants (n = 4874) from the Concussion Assessment, Research, and Education Consortium completed annual baseline assessments on two or three occasions. Each assessment included measures of self-reported concussion symptoms, motor control, brief and extended neurocognitive function, reaction time, oculomotor/oculovestibular function, and quality of life. Consistency between years 1 and 2 and 1 and 3 were estimated using intraclass correlation coefficients or Kappa and effect sizes (Cohen's d). Clinical interpretation guidelines were also generated using confidence intervals to account for non-normally distributed data.

Results

Reliability for the self-reported concussion symptoms, motor control, and brief and extended neurocognitive assessments from year 1 to 2 ranged from 0.30 to 0.72 while effect sizes ranged from 0.01 to 0.28 (i.e., small). The reliability for these same measures ranged from 0.34 to 0.66 for the year 1–3 interval with effect sizes ranging from 0.05 to 0.42 (i.e., small to less than medium). The year 1–2 reliability for the reaction time, oculomotor/oculovestibular function, and quality-of-life measures ranged from 0.28 to 0.74 with effect sizes from 0.01 to 0.38 (i.e., small to less than medium effects).

Conclusions

This investigation noted less than optimal reliability for most common and emerging concussion assessment tools. Despite this finding, their use is still necessitated by the absence of a gold standard diagnostic measure, with the ultimate goal of developing more refined and sound tools for clinical use. Clinical interpretation guidelines are provided for the clinician to apply with a degree of certainty in application.

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Correction to: The Effect of Natural or Simulated Altitude Training on High-Intensity Intermittent Running Performance in Team-Sport Athletes: A Meta-Analysis

Page 10, Fig. 2: The filled circle labelled "3" was plotted inaccurately and should have been in the "harmful" section of the graph, as shown in the corrected version below:

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Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review

Abstract

An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.

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The Effect of Physical Activity Interventions on Glycosylated Haemoglobin (HbA 1c ) in Non-diabetic Populations: A Systematic Review and Meta-analysis

Abstract

Background

Physical activity is widely perceived to be beneficial for preventing type 2 diabetes mellitus and for controlling glycaemic levels in patients with type 2 diabetes, but evidence supporting a positive effect in the control of glycaemic levels in healthy people is rather weak. The aim of this review was to estimate the effect of physical activity on glycaemic control measured by glycosylated haemoglobin (HbA_1c) levels in non-diabetic populations, and to determine which type of physical activity has a greater influence on glycaemic control.

Methods

We systematically searched the MEDLINE, EMBASE, Cochrane Library and Web of Science databases, from inception to May 2017, for experimental studies addressing the effect of physical activity on glycaemic control measured by HbA_1c levels in non-diabetic populations. The DerSimonian and Laird method was used to compute pooled estimates of effect size (ES) and respective 95% confidence intervals (CIs). The effect of physical activity on HbA_1c levels was estimated in two ways: (1) physical activity intervention versus control; and (2) physical activity pre–post intervention. Additionally, subgroup analyses were performed based on age of participants and different aspects of the intervention.

Results

Fifteen published studies were included in the meta-analysis. In analyses comparing physical activity intervention and control, we found a decrease of HbA_1c levels in favour of the intervention group (ES = 0.32; 95% CI 0.01–0.62) with substantial heterogeneity (I² = 63.2%; p = 0.008). In the pre–post analysis, there was a decrease in HbA_1c levels post physical activity intervention (ES = 0.17; 95% CI 0.01–0.33) with low heterogeneity (I² = 25.8%; p = 0.164). Additionally, for physical activity intervention versus control, a decrease in HbA_1c levels was observed in resistance exercise and in intervention length below 12 weeks. Furthermore, for pre–post effect analyses, a decrease in HbA_1c levels was observed in the supervised physical activity programme, other type of exercises, intervention length below 12 weeks and exercise intervention week duration above 150 min subgroups.

Conclusions

This systematic review and meta-analysis provides an overview of the evidence supporting physical activity as a suitable intervention for glycaemic control as measured by HbA_1c levels in non-diabetic populations.

Trial Registration

PROSPERO CRD42016050991.

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The Effect of Head-to-Head Competition on Behavioural Thermoregulation, Thermophysiological Strain and Performance During Exercise in the Heat

Abstract

Background

It has been suggested that pacing is a thermoregulatory behaviour. We investigated the effect of competition on pacing, performance and thermophysiological strain during exercise in the heat and the psychological factors mediating competition effects.

Method

Eighteen males (maximum oxygen uptake [V O _2max] 3.69 [0.44] L min⁻¹) undertook a preliminary 20-km cool (wet-bulb globe temperature [WBGT] 12 °C) cycling time trial (TT) and three experimental 20-km trials (balanced order): (i) cool TT (CoolSolo); (ii) hot (WBGT 26 °C) TT (HotSolo); (iii) hot head-to-head competition (HotH2H). During TTs, an avatar of the participant's performance was visible. During HotH2H, participants believed they were competing against another participant, but the competitor's avatar replicated their own preliminary (cool) TT.

Results

TTs (min:sec [SD]) slowed with increased ambient temperature [CoolSolo 35:31 (2:11) versus HotSolo 36:10 (2:26); p = 0.011]. This effect was negated by competition; performances were not different between HotH2H [35:17 (1:52)] and CoolSolo (p = 0.160) and were quicker in HotH2H versus HotSolo (p = 0.001). End-exercise rectal temperature, mean body temperature and physiological strain index were (p < 0.05) higher in HotH2H than either solo condition. Despite faster performance and greater thermophysiological strain, rating of perceived exertion (RPE), thermal comfort and sensation, and perceptual strain index were not different between HotH2H and HotSolo. The difference in end-exercise rectal temperature between HotH2H and HotSolo was related to pre-exercise anticipatory heart rate response (r = 0.608, p = 0.010) and participants' propensity for deliberate risk-taking (B = 0.12, p < 0.001), whereas self-reported resilience predicted change in performance times between HotH2H versus HotSolo (B = − 9.40, p = 0.010).

Conclusion

Competition changes the relationship between perceived and actual thermophysiological state, altering behavioural thermoregulation and increasing thermophysiological strain; this could increase heat-illness risk. Psychophysiological and psychological measures may identify susceptible individuals.

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Wearable Inertial Sensor Systems for Lower Limb Exercise Detection and Evaluation: A Systematic Review

Abstract

Background

Analysis of lower limb exercises is traditionally completed with four distinct methods: (1) 3D motion capture; (2) depth-camera-based systems; (3) visual analysis from a qualified exercise professional; and (4) self-assessment. Each method is associated with a number of limitations.

Objective

The aim of this systematic review is to synthesise and evaluate studies which have investigated the capacity for inertial measurement unit (IMU) technologies to assess movement quality in lower limb exercises.

Data Sources

A systematic review of studies identified through the databases of PubMed, ScienceDirect and Scopus was conducted.

Study Eligibility Criteria

Articles written in English and published in the last 10 years which investigated an IMU system for the analysis of repetition-based targeted lower limb exercises were included.

Study Appraisal and Synthesis Methods

The quality of included studies was measured using an adapted version of the STROBE assessment criteria for cross-sectional studies. The studies were categorised into three groupings: exercise detection, movement classification or measurement validation. Each study was then qualitatively summarised.

Results

From the 2452 articles that were identified with the search strategies, 47 papers are included in this review. Twenty-six of the 47 included studies were deemed as being of high quality.

Conclusions

Wearable inertial sensor systems for analysing lower limb exercises is a rapidly growing field of research. Research over the past 10 years has predominantly focused on validating measurements that the systems produce and classifying users' exercise quality. There have been very few user evaluation studies and no clinical trials in this field to date.

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Effect of Resistance Training Frequency on Gains in Muscular Strength: A Systematic Review and Meta-Analysis

Abstract

Background

Current recommendations on resistance training (RT) frequency for gains in muscular strength are based on extrapolations from limited evidence on the topic, and thus their practical applicability remains questionable.

Objective

To elucidate this issue, we conducted a systematic review and meta-analysis of the studies that compared muscular strength outcomes with different RT frequencies.

Methods

To carry out this review, English-language literature searches of the PubMed/MEDLINE, Scopus, and SPORTDiscus databases were conducted. The meta-analysis was performed using a random-effects model. The meta-analysis models were generated with RT frequencies classified as a categorical variable as either 1, 2, 3, or 4+ times/week, or, if there were insufficient data in subgroup analyses, the training frequencies were categorized as 1, 2, or 3 times/week. Subgroup analyses were performed for potential moderators, including (1) training volume; (2) exercise selection for the 1 repetition maximum (RM) test (for both multi-joint and single-joint exercises); (3) upper and lower body strength gains; (4) training to muscular failure (for studies involving and not involving training to muscular failure); (5) age (for both middle-aged/older adults and young adults); and (6) sex (for men and for women). The methodological quality of studies was appraised using the modified Downs and Black checklist.

Results

A total of 22 studies were found to meet the inclusion criteria. The average score on the Downs and Black checklist was 18 (range 13–22 points). Four studies were classified as being of good methodological quality, while the rest were classified as being of moderate methodological quality. Results of the meta-analysis showed a significant effect (p = 0.003) of RT frequency on muscular strength gains. Effect sizes increased in magnitude from 0.74, 0.82, 0.93, and 1.08 for training 1, 2, 3, and 4+ times per week, respectively. A subgroup analysis of volume-equated studies showed no significant effect (p = 0.421) of RT frequency on muscular strength gains. The subgroup analysis for exercise selection for the 1RM test suggested a significant effect of RT frequency on multi-joint (p < 0.001), but not single-joint, 1RM test results (p = 0.324). The subgroup analysis for upper and lower body showed a significant effect of frequency (p = 0.004) for upper body, but not lower body, strength gains (p = 0.070). In the subgroup analysis for studies in which the training was and was not carried out to muscular failure, no significant effect of RT frequency was found. The subgroup analysis for the age groups suggested a significant effect of training frequency among young adults (p = 0.024), but not among middle-aged and older adults (p = 0.093). Finally, the subgroup analysis for sex indicated a significant effect of RT frequency on strength gains in women (p = 0.030), but not men (p = 0.190).

Conclusions

The results of the present systematic review and meta-analysis suggest a significant effect of RT frequency as higher training frequencies are translated into greater muscular strength gains. However, these effects seem to be primarily driven by training volume because when the volume is equated, there was no significant effect of RT frequency on muscular strength gains. Thus, from a practical standpoint, greater training frequencies can be used for additional RT volume, which is then likely to result in greater muscular strength gains. However, it remains unclear whether RT frequency on its own has significant effects on strength gain. It seems that higher RT frequencies result in greater gains in muscular strength on multi-joint exercises in the upper body and in women, and, finally, in contrast to older adults, young individuals seem to respond more positively to greater RT frequencies. More evidence among resistance-trained individuals is needed as most of the current studies were performed in untrained participants.

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Spatiotemporal heterogeneity and patterning of developing renal blood vessels

Abstract

The kidney vasculature facilitates the excretion of wastes, the dissemination of hormones, and the regulation of blood chemistry. To carry out these diverse functions, the vasculature is regionalized within the kidney and along the nephron. However, when and how endothelial regionalization occurs remains unknown. Here, we examine the developing kidney vasculature to assess its 3-dimensional structure and transcriptional heterogeneity. First, we observe that endothelial cells (ECs) grow coordinately with the kidney bud as early as E10.5, and begin to show signs of specification by E13.5 when the first arteries can be identified. We then focus on how ECs pattern and remodel with respect to the developing nephron and collecting duct epithelia. ECs circumscribe nephron progenitor populations at the distal tips of the ureteric bud (UB) tree and form stereotyped cruciform structures around each tip. Beginning at the renal vesicle (RV) stage, ECs form a continuous plexus around developing nephrons. The endothelial plexus envelops and elaborates with the maturing nephron, becoming preferentially enriched along the early distal tubule. Lastly, we perform transcriptional and immunofluorescent screens to characterize spatiotemporal heterogeneity in the kidney vasculature and identify novel regionally enriched genes. A better understanding of development of the kidney vasculature will help instruct engineering of properly vascularized ex vivo kidneys and evaluate diseased kidneys.

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Cancers, Vol. 10, Pages 111: Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects

Cancers, Vol. 10, Pages 111: Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects

Cancers doi: 10.3390/cancers10040111

Authors: Valentina Ovalle Eric A. Strom Simona Shaitelman Karen Hoffman Richard Amos George Perkins Welela Tereffe Benjamin D. Smith Michael Stauder Wendy Woodward

Introduction: Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common tool to compare experience with this developing technology. Methods: Sixty sequential patients treated with proton APBI on a prospective protocol were evaluated and 43 patients with a minimum six-month follow-up underwent detailed photographic and radiologic analysis. The tumorectomy cavity plus an additional 1.5 cm clinical target volume (CTV) was treated with two or three passively-scattered proton beams to a dose of 34 Gy in 10 fractions in one week. Photographs were taken at the end of radiation, at two weeks, six weeks, and every six months thereafter. Mammography was obtained at six months after radiation and annually thereafter. All visual changes were categorized using the smallest meaningful gradations in findings and are demonstrated herein. All treatment-related mammographic findings are reported. Findings: Visual and mammographic findings showed a clear time-dependent relationship and significant variation between individuals. Peak skin reaction occurred at two to six weeks after completion of therapy. At two weeks most patients had either no visible effects and patchy erythema involving &lt;50% of the treated skin (60%). At six weeks most patients had either patchy erythema involving &lt;50% of the overlying skin (33%) or patchy erythema involving &gt;50% of the treated skin (28%). Only one patient developed any moist desquamation. At six months most patients had no visible skin changes (57%) or a small, circular area of mild hyperpigmentation (33%). Mammographic changes seen at six months were regional skin thickening (40%), residual seroma (14%), localized retraction (26%), and fat necrosis (2%). A subcategorized variant on the CTCAE 4.0 was developed to foster granular recording of these findings.

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Vowel-speech versus pure-tone processing in healthy subjects

Publication date: Available online 6 April 2018
Source:Neuroscience Research
Author(s): Hiroko Iino, Katsuya Ohta, Keiko Hara, Miho Miyajima, Minoru Hara, Eisuke Matsushima, Masato Matsuura
To investigate the characteristics of speech perception, we evaluated the differences in mismatch negativity (MMN) between vowel change and frequency change. Additionally, we examined the effects of gender, age, and educational length on MMN. Forty healthy adults (21 females), who were native Japanese speakers, participated in the study. A Japanese vowel-speech pair (standard/a/vs. deviant/o/) and a pure-tone pair (standard 1000 Hz vs. deviant 1050 Hz) were constructed. MMN elicited by vowel-speech sounds was larger and earlier compared with pure-tone sounds. Larger and earlier MMNs for vowel-speech sounds than for pure-tone sounds suggest different processing of linguistically relevant information at the early stage in the auditory cortex. In conclusion, the factors influencing on MMN are different between vowel-speech sounds and pure-tone sounds.



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Sarcomatoid Adenocarcinoma of the Ampulla of Vater

Abstract

Sarcomatoid adenocarcinoma of ampulla of Vater is an extremely rare malignant neoplasm that displays both carcinomatous and sarcomatous component. A 58-year-old woman was admitted to our hospital under the suspicion of an ampulla of Vater cancer. Abdominal computed tomography and endoscopy demonstrated a bulging of ampulla and the biopsy specimen revealed an adenocarcinoma, well differentiated in the background of tubulovillous adenoma. So we performed the pylorus preserving pancreaticoduodenectomy. At postoperative biopsy, the tumor was composed of adenocarcinoma component and sarcomatoid component. Thus, a diagnosis of sarcomatoid adenocarcinoma of ampulla of Vater could be made. Here, we present a case of sarcomatoid adenocarcinoma of ampulla of Vater.

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The Influence of Post-Exercise Cold-Water Immersion on Adaptive Responses to Exercise: A Review of the Literature

Abstract

Post-exercise cold-water immersion (CWI) is used extensively in exercise training as a means to minimise fatigue and expedite recovery between sessions. However, debate exists around its merit in long-term training regimens. While an improvement in recovery following a single session of exercise may improve subsequent training quality and stimulus, reports have emerged suggesting CWI may attenuate long-term adaptations to exercise training. Recent developments in the understanding of the molecular mechanisms governing the adaptive response to exercise in human skeletal muscle have provided potential mechanistic insight into the effects of CWI on training adaptations. Preliminary evidence suggests that CWI may blunt resistance signalling pathways following a single exercise session, as well as attenuate key long-term resistance training adaptations such as strength and muscle mass. Conversely, CWI may augment endurance signalling pathways and the expression of genes key to mitochondrial biogenesis following a single endurance exercise session, but have little to no effect on the content of proteins key to mitochondrial biogenesis following long-term endurance training. This review explores current evidence regarding the underlying molecular mechanisms by which CWI may alter cellular signalling and the long-term adaptive response to exercise in human skeletal muscle.

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The occurrence of dynamic structural disorders in the pharynx and larynx, at rest and during exercise, in horses diagnosed with mild and moderate Equine Asthma (Inflammatory Airway Disease).

The occurrence of dynamic structural disorders in the pharynx and larynx, at rest and during exercise, in horses diagnosed with mild and moderate Equine Asthma (Inflammatory Airway Disease).

Pol J Vet Sci. 2018 Mar;21(1):203-211

Authors: Wysocka B, Kluciński W

Abstract
The goal of the present study was to establish the occurrence of structural disorders in the larynx and pharynx during treadmill exercise tests in horses diagnosed with Equine Asthma (EA). Investigation was performed in 29 horses, patients of the Equine Clinic of the Warsaw University of Life Sciences in Poland, admitted with poor exercise performance. Upper and lower airway examinations were performed in all patients revealing both mild to moderate Equine Asthma (13 horses), and no lower airway abnormalities (16 animals). In the group of horses with EA, 11 did not have structural disorders of the pharynx and larynx at rest. During exercise two horses were free of abnormalities, while 11 had structural disorders, eight of them solely in the pharynx, two in the larynx, and one in both the pharynx and larynx. In the non- asthmatic group, 11 horses had no structural disorders during resting endoscopy. Endoscopy performed during exercise revealed disorders of the larynx in 10 horses, of the pharynx in three horses, and in both the larynx and pharynx in the remaining three horses.
IN CONCLUSION: horses with diagnosed EA frequently have disorders of the pharynx during treadmill exercise tests, while without EA, often have disorders of the larynx. Endoscopy of upper airways during exercise testing is a valuable tool in the diagnosis of poor performance in horses with lower airway inflammatory disease.

PMID: 29624000 [PubMed - in process]

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Role of ancillary techniques in profiling unclassified laryngeal malignancies.

Related Articles

Role of ancillary techniques in profiling unclassified laryngeal malignancies.

Virchows Arch. 2018 Apr 06;:

Authors: Hellquist H, Hunt JL, Cardesa A, Skalova A, Slootweg PJ, Rinaldo A, Ferlito A

Abstract
Laryngeal biopsies, contrary to biopsies from many other sites of the body, very often contain minute amounts of tumour tissue that may consist of morphologically undifferentiated tumour only. In haematoxylin- and eosin-stained sections, there may be no indicative features of what specific tumour entity that is present. In the larynx, particularly small round cell neoplasms, primary or metastatic, often cause a diagnostic dilemma and where an incorrect diagnosis can induce substantial clinical consequences for the patient (e.g., primary neuroendocrine carcinomas vs metastatic variants, certain sarcomas). If sufficient/representative material has been obtained, the application of immunohistochemistry and/or molecular techniques should in virtually every case reveal the true nature of the malignancy. In cases with sparse amount of material, and therefore a limited number of sections to be cut, a careful and thoughtful stepwise approach is necessary to ascertain a reliable diagnosis, or at least guide the clinician to the most likely diagnoses. With today's advanced and widely available technology with an abundance of markers to discriminate different tumours, the use of the term "undifferentiated" should be largely unnecessary. In the exceptional, and indeed exceedingly rare cases, when a classification is not possible, even after repeat biopsy, we suggest that the laryngeal neoplasm is better termed "unclassified malignant neoplasm" rather than "undifferentiated malignant neoplasm".

PMID: 29623469 [PubMed - as supplied by publisher]

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Laryngomalacia, Tracheomalacia and Bronchomalacia.

Related Articles

Laryngomalacia, Tracheomalacia and Bronchomalacia.

Curr Probl Pediatr Adolesc Health Care. 2018 Apr 03;:

Authors: Hysinger EB

Abstract
Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital abnormalities of the pediatric airway and are characterized by increased airway compliance, resulting in excessive dynamic collapse during the respiratory cycle. While a diagnosis can be suspected based on clinical history and physical examination, definitive evaluation is based of nasopharyngolaryngoscopy and/or bronchoscopy. Observation and conservative management are typically all that are required. However, surgical intervention can be necessary in the most severe cases, and can result in significant improvement in symptoms.

PMID: 29622320 [PubMed - as supplied by publisher]

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A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina.

Related Articles

A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina.

Int J Pediatr Otorhinolaryngol. 2018 Feb;105:90-96

Authors: Lorenzoni G, Umihanić S, Azzolina D, Manza E, Brkić F, Gregori D

Abstract
OBJECTIVES: The present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from European countries.
METHODS: The analysis is based on FB injury cases included in the Susy Safe registry. Cases from the Ear-Nose-Throat (ENT) Clinic, University Clinical Center of Tuzla (B&H) were compared with cases from European countries participating in the Susy Safe project. Multiple Correspondence Analysis (MCA) was performed to elucidate differences within a large data set regarding mechanisms and objects causing injuries.
RESULTS: The results of the MCA showed that the first three dimensions explained 43% of the variability. The first dimension was identified by children hospitalized for FB ingestion, the second one by children hospitalized for FB aspiration (lower airways), and the third one by children with an FB in the ear or in the upper airways. The analysis of the median of coordinates of factors contributing to each dimension showed that the greatest difference between B&H and European countries regarded the third one. Looking at the profile of these patients, it might be suggested that the proportion of males and females and the type of activity in which they were involved at time of injury occurrence are different among the countries considered CONCLUSIONS: This study proposes a simple tool for assessing differences among countries in the distribution of FB injuries. This case study shows that B&H has different patterns of FB injuries in the upper respiratory tract.

PMID: 29447827 [PubMed - indexed for MEDLINE]

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