Αρχειοθήκη ιστολογίου

Σάββατο 14 Απριλίου 2018

Combined effects of rat Schwann cells and 17β-estradiol in a spinal cord injury model

Abstract

Spinal cord injury (SCI) is a devastating traumatic event which burdens the affected individuals and the health system. Schwann cell (SC) transplantation is a promising repair strategy after SCI. However, a large number of SCs do not survive following transplantation. Previous studies demonstrated that 17β-estradiol (E2) protects different cell types and reduces tissue damage in SCI experimental animal model. In the current study, we evaluated the protective potential of E2 on SCs in vitro and investigated whether the combination of hormonal and SC therapeutic strategy has a better effect on the outcome after SCI. Primary SC cultures were incubated with E2 for 72 h. In a subsequent experiment, thoracic contusion SCI was induced in male rats followed by sustained administration of E2 or vehicle. Eight days after SCI, DiI-labeled SCs were transplanted into the injury epicenter in vehicle and E2-treated animals. The combinatory regimen decreased neurological and behavioral deficits and protected neurons and oligodendrocytes in comparison to vehicle rats. Moreover, E2 and SC significantly decreased the number of Iba-1+ (microglia) and GFAP+ cells (astrocyte) in the SCI group. In addition, we found a significant reduction of mitochondrial fission-markers (Fis1) and an increase of fusion-markers (Mfn1 and Mfn2) in the injured spinal cord after E2 and SC treatment. These data demonstrated that E2 protects SCs against hypoxia-induced SCI and improves the survival of transplanted SCs.



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Hospital readmissions after spontaneous intracerebral hemorrhage in Southern Portugal

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Publication date: June 2018
Source:Clinical Neurology and Neurosurgery, Volume 169
Author(s): Hipólito Nzwalo, Jerina Nogueira, Patrícia Guilherme, Pedro Abreu, Catarina Félix, Fátima Ferreira, Sara Ramalhete, Ana Marreiros, Turgut Tatlisumak, Lars Thomassen, Nicola Logallo
ObjectivesSpontaneous intracerebral hemorrhage (SICH) survivors are at risk of hospital readmissions. Data on readmissions after SICH is scarce. We aimed to study the frequency and predictors of readmissions after SICH in Algarve, Portugal.Patients and methodsRetrospective study of a community representative cohort of SICH survivors (2009–2015). The first unplanned readmission in the first year after discharge was the outcome. Cox regression analysis was performed to identify predictors of 1-year readmission.ResultsOf the 357 SICH survivors followed, 116 (32.5%) were readmitted within the first-year. Sixty-seven (18.8%) of the survivors were early readmitted (<90 days), corresponding to 57.8% or all readmissions. Common causes were pneumonia, endocrine/nutritional/metabolic and cardiovascular complications. The risk of readmission was increased by prior to index SICH history of ≥ 3 previous emergency department visits (hazards ratio (HR) = 2.663 (1.770–4.007); P < 0.001), pneumonia during index hospitalization (HR = 2.910 (1.844–4.592); P < 0.001) and reduced in patients discharge home (HR = 0.681 (0.366–0.976); P = 0.048).ConclusionsThe rate of readmissions after SICH is high, predictors are identifiable and causes are potentially preventable. Improvement of care can potentially reduce this burden.



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Comparing human and automatic speech recognition in simple and complex acoustic scenes

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Publication date: Available online 14 April 2018
Source:Computer Speech & Language
Author(s): Constantin Spille, Birger Kollmeier, Bernd T. Meyer
Former comparisons of human speech recognition (HSR) and automatic speech recognition (ASR) have shown that humans outperform ASR systems in nearly all speech recognition tasks. However, recent progress in ASR has led to substantial improvements of recognition accuracy, and it is therefore unclear how large the task-dependent human-machine gap still remains. This paper investigates this gap between HSR and ASR based on deep neural networks (DNNs) in different acoustic conditions, with the aim of comparing differences and identifying processing strategies that should be considered in ASR. We find that DNN-based ASR reaches human performance for single-channel, small-vocabulary tasks in the presence of speech-shaped noise and in multi-talker babble noise, which is an important difference to previous human-machine comparisons: The speech reception threshold, i.e., the signal-to-noise ratio with 50 % word recognition rate is at about -7 to -8 dB both for HSR and ASR. However, in more complex spatial scenes with diffuse noise and moving talkers, the SRT gap amounts to approximately 12 dB. Based on cross comparisons that use oracle knowledge (e.g., the speakers' true position), incorrect responses are attributed to localization errors or missing pitch information to distinguish between speakers with different gender. In terms of the SRT, localization errors and missing spectral information amount to 2.1 and 3.2 dB, respectively. The comparison hence identifies specific components in ASR that can profit from learning from auditory signal processing.



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CA125 suppresses amatuximab immune-effector function and elevated serum levels are associated with reduced clinical response in first line mesothelioma patients.

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CA125 suppresses amatuximab immune-effector function and elevated serum levels are associated with reduced clinical response in first line mesothelioma patients.

Cancer Biol Ther. 2018 Apr 13;:1-22

Authors: Nicolaides NC, Schweizer C, Somers EB, Wang W, Fernando S, Ross EN, Grasso L, Hassan R, Kline JB

Abstract
The tumor-shed antigen CA125 has recently been found to bind certain monoclonal antibodies (mAbs) and suppress immune-effector mediated killing through perturbation of the Fc domain with CD16a and CD32a Fc-γ activating receptors on immune-effector cells. Amatuximab is a mAb targeting mesothelin whose mechanism of action utilizes in part antibody-dependent cellular cytotoxicity (ADCC). It is being tested for its therapeutic activity in patients with mesothelioma in combination with first line standard-of-care. To determine if CA125 has immunosuppressive effects on amatuximab ADCC and associated clinical outcomes, post hoc subgroup analysis of patients from a Phase 2 study with primary diagnosed stage 3/4 unresectable mesothelioma treated with amatuximab plus cisplatin and pemetrexed were conducted. Analysis found patients with baseline CA125 levels no greater than 57 U/m ( ∼3X the upper limit of normal) had a 2 month improvement in progression free survival (HR = 0.43, p = 0.0062) and a 7 month improvement in overall survival (HR = 0.40, p = 0.0022) as compared to those with CA125 above 57 U/mL. In vitro studies found that CA125 was able to bind amatuximab and perturb ADCC activity via decreased Fc-γ-receptor engagement. These data suggest that clinical trial designs of antibody-based drugs in cancers producing CA125, including mesothelioma, should consider stratifying patients on baseline CA125 levels for mAbs that are experimentally determined to be bound by CA125.

PMID: 29652548 [PubMed - as supplied by publisher]



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Nucleoside diphosphate kinase B promotes osteosarcoma proliferation through c-Myc.

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Nucleoside diphosphate kinase B promotes osteosarcoma proliferation through c-Myc.

Cancer Biol Ther. 2018 Apr 09;:1-8

Authors: Li S, Hu T, Yuan T, Cheng D, Yang Q

Abstract
Osteosarcoma (OS) is one of the most common primary bone tumors and has a high disablity rate and case-fatality rate. The protracted stagnancy of the chemotherapy program and surgical technology for OS treatment prompted us to focus on the mechanisms of cancer carcinogenesis progression in OS. Nucleoside diphosphate kinase B (NME2) is a type of nucleoside diphosphate kinase that plays an important role in cellular processes. In this study, we report overexpression of NME2 in OS cell lines and correlate this overexpression with the clinicopathologic features of osteosarcoma. We used si-NME2 to downregulate expression of NME2 in OS cell lines. The results of the CCK8 and clone forming assays show that NME2 promotes OS cell line proliferation. Western blot assays show that deregulation of NME2 results in enhanced the expression of c-Myc, which promotes OS proliferation.

PMID: 29630434 [PubMed - as supplied by publisher]



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Cisplatin based therapy: the role of the mitogen activated protein kinase signaling pathway.

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Cisplatin based therapy: the role of the mitogen activated protein kinase signaling pathway.

J Transl Med. 2018 Apr 11;16(1):96

Authors: Achkar IW, Abdulrahman N, Al-Sulaiti H, Joseph JM, Uddin S, Mraiche F

Abstract
Cisplatin is a widely used chemotherapeutic agent for treatment of various cancers. However, treatment with cisplatin is associated with drug resistance and several adverse side effects such as nephrotoxicity, reduced immunity towards infections and hearing loss. A Combination of cisplatin with other drugs is an approach to overcome drug resistance and reduce toxicity. The combination therapy also results in increased sensitivity of cisplatin towards cancer cells. The mitogen activated protein kinase (MAPK) pathway in the cell, consisting of extracellular signal regulated kinase, c-Jun N-terminal kinase, p38 kinases, and downstream mediator p90 ribosomal s6 kinase (RSK); is responsible for the regulation of various cellular events including cell survival, cell proliferation, cell cycle progression, cell migration and protein translation. This review article demonstrates the role of MAPK pathway in cisplatin based therapy, illustrates different combination therapy involving cisplatin and also shows the importance of targeting MAPK family, particularly RSK, to achieve increased anticancer effect and overcome drug resistance when combined with cisplatin.

PMID: 29642900 [PubMed - in process]



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Caregiver-Reported Indicators of Communication and Social Functioning for Young Children Who Are Deaf or Hard of Hearing.

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Caregiver-Reported Indicators of Communication and Social Functioning for Young Children Who Are Deaf or Hard of Hearing.

J Deaf Stud Deaf Educ. 2018 Apr 04;:

Authors: Patrick DL, Edwards TC, Kushalnagar P, Topolski T, Schick B, Skalicky A, Sie K

Abstract
We elicited caregiver-reported observations of children aged 5-10 who were deaf or hard of hearing (DHH) that resulted in two age-specific instruments: Caregiver Report of Behaviors and Events (CROBE-DHH 5-7 and 8-10). These new instruments record observations on communication and social behaviors/events. In Study 1, 36 caregivers provided qualitative data on important content on what they were able to observe for instrument development and in Study 2, 271 provided data for studying cross-sectional measurement properties. Two modules resulted in 11 items for children age 5-7 and 15 items for children 8-10 years. Items showing good 7-day reproducibility (ICC over .70) and fair 4-week reproducibility (ICC over .50) were retained. Children with milder hearing loss received higher (better) scores. Items did not distinguish between those with or without cochlear implants. Analyses suggest that the instruments are best used as individual indicator items. In both age groups, caregivers reported youths missed out on family conversations and spent little time on their own. These content-validated indicators apply to all children with DHH. Further work will evaluate the usefulness of these indicators in evaluating change in communication and social behaviors, and the implications of results for intervention.

PMID: 29635427 [PubMed - as supplied by publisher]



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Monogenic diabetes syndromes: Locus-specific databases for Alström, Wolfram, and Thiamine-responsive megaloblastic anemia.

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Monogenic diabetes syndromes: Locus-specific databases for Alström, Wolfram, and Thiamine-responsive megaloblastic anemia.

Hum Mutat. 2017 Jul;38(7):764-777

Authors: Astuti D, Sabir A, Fulton P, Zatyka M, Williams D, Hardy C, Milan G, Favaretto F, Yu-Wai-Man P, Rohayem J, López de Heredia M, Hershey T, Tranebjaerg L, Chen JH, Chaussenot A, Nunes V, Marshall B, McAfferty S, Tillmann V, Maffei P, Paquis-Flucklinger V, Geberhiwot T, Mlynarski W, Parkinson K, Picard V, Bueno GE, Dias R, Arnold A, Richens C, Paisey R, Urano F, Semple R, Sinnott R, Barrett TG

Abstract
We developed a variant database for diabetes syndrome genes, using the Leiden Open Variation Database platform, containing observed phenotypes matched to the genetic variations. We populated it with 628 published disease-associated variants (December 2016) for: WFS1 (n = 309), CISD2 (n = 3), ALMS1 (n = 268), and SLC19A2 (n = 48) for Wolfram type 1, Wolfram type 2, Alström, and Thiamine-responsive megaloblastic anemia syndromes, respectively; and included 23 previously unpublished novel germline variants in WFS1 and 17 variants in ALMS1. We then investigated genotype-phenotype relations for the WFS1 gene. The presence of biallelic loss-of-function variants predicted Wolfram syndrome defined by insulin-dependent diabetes and optic atrophy, with a sensitivity of 79% (95% CI 75%-83%) and specificity of 92% (83%-97%). The presence of minor loss-of-function variants in WFS1 predicted isolated diabetes, isolated deafness, or isolated congenital cataracts without development of the full syndrome (sensitivity 100% [93%-100%]; specificity 78% [73%-82%]). The ability to provide a prognostic prediction based on genotype will lead to improvements in patient care and counseling. The development of the database as a repository for monogenic diabetes gene variants will allow prognostic predictions for other diabetes syndromes as next-generation sequencing expands the repertoire of genotypes and phenotypes. The database is publicly available online at https://ift.tt/2oe8R64.

PMID: 28432734 [PubMed - indexed for MEDLINE]



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Application of uncertainty and sensitivity analysis to the air quality SHERPA modelling tool

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): E. Pisoni, D. Albrecht, T.A. Mara, R. Rosati, S. Tarantola, P. Thunis
Air quality has significantly improved in Europe over the past few decades. Nonetheless we still find high concentrations in measurements mainly in specific regions or cities. This dimensional shift, from EU-wide to hot-spot exceedances, calls for a novel approach to regional air quality management (to complement EU-wide existing policies). The SHERPA (Screening for High Emission Reduction Potentials on Air quality) modelling tool was developed in this context. It provides an additional tool to be used in support to regional/local decision makers responsible for the design of air quality plans. It is therefore important to evaluate the quality of the SHERPA model, and its behavior in the face of various kinds of uncertainty. Uncertainty and sensitivity analysis techniques can be used for this purpose. They both reveal the links between assumptions and forecasts, help in-model simplification and may highlight unexpected relationships between inputs and outputs.Thus, a policy steered SHERPA module - predicting air quality improvement linked to emission reduction scenarios - was evaluated by means of (1) uncertainty analysis (UA) to quantify uncertainty in the model output, and (2) by sensitivity analysis (SA) to identify the most influential input sources of this uncertainty. The results of this study provide relevant information about the key variables driving the SHERPA output uncertainty, and advise policy-makers and modellers where to place their efforts for an improved decision-making process.



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A national-scale review of air pollutant concentrations measured in the U.S. near-road monitoring network during 2014 and 2015

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Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Jennifer L. DeWinter, Steven G. Brown, Annie F. Seagram, Karin Landsberg, Douglas S. Eisinger
In 2010, the U.S. Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) for NO2 to include a primary health-based standard for hourly NO2, and required air quality monitoring next to major roadways in urban areas in the U.S. Requirements for near-road measurements also include carbon monoxide (CO) and particulate matter smaller than 2.5 μm in diameter (PM2.5). We performed a national-scale assessment of air pollutants measured at 81 sites in the near-road environment during the first two years (2014 and 2015) of the new measurement program. We evaluated how concentrations at these locations compared to the NAAQS, to concentrations measured at other sites within the same urban areas, and when considering their site characteristics (distance of monitor to road, traffic volume, and meteorology). We also estimated the contribution of emissions from adjacent roadways at each near-road site to the PM2.5 concentrations above the local urban background concentrations, i.e., the near-road "increment." Hourly values of CO reached a maximum of 4.8 ppm across 31 sites in 2014 and 9.6 ppm across 47 sites in 2015, and were well below the NAAQS levels for both the 1-hr (35 ppm) and 8-hr (9 ppm) standards. Hourly concentrations of near-road NO2 reached 258 ppb across 40 sites in 2014; however, there were only two occurrences of a daily 1-hr maximum NO2 concentration above 100 ppb (the level of the hourly NO2 standard). In 2015, hourly concentrations of near-road NO2, monitored at 61 sites in 55 urban areas, reached 154 ppb. Only 0.0015% (n = 5) of hourly NO2 observations in 2015 exceeded 100 ppb. The highest annual NO2 average recorded in 2015 (29.9 ppb) occurred at the Ontario site located along I-10 in the Los Angeles, California, area and was below the level of the NO2 annual standard (53 ppb); in 2014, the highest annual mean NO2 was also observed in Los Angeles at the Anaheim site (27.1 ppb). In 2014, sites in Cincinnati, Indianapolis, and Louisville recorded annual average PM2.5 concentrations at or above 12 μg/m3 (the level of the annual standard). There were 15 occurrences in 2014 of 24-hr PM2.5 concentrations above the NAAQS level of 35 μg/m3. Annual average PM2.5 exceeded 12 μg/m3 at near-road sites in five urban areas in 2015, and there were 33 days across 12 near-road locations with 24-hr PM2.5 concentrations above 35 μg/m3. Across the near-road monitoring network, annual average PM2.5 concentrations did not have a significant relationship with traffic volume or distance between the monitor and the adjacent roadway; rather, variations in PM2.5 were mostly driven by urban-scale PM2.5, with a typically small "increment" above urban-scale concentrations due to a site's proximity to the roadway. We estimated this increment, i.e., the difference between near-road PM2.5 concentrations and the concentrations at sites in the urban area of each near-road monitor, to be on average 1.2 μg/m3 (σ = 0.3 μg/m3), with a range of −1.2 μg/m3 to 3.1 μg/m3 across the 26 sites (four of which had a negative increment). The near-road increment is on average 13% of the near-road PM2.5, and 15% of the near-road PM2.5 for sites within 20 m of the roadway.



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Anal Cytology: Institutional Statistics, Correlation With Histology, and Development of Multidisciplinary Screening Program With Review of the Current Literature.

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Anal Cytology: Institutional Statistics, Correlation With Histology, and Development of Multidisciplinary Screening Program With Review of the Current Literature.

Arch Pathol Lab Med. 2018 Apr 13;:

Authors: Morency EG, Harbert T, Fatima N, Samolcyzk J, Maniar KP, Nayar R

Abstract
CONTEXT: - The incidence of anal cancer in the United States is on the rise in high-risk populations. The anal Papanicolaou test (APT) is advocated as a screening tool, in addition to digital rectal examination and high-resolution anoscopy.
OBJECTIVE: - To review our experience and the current literature to create, in cooperation with clinicians, a standardized screening and treatment algorithm given our large volume of APTs.
DATA SOURCES: - All APTs collected between January 2013 and June 2015 were reviewed and correlated with follow-up/concurrent biopsy diagnoses, and clinical and social history. In total, 1417 APTs were performed on 1185 patients and APT results were as follows: 17.4% (247 of 1417) unsatisfactory; 27.9% (395 of 1417) negative; 19.5% (276 of 1417) atypical squamous cells of undetermined significance (ASC-US); 24.1% (342 of 1417) low-grade squamous intraepithelial lesion (LSIL); 3.6% (51 of 1417) atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H); and 7.5% (106 of 1417) HSIL. In total 376 cases (26.5%) had concurrent/follow-up biopsy. Review of all unsatisfactory cases with squamous intraepithelial lesion (SIL) on biopsy showed LSIL in 19.2% (5 of 26). Anal Papanicolaou test with cytologic abnormality (ASC-US+) had an 83.8% (315 of 376) rate of biopsy-proven disease, and sensitivity was higher (92%) for high-grade anal intraepithelial neoplasia or worse (AIN2+). Overall detection of AIN2+ using ASC-US+ showed specificity of 26%, negative predictive value of 92%, and positive predictive value of 26%.
CONCLUSIONS: - Anal cytology has a high abnormal rate (54.7%) and sensitivity but poor correlation with histologic grade. High unsatisfactory rate indicates need for improvement in sampling with 68.4% of cases having SIL on biopsy. Multidisciplinary effort led to improvements in sampling, cytologic interpretation, and development of a standardized management algorithm.

PMID: 29652190 [PubMed - as supplied by publisher]



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Molecular Testing in Lung Cancer: Where to Draw the Line?

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Molecular Testing in Lung Cancer: Where to Draw the Line?

Arch Pathol Lab Med. 2018 Apr 06;:

Authors: Halmos B

PMID: 29624077 [PubMed - as supplied by publisher]



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High-resolution MRI of the inner ear enables syndrome differentiation and specific treatment of cerebellar downbeat nystagmus and secondary endolymphatic hydrops in a postoperative ELST patient.

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High-resolution MRI of the inner ear enables syndrome differentiation and specific treatment of cerebellar downbeat nystagmus and secondary endolymphatic hydrops in a postoperative ELST patient.

J Neurol. 2018 Apr 11;:

Authors: Kirsch V, Ertl-Wagner B, Berman A, Gerb J, Dieterich M, Becker-Bense S

PMID: 29644399 [PubMed - as supplied by publisher]



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Non-typeable Haemophilus Influenzae detection in the lower airways of patients with lung cancer and chronic obstructive pulmonary disease

Chronic airway inflammation and hypersensitivity to bacterial infection may contribute to lung cancer pathogenesis. Previous studies have demonstrated that nontypeable Haemophilus influenzae (NTHi) is the most co...

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Examining the social status, risk factors and lifestyle changes of tuberculosis patients in Sri Lanka during the treatment period: a cross-sectional study

Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socia...

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Intestinal Microbiota in Hirschsprung Disease

Objectives: To characterize the microbiota profiles of patients with Hirschsprung's disease (HD), and to evaluate this in relation to postoperative bowel function and the incidence of Hirschsprung-associated enterocolitis (HAEC). Methods: All patients operated on for HD at our center between 1987–2011 were invited to answer questionnaires on bowel function and to participate in a clinical follow-up for laboratory investigations, including fecal DNA extraction, fecal calprotectin (FC), and brush border lactase (LCT) genotyping. The microbiota compositions of HD patients were compared to those of healthy controls aged 2–7 years. Results: The microbiota composition of eligible HD patients (n = 34; median age 12 (range, 3–25) years) differed from the healthy controls (n = 141), showing decreased overall microbial richness (p 

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Anorectal Manometry May Reduce the Number of Rectal Suction Biopsy Procedures Needed to Diagnose Hirschsprung's Disease

Objectives: To evaluate whether anorectal manometry (ARM), which is used to test the rectoanal inhibitory reflex (RAIR), is a safe alternative for reducing the number of invasive rectal suction biopsy (RSB) procedures needed to diagnose Hirschsprung's disease (HD). Methods: Between 2010 and 2017, we prospectively collected the ARM results of 105 patients suspected of having HD. Following the outcome, the patients either underwent additional tests to confirm HD or they were treated conservatively. Primary ARM-based diagnoses were compared with the definitive diagnoses based on the pathology reports and/or clinical follow-ups. Additionally, we analyzed whether modifications to our ARM protocol improved diagnostic accuracy. Results: The sensitivity of ARM and RSB was comparable (97% versus 97%). The specificity of ARM, performed according to our initial protocol, was significantly lower than that of RSB. After we modified the protocol the difference between the specificity of ARM and RSB was no longer statistically significant (74% versus 84%, respectively, P = .260). The negative predictive value of ARM was 100%, while their positive predictive value was significantly lower than that of RSB (56% versus 97%, P 

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Birth Month as a Risk Factor for the Diagnosis of Celiac Disease Later in Life: A Population-based Study

Various perinatal factors have been implicated in association with the risk of developing celiac disease (CD) in genetically susceptible individuals. Our aim was to investigate the association of month and season of birth with the development of CD later in life in a large National cohort in Israel. Data were retrieved from a National database of more than 2 million Israeli Jewish adolescents born between 1971 and 1998. Overall, 10,566 CD cases out of 2,001,353 subjects (0.53%) were identified and analyzed. CD risk was significantly higher for subjects born in May (odds ratio [OR] 1.07, P = 0.04) and June (OR 1.09, P = 0.008). Birth during the winter season (December to February) showed a marginal significance toward reduced risk (OR 0.97, P = 0.05). In conclusion, children born in May and June are at increased risk for CD. This increased risk provides further evidence that perinatal environmental factors increase the risk of developing CD. Address correspondence and reprint requests to Amit Assa, MD, MHA, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel- Aviv University, 14 Kaplan St. Petach-Tikva, 4920235, Israel (e-mail: dr.amit.assa@gmail.com). Received 27 November, 2017 Accepted 31 March, 2018 The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Pediatric Liver Transplant Teams’ Coping with Patient Death

Objectives: Coping with patient death among pediatric liver transplant teams has received little attention despite general recognition of the potentially negative emotional consequences associated with such loss. The purpose of this study was to investigate 1) the ways in which members of pediatric liver transplant teams cope with the death of patients on the waitlist and post-transplant and 2) the institutional resources available to facilitate this coping. Methods: Participants included 120 physicians, nurses, and mental health professionals from multiple transplant centers across the United States. Participants completed an online questionnaire that assessed the availability of formal coping resources at their institutions, informal sources of support used to cope with patient death, and as indices of coping, bereavement and emotional exhaustion symptoms experienced. Results: Debriefing, the most commonly offered support, was available to about half (55.8%) of the sample; yet, nearly all respondents (98.3%) indicated that debriefing would be useful. On average, bereavement and emotional exhaustion levels were comparable to normative data, but patterns of coping varied based on participants' position within the transplant team. For participants who reported that debriefing was available at their institutions, emotional exhaustion was lower. Conclusions: Overall, formal supports were inconsistently offered to pediatric transplant team members. Team members expressed high acceptability for debriefing, which has been associated with benefits in other populations, and findings indicated better coping in the transplant setting when it was offered. Address correspondence and reprint requests to Sarah E. Duncan, Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458 (e-mail: sduncan6@fordham.edu). Received 20 July, 2017 Accepted 17 January, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Authorship Statements Sarah E Duncan: Concept/design, statistics, data analysis/interpretation, drafting article, critical revision of article, approval of article Ronen Arnon: Concept/design, data analysis/interpretation, critical revision of article, approval of article Christie DiPietrantonio: Concept/design, data collection, critical revision of article, approval of article Katie Ehrlich: Concept/design, data collection, critical revision of article, approval of article Christopher S Knight: Concept/design, data collection, critical revision of article, approval of article Jaime Chu: Data analysis/interpretation, critical revision of article, approval of article Rachel A Annunziato: Concept/design, data collection, statistics, data analysis/interpretation, drafting article, critical revision of article, approval of article Conflict of Interest and Sources of Funding: The authors of this manuscript have no conflicts of interest or sources of funding to disclose. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Early Serum Gut Hormone Concentrations Associated with Time to Full Enteral Feedings in Preterm Infants

Objectives: The primary objective of this study was to evaluate early postnatal serum gut hormone concentrations in preterm infants as predictors of time to full enteral feedings. The secondary objective was to identify infant characteristics and nutritional factors that modulate serum gut hormone concentrations and time to full enteral feedings. Methods: Sixty-four preterm infants less than 30 weeks of gestation were included in this retrospective cohort study. Serum gut hormone concentrations at postnatal days 0 and 7 were measured using enzyme-linked immunosorbent assays. Linear regression and mediation analyses were performed. Results: Median (IQR) serum concentrations of glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY) on postnatal day 7 were 31.3 pg/mL (18.2, 52.3) and 1181.7 pg/mL (859.0, 1650.2), respectively. GIP and PYY concentrations on day 7 were associated with days to full enteral feedings after adjustment for confounders (β = −1.1, p = 0.03; and β = −0.002, p = 0.02, respectively). Nutritional intake was correlated with serum concentrations of GIP and PYY on postnatal day 7 and time to full enteral feedings. Mediation analysis revealed that the effect of serum gut hormone concentrations on time to full enteral feedings was not fully explained by nutritional intake. Intrauterine growth restriction (IUGR), mechanical ventilation on postnatal day 7, and patent ductus arteriosus (PDA) treated with indomethacin were associated with longer time to full enteral feedings. Conclusions: Serum concentrations of GIP and PYY on postnatal 7 are independently associated with time to full enteral feedings. The link between serum gut hormone concentrations and time to full enteral feedings is not fully mediated by nutritional factors, suggesting an independent mechanism underlying the influence of gut hormones on feeding tolerance and time to full enteral feedings. Address correspondence and reprint requests to: Camilia R. Martin, MD, MS, Beth Israel Deaconess Medical Center, Department of Neonatology, 330 Brookline Avenue, Rose-318, Boston, MA 02215 (e-mail: cmartin1@bidmc.harvard.edu). Received 29 October, 2017 Accepted 16 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Author Contributions: Kristen H. Shanahan: conception and design of the study, acquisition, analysis, and interpretation of the data, drafting and revision of manuscript, final approval of manuscript for submission Xinting Yu: analysis and interpretation of data, final approval of manuscript for submission Laura G. Miller: acquisition of data, final approval of manuscript for submission Steven D. Freedman: conception and design of the study, analysis and interpretation of the data, drafting and revision of manuscript, final approval of manuscript for submission Camilia R. Martin: conception and design of the study, analysis and interpretation of the data, drafting and revision of manuscript, final approval of manuscript for submission Conflicts of Interest and Sources of Funding: CRM receives research funding from Abbott Nutrition and Alcresta Therapeutics. The other authors have no conflicts of interest. KHS was supported by the Alpha Omega Alpha Honor Medical Society (Carolyn L. Kuckein Student Research Fellowship). CRM and SDF were supported by philanthropic contributions to the Charles and Judy Hood Family Infant Health Repository Program, Abbott Nutrition, and Alcresta Therapeutics. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Gestational Obstructive Sleep Apnea: Biomarker Screening Models and Lack of Postpartum Resolution.

Related Articles

Gestational Obstructive Sleep Apnea: Biomarker Screening Models and Lack of Postpartum Resolution.

J Clin Sleep Med. 2018 Mar 30;:

Authors: Street LM, Aschenbrenner CA, Houle TT, Pinyan CW, Eisenach JC

Abstract
STUDY OBJECTIVES: To measure prevalence and severity of third trimester obstructive sleep apnea and evaluate postpartum resolution. To assess a novel biomarker for screening for obstructive sleep apnea in pregnancy.
METHODS: This prospective observational study was performed at Wake Forest School of Medicine obstetrics clinics between April 2014 and December 2015. Fractional exhaled nitric oxide measurements and sleep studies were obtained and compared at 32 0/7 to 35 6/7 weeks gestation and postpartum. Exhaled nitric oxide and risk factors for the development of gestational sleep apnea were evaluated for predictive ability independently and in screening models.
RESULTS: Of 76 women enrolled, 73 performed valid sleep studies in pregnancy and 65 had an additional valid study 6 to 15 weeks postpartum. Twenty-four women (37%) had gestational sleep apnea compared with 23 (35%) with postpartum sleep apnea (P> .99). Eight of 11 women (73%) retested 6 to 8 months postpartum had persistent sleep apnea. Exhaled nitric oxide had moderate discrimination screening for sleep apnea in pregnancy (area under the receiver operating characteristic curve = 0.64). A model utilizing exhaled nitric oxide, pregnancy-specific screening, and Mallampati score improved ability to identify women at risk for gestational sleep apnea (sensitivity = 46%, specificity = 91% and likelihood ratio = 5.11, area under receiver operating characteristic curve = 0.75).
CONCLUSIONS: Obstructive sleep apnea is common in the early postpartum period and often persisted at least 6 months. Exhaled nitric oxide as a sole biomarker to screen for sleep apnea in pregnancy has only modest discrimination. Combined with additional parameters sensitivity and specificity improved.
CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov, Identifier: NCT02100943, Title: Exhaled Nitric Oxide as a Biomarker of Gestational Obstructive Sleep Apnea and Persistence Postpartum, URL: https://ift.tt/2HCeamq.

PMID: 29609706 [PubMed - as supplied by publisher]



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Evaluation of the inter-person variability of hazards to the users of BAHA hearing implants caused by exposure to a low frequency magnetic field

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R. J. Michael Fry (8/7/1924–24/11/2017)

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Experimental studies on the biological effects of chronic low dose-rate radiation exposure in mice: overview of the studies at the Institute for Environmental Sciences

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Education and training to support radiation protection research in Europe: the DoReMi experience

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Characterization of a partial-body irradiation model with oral cavity shielding in nonhuman primates

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3 takeaways on how EMS providers train to use supraglottic airways

By Sarah Calams, EMS1 Associate Editor Supraglottic airways are a valuable airway management tool. Which methods of training do you use to refresh your knowledge of and ability to use supraglottic airways" Furthermore, how often do you complete refresher training" We asked these questions, along with six others, in a survey to help us gain a better understanding of how EMS providers train to use supraglottic ...

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Efficacy of PD-1 & PD-L1 inhibitors in older adults: a meta-analysis

Abstract

Background

Immune checkpoint inhibitors targeting PD-1/PD-L1 pathway demonstrated promising activities in variety of malignancies, however little is known regarding their efficacy in adults aged ≥65 years.

Methods

We conducted a systematic review and a study-level meta-analysis to explore efficacy of ICIs based on age, younger vs older than 65 years. We included in this analysis randomized controlled phase II or III studies in patients with metastatic solid tumors that compared efficacy of PD-1 or PD-L1 inhibitors to a non-PD-1/PD-L1 inhibitor. Aggregated estimates of overall survival (OS) and progression-free survival (PFS) are based on random/mixed effects (RE) models to allow for heterogeneity between the studies.

Results

Initial search identified 53 articles, 17 were randomized controlled trials that compared nivolumab, pembrolizumab or atezolizumab to chemotherapy or targeted therapy. Only 9 trials reported hazard ratiios (HR) for OS based on age and were included in this meta-analysis. Out of those studies seven reported HR for PFS but only 4 studies included subgroup-analysis based on age for PFS. The overall estimated random-effects HR for death was 0.64 with 95% CI of 0.54–0.76 in patients ≥65 years vs. 0.68 with 95% CI of 0.61–0.75 in patients < 65 years. The overall estimated random-effects for HR for progression was 0.74 with 95% CI of 0.60–0.92 in patients ≥65 years vs. 0.73 with 95% CI of 0.61–0.88 in patients < 65 years.

Conclusions

PD-1 (nivolumab and pembrolizumab) and PD-L1 (atezolizumab) inhibitors had comparable efficacy in adults younger vs ≥ 65 years.



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Pseudoprogression manifesting as recurrent ascites with anti-PD-1 immunotherapy in urothelial bladder cancer

Abstract

Background

Immunotherapies targeting the PD-1 checkpoint pathway have recently gained regulatory approval in numerous cancer types. With the widespread use of immune checkpoint therapies, varying patterns of responses and immune-related adverse events are being observed.

Case Presentation

In this case, we highlight a patient who developed recurrent, large-volume ascites, while simultaneously having a 49% reduction in peritoneal tumor lesion size by RECIST criteria. Sampling of the fluid revealed high levels of IL-6 and IL-15. Cytology revealed no malignant cells on 4 separate paracenteses over a period of 6 weeks. Cell counts revealed that 45% of cells were lymphocytes, and further analysis was performed by fluorescence-activated cell sorting (FACS). The majority of lymphocytes were CD8+, of which 78% were PD-1+ and 43% were HLA-DR+ indicating an activated phenotype.

Conclusions

In summary, treatment with anti-PD-1 therapy may result in pseudoprogression manifested by ascitic fluid accumulation due to the influx of activated T cells. Since worsening of ascites is typically associated with disease progression, it is important to consider the possibility of pesudoprogression in such patients undergoing therapy with immune checkpoint inhibitors.



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Most-enhancing tumor volume by MRI radiomics predicts recurrence-free survival “early on” in neoadjuvant treatment of breast cancer

Abstract

Background

The hypothesis of this study was that MRI-based radiomics has the ability to predict recurrence-free survival "early on" in breast cancer neoadjuvant chemotherapy.

Methods

A subset, based on availability, of the ACRIN 6657 dynamic contrast-enhanced MR images was used in which we analyzed images of all women imaged at pre-treatment baseline (141 women: 40 with a recurrence, 101 without) and all those imaged after completion of the first cycle of chemotherapy, i.e., at early treatment (143 women: 37 with a recurrence vs. 105 without). Our method was completely automated apart from manual localization of the approximate tumor center. The most enhancing tumor volume (METV) was automatically calculated for the pre-treatment and early treatment exams. Performance of METV in the task of predicting a recurrence was evaluated using ROC analysis. The association of recurrence-free survival with METV was assessed using a Cox regression model controlling for patient age, race, and hormone receptor status and evaluated by C-statistics. Kaplan-Meier analysis was used to estimate survival functions.

Results

The C-statistics for the association of METV with recurrence-free survival were 0.69 with 95% confidence interval of [0.58; 0.80] at pre-treatment and 0.72 [0.60; 0.84] at early treatment. The hazard ratios calculated from Kaplan-Meier curves were 2.28 [1.08; 4.61], 3.43 [1.83; 6.75], and 4.81 [2.16; 10.72] for the lowest quartile, median quartile, and upper quartile cut-points for METV at early treatment, respectively.

Conclusion

The performance of the automatically-calculated METV rivaled that of a semi-manual model described for the ACRIN 6657 study (published C-statistic 0.72 [0.60; 0.84]), which involved the same dataset but required semi-manual delineation of the functional tumor volume (FTV) and knowledge of the pre-surgical residual cancer burden.



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Language development in children who stutter: A review of recent research.

Related Articles

Language development in children who stutter: A review of recent research.

Int J Speech Lang Pathol. 2018 Apr 11;:1-9

Authors: Nippold MA

Abstract
PURPOSE: This article reviews recent studies that examined the controversial claim that children who stutter (CWS), as a group, have weaker language skills than children who do not stutter (CWNS). The article was an effort to address the conflicting conclusions of two previous reviews of the research in this area.
METHOD: Studies published in research journals during the past 7 years (2011-2018) were located through a systematic review of the literature. Each study was analysed to determine how well it supported the claim that CWS, as a group, have weaker language skills than CWNS.
RESULT: The evidence was not convincing to support this controversial claim. Rather, the review indicated that CWS performed as well as or better than CWNS on formal language tasks.
CONCLUSION: The claim that language weaknesses are linked to children's stuttering is not well supported by recently published studies. Alternative interpretations of the literature are offered.

PMID: 29642734 [PubMed - as supplied by publisher]



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The effect of speech-language pathology students on clinician time use and activity.

Related Articles

The effect of speech-language pathology students on clinician time use and activity.

Int J Speech Lang Pathol. 2018 Apr 03;:1-12

Authors: Bourne E, McAllister L, Nagarajan S, Short K

Abstract
PURPOSE: This prospective study investigated the impact of supervising students on public health speech-language pathologists' (SLPs) time and patient activity levels in order to broaden evidence in the profession.
METHOD: Thirty-four SLPs supervising students collected data profiling their time use and activity during the first, middle and penultimate placement week. They also collected data for a week when not supervising students. Pre- and post-placement surveys were used to supplement quantitative data with additional information such as clinician and student experience levels.
RESULT: Overall clinical time (face-to-face and indirect) and the number of patients seen neither increased nor decreased during student placements. However, clinicians' use of time altered across placement periods. For example, SLP time delivering clinical services decreased but time observing students providing clinical services increased as the placement progressed. Some differences in time spent in non-clinical activities (e.g. student teaching and SLP administration) were found. Comparing data from placements with varying supervision models or student competence level showed few significant differences in time use, activity or productivity.
CONCLUSION: There was no significant difference in overall clinical time used, nor patient activity or productivity whether clinicians were supervising students or not. Further research is required within SLP services.

PMID: 29614233 [PubMed - as supplied by publisher]



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Auditory brainstem implant in postmeningitis totally ossified cochleae.

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Auditory brainstem implant in postmeningitis totally ossified cochleae.

Acta Otolaryngol. 2018 Apr 01;:1-5

Authors: Malerbi AFDS, Goffi-Gomes MVS, Tsuji RK, Gomes MQT, Brito Neto R, Bento RF

Abstract
INTRODUCTION: An auditory brainstem implant (ABI) is an option for auditory rehabilitation in patients with totally ossified cochleae who cannot receive a conventional cochlear implant.
OBJECTIVE: To evaluate the outcomes in audiometry and speech perception tests after the implantation of an ABI via the extended retrolabyrinthine approach in patients with postmeningitis hearing loss.
MATERIALS AND METHODS: Ten patients, including children and adults, with postmeningitis hearing loss and bilateral totally ossified cochleae received an ABI in a tertiary center from 2009 to 2015. The extended retrolabyrinthine approach was performed in all the patients by the same surgeons. A statistical analysis compared pure tonal averages and speech perception tests before and at least 12 months after the ABI activation.
RESULTS: Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognized up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response.
CONCLUSIONS: The ABI improved hearing performance in audiometry and speech perception tests in cases of postmeningitis hearing loss. The extended retrolabyrinthine approach is a safe surgical option for patients with postmeningitis hearing loss and bilateral totally ossified cochleae.

PMID: 29607748 [PubMed - as supplied by publisher]



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Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

http:--www.tandfonline.com-templates-jsp Related Articles

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

Int J Audiol. 2018 Apr 06;:1-8

Authors: Xu J, Galster J, Galster E, Gruhlke A, Wolfe A

Abstract
OBJECTIVE: The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies.
DESIGN: This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field.
STUDY SAMPLE: The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials.
RESULTS: The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements.
CONCLUSIONS: Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

PMID: 29621924 [PubMed - as supplied by publisher]



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The development of a vocabulary for PEEPS-SE-profiles of early expressive phonological skills for Swedish.

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The development of a vocabulary for PEEPS-SE-profiles of early expressive phonological skills for Swedish.

Clin Linguist Phon. 2018 Apr 10;:1-16

Authors: Marklund U, Lacerda F, Persson A, Lohmander A

Abstract
This paper describes the development of a vocabulary for Profiles of Early Expressive Phonological Skills for Swedish (PEEPS-SE), a tool for assessment of expressive phonology in Swedish-learning children in the age range of 18-36 months. PEEPS-SE is the Swedish version of the original PEEPS, Profiles of Early Expressive Phonological Skills, which uses two age-adequate word lists-a basic word list (BWL) for the assessment of 18-24-month-old children, to which an expanded word list (EWL) is added for assessment of 24-36-month-old children, or children with more than 250 words in their expressive vocabulary. The selection of words in PEEPS-SE is based on two types of criteria: age of acquisition and phonological complexity. The words also need to be easy to elicit in a natural way in test situations. Vocabulary data previously collected with the Swedish Early Communicative Development Inventory are used for selection of age-adequate words, where the BWL contains words acquired earlier compared to the additional words in the EWL. The latter also contains words that are more phonologically complex compared to those in the BWL. Word complexity was determined by the Swedish version of word complexity measure. PEEPS-SE has made an attempt to match the original version of PEEPS in terms of both assessment method and word selection.

PMID: 29634359 [PubMed - as supplied by publisher]



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The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study.

https:--linkinghub.elsevier.com-ihub-ima Related Articles

The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study.

Auris Nasus Larynx. 2018 Mar 30;:

Authors: Lin DL, Wu CS, Tang CH, Kuo TY, Tu TY

Abstract
OBJECTIVE: To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.
METHODS AND MATERIALS: This study was based on data obtained from Taiwan's National Health Insurance Research Database from the period 2002-2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy.
RESULTS: A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0-4 years (0.61%), 4-12 years (2.06%) and 12-18 years (2.56%). The revision rate associated with surgeon age showed: 28-41 years (1.42%), 41-50 years (2.96%), 50-65 years (2.74%); the surgeons' surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other.
CONCLUSIONS: Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.

PMID: 29609841 [PubMed - as supplied by publisher]



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A comparison of tonsillar surface swabbing, fine-needle aspiration core sampling, and dissected tonsillar core biopsy culture in children with recurrent tonsillitis.

Related Articles

A comparison of tonsillar surface swabbing, fine-needle aspiration core sampling, and dissected tonsillar core biopsy culture in children with recurrent tonsillitis.

Ear Nose Throat J. 2017 Jun;96(6):E29-E32

Authors: Sarkar S, Sil A, Sarkar S, Sikder B

Abstract
In recurrent tonsillitis, the pathogenic bacteria are harbored in the tonsil core, and therefore cultures of superficial swab samples are not particularly accurate in identifying specific types of core bacteria. On the other hand, the results of fine-needle aspiration (FNA) cultures of core samples have been closely correlated with the findings of core cultures in excised tonsils, and both methods are far superior to surface swabbing. We conducted a prospective study to compare the accuracy of culture findings from tonsillar tissue obtained by surface swabbing, FNA sampling of the tonsil core in situ, and core sampling of the excised tonsil in children with recurrent tonsillitis. Our patient population was made up of 54 children-22 boys and 32 girls, aged 4 to 14 years (mean: 10.7)-who were undergoing elective tonsillectomy during a 1-year period. On the day of surgery, a surface swab, core FNA sample, and dissected core sample were obtained from each patient and sent for culture. Culture showed that the three methods were in agreement in 34 cases (63.0%). In 9 cases (16.7%) the surface swab culture grew different pathogens from those of the two core cultures, and in 3 other cases (5.6%) the surface swab culture was negative while the two core cultures were positive for the same pathogens. In all, the results of core FNA culture and dissected core culture were in agreement in 46 cases (85.2%); in only 4 cases (7.4%) did the core FNA culture fail to accurately identify the causative pathogens. Overall, the sensitivity and specificity of core FNA sampling were 100 and 50% respectively, compared with 82.9 and 30.8% for the superficial tonsillar swab. We conclude that routine culture of surface swab specimens in patients with chronic or recurrent tonsillitis is neither reliable nor valid. We recommend that core FNA sampling be considered the diagnostic method of choice since it can be done on an outpatient basis, it would reliably allow for culture-directed antibiotic therapy, and it could obviate the need for elective tonsillectomy in many cases. However, its feasibility as an office procedure in children remains to be determined.

PMID: 28636739 [PubMed - indexed for MEDLINE]



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Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

http:--www.tandfonline.com-templates-jsp Related Articles

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

Int J Audiol. 2018 Apr 06;:1-8

Authors: Xu J, Galster J, Galster E, Gruhlke A, Wolfe A

Abstract
OBJECTIVE: The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies.
DESIGN: This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field.
STUDY SAMPLE: The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials.
RESULTS: The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements.
CONCLUSIONS: Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

PMID: 29621924 [PubMed - as supplied by publisher]



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Editorial: Spontaneous Activity in Sensory Systems.

Related Articles

Editorial: Spontaneous Activity in Sensory Systems.

Front Neural Circuits. 2018;12:27

Authors: Imaizumi K, Ruthazer ES, MacLean JN, Lee CC

PMID: 29651239 [PubMed - in process]



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Temporal Bone Histopathology in Cockayne Syndrome.

http:--pt.wkhealth.com-pt-pt-core-templa Related Articles

Temporal Bone Histopathology in Cockayne Syndrome.

Otol Neurotol. 2018 Apr 11;:

Authors: Handzel O, Nadol JB

Abstract
: Cockayne syndrome (CS) is a rare autosomal recessive syndrome resulting in defective DNA repair. Its features include cachectic dwarfism, hearing loss, skin hypersensitivity to sunlight, premature aging, and dementia. Presented is a right temporal bone of a patient who died at the age of 29 years. The clinical course was compatible with type 1 CS, the classical form. Homozygous missense variant in the ERCC6 gene (Excision Repair Cross-Complementation group 6) was found, compatible with CS complementation group B. Five years before his death he complained of tinnitus. An audiogram 3 and a 1/2 years before his death demonstrated a moderate symmetrical sensorineural hearing loss at 2 to 8 kHz. The speech reception threshold was 20 dB, and the word recognition score was 100% on the right.Histopathology revealed a near normal population of inner hair cells except in the basal 5 mm of the cochlea, and mild loss of outer hair cells particularly at the base of the cochlea. Severe atrophy of the spiral ligament and atrophy of stria vascularis and spiral prominence was present. There was loss of Claudius cells, outer sulcus cells, and mesenchymal cells on the scala tympani side of the basilar membrane and loss of cellularity of the limbus. There was a moderate loss of Scarpa's and spiral ganglion neurons, with the most severe loss in the basal segment. The vestibular neuro-epithelium was nearly intact, with the exception of mild loss in the saccule. The vestibular perilymphatic, and to a lesser extent endolymphatic spaces, were filled with filamentous material and osteoid. The patient had better hearing and a larger complement of neurons compared with the few published case reports.Neurodegenerative symptoms are likely attributed to the effect of intramitochondrial reactive oxygen species. The pathogenesis of hearing loss in CS may shed light on other causes of hearing loss, such as that induced by noise.

PMID: 29649050 [PubMed - as supplied by publisher]



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Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

http:--www.tandfonline.com-templates-jsp Related Articles

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

Int J Audiol. 2018 Apr 06;:1-8

Authors: Xu J, Galster J, Galster E, Gruhlke A, Wolfe A

Abstract
OBJECTIVE: The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies.
DESIGN: This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field.
STUDY SAMPLE: The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials.
RESULTS: The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements.
CONCLUSIONS: Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

PMID: 29621924 [PubMed - as supplied by publisher]



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Durable response to bevacizumab in adults with recurrent pilocytic astrocytoma

CNS Oncology, Ahead of Print.


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"NQO1 Gene C609T Polymorphism (dbSNP: rs1800566) and Digestive Tract Cancer Risk: A Meta-Analysis."

Related Articles

"NQO1 Gene C609T Polymorphism (dbSNP: rs1800566) and Digestive Tract Cancer Risk: A Meta-Analysis."

Nutr Cancer. 2018 Apr 13;:1-12

Authors: Yadav U, Kumar P, Rai V

Abstract
Several studies reported that polymorphism C609T (rs1800566) in (NAD(P)H): quinoneoxidoreductase 1 (NQO1) gene is associated with risk to digestive tract (DT) cancers, like esophageal cancer (EC), gastric cancer (GC), and colorectal cancer (CRC). Authors conducted a meta-analysis to investigate association between C609T polymorphism and DT cancer risk. Eligible studies were extracted from the databases of PubMed, Google Scholar, Science Direct, and Springer Link. All retrieved articles were evaluated. All statistical analyses were performed using Open Meta-Analyst and MIX1.7 programs. A total of 34 studies including 12,043 DT cancer cases and 15,209 healthy controls were included in the present meta- analysis. Results of meta-analysis revealed a significant association between NQO1 C609T polymorphism and DT cancer risk adopting all 5 genetic models (T vs. C: OR = 1.21, 95% CI = 1.11-1.31, p < 0.001; TT vs. CC: OR = 1.48, 95% CI = 1.22-1.79, p < 0.001; TT + CT vs. CC: OR = 1.23, 95% CI = 1.12-1.35, p < 0.001; TT vs. CT + CC: OR = 1.36, 95% CI = 1.15-1.60, p < 0.001; CT vs. CC: OR = 1.16, 95% CI = 1.07-1.27, p < 0.001). In the stratified analysis based on cancer types, significant associations were observed between NQO1 C609T polymorphism and GC (OR = 1.38, 95% CI = 1.11-1.72, p = 0.003) and CRC (OR = 1.18, 95% CI = 1.06-1.30, p = 0.001), but not with EC (OR = 1.16, 95% CI = 0.99-1.35, p = 0.06). Furthermore, stratified analysis based on ethnicity indicated that there was a significant association between NQO1 C609T polymorphism and DT cancer risk in the Asian (TT vs. CC: OR = 1.55, 95% CI = 1.21-2.00, p ≤ 0.001) as well as in Caucasian populations (TT vs. CC: OR = 1.34, 95% CI = 1.04-1.73, p = 0.02). In conclusion, the results of meta-analysis suggested that the NQO1 C609T polymorphism is a risk factor for DT cancers, including GC and CRC.

PMID: 29652514 [PubMed - as supplied by publisher]



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Terminalia ferdinandiana Exell. Fruit and Leaf Extracts Inhibit Proliferation and Induce Apoptosis in Selected Human Cancer Cell Lines.

Related Articles

Terminalia ferdinandiana Exell. Fruit and Leaf Extracts Inhibit Proliferation and Induce Apoptosis in Selected Human Cancer Cell Lines.

Nutr Cancer. 2018 Apr 11;:1-15

Authors: Shalom J, Cock IE

Abstract
Terminalia spp. are characterized by their high antioxidant contents and several species have anticancer activity. This study examined T. ferdinandiana fruit and leaf extracts for antiproliferative and apoptotic activities against a panel of human carcinoma cell lines. All extracts inhibited Caco2, HeLa, Jeg-3, JAR, MC3T3-E1, and MG63 proliferation. The leaf ethyl acetate extract was the most potent inhibitor of proliferation (MC3T3-E1 IC50 = of 6 µg/ml; Caco2 IC50 = 102 µg/ml). Furthermore, IC50's < 500 µg/ml were determined against all cell lines tested against that extract. The methanolic leaf extract was also a potent inhibitor of cell proliferation (Jeg-3 IC50 = 147 µg/ml; MC3T3-E1 IC50 = 40 µg/ml). The fruit extracts were also good inhibitors of carcinoma cell proliferation. Cell imaging studies detected morphological features consistent with apoptosis in Caco2 cells exposed to the ethyl acetate, methanolic, and aqueous extracts. Caspase 3 activity was significantly elevated in Caco2 cells exposed to these extracts, indicating that apoptosis was induced. The leaf ethyl acetate extract contained a high diversity and relative abundance of tannins and flavonoids. All T. ferdinandiana fruit and leaf extracts displayed either no toxic or low toxicity in the Artemia franciscana bioassay and in a HDF viability assay.

PMID: 29641917 [PubMed - as supplied by publisher]



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Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

http:--www.tandfonline.com-templates-jsp Related Articles

Using the device-oriented subjective outcome (DOSO) scale to measure outcomes of different hearing aids.

Int J Audiol. 2018 Apr 06;:1-8

Authors: Xu J, Galster J, Galster E, Gruhlke A, Wolfe A

Abstract
OBJECTIVE: The device-oriented subjective outcome (DOSO) is a device-oriented questionnaire, intended to minimise the influence of personality on self-reported measures. The aim of this study was to provide normative data with 2015-era hearing aid technologies.
DESIGN: This retrospective study evaluated data from records of three clinical trials. The DOSO was administered for the participants' own devices as a part of the intake and after using research devices in the field.
STUDY SAMPLE: The DOSO data were collected from 132 experienced bilateral hearing aid wearers who participated in the clinical trials.
RESULTS: The DOSO data collected with the participants' own devices were compared to the interim normative data collected between 2004 and 2005. The DOSO subscale scores from the participants' own devices were significantly higher than those from the interim norms, except Listening Effort subscale. To demonstrate the utility of the new norms, a separate set of DOSO data collected from the same participants after using research hearing aids were contrasted to the new normative data. After accounting for possible placebo effects, the DOSO data with research devices revealed additional self-reported benefit of technological advancements.
CONCLUSIONS: Norms for the DOSO are recommended for evaluating hearing aids with more recent technologies.

PMID: 29621924 [PubMed - as supplied by publisher]



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Interessenkonflikte in Leitlinien



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Neue klinische Anwendungen der Laser-Doppler-Vibrometrie in der Otologie

Zusammenfassung

Hintergrund

Für die Untersuchung der Mittelohrmechanik ist eine Messmethode erforderlich, die Vibrationsbewegungen im Nanometerbereich zu messen vermag, ohne dabei den Schwingungsvorgang zu beeinflussen. Zahlreiche Messverfahren kamen zur Anwendung, bis sich die Laser-Doppler-Vibrometrie (LDV) als Standardverfahren in der Ohrforschung etablierte.

Ziel der Arbeit

Ziel war die Darstellung der klinischen Anwendungsmöglichkeiten eines LDV-Systems in der Otologie.

Material und Methoden

Verwendet wurde ein kommerzielles Ein-Punkt-Vibrometer. Der Lasermesskopf wurde sowohl in Verbindung mit einem Operationsmikroskop verwendet als auch als handgeführtes Messgerät zur Messung direkt im Gehörgang. Hierbei kam eine selbstentwickelte Vorsatzeinheit unter Verwendung einer elastischen Linse zur Anwendung. Schwingungsmessungen des Mittelohrs erfolgten im Felsenbeinmodell sowie intra- und postoperativ an Patienten im Zuge der Implantation einer Vibrant Soundbridge (VSB, Fa. MED-EL GmbH, Innsbruck, Österreich).

Ergebnisse

Verschiedene pathologische Mittelohrveränderungen zeigen eine unterschiedliche Frequenzantwort des Umbos. Die LDV kann für eine intraoperative objektive Ankopplungsüberprüfung des Floating Mass Transducer (FMT, Fa. MED-EL) an die Ossikelkette bei der Implantation einer Vibrant Soundbridge verwendet werden. Postoperativ kann die Methode hilfreich sein, falls eine Verschlechterung der Soundbridge-Verstärkungsleistung bemerkt wird. Gemessen wird eine Veränderung der Transferfunktion des Umbos, hervorgerufen z. B. durch eine Vernarbung des Mittelohrs oder eine Dislokation des FMT.

Schlussfolgerung

Die LDV bietet sich für viele klinische Fragestellungen in der Otologie an. Durch die hohen Kosten für ein LDV-System und den verhältnismäßig großen apparativen Aufwand sowie einen breiten Korridor zur Interpretation der Messergebnisse hat es die Methode jedoch (noch) nicht geschafft, sich im klinischen Alltag zu etablieren.



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Plastische Operationen



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Preisträger 2015 und 2017 der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.



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FORSCHUNG HEUTE – ZUKUNFT MORGEN



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Das angeborene Immunsystem beim Oropharynxkarzinom

Zusammenfassung

Klinisch und biologisch können Plattenepithelkarzinome des Oropharynx („oropharyngeal squamous cell carcinoma", OPSCC), die mit humanen Papillomaviren (HPV) assoziiert sind, als eine eigene Tumorentität im Kopf-Hals-Bereich betrachtet werden. Bisher hat dies außerhalb klinischer Studien keinen Einfluss auf Therapiekonzepte. Der natürliche Replikationszyklus von HPV findet „räumlich getrennt" von zytotoxischen Immunzellen in der Epidermis statt. Dendritische (Langerhans‑)Zellen finden sich jedoch häufig in dieser oberen Hautschicht. Ihre Fähigkeit Antigene zu prozessieren, zu migrieren und schließlich T‑Zellen zu aktivieren, wird durch die Aktivität der viralen Onkoproteine (E5–E7) inhibiert. Die Repression einer funktionellen HLA-I(Human-Leukocyte-Antigen-I)-Expression auf der Oberfläche von Epithelzellen ist hierbei wichtig. Eine entsprechende Aktivierung von natürlichen Killer(NK)-Zellen („Missing-Self-Erkennung") unterbleibt jedoch, da diese in der Epidermis normalerweise fehlen. Genomweite Untersuchungen zeigen spezifische Signaturen bei HPV-assoziierten OPSCC, die distinkt sind von HPV-negativen Tumoren. Dabei sind Gene des HLA-I-Systems bei HPV-assoziierten OPSCC vermehrt von genetischen Veränderungen betroffen. Eigene Daten deuten darauf hin, dass HPV-assoziierte OPSCC häufiger durch CD56-positive (CD56+-)NK-Zellen infiltriert sind, was mit dem Verlust der HLA-I-Oberflächenexpression bei der HPV-assoziierten Karzinogenese zusammenhängen könnte. Bei Patienten mit OPSCC korrelieren CD56+-Zellen mit einem günstigeren Verlauf nach konventioneller Therapie. Die vorliegenden Daten zeigen, dass HPV-assoziierte OPSCC für künftige immunmodulatorische Therapiekonzepte geeignet sein könnten und der Immunstatus für die Planung klinischer Studien bedeutsam ist.



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Lärminduzierte Neurodegeneration der zentralen Hörbahn

Zusammenfassung

Hintergrund

Ein Lärmtrauma induziert zentralnervöse Pathologien, die zur Generierung von Hör- und Wahrnehmungsstörungen führen.

Fragestellung

Sind degenerative Prozesse in der zentralen Hörbahn eine direkte Auswirkung der Überstimulation oder eine Folge akustischer Deprivation?

Material und Methode

Bestimmung von Zelltodmechanismen im Mausmodell eines lärminduzierten Hörverlusts zu verschiedenen Zeitpunkten nach einfacher oder wiederholter Lärmexposition.

Ergebnisse

Eine einmalige Lärmexposition (3 h, 115 dB SPL, 5–20 kHz) induziert akute (≤1 Tag) und längerfristige (Beobachtungszeitraum 14 Tage) Degeneration insbesondere in subkortikalen Strukturen. Nach einem wiederholten Lärmtrauma treten v. a. pathologische Veränderungen im auditorischen Thalamus und Kortex auf.

Schlussfolgerung

Lärm hat direkte Auswirkungen auf basale Strukturen der zentralen Hörbahn, eine Protektion kortikaler Areale erfolgt möglicherweise aufgrund inhibitorischer neuronaler Projektionen. Degenerative Mechanismen in höheren Strukturen des vorgeschädigten Systems deuten auf eine zunehmende Beeinträchtigung komplexer Verarbeitung akustischer Informationen.



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Adipose tissue, but not skeletal muscle, sirtuin 1 expression is decreased in obesity and related to insulin sensitivity

Abstract

Purpose

Sirtuin 1 may regulate glucose and lipid metabolism. We aimed to assess adipose tissue and skeletal muscle sirtuin 1 expression in relation to insulin sensitivity, the expression of proinflammatory and metabolic genes, and to study the regulation of sirtuin 1 expression by hyperinsulinemia and circulating free fatty acids elevation.

Methods

We examined 60 normal-weight, 42 overweight and 15 obese young subjects. The hyperinsulinemic-euglycemic clamp technique was applied throughout to measure insulin sensitivity. In 20 subjects, two 6 h clamps were performed, one of them with concurrent Intralipid/heparin infusion. Biopsies of subcutaneous adipose tissue and skeletal muscle were collected for the measurement of gene and protein expression.

Results

Obese subjects had lower adipose sirtuin 1 in comparison with normal-weight and overweight participants. Muscle sirtuin 1 did not differ between the groups. Adipose tissue sirtuin 1 was related to insulin sensitivity, adipose tissue SLC2A4. The relationship between adipose tissue sirtuin 1 and insulin sensitivity was still present after controlling for BMI, however, it disappeared after controlling for adipose tissue SLC2A4. Muscle sirtuin 1 was not related to insulin sensitivity. Hyperisulinemia decreased adipose tissue and increased muscle sirtuin 1 expression. Intralipid/heparin infusion negated these effects.

Conclusions

Adipose tissue, but not muscle, sirtuin 1 is associated with insulin sensitivity in humans, possibly because of its correlation with adipose tissue SLC2A4 expression. Insulin differentially regulates adipose tissue and skeletal muscle sirtuin 1 expression in the short-term and circulating free fatty acids elevation negates these effects, which may be associated with lipid-induced insulin resistance.



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Predicting an adrenal crisis: can we do it?



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Effect of ezetimibe on glycemic control: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

Given the increased risk of incident diabetes and the side effects on glycemic control with statin treatment, statin and ezetimibe combination therapy has been widely used. However, whether the same concern exists in ezetimibe remains uncertain. This meta-analysis aimed to investigate the influence of ezetimibe treatment on glycemic control.

Methods

Articles were searched from PubMed, EMBASE, and Cochrane Library. Randomized controlled trials (RCTs) were included if they compared the effects of ezetimibe with placebo, ezetimibe plus statin with the same statin, or low-dose stain plus ezetimibe with high-dose statin on FBG and glycosylated hemoglobin A1c (HbA1c).

Results

Of the 2440 articles retrieved, 16 RCTs were included. Ezetimibe did not cause side effects on FBG (WMD −0.62, 95% CI: −3.13 to 1.90) and HbA1c (WMD 0.07, 95% CI: −0.07 to 0.20%). No significant changes in FBG (WMD −1.78, 95% CI: −6.33 to 2.77%) and HbA1c (WMD −0.05, 95% CI: −0.14 to 0.05%) were observed in ezetimibe plus low-dose statin treatment compared with high-dose statin. According to subgroup analysis, in comparison with high-dose statin, ezetimibe plus low-dose statin taken for more than 3 months showed a significant decrease in FBG (WMD −7.12, 95% CI: −13.86 to −0.38%) compared with that taken for less than 3 months (WMD 0.90, 95% CI: −2.91 to 4.71%). Nevertheless, this difference was invalid when the study conducted by Dagli et al. was removed.

Conclusions

Compared with high-dose statin therapy, ezetimibe with low-dose statin for more than 3 months may have a beneficial tendency of effects on glycemic control.



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IGF-1-based screening reveals a low prevalence of acromegaly in patients with obstructive sleep apnea

Abstract

Purpose

Recent epidemiologic studies suggest a high prevalence of acromegaly. The prevalence of obstructive sleep apnea syndrome (OSAS) in acromegaly patients ranges from 47 to 70%. A recent study identified 2 patients with acromegaly among 567 OSAS patients. However, it remains unclear whether screening for acromegaly among OSAS patients is necessary. The aim was to screen for acromegaly among OSAS patients by measuring IGF-1 levels and performing confirmatory tests if necessary.

Methods

We performed a prospective cross-sectional diagnostic study on the prevalence of acromegaly in patients with OSAS. A total of 507 patients with a confirmed diagnosis of OSAS (357 male, 150 female) were screened.

Results

Seven male and three female patients (1.97% of total) were positively screened for elevated IGF-1 levels. Nine out of ten patients suppressed growth hormone levels during OGTT excluding acromegaly, whereas one individual was identified to have acromegaly according to established criteria (1/507, prevalence 0.2%). Analysis of the data showed no correlation between elevated IGF-1 values and the severity of OSAS or BMI.

Conclusions

Our data demonstrate a low prevalence of acromegaly in patients with OSAS. Until data from population-based studies is available we suggest restricting screening for acromegaly in OSAS to those patients who have additional clinical features of acromegaly.



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The associations of metabolic syndrome with incident hypertension, type 2 diabetes mellitus and chronic kidney disease: a cohort study

Abstract

Purpose

Metabolic syndrome (MetS) has been extensively studied for its long-term health effects, typically through conventional Cox proportional hazards regression modeling of the overall association of MetS with a single outcome. Such an approach neglects the inherent links between MetS-related disease outcomes and fails to provide sufficient insights into the impact of each component of MetS over time.

Methods

We therefore conducted a retrospective cohort study of 63,680 individuals who received health check-ups at the MJ Health Screening Center in Taiwan from 1997–2005 to study the subsequent risks of hypertension, type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) simultaneously for MetS and its components. Multivariate-adjusted hazard ratios (HRs) were calculated using Cox models for multiple failure outcomes.

Results

At baseline, MetS was identified in 7835 participants. Over a median follow-up of 3 years, 8252, 1634, and 6714 participants developed hypertension, T2DM and CKD, respectively. The HR for MetS was 2.41 (95% CI 2.29–2.53) for hypertension, 5.17 (95% CI 4.68–5.71) for T2DM and 1.22 (95% CI 1.15–1.31) for CKD. Three MetS components showed the strongest association with each of the outcomes: elevated blood pressure with hypertension (HR = 3.62, 95% CI 3.46–3.79), raised fasting plasma glucose with T2DM (HR = 8.89, 95% CI 7.86–10.06) and elevated triglycerides with CKD (HR = 1.14, 95% CI 1.08–1.21).

Conclusions

MetS may help identify individuals with metabolic profiles that confer incremental risks for multiple diseases. Additionally, several components of the syndrome should be considered by clinicians, as they show stronger associations with specific diseases than MetS.



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Pancreatic neuroendocrine tumors in MEN1 disease: a mono-centric longitudinal and prognostic study

Abstract

Purpose

Multiple endocrine neoplasia type 1 (MEN1) is an inherited endocrine neoplastic syndrome associated with a greater risk of endocrine tumor development like pancreatic neuroendocrine tumors (p-NET), with different clinical characteristics from sporadic ones. This paper aims to compare clinical, hystological and morphological aspects of p-NET in patients affected from MEN1 (MEN1+) and not-affected ones (MEN1−).

Methods

We performed a retrospective observational study. Data was collected between December 2010 and December 2015, including patients with a histological diagnosis of p-NET and radiological imaging. We compared clinical, histological, radiological, and prognostic aspects of MEN+ p-NET with MEN−1 p-NET.

Results

Of the 45 patients enrolled, 13 MEN1+ and 21 MEN1− cases were analyzed. Frequency of not secreting p-NETs and insulin secreting p-NETs, histopathological grades and Ki67 expression were superimposable between MEN1+ and MEN1− patients. MEN1+ pNETs are more often multicentric compared to MEN1− pNETs. Frequency of liver and nodes metastatic spread was higher in MEN1− p-NET compared to MEN1+ p-NET. Analyzing p-NET according to the disease outcome, we found that recovered and stable p-NETs in MEN1+ patients, compared to MEN1− cases, are diagnosed at lower age (p = 0.04/p = 0.002) and that are more frequently multifocal lesions (p = 0.009/p = 0.002).

Conclusions

In our study pNETs in MEN1+ and pNETs in MEN1− don't significantly differ for prognosis but only for clinical features. p-NET stage disease and prognosis can be positively influenced by early diagnosis and screening in index patients' first-degree relatives



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Morphologic and molecular pathway of cushing syndrome cardiomyopathy



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Oro-dental pathologies in acromegaly

Abstract

Purpose

Oro-dental pathologies (ODP) such as enlargement of the tongue, mandibular prognathism, and spaced teeth are characteristic features of acromegaly. Their frequency of occurrence during the course of the disease is largely unresolved. Purpose of this study was to assess ODP and oro-dental treatments in patients with acromegaly with regard to the length of the diagnostic process, tumor histology, and quality of life (QoL).

Methods

Single-center retrospective survey study using questionnaires on dental symptoms, diagnostic process, and treatment in patients with acromegaly operated on a growth hormone-secreting pituitary adenoma. The association between ODP and QoL was assessed using the Short-Form 36 (SF-36) Health Survey.

Results

145/314 patients completed the questionnaires. 80.7% were affected by any ODP, most frequently enlargement of the tongue (57.9%), spaced teeth (42.8%), mandibular growth (24.1%), and mandibular prognathism (22.1%). ODP were significantly more frequent in patients with sparsely vs. densely granulated adenomas (p = 0.045). Early diagnosis within 2 years was associated with significantly fewer ODP than later diagnosis (68.5 vs. 87.2%, p = 0.009). Treatments included dental crowns (16.6%), dental bridges (12.4%), dental implants (9.7%), dental prostheses (3.4%), orthodontal (i.e., braces, 6.9%), and surgical correction of the teeth (2.1%). Physical QoL was significantly lower in patients with ODP than in those without (p = 0.014).

Conclusion

In our large series of patients, four of five patients were affected by ODP at any time during the course of the disease. The results highlight the importance of early identification and treatment of oro-dental problems in patients with acromegaly as hallmarks of the disease.



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Complete evaluation of pituitary tumours in a single tertiary care institution

Abstract

Introduction

We retrospectively evaluated all patients with pituitary tumours treated in our department from 1/1/1997 to 01/11/2014.

Patients and methods

Two hundred and fifteen patients (124 females, 91 males, mean age 50.9 years) were treated because of pituitary tumours. All patients underwent basal hormonal analysis and when required dynamic testing in order to check for hormonal activity. Pituitary masses were divided into groups concerning their hormonal status and were further classified according to gender, age at diagnosis, tumour size, and the development of postoperative pituitary insufficiency when neurosurgical intervention was conducted.

Results

One hundred and twenty-one patients had hormonally inactive tumours (non-functional adenomas; 56.3%), 57 prolactinomas (26.5%), 17 growth hormone secreting adenomas (7.9%), 16 Cushing's disease (7.4%), and 4 craniopharyngiomas (1.9%). Tumours with maximum size <1 cm (microadenomas) were detected in 62 patients (28.8%) and ≥1 cm (macroadenomas) in 153 (71.2%) of all cases (rate 1:2.5). Ninty eight patients (45.6%) had surgery (87 transsphenoidal and 11 transcranial), of this group 34 with hormonally active tumours (37.8% of the 90 patients of this subcohort). Indications for surgery were an increased risk or manifestation of chiasma syndrome and clinical symptoms due to hormonal hypersecretion. Complete [32 cases (32.6%)] or partial [33 cases (33.7%)] postoperative insufficiency in minimum one pituitary axis was present in 65/98 (66.3%) of the operated patients.

Conclusions

Pituitary adenoma prevalence is rising due to widely available imaging procedures. The majority of the tumours in our cohort were macroadenomas and hormonally inactive. Tumour extirpation via the transsphenoidal or transcranial route resulted in functional pituitary impairment of variable extent in 2/3 of the patients.



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Massive Macroglossia After Posterior Cranial Fossa Surgery: A Case Report.

Related Articles

Massive Macroglossia After Posterior Cranial Fossa Surgery: A Case Report.

A A Pract. 2018 Apr 15;10(8):204-208

Authors: Ha JF, Vitale LN, Pfarr MA, Kawai Y, Zopf DA

Abstract
A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. After extubation, he developed progressive upper airway obstruction and became obtunded. He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated. This report describes the clinical course of his massive macroglossia and discusses short- and long-term management.

PMID: 29652686 [PubMed]



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Traumatic postero-lateral C1-C2 dislocation complicated with locked lateral mass and type II odontoid fracture - a 5-year follow-up: A case report.

https:--linkinghub.elsevier.com-ihub-ima Related Articles

Traumatic postero-lateral C1-C2 dislocation complicated with locked lateral mass and type II odontoid fracture - a 5-year follow-up: A case report.

World Neurosurg. 2018 Apr 04;:

Authors: Minyu Z, Shiyang W, Suraj C, Kelun H, Chaowei L, Honglin T

Abstract
STUDY DESIGN: case report: Objective: To document our experience in managing a rare complex of traumatic postero-lateral atlantoaxial dislocation combined with locked lateral mass and type II odontoid fracture.
SUMMARY OF BACKGROUND DATA: METHOD: A 30 years-old male patient was referred to the author's department. He complained of a decrease in neck range of motion following a traffic accident. Neurological examination was normal. Computed tomography (CT) and open mouth X-ray showed a type II odontoid fracture and a postero-lateral dislocation with laterally locked left lateral mass at the C1-C2 level. Considering the difficulty and risk in reduction, due to this rare instability and dislocation, a two-staged treatment was performed. With up to 11 kg skull traction for 7 days before surgery, the locked lateral mass and the lateral dislocation was finally reduced without any neurological deficit. And once closed reduction was confirmed by open-mouth and lateral X-ray views in the cervical spine, a second staged C1-C2 surgical fixation and fusion with iliac bone graft was performed to achieve a normal anatomic alignment with a better stability.
RESULT: The patient showed significant amelioration of neck symptoms post-operatively and a successful reduction and fixation of the C1-C2 articulation was achieved. At the 5-year follow up, solid bone fusion was evident on the CT-scan.
CONCLUSION: For traumatic posterolateral atlantoaxial dislocation complicated with type II odontoid fracture, a closed reduction of the lateral dislocation before operation is both useful and safe because the surgeons do not need to reduce the extremely rare lateral dislocation during the operation. Posterior atlantoaxial stabilization and fusion, rather than the occipitocervical fusion as reported previously, is biomechanically stable enough to achieve solid fusion in this rare trauma while not sacrificing the occipito-atlantal joint.

PMID: 29626690 [PubMed - as supplied by publisher]



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