Increasing FLAIR signal intensity in the postoperative cavity predicts progression in gross-total resected high-grade gliomas

Abstract

To evaluate the prognostic value of fluid-attenuated inversion recovery (FLAIR) signal intensity of postoperative cavity on progression free survival (PFS) and overall survival (OS) in patients with high-grade gliomas (HGG). This study retrospectively enrolled 45 consecutive HGG patients. These patients had chemoradiotherapy after gross-total resection of tumors. Quantitative analysis of the FLAIR signal intensity in postoperative cavity and background was made. We evaluated the threshold value, accuracy, sensitivity, specificity, and survival state with this technique. The patients who progressed and patients who did not progress were 33 and 12 cases separately. The ratio of postoperative cavity and background (C–B) on FLAIR sequence in patients who progressed was higher than that of patients who did not progress (P = 0.014). The PFS of the patients who progressed was shorter than that of patients who did not progress (P = 0.008). The area under ROC curve, threshold, sensitivity, specificity of C–B ratio for predicting tumor progression were 0.875, 62.3, 69.7, 0.84, and 0.50% respectively. The PFS of lower signal group was much longer than that of higher signal group (P = 0.004). The OS of the patients with higher signal was shorter than that of patients with lower signal (P = 0.034). The increase of gray value of FLAIR in postoperative cavity may be used as an imaging marker for predicting tumor progression.

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Spatial orientation of the adult cochlea: rotation, tilt, and angle theta 3

Abstract

Objective

Quantitative description in adult crania of (1) angular orientation of the basal turn of the cochlea relative to the sagittal (termed "rotation") and Frankfort horizontal (termed "tilt") planes, and angle theta 3 [angular relationship of the line defined by the cochlea's spiral center and cochlear (round) window, to the cochlear window]; (2) orientation of the cochlea relative to the plane defined by the horizontal and vertical portions of the facial nerve; (3) orientation of the basal turn of the cochlea relative to the plane of the posterior semicircular canal; and (4) the association of these orientations with the extent of mastoid pneumatization.

Methods

Postmortem material analysis. From 41 bequeathed anatomical ear-normal cadaveric cranial, high-resolution CT scans were performed of the five crania with the largest and the five with the smallest mastoids. Eleven points in three-dimensional Cartesian space were appointed and studied with the software program FIJI.

Results

The median angle values (and ranges) for right ears were: "rotation" 52° (range 47–61); and, "tilt" 84° (79–89). The planes of the cochlear basal turn and facial nerve approximated superimposition: median 15° (2–19). Angle theta 3 for right ears was median 40° (28–44). Bilateral symmetry was found for the relationships between the planes. However, no association of any planar relationship with mastoid pneumatization was suggested.

Conclusion

Considering the range of angles found in clinically normal adult specimens, spatial orientation of the cochlea may explain some of the difficulties in implantation.

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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply

In Reply We thank Dr Bradley for his commentary regarding our recently published article, "Serial In-Office Intralesional Steroid Injections in Airway Stenosis." We agree with his comment highlighting how advances in one discipline can forward another, and that the treatment of scarring has been well studied. Applying proven treatments for scarring in other locations of the body is prudent, and we foresee the application of a number of newer treatments for scarring (ie, flourourocil) in airway stenosis. We acknowledge the lack of a true control group in this particular study. In addition, we appreciate that it is not clear how many total injections are required to effect positive changes for any given patient. With future evaluation of a larger cohort, we anticipate elucidating this more clearly and will likely be able to target different etiologic subgroups more specifically. Recognizing that intralesional steroid injections for airway stenosis will not be a panacea, patients with different etiologies of subglottic stenosis will need to be treated slightly differently, tailoring treatment to the patient's disease. We use intralesional steroid injections largely in 3 different ways. The first is as an adjuvant after an endoscopic procedure; this is done for patients in all etiologic subgroups. For patients in the traumatic subgroup for whom intralesional steroid injection is effective (ie, without significant cartilage collapse), ongoing intervention may not be required because they do not have a relapsing disorder. On the other hand, patients with inflammatory causes of stenosis, who have a high chance of recurrence, can benefit from adjuvant injections after surgery as well as maintenance injections for early recurrence. Recent reports aimed at identifying the etiology of idiopathic subglottic stenosis (iSGS), have suggested a local, inflammatory, immune response. The early stage of recurrence in both iSGS and rheumatologic-types of stenosis is granulation and erythema in the subglottis, followed by healing with fibrosis. Intervention with intralesional steroid injections (or potentially another immune modulator) at this early stage may alter wound healing, avoid scar formation, and therefore circumvent the need for surgical intervention. Several studies have shown efficacy, safety, and tolerance in patients with iSGS in addition to reducing the need for surgical treatment. Last, as previously observed, we have seen steroid injections dissolve scar tissue that has already formed, therefore obviating the need for surgical intervention in some patients when presenting without critical stenosis. Investigating alternative treatments for scarring is relevant in subglottic stenosis, but we also suggest exploring ways to pharmacologically modulate the inflammatory phase of the disease.

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Extending the Ear-Kidney Association to Presbycusis

Understanding the causes of presbycusis is a major goal of health research because it is such a common human condition. The ear-kidney association has been known at least since the early 20th century, when the Alport and branchio-oto-renal syndromes were described. It was also noted that the cochlea and kidney share the presence of pericytes and podocytes in the glomeruli and inner ear, indicating similarities in microcirculation. The ear and kidney have in common some forms of organ-specific toxic effects (eg, due to treatment with aminoglycosides or cisplatin), and both organs are actively engaged in ion transport functions to maintain homeostasis. On the other hand, there has been little evidence that the ear-kidney association might be important in presbycusis.

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Hearing Aid Use and Health Care Costs Among Older Adults

A number of studies have attempted to quantify the cost of hearing loss, including ones using the same data source but an earlier time. A systematic review that summarized many of these findings documented the financial results of hearing loss, but also highlighted the variability across studies and lack of standardization of how hearing loss is defined when using large data sets. Fewer data are available, however, on whether the use of hearing aids (HAs) mitigates, attenuates, or contributes to these costs. Given the lack of data, the increasing numbers of older adults who might benefit from the use of HAs and the current lack of health care coverage for hearing health care, Mahmoudi et al is exploring an important topic in this issue of JAMA Otolaryngology–Head and Neck Surgery. Elucidating the outcomes of HA use on health care costs could provide valuable data for those designing health care policy. The findings are interesting, yet raise a number of issues that could inform data interpretation as well as highlight additional research priorities.

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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?

To the Editor "Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow."—William Pollard

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Cystatin C and 20-Year Incidence of Hearing Impairment

This longitudinal, population-based study uses data from the Epidemiology of Hearing Loss Study to investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of hearing impairment in a cohort of middle-aged and older adults.

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Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

This population-based cohort study of older adults with hearing loss evaluates the association of hearing aid use and health care use and cost.

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Effect of Perioperative Gabapentin Use in Patients Undergoing Head and Neck Mucosal Surgery

This randomized clinical trial investigates the effect of perioperative gabapentin treatment vs placebo on postsurgical pain in patients undergoing head and neck mucosal surgery.

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Spatial orientation of the adult cochlea: rotation, tilt, and angle theta 3

Abstract

Objective

Quantitative description in adult crania of (1) angular orientation of the basal turn of the cochlea relative to the sagittal (termed "rotation") and Frankfort horizontal (termed "tilt") planes, and angle theta 3 [angular relationship of the line defined by the cochlea's spiral center and cochlear (round) window, to the cochlear window]; (2) orientation of the cochlea relative to the plane defined by the horizontal and vertical portions of the facial nerve; (3) orientation of the basal turn of the cochlea relative to the plane of the posterior semicircular canal; and (4) the association of these orientations with the extent of mastoid pneumatization.

Methods

Postmortem material analysis. From 41 bequeathed anatomical ear-normal cadaveric cranial, high-resolution CT scans were performed of the five crania with the largest and the five with the smallest mastoids. Eleven points in three-dimensional Cartesian space were appointed and studied with the software program FIJI.

Results

The median angle values (and ranges) for right ears were: "rotation" 52° (range 47–61); and, "tilt" 84° (79–89). The planes of the cochlear basal turn and facial nerve approximated superimposition: median 15° (2–19). Angle theta 3 for right ears was median 40° (28–44). Bilateral symmetry was found for the relationships between the planes. However, no association of any planar relationship with mastoid pneumatization was suggested.

Conclusion

Considering the range of angles found in clinically normal adult specimens, spatial orientation of the cochlea may explain some of the difficulties in implantation.

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Volunteering Could Equal Better Well Being

Whether you are feeling excited to get more involved, or glad that your volunteering time has concluded with this year's convention there is mounting evidence to support that the simple act of volunteering may positively impact your well-being.  A 2016 longitudinal study found that participants who regularly partook in volunteer activities experienced greater mental well-being ratings using the General Health Questionnaire.

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Preoperative Photographing and Morphing for Predictable Profiles in Rhinoplasty

This Surgical Pearl discusses preoperative photographing and morphing for predictable profiles in rhinoplasty.

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A Closer Look at the Analgesic Regimen After Rhinoplasty—Reply

In Reply We thank Kendall and Castro-Alves for taking the time to read and critically analyze our article. Their commentary was very insightful and thought provoking. First, to directly answer their inquiries, we did not use a consistent standardized intraoperative or perioperative pain regimen, although that would have been desirable. In large medical center and academic medical center hospitals, and especially now with large anesthesia groups, the ability to have the same anesthesia team even throughout a single case is difficult because different anesthesiologists and certified registered nurse anesthetists continually come in and out of the operating room to spell one another for breaks and leave at shift changes so that the person who started the anesthesia portion is often not the same as who ends the case and extubates the patient. We agree that pain management should be discussed and coordinated with the anesthesiology team, and this should be a proactive venture that is highly dependent on the ability of local anesthesia to quell the need for intravenous medications during the case.

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A Closer Look at the Analgesic Regimen After Rhinoplasty

To the Editor We read with great interest the article of Patel and colleagues in a recent issue of the JAMA Facial Plastic Surgery. The authors performed a retrospective study of 62 patients who underwent rhinoplasty, and they proposed a multifaceted pain control program to manage postoperative pain and ascertain the balance between controlling pain and avoiding overprescribing narcotics. The authors should be commended for performing a study in an important topic (eg, opioid consumption) in patients undergoing outpatient surgery. The current emphasis on the need to improve postoperative pain using multimodal analgesic strategies makes the topic very relevant in perioperative medicine.

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A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair

This feasibility study explores the potential application of a 3-dimensional–printed short-segment mandibular template in the management of complex mandibular fractures.

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Intracranial meningioma with carcinoma tumor-to-tumor metastasis: two case reports

CNS Oncology, Ahead of Print.


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Reply: Postoperative Patient- and Parent-Reported Outcomes for Children with Congenital Hand Differences A Systematic Review

No abstract available

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Discussion: Evaluating the July Phenomenon in Plastic Surgery A National Surgical Quality Improvement Program Analysis

No abstract available

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Aseptic Freeze-Dried versus Sterile Wet-Packaged Human Cadaveric Acellular Dermal Matrix in Immediate Tissue Expander Breast Reconstruction: A Propensity Score Analysis

Background: Although multiple acellular dermal matrix sources exist, it is unclear how its processing impacts complication rates. The authors compared complications between two preparations of human cadaveric acellular dermal matrix (freeze dried and ready-to-use) in immediate tissue expander breast reconstruction to analyze the effect of processing on complications. Methods: The authors retrospectively reviewed all alloplastic breast reconstructions with freeze-dried or ready-to-use human acellular dermal matrices between 2006 and 2016. The primary outcome measure was surgical-site occurrence defined as seroma, skin dehiscence, surgical-site infection, or reconstruction failure. The two groups were compared before and after propensity score matching. Results: The authors included 988 reconstructions (freeze-dried, 53.8 percent; ready-to-use, 46.2 percent). Analysis of 384 propensity score–matched pairs demonstrated a slightly higher rate of surgical-site occurrence (21.4 percent versus 16.7 percent; p = 0.10) and surgical-site infection (9.6 percent versus 7.8 percent; p = 0.13) in the freeze-dried group than in the ready-to-use group, but the difference was not significant. However, failure was significantly higher for the freeze-dried versus ready-to-use group (7.8 percent versus 4.4 percent; p = 0.050). Conclusions: This is the largest study comparing the outcomes of alloplastic breast reconstruction using human acellular dermal matrix materials prepared by different methods. The authors demonstrated higher early complications with aseptic, freeze-dried matrix than with sterile ready-to-use matrix; reconstructive failure was the only outcome to achieve statistical significance. The authors conclude that acellular dermal matrix preparation has an independent impact on patient outcomes in their comparison of one company's product. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Preoperative and Postoperative Assessment of Rectus Abdominis Muscle Size and Function following DIEP Flap Surgery

Background: Prospective evaluation of rectus abdominis muscle function after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is limited. Elimination of muscle harvest with this procedure is theoretically associated with preservation of rectus abdominis function and minimization of abdominal wall morbidity. In this study, the authors evaluate the change in rectus abdominis muscle size and function after DIEP flap surgery. Methods: Patients undergoing unilateral DIEP flap surgery were recruited prospectively. Using computed tomography, the change in preoperative to postoperative rectus abdominis muscle size was compared between the operative side rectus abdominis muscle and the contralateral, nonoperative control rectus abdominis. Postoperative muscle integrity and contractility were evaluated using ultrasound by comparing the change in rectus abdominis muscle dimensions between contractile and relaxed states. The BREAST-Q was used to score patients' subjective satisfaction. Clinical and radiographic hernia rates were also calculated. Results: Analysis of 26 paired rectus abdominis muscles revealed no significant change in muscle size from preoperative to postoperative values. Furthermore, dimensional change from contractile to relaxed states postoperatively was similar for paired operative and nonoperative rectus abdominis muscles. BREAST-Q scores indicated a high degree of satisfaction in abdominal well-being, breast satisfaction, and surgical experience domains. There were no clinical or radiographic abdominal wall hernias noted. Conclusions: The DIEP flap is an effective surgical procedure with minimal abdominal wall morbidity that is associated with no measurable loss in rectus abdominis size and contractile function postoperatively. Patients are highly satisfied with their abdominal function postoperatively using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?

Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p

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Medial Row Perforators Are Associated with Higher Rates of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction

No abstract available

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The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

Background: Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Methods: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with contralateral prophylactic mastectomy and immediate breast reconstruction were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2343 women were identified who met our inclusion criteria, with 1295 undergoing unilateral mastectomy and 1048 undergoing contralateral prophylactic mastectomy. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39 percent versus 42 percent; p = 0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. Contralateral prophylactic mastectomy with reconstruction was an additional $11,872 in expenditure (p

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ASPS/PSF Sponsored Symposia and Workshops

No abstract available

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Discussion: The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

No abstract available

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Photoacoustic Tomography Shows the Branching Pattern of Anterolateral Thigh Perforators In Vivo

Summary: The distal branching pattern of perforators is associated with thin anterolateral thigh flap failure. The purpose of this study was to investigate the feasibility of using photoacoustic tomography as a diagnostic imaging modality to identify anterolateral thigh perforators and their branching patterns in the subcutaneous layer. Ten thighs in five healthy men were studied. The anterolateral aspect of the midthigh was examined using photoacoustic tomography. The correlation between photoacoustic tomography and ultrasound findings was evaluated. To determine the detectability of photoacoustic tomography by depth, the depth of vessels in the stem portion was compared to the depth of the deep fascia measured by ultrasound. Branching patterns of vessels in the adipose and suprafascial layers were evaluated by three-dimensional observation. A total of 18 perforators were visualized by photoacoustic tomography. Photoacoustic tomography and ultrasound had comparable diagnostic potential for the detection of perforators. Photoacoustic tomography visualized microvessels in the subcutaneous layer, especially those in oblique or horizontal orientations. The estimated mean depth of visualized vessels was 9 mm; the maximum depth was 13 mm. There was a strong correlation between the depth of visualized vessels in the stem portion and the depth of the deep fascia. Three-dimensional observation of photoacoustic tomographic images showed the branching morphology of perforators. This study showed the applicability of photoacoustic tomography to identification of the branching patterns of anterolateral thigh perforators in vivo, although limited visualization of subfascial vessels is a technical issue. The authors believe that photoacoustic tomography has the potential to be a new imaging modality for thin anterolateral thigh flap surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

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Validated Outcomes in the Grafting of Autologous Fat to the Breast: The VOGUE Study. Development of a Core Outcome Set for Research and Audit

Background: Autologous fat grafting is an important part of the reconstructive surgeon's toolbox when treating women affected by breast cancer and subsequent tumor extirpation. The debate over safety and efficacy of autologous fat grafting continues within the literature. However, work performed by the authors' group has shown significant heterogeneity in outcome reporting. Core outcome sets have been shown to reduce heterogeneity in outcome reporting. The authors' goal was to develop a core outcome set for autologous fat grafting in breast reconstruction. Methods: The authors published their protocol a priori. A Delphi consensus exercise among key stakeholders was conducted using a list of outcomes generated from their previous work. These outcomes were divided into six domains: oncologic, clinical, aesthetic and functional, patient-reported, process, and radiologic. Results: In the first round, 55 of 78 participants (71 percent) completed the Delphi consensus exercise. Consensus was reached on nine of the 13 outcomes. The clarity of the results and lack of additional suggested outcomes deemed further rounds to be unnecessary. Conclusions: The VOGUE Study has led to the development of a much-needed core outcome set in the active research front and clinical area of autologous fat grafting. The authors hope that clinicians will use this core outcome set to audit their practice, and that researchers will implement these outcomes in their study design and reporting of autologous fat grafting outcomes. The authors encourage journals and surgical societies to endorse and encourage use of this core outcome set to help refine the scientific quality of the debate, the discourse, and the literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Peak: How to Master Almost Anything

No abstract available

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Facebook Facts: Breast Reconstruction Patient-Reported Outcomes Using Social Media

Background: Social media are used for information sharing among patients with similar health conditions, and analysis of social media activity could inform clinical decision-making. The aim of this study was to use Facebook to evaluate a cohort of individuals' perceptions of and satisfaction with breast reconstruction. Methods: In this observational study, the authors collected and analyzed posts pertaining to autologous and implant-based breast reconstruction from active Facebook groups. Patient satisfaction data were categorized, and a thematic analysis of posts was conducted. Qualitative posts were grouped based on common themes and quantitatively compared using frequency and chi-square analysis. Results: The authors evaluated 500 posts from two Facebook groups. Two hundred sixty-four posts referenced deep inferior epigastric perforator (DIEP) flap reconstruction and 117 were related to implant-based reconstruction. Among individuals referencing DIEP flap reconstruction, 52 percent were satisfied, compared with 20 percent of individuals who referenced satisfaction with implant-based reconstruction (p

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Reply: Smaller Diameter Anastomotic Coupling Devices Have Higher Rates of Venous Thrombosis in Microvascular Free Tissue Transfer

No abstract available

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Evaluating Platelet-Rich Therapy for Facial Aesthetics and Alopecia: A Critical Review of the Literature

Background: Despite the growing popularity of platelet-rich plasma, existing evidence supporting its efficacy remains controversial due to the lack of large-scale studies and standardized protocols for preparation and application. This article reviews its use in facial rejuvenation, fat grafting, acne scarring, and androgenic alopecia. Emphasis is placed on comparing methods of platelet-rich plasma preparation and application across studies. Methods: A systematic review was performed for articles published between 2006 and 2015. All clinical studies and case reports that addressed platelet-rich plasma alone and/or in combination with fat grafting for facial rejuvenation, acne scarring, or androgenic alopecia were included. Results: Of the 22 articles included in the analysis, seven studies used platelet-rich plasma alone for facial rejuvenation, seven in combination with fat grafting, two for treatment of acne scarring, and six for treatment of androgenic alopecia. Individual study procedures, means of evaluation, and significant results are summarized. Although the majority of studies in this review report positive results, significant variation exists in preparation protocols and in the number and frequency of clinical treatments. Conclusions: The majority of studies report positive results for all indications evaluated in this review, but the procedure is limited by the lack of a standardized method for preparation and application of platelet-rich plasma. The extent to which significant variability in platelet-rich plasma preparation and/or application methods may affect clinical outcomes is not completely clear. In the interim, we present a consolidation of platelet-rich plasma treatment techniques and outcomes currently in use to help guide physicians in their clinical practice.

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Reply: Vectra 3D Imaging for Quantitative Volumetric Analysis of the Upper Limb A Feasibility Study for Tracking Outcomes of Lymphedema Treatment

No abstract available

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Cheek Volumization and the Nasolabial Fold

Background: The impression that cheek filling results in longitudinal shortening ("lift") of the skin and elevation of the nasolabial crease or nasolabial fold has become common within the facial injection community but remains unsubstantiated. Methods: In this study, 77 patients were evaluated before and after injection of the cheeks with a hyaluronic acid filler using a three-dimensional camera system. Results: A constant pattern of skin expansion away from the center of the injection and perpendicular to the surface of the skin was observed. A subgroup of 37 patients without differences in their preinjection and postinjection facial expression were analyzed by direct comparison and failed to demonstrate lateral traction (or "pull") on the intervening skin from the cheek injection site to the nasolabial crease. Furthermore, there was no photographic difference in the nasolabial fold or nasolabial crease. The only patients who demonstrated photographic improvement of the medial face were those who had filler placed directly in the transition between the lateral nasolabial fold and cheek (nasojugal crease). Conclusions: Filling the cheek with 3 cc of volume does not create traction forces or move the skin between the site of injection and the nasolabial crease. It is likely that expanding the nasojugal crease is the direct visual cue that leads to perceived improvement in the nasolabial fold.

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Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Migraine Headache, Migraine Surgery, and Cosmetic Temple Filler Injection

Background: Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection. Methods: A retrospective review of 113 patients who underwent frontal migraine decompression surgery at the University of Texas Southwestern Medical Center from July of 2011 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve. Results: This frontotemporal nerve was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. Conclusions: The identification and proper avulsion neurectomy of this newly described sensory frontotemporal nerve may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

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Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation

Background: Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site, and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion vibration lipofilling is a syringe-free surgical strategy that is a logical extension of Separation, Aspiration, and Fat Equalization (SAFELipo). In expansion vibration lipofilling, there is simultaneous disruption of recipient-site connective tissue, internal expansion using exploded-tip cannulas, and backfilling of these spaces with roller pump–propelled fat. Methods: Two thousand four hundred nineteen consecutive cases of expansion vibration lipofilling fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of expansion vibration lipofilling is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory power-assisted liposuction device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure. Results: Operating times averaged 1 hour 40 minutes. The average volume of fat inserted was 1003 cc. Complications included donor-site seroma, infection, and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death. Conclusions: Expansion vibration lipofilling is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon's complete knowledge of cannula tip location at all times during the procedure. Syringe-free, larger caliber, and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue, may contribute to avoidance of this dreadful complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Frequency of pathogenic germline mutations in cancer susceptibility genes in breast cancer patients

Abstract

In this study, we evaluated the incidence of pathogenic germline mutations in 30 breast cancer susceptibility genes in breast cancer patients. Our aim was to understand the involvement of the inherited mutations in these genes in a breast cancer cohort. Two hundred ninety-six female breast cancer patients including 4.5% of familial breast cancer cases were included in the study. 200 ng of genomic DNA was used to evaluate the pathogenic mutations, detected using Global Screening Array (GSA) microchip (Illumina Inc.) according to the manufacturer's instructions. The pathogenic frameshift and nonsense mutations were observed in BRCA2 (10.9%), MLH1 (58.6%), MTHFR (50%), MSH2 (14.2%), and CYTB (52%) genes. Familial breast cancer patients (4.5%) had variations in BRCA2, MLH1, MSH2, and CYTB genes. 28% of patients with metastasis, recurrence, and death harbored mono/biallelic alterations in MSH2, MLH1, and BRCA2 genes. The results of this study can guide to develop a panel to test the breast cancer patients for pathogenic mutations, from Malwa region of Punjab. The screening of MSH2, MLH1, and BRCA2 should be carried in individuals with or without family history of breast cancer as these genes have been reported to increase the cancer risk by tenfold.

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A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

International Journal of Cancer, EarlyView.


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Phase Ib/II study of safety and efficacy of low‐dose decitabine‐primed chemoimmunotherapy in patients with drug‐resistant relapsed/refractory alimentary tract cancer

International Journal of Cancer, EarlyView.


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Die neue S3-Leitlinie „Prävention des Zervixkarzinoms“

Zusammenfassung

Von den zahlreichen Aspekten, die die Diagnostik, Behandlung und Nachsorge der Krebsvorstufen der Cervix uteri betreffen, sind die Epidemiologie, die Virologie, die Zytologie, der Test zum Nachweis humaner Papillomviren (HPV) und die Abklärungsalgorithmen auffälliger und HPV-positiver Befunde für die Pathologen von Bedeutung. Die Zytologie soll auch in Zukunft bei jungen Frauen als Vorsorgeuntersuchung beibehalten werden, während bei älteren Frauen ein HPV-basiertes Screening vorgeschlagen wird. Im Gegensatz zur Sensitivität ist die Spezifität des HPV-Tests schlechter als die der Zytologie und des morphologisch basierten Biomarkers p16/Ki-67, sodass diese als Methoden in der Triage HPV-positiver Befunde infrage kommen. Zytologisch auffällige und leichtgradig dysplastische Veränderungen könnten durch einen HPV-Test oder den p16/Ki-67-Test weiter abgeklärt werden. Der HPV-Test sollte auch im Follow-up bei Patientinnen mit Zustand nach Konisation eingesetzt werden.

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Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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Proficiency-based cervical cancer brachytherapy training

Publication date: Available online 26 April 2018
Source:Brachytherapy
Author(s): Sherry Zhao, Louise Francis, Dorin Todor, Emma C. Fields
PurposeAlthough brachytherapy increases the local control rate for cervical cancer, there has been a progressive decline in its use. Furthermore, the training among residency programs for gynecologic brachytherapy varies considerably, with some residents receiving little to no training. This trend is especially concerning given the association between poor applicator placement and decline in local control. Considering the success of proficiency-based training in other procedural specialties, we developed and implemented a proficiency-based cervical brachytherapy training curriculum for our residents.Methods and MaterialsEach resident placed tandem and ovoid applicators with attending guidance and again alone 2 weeks later using a pelvic model that was modified to allow for cervical brachytherapy. Plain films were taken of the pelvic model, and applicator placement quality was evaluated. Other evaluated metrics included retention of key procedural details, the time taken for each procedure and presession and postsession surveys to assess confidence.ResultsDuring the initial session, residents on average met 4.5 of 5 placement criteria, which improved to 5 the second session. On average, residents were able to remember 7.6 of the 8 key procedural steps. Execution time decreased by an average of 10.5%. Resident confidence with the procedure improved dramatically, from 2.6 to 4.6 of 5. Residents who had previously never performed a tandem and ovoid procedure showed greater improvements in these criteria than those who had. All residents strongly agreed that the training was helpful and wanted to participate again the following year.ConclusionsResidents participating in this simulation training had measurable improvements in the time to perform the procedure, applicator placement quality, and confidence. This curriculum is easy to implement and is of great value for training residents, and would be particularly beneficial in programs with low volume of cervical brachytherapy cases. Simulation programs could also be created for other technically challenging radiation oncology procedures.



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Molecular diversity underlying cortical excitatory and inhibitory synapse development

Publication date: December 2018
Source:Current Opinion in Neurobiology, Volume 53
Author(s): Emilia Favuzzi, Beatriz Rico
The complexity and precision of cortical circuitries is achieved during development due to the exquisite diversity of synapse types that is generated in a highly regulated manner. Here, we review the recent increase in our understanding of how synapse type-specific molecules differentially regulate the development of excitatory and inhibitory synapses. Moreover, several synapse subtype-specific molecules have been shown to control the targeting, formation or maturation of particular subtypes of excitatory synapses. Because inhibitory neurons are extremely diverse, a similar molecular diversity is likely to underlie the development of different inhibitory synapses making it a promising topic for future investigation in the field of the synapse development.



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Developmental interactions between thalamus and cortex: a true love reciprocal story

Publication date: October 2018
Source:Current Opinion in Neurobiology, Volume 52
Author(s): Noelia Antón-Bolaños, Ana Espinosa, Guillermina López-Bendito
The developmental programs that control the specification of cortical and thalamic territories are maintained largely as independent processes. However, bulk of evidence demonstrates the requirement of the reciprocal interactions between cortical and thalamic neurons as key for the correct development of functional thalamocortical circuits. This reciprocal loop of connections is essential for sensory processing as well as for the execution of complex sensory-motor tasks. Here, we review recent advances in our understanding of how mutual collaborations between both brain regions define area patterning and cell differentiation in the thalamus and cortex.



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Personalized brain network models for assessing structure–function relationships

Publication date: October 2018
Source:Current Opinion in Neurobiology, Volume 52
Author(s): Kanika Bansal, Johan Nakuci, Sarah Feldt Muldoon
Many recent efforts in computational modeling of macro-scale brain dynamics have begun to take a data-driven approach by incorporating structural and/or functional information derived from subject data. Here, we discuss recent work using personalized brain network models to study structure–function relationships in human brains. We describe the steps necessary to build such models and show how this computational approach can provide previously unobtainable information through the ability to perform virtual experiments. Finally, we present examples of how personalized brain network models can be used to gain insight into the effects of local stimulation and improve surgical outcomes in epilepsy.

Graphical abstract

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Active mechanosensory feedback during locomotion in the zebrafish spinal cord

Publication date: October 2018
Source:Current Opinion in Neurobiology, Volume 52
Author(s): Steven Knafo, Claire Wyart
The investigation of mechanosensory feedback to locomotion has been hindered by the challenge of recording neurons in motion. Genetic accessibility and optical transparency of zebrafish larvae provide means to revisit this question. Glutamatergic Rohon-Beard (RB) and GABAergic CSF-contacting neurons (CSF-cNs) are spinal mechanosensory neurons. Recent studies combining bioluminescence, silencing and optogenetic activation show that mechanosensory neurons enhance speed and stabilize posture during locomotion. RB neurons can modulate speed by projecting onto glutamatergic premotor V2a interneurons during fast swimming, while CSF-cNs inhibit V0-v interneurons sustaining slow swimming. Sensory gating, either through inhibition of sensory interneurons (CoPA) or though the direct inhibition of primary motor neurons by CSF-cNs, mediates postural control. Advanced optical methods have shed light on the dynamics of sensorimotor integration during active locomotion unraveling implications for translational research.



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Sinusbodenelevation

Zusammenfassung

Hintergrund

Der klassischen Sinusbodenelevation und ihren Modifikationen kommt in der Versorgung des atrophen posterioren Oberkiefers eine zentrale Bedeutung zu. Erstmals berichtete Tatum 1977 über eine neue Operationsmethode zur Verbesserung der vertikalen Knochenhöhe im Sinusboden, 1980 veröffentlichten Boyne u. James den lateralen Zugang mittels Antrotomie in Verbindung mit einer Sinusbodenelevation. Zur Kompensation des Volumendefekts im Rahmen der Sinusbodenelevation wurden autologer Knochen, Knochenersatzmaterial und Kombinationen dieser Materialen eingesetzt.

Methoden

Die häufig schwierige anatomische Situation im distalen Oberkiefer wird durch die Pneumatisation des Sinusbodens in Kombination mit einer Alveolarfortsatzatrophie definiert. Die vertikale Problematik kann zudem mit einem horizontalen Knochenverlust vergesellschaftet sein. Diese Kombinationsdefekte verlangen umfassende Kenntnisse in der Planung und Durchführung augmentativer Maßnahmen. Der Erfolg der Gesamtbehandlung wird auch wesentlich durch die prothetische Konzeption bestimmt. Aus den statisch funktionellen und ästhetischen Planungsdaten ergeben sich die optimale Implantatposition und somit die notwendigen augmentativen Maßnahmen („backward planning"). In vielen Fällen sind die Planung und Durchführung einer Sinusbodenaugmentation nur auf der Basis einer digitalen Volumentomographie oder Computertomographie möglich. Exakte Kenntnisse der Anatomie und Physiologie des Mittelgesichtes sowie der absoluten und relativen Kontraindikationen auch auf Hals-Nasen-Ohren-ärztlichem Gebiet sind wichtige Voraussetzungen für eine erfolgreiche Gesamtstrategie.

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Retraction Note: SNPs in genes implicated in radiation response are associated with radiotoxicity and evoke roles as predictive and prognostic biomarkers

The authors are retracting this article [1] because the data have already been published in [2] making this a redundant publication. Ghazi Alsbeih, Najla Al-Harbi, Khaled Al-Hadyan, Mohamed Shoukri and Nasser ...

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Dosimetric feasibility of 4DCT-ventilation imaging guided proton therapy for locally advanced non-small-cell lung cancer

The principle aim of this study is to incorporate 4DCT ventilation imaging into functional treatment planning that preserves high-functioning lung with both double scattering and scanning beam techniques in pr...

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Stereotactic body radiotherapy for central lung tumors, yes we can!

SBRT is standard therapy for early stage lung cancer. Toxicity in central tumors has been a concern. RTOG 0813 showed that central SBRT is safe and effective. We report our experience with central SBRT.

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Response to “Immune-mediated cholangitis: is it always nivolumab’s fault?”

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Results of a phase II trial for high-risk neuroblastoma treatment protocol JN-H-07: a report from the Japan Childhood Cancer Group Neuroblastoma Committee (JNBSG)

Abstract

Background

The Japanese Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG) conducted a phase II clinical trial for high-risk neuroblastoma treatment. We report the result of the protocol treatment and associated genomic aberration studies.

Methods

JN-H-07 was a single-arm, late phase II trial for high-risk neuroblastoma treatment with open enrollment from June 2007 to February 2009. Eligible patients underwent five courses of induction chemotherapy followed by high-dose chemotherapy with hematopoietic stem cell rescue. Surgery for the primary tumor was scheduled after three or four courses of induction chemotherapy. Radiotherapy was administered to the primary tumor site and to any bone metastases present at the end of induction chemotherapy.

Results

The estimated 3-year progression-free and overall survival rates of the 50 patients enrolled were 36.5 ± 7.0 and 69.5 ± 6.6%, respectively. High-dose chemotherapy caused severe toxicity including three treatment-related deaths. In response to this, the high-dose chemotherapy regimen was modified during the trial by infusing melphalan before administering carboplatin and etoposide. The modified high-dose chemotherapy regimen was less toxic. Univariate analysis revealed that patients younger than 547 days and patients whose tumor showed a whole chromosomal gains / losses pattern had a significantly poor prognosis. Notably, the progression-free survival of cases with MYCN amplification were not inferior to those without MYCN amplification.

Conclusions

The outcome of patients treated with the JN-H-07 protocol showed improvement over the results reported by previous studies conducted in Japan. Molecular and genetic profiling may enable a more precise stratification of the high-risk cohort.

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Response to “Immune-mediated cholangitis: is it always nivolumab’s fault?”

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Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

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Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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"Asian Pac J Cancer Prev"[jour]; +26 new citations

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

"Asian Pac J Cancer Prev"[jour]

These pubmed results were generated on 2018/04/26

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

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Response to “Immune-mediated cholangitis: is it always nivolumab’s fault?”

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Author’s Reply to Cheung et al. Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”

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Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”

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Neurovascular and tendon injuries due to ankle arthroscopy portals: a meta-analysis of interventional cadaveric studies

Abstract

Neurovascular and tendon structures are considered at risk when performing ankle arthroscopy. Injury rate and distance from portals to such structures varied in the literature. The aim of this meta-analysis is to evaluate the injury risk of these structures in terms of proximity and injury prevalence. Thirteen studies including 184 cadaveric ankle arthroscopy procedures met the inclusion criteria. The antero-central portal exhibited the highest frequencies of nerve/vessel proximity and nerve/vessel missed injuries. Weighted mean distances were as follows: 2.76 ± 2.37 mm for the superficial fibular nerve (SFN) to the antero-lateral portal, 8.13 ± 2.45 mm for the saphenous nerve to the antero-medial portal, 2.1 ± 1.7 mm for the dorsalis pedis artery (DPA) to the antero-central (AC) portal, 6.84 ± 2.59 mm for the sural nerve to the postero-lateral portal. Distances to the postero-medial portal were 7.82 ± 2.98 and 11.03 ± 3.2 mm for the posterior tibial nerve and the posterior tibial artery, respectively. A total of 14 (10.3%) nerve injuries and 17 (12.5%) missed nerve injuries with a cumulative frequency of 22.8% of nerve structure at high risk. The SFN was the most vulnerable (10.3% of injury/missed injury), and it was the closest nerve to a portal. Vascular involvement consisted of 2 (1.5%) injuries and 12 (8.8%) missed injuries with the DPA being the most vulnerable (20%) through the AC portal. Tendon injuries were found in 8.7% procedure acts. The injury rates of extra-articular structures were found to be higher than previously reported in clinical literature. Apart from clinical studies, distance to portals and missed injuries of these structures could be evaluated. This cadaveric meta-analysis yielded more accurate results over the proximity and potential injury risk of ankle noble structure and should incite surgeons for more attention during portal placement. Such anatomical meta-analyses could offer an excellent statistical model of evidence synthesis when assessing injury risk in mini-invasive surgeries.

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Blind method regarding the effect of dexmedetomidine on CRBD

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Two novel PRNP truncating mutations broaden the spectrum of prion amyloidosis

Annals of Clinical and Translational Neurology, EarlyView.


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Treatment of retinoblastoma in Sub‐Saharan Africa: Experience of the paediatric oncology unit at Gabriel Toure Teaching Hospital and the Institute of African Tropical Ophthalmology, Bamako, Mali

Pediatric Blood &Cancer, EarlyView.


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Crizotinib induces apoptosis and gene expression changes in ALK+ anaplastic large cell lymphoma cell lines; brentuximab synergizes and doxorubicin antagonizes

Pediatric Blood &Cancer, EarlyView.


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Solid pseudopapillary and malignant pancreatic tumors in childhood: A systematic review and evidence quality assessment

Pediatric Blood &Cancer, EarlyView.


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Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective

Pediatric Blood &Cancer, EarlyView.


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Combining Intraoral Scans, Cone Beam Computed Tomography and Face Scans: The Virtual Patient

Purpose: The aim of this literature review was to provide an update on the current scientific knowledge in the field of 3D virtual patient science and to identify a possible easy, smart, and affordable method to combine different file formats obtained from different digital devices. Methods: Electronic searches of the Medline database was performed, up to May 2017, for articles dealing with the construction of a 3D virtual patient; the matching of data acquired with different digital devices (cone beam computed tomography, CBCT; face scanner, FS; intraoral scanner, IOS; and desktop scanner, DS) was considered. The inclusion of studies was based on the superimposition of at least 2 different digital sources. Results: Twenty-five studies were selected for subsequent examination. Only 3 studies analyzed the feasibility of superimposition of 3 different types of 3D data (CBCT + FS + IOS/DS). The most frequently used matching procedure was between CBCT and FS and CBCT and IOS/DS. Conclusion: The procedure of superimposition of data from CBCT, IOS, and FS is currently feasible and it is now possible to create a 3D "virtual patient" to better diagnose, plan the treatment, and communicate with patients. Address correspondence and reprint requests to Francesco Guido Mangano, DDS, PhD, Piazza Trento 4, 22015 Gravedona (Como), Italy; E-mail: francescomangano1@mclink.net Received 6 November, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

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Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

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Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy

Epilepsia, EarlyView.


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Hierarchical Cluster Analysis of Semicircular Canal and Otolith Deficits in Bilateral Vestibulopathy.

Hierarchical Cluster Analysis of Semicircular Canal and Otolith Deficits in Bilateral Vestibulopathy.

Front Neurol. 2018;9:244

Authors: Tarnutzer AA, Bockisch CJ, Buffone E, Weber KP

Abstract
Background: Gait imbalance and oscillopsia are frequent complaints of bilateral vestibular loss (BLV). Video-head-impulse testing (vHIT) of all six semicircular canals (SCCs) has demonstrated varying involvement of the different canals. Sparing of anterior-canal function has been linked to aminoglycoside-related vestibulopathy and Menière's disease. We hypothesized that utricular and saccular impairment [assessed by vestibular-evoked myogenic potentials (VEMPs)] may be disease-specific also, possibly facilitating the differential diagnosis.
Methods: We searched our vHIT database (n = 3,271) for patients with bilaterally impaired SCC function who also received ocular VEMPs (oVEMPs) and cervical VEMPs (cVEMPs) and identified 101 patients. oVEMP/cVEMP latencies above the 95th percentile and peak-to-peak amplitudes below the 5th percentile of normal were considered abnormal. Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology.
Results: Rates of utricular and saccular loss of function were similar (87.1 vs. 78.2%, p = 0.136, Fisher's exact test). oVEMP abnormalities were found more frequent in aminoglycoside-related bilateral vestibular loss (BVL) compared with Menière's disease (91.7 vs. 54.6%, p = 0.039). Hierarchical cluster analysis indicated distinct patterns of vestibular end-organ impairment, showing that the results for the same end-organs on both sides are more similar than to other end-organs. Relative sparing of anterior-canal function was reflected in late merging with the other end-organs, emphasizing their distinct state. An anatomically corresponding pattern of SCC/otolith hypofunction was present in 60.4% (oVEMPs vs. horizontal SCCs), 34.7% (oVEMPs vs. anterior SCCs), and 48.5% (cVEMPs vs. posterior SCCs) of cases. Average (±1 SD) number of damaged sensors was 6.8 ± 2.2 out of 10. Significantly (p < 0.001) more sensors were impaired in patients with aminoglycoside-related BVL (8.1 ± 1.2) or inner-ear infections (8.7 ± 1.8) compared with Menière-related BVL (5.5 ± 1.5).
Discussion: Hierarchical cluster analysis may help differentiate characteristic patterns of BVL. With a prevalence of ≈80%, utricular and/or saccular impairment is frequent in BVL. The extent of SCC and otolith impairment was disease-dependent, showing most extensive damage in BVL related to inner-ear infection and aminoglycoside-exposure and more selective impairment in Menière's disease. Specifically, assessing utricular function may help in the distinction between aminoglycoside-related BVL and bilateral Menière's disease.

PMID: 29692756 [PubMed]

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Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report.

Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report.

J Oral Facial Pain Headache. 2018 Spring;32(2):e34-e36

Authors: Rossi FH, Gonzalez E, Rossi EM, Tsakadze N

Abstract
This article reports a case of exploding head syndrome (EHS) as an aura of migraine with brainstem aura (MBA). A middle-aged man presented with intermittent episodes of a brief sensation of explosion in the head, visual flashing, vertigo, hearing loss, tinnitus, confusion, ataxia, dysarthria, and bilateral visual impairment followed by migraine headache. The condition was diagnosed as MBA. Explosive head sensation, sensory phenomena, and headaches improved over time with nortriptyline. This case shows that EHS can present as a primary aura symptom in patients with MBA.

PMID: 29694468 [PubMed - in process]

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Towards an objective test of chronic tinnitus: Properties of auditory cortical potentials evoked by silent gaps in tinnitus-like sounds.

Towards an objective test of chronic tinnitus: Properties of auditory cortical potentials evoked by silent gaps in tinnitus-like sounds.

Hear Res. 2018 Apr 17;:

Authors: Paul BT, Schoenwiesner M, Hébert S

Abstract
A common method designed to identify if an animal hears tinnitus assumes that tinnitus "fills-in" silent gaps in background sound. This phenomenon has not been reliably demonstrated in humans. One test of the gap-filling hypothesis would be to determine if gap-evoked cortical potentials are absent or attenuated when measured within background sound matched to the tinnitus sensation. However the tinnitus sensation is usually of low intensity and of high frequency, and it is unknown if cortical responses can be measured with such "weak" stimulus properties. Therefore the aim of the present study was to test the plausibility of observing these responses in the EEG in humans without tinnitus. Twelve non-tinnitus participants heard narrowband noises centered at sound frequencies of 5 or 10 kHz at sensation levels of either 5, 15, or 30 dB. Silent gaps of 20 ms duration were randomly inserted into noise stimuli, and cortical potentials evoked by these gaps were measured by 64-channel EEG. Gap-evoked cortical responses were statistically identifiable in all conditions for all but one participant. Responses were not significantly different between noise frequencies or levels. Results suggest that cortical responses can be measured when evoked by gaps in sounds that mirror acoustic properties of tinnitus. This design can validate the animal model and be used as a tinnitus diagnosis test in humans.

PMID: 29692331 [PubMed - as supplied by publisher]

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Prevalence of mental disorders and psychosocial distress in German adolescent and young adult cancer patients (AYA)

Psycho-Oncology, EarlyView.


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Neurovascular and tendon injuries due to ankle arthroscopy portals: a meta-analysis of interventional cadaveric studies

Abstract

Neurovascular and tendon structures are considered at risk when performing ankle arthroscopy. Injury rate and distance from portals to such structures varied in the literature. The aim of this meta-analysis is to evaluate the injury risk of these structures in terms of proximity and injury prevalence. Thirteen studies including 184 cadaveric ankle arthroscopy procedures met the inclusion criteria. The antero-central portal exhibited the highest frequencies of nerve/vessel proximity and nerve/vessel missed injuries. Weighted mean distances were as follows: 2.76 ± 2.37 mm for the superficial fibular nerve (SFN) to the antero-lateral portal, 8.13 ± 2.45 mm for the saphenous nerve to the antero-medial portal, 2.1 ± 1.7 mm for the dorsalis pedis artery (DPA) to the antero-central (AC) portal, 6.84 ± 2.59 mm for the sural nerve to the postero-lateral portal. Distances to the postero-medial portal were 7.82 ± 2.98 and 11.03 ± 3.2 mm for the posterior tibial nerve and the posterior tibial artery, respectively. A total of 14 (10.3%) nerve injuries and 17 (12.5%) missed nerve injuries with a cumulative frequency of 22.8% of nerve structure at high risk. The SFN was the most vulnerable (10.3% of injury/missed injury), and it was the closest nerve to a portal. Vascular involvement consisted of 2 (1.5%) injuries and 12 (8.8%) missed injuries with the DPA being the most vulnerable (20%) through the AC portal. Tendon injuries were found in 8.7% procedure acts. The injury rates of extra-articular structures were found to be higher than previously reported in clinical literature. Apart from clinical studies, distance to portals and missed injuries of these structures could be evaluated. This cadaveric meta-analysis yielded more accurate results over the proximity and potential injury risk of ankle noble structure and should incite surgeons for more attention during portal placement. Such anatomical meta-analyses could offer an excellent statistical model of evidence synthesis when assessing injury risk in mini-invasive surgeries.

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PIK3CA mutations are associated with reduced pathological complete response rates in primary HER2-positive breast cancer: pooled analysis of 967 patients from five prospective trials investigating lapatinib and trastuzumab

Ann Oncol 2016; 27: 1519–1525 (doi: 10.1093/annonc/mdw197)

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Pathway level alterations rather than mutations in single genes predict response to HER2-targeted therapies in the neo-ALTTO trial

Ann Oncol 2017; 28: 128–135 (doi: 10.1093/annonc/mdw434)

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Ovarian dysgerminoma in pregnancy: A case report and literature review

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Natural dietary compound naringin prevents azoxymethane/dextran sodium sulfate-induced chronic colorectal inflammation and carcinogenesis in mice

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Selective Cytotoxicity of Luteolin and Kaempferol on Cancerous Hepatocytes Obtained from Rat Model of Hepatocellular Carcinoma: Involvement of ROS-Mediated Mitochondrial Targeting.

Selective Cytotoxicity of Luteolin and Kaempferol on Cancerous Hepatocytes Obtained from Rat Model of Hepatocellular Carcinoma: Involvement of ROS-Mediated Mitochondrial Targeting.

Nutr Cancer. 2018 Apr 25;:1-11

Authors: Seydi E, Salimi A, Rasekh HR, Mohsenifar Z, Pourahmad J

Abstract
To evaluate the cytotoxicity effects of luteolin (LUT) and kaempferol (KAE) via reactive oxygen species (ROS) mediated mitochondrial targeting on hepatocytes obtained from the liver of hepatocellular carcinoma (HCC) rats. In this study, HCC induced by diethylnitrosamine (DEN) and 2-acetylaminofluorene (2-AAF). In the following, rat liver hepatocytes and mitochondria were isolated and tested for every eventual apoptotic and anti-HCC effects of LUT and KAE. The results of MTT assay showed that LUT and KAE were able to induce selective cytotoxicity in hepatocytes of HCC group in a dose- and time-dependent manner. Treatment of mitochondria from hepatocytes of HCC group with LUT and KAE were accompanied by loss of mitochondrial membrane potential (MMP) and mitochondrial swelling and release of cytochrome c (P < 0.001) via reactive oxygen species (ROS) generation before cytotoxicity ensued. LUT and KAE also increased activation of caspase-3 (P < 0.001 and P < 0.01, respectively). Flow-cytometry analysis indicated that the mode of cell death induced by these flavonoids were mostly apoptosis. Importantly, LUT and KAE were nontoxic for healthy hepatocytes and mitochondria. Therefore, we suggest that LUT and KAE are a good candidate for the complementary therapeutic agent against HCC.

PMID: 29693446 [PubMed - as supplied by publisher]

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Usual Cruciferous Vegetable Consumption and Ovarian Cancer: A Case-Control Study.

Usual Cruciferous Vegetable Consumption and Ovarian Cancer: A Case-Control Study.

Nutr Cancer. 2018 Apr 25;:1-6

Authors: McManus H, Moysich KB, Tang L, Joseph J, McCann SE

Abstract
Ovarian cancer is the fifth leading cause of cancer-related deaths among women, primarily due to diagnosis at late stages. Therefore, identification of modifiable risk factors for this disease is warranted. Using the Patient Epidemiology Data System (PEDS), collected from 1981 to 1998 at Roswell Park Cancer Institute, Buffalo, NY, we conducted a hospital-based, case-control analysis of self-reported cruciferous vegetable intake and ovarian cancer among 675 women with primary, incident ovarian cancer, and 1275 without cancer. Cruciferous vegetable intake was queried using a 44-item food frequency questionnaire (FFQ). Odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression, adjusting for age, body mass index (BMI), education, smoking status, parity, family history of ovarian cancer, total fruit consumption, total meat consumption, and total noncruciferous vegetable consumption. We observed a significant inverse association for women with highest vs. lowest intakes of total vegetables (OR = 0.65, 95% CI = 0.46-0.92), cooked cauliflower (OR = 0.82, 95% CI = 0.67-0.99), and cooked greens (OR = 0.63, 95% CI = 0.46-0.86) and an inverse, dose-dependent association between cooked cruciferous vegetables intake and ovarian cancer (for each additional ten servings per month, OR = 0.85, 95% CI = 0.76-0.96). These findings suggest that a diet that includes cruciferous vegetables could be an important modifiable risk factor for ovarian cancer.

PMID: 29693426 [PubMed - as supplied by publisher]

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Relationship Between Audio-Vestibular Functional Tests and Inner Ear MRI in Meniere’s Disease

Objectives: Meniere's disease is an inner ear disorder generally attributed to an endolymphatic hydrops. Different electrophysiological tests and imaging techniques have been developed to improve endolymphatic hydrops diagnosis. The goal of our study was to compare the sensitivity and the specificity of delayed inner ear magnetic resonance imaging (MRI) after intravenous injection of gadolinium with extratympanic clicks electrocochleography (EcochG), phase shift of distortion product otoacoustic emissions (shift-DPOAEs), and cervical vestibular-evoked myogenic potentials (cVEMP) for the diagnosis of Meniere's disease. Design: Forty-one patients, with a total of 50 affected ears, were included prospectively from April 2015 to April 2016 in our institution. Patients included had definite or possible Meniere's disease based on the latest American Academy of Otolaryngology-Head and Neck Surgery guidelines revised in 2015. All patients went through delayed inner ear MRI after intravenous injection of gadolinium (three dimension-fluid attenuated inversion recovery sequences), pure-tone audiometry, extratympanic clicks EcochG, shift-DPOAEs, and cVEMP on the same day. Endolymphatic hydrops was graded on MRI using the saccule to utricle ratio inversion defined as when the saccule appeared equal or larger than the utricle. Results: Abnormal EcochG and shift-DPOAEs in patients with definite Meniere's disease (DMD) were found in 68 and 64.5%, respectively. The two methods were significantly associated in DMD group. In DMD group, 25.7% had a positive MRI. The correlation between MRI versus EcochG and MRI versus shift-DPOAEs was not significant. MRI hydrops detection was correlated with hearing loss. Finally, 22.9% of DMD group had positive cVEMP. Conclusions: EcochG and shift-DPOAEs were both well correlated with clinical criteria of Meniere's disease. Inner ear MRI showed hydrops when hearing loss was higher than 35 dB. The shift-DPOAEs presented the advantage of a rapid and easy measurement if DPOAEs could be recorded (i.e., hearing threshold

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A neglected reddish penile patch: A wolf in sheep's clothing.

A neglected reddish penile patch: A wolf in sheep's clothing.

Indian J Urol. 2018 Apr-Jun;34(2):155-157

Authors: Murugavaithianathan P, Devana SK, Vaiphei K, Mavuduru R, Bora GS

Abstract
Microinvasive squamous cell carcinoma (SCC) is a known premalignant lesion of carcinoma cervix. It is also reported from other sites such as the oral cavity, larynx, and vulva. Microinvasive SCC is very rarely reported from the penis. We report the occurrence of microinvasive SCC in a long-standing erythematous lesion of glans penis in a patient, with extensive metastasis. We emphasize the need for awareness among patients and urologists about the premalignant lesions of penis and prompt treatment of such lesions to prevent possible spread of the disease.

PMID: 29692512 [PubMed]

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Overcoming wound complications in head and neck salvage surgery.

Overcoming wound complications in head and neck salvage surgery.

Auris Nasus Larynx. 2018 Apr 21;:

Authors: Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A, Rapidis AD, Takes RP, Ferlito A

Abstract
BACKGROUND: Loco-regional treatment failure after radiotherapy with or without chemotherapy and/or prior surgery represents a significant portion of head and neck cancer patients. Due to a wide array of biological interactions, these patients have a significantly increased risk of complications related to wound healing.
METHODS: Review of the current literature was performed for wound healing pathophysiology, head and neck salvage surgery, and wound therapy.
RESULTS: The biology of altered wound healing in the face of previous surgery and chemoradiotherapy is well described in the literature. This is reflected in multiple clinical studies demonstrating increased rates of wound healing complications in salvage surgery, most commonly in the context of previous irradiation. Despite these disadvantages, multiple studies have described strategies to optimize healing outcomes. The literature supports preoperative optimization of known wound healing factors, adjunctive wound care modalities, and microvascular free tissue transfer for salvage surgery defects and wounds.
CONCLUSION: Previously treated head and neck patients requiring salvage surgery have had a variety of disadvantages related to wound healing. Recognition and treatment of these factors can help to reverse adverse tissue conditions. A well-informed approach to salvage surgery with utilization of free vascularized or pedicled tissue transfer as well as optimizing wound healing factors is essential to obtaining favorable outcomes.

PMID: 29692326 [PubMed - as supplied by publisher]

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Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures.

Related Articles

Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures.

Simul Healthc. 2017 Apr;12(2):76-82

Authors: Petrosoniak A, Ryzynski A, Lebovic G, Woolfrey K

Abstract
INTRODUCTION: Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session.
METHODS: Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale.
RESULTS: Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P < 0.0001). Both checklist and global rating scales improved significantly from the pretest to the posttest with a mean difference of 1.82 (P = 0.002) and 6.87 (P = 0.0025), respectively. Postcourse survey responses were favorable for both the overall curriculum experience and the unannounced ISS.
CONCLUSIONS: This pilot study demonstrated that unannounced ISS is feasible and can be used to effectively measure cricothyroidotomy performance among EM residents. After a two-part training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.

PMID: 28704285 [PubMed - indexed for MEDLINE]

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Cirrhosis is not a contraindication to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in highly selected patients

Abstract

Background

Patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is critically important to optimizing outcomes. There is currently no literature regarding the safety of CRS/HIPEC in patients with cirrhosis. The aim of this case series is to report the outcomes of three patients with well-compensated cirrhosis who underwent CRS/HIPEC.

Methods

Patients were identified from a prospectively maintained peritoneal surface malignancy database. Patient, tumor, and operative-related details were recorded as short-term postoperative outcomes. Results were analyzed using descriptive statistics.

Results

All patients had well-compensated (Child-Pugh Class A) cirrhosis and Eastern Cooperative Oncology Group (ECOG) performance status of 0. One patient had preoperative evidence of portal hypertension. All safely underwent CRS/HIPEC with completeness of cytoreduction (CC) scores of 0. The postoperative morbidity profile was unique, but all complications were manageable and resulted in full recovery to preoperative baseline status.

Conclusions

Patient selection for CRS/HIPEC is critical for optimization of short- and long-term outcomes. This small series suggests that well-compensated cirrhosis should not be an absolute contraindication to CRS/HIPEC.

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Safety and efficacy of dehydrated ethanol soaking of the operative field in the treatment of spontaneous hepatocellular carcinoma rupture

Abstract

Background

The aim of our study was to evaluate the clinical safety and value of ethanol surgical field infiltration (ESFI), combined with distilled water peritoneal lavage (DWPL), after hepatectomy in patients with hepatocellular carcinoma (HCC) rupture.

Methods

Rat liver tissue samples were soaked in dehydrated ethanol for different soaking times, and 18 rats were assigned to three groups that underwent different soaking methods of the hepatectomy cut surface. We retrospectively reviewed 45 patients who underwent hepatectomy for treatment of ruptured HCC. Among these, EFSI combined with DWPL was used in 21 patients (DAW group), with only DWPL used in the other 24 patients (DW group). Clinical outcomes were compared between the two groups.

Results

For in vitro experiments, the depth of coagulation degeneration and necrosis increased with the duration of soaking. For in vivo experiments, rats in all three groups survived until postoperative day 7 without significant postoperative complication. In patients, the rate of post-operation complication was comparable between the two groups (P = 0.398), with no between-group differences in liver function levels. The incidence of peritoneal dissemination was significantly higher for DW than DAW group (P = 0.037). Kaplan–Meier test identified dehydrated ethanol treatment as a significant factor of disease-free survival (DFS) (P = 0.036). On univariate analysis, dehydrated ethanol treatment was associated with better prognostic outcomes, although it was not retained as an independent factor of patient outcome.

Conclusions

Dehydrated ethanol soaking of the cut surface of the hepatectomy could potentially lower the risk of metastasis and improve the effect of hepatectomy for ruptured HCC as well as showed potential therapeutic value for intraoperative iatrogenic rupture of HCC.

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Intraoperative pediatric acupuncture is widely accepted by parents

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): James W. Ochi, Andrew C. Richardson
ObjectiveMedical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so.MethodsA retrospective review of all surgical procedures performed by one surgeon over 12 months was done. This yielded 401 unique patients ranging in age from 3 months to 21 years with a mean of 6 years. Five of these patients had emergent surgery and 396 patients had scheduled surgery; there were a total of 822 surgical procedures performed on these individuals. Intraoperative acupuncture was offered only to the scheduled surgical patients.Results388 of 396 (98%) parents chose to have intraoperative acupuncture done for their child. No complications of acupuncture were encountered.ConclusionThese results demonstrate strong acceptance of intraoperative acupuncture by parents. We hope this report encourages surgeons to become trained in medical acupuncture.



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A "golden age" in skull base and rhinology research.

A "golden age" in skull base and rhinology research.

Int Forum Allergy Rhinol. 2018 May;8(5):561-562

Authors: Bleier BS

PMID: 29694736 [PubMed - in process]

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Clinical factors predictive of traumatic brain injuries in case of mild traumatic brain injury in children: case-control study.

Clinical factors predictive of traumatic brain injuries in case of mild traumatic brain injury in children: case-control study.

Tunis Med. 2017 Jul;95(7):488-493

Authors: Gueddari W, Ouardi A, Talbi S, Salam S, Zineddine A

Abstract
BACKGROUND: Mild head injury (MHI) is very common in children and the problem is a lack of consensus criteria for the indication of a brain CT.
OBJECTIVE: To determine predictors of cranio-cerebral lesions (CCL) in the case of MHI in children.
METHODS: Case-control study over a period of 3 years. Included children aged 1 month to 15 years, were those admitted to the department of Pediatric Emergencies for MHI and had performed a brain CT. The principal outcome was the presence of traumatic brain injury. Statistical analysis focused on univariate and multivariate tests was done using SPSS version 16.0.
RESULTS: We included 418 children. The median age was 6 years with a sex ratio of 2.24. The main mechanisms of trauma were the traffic accident. Cerebral CT proved to be abnormal in 191 children (45.7%). The main lesions found were the skull fractures, brain contusion and epidural hematoma. Predictors retained after logistic regression were the presence of an initial loss of consciousness regardless of its duration (p = 0.007), hematoma of the scalp (p = < 0.0001) and at least one clinical sign for a fracture of the skull base (p = 0.016).
CONCLUSION: In case of MHI in children, the initial loss of consciousness, the presence of a hematoma of the scalp and the presence of at least one sign in favor of the skull base fracture seem most predictive of cranio-cerebral lesions.

PMID: 29694653 [PubMed - in process]

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Single piece fronto-temporo-orbito-zygomatic craniotomy: a personal experience and review of surgical technique.

Single piece fronto-temporo-orbito-zygomatic craniotomy: a personal experience and review of surgical technique.

Br J Neurosurg. 2018 Apr 25;:1-7

Authors: Sharma M, Shastri S

Abstract
BACKGROUND: Fronto-Temporo-Orbito-Zygomatic (FTOZ) craniotomy has progressed from its humble beginnings. Numerous variations including one piece, two piece and even three piece FTOZ craniotomies have been described. The ideal technique still remains elusive and its use remains restricted to a few specialised centres even when benefits far outweigh the surgical difficulties.
OBJECTIVE: To analyse 11 cases in which single piece FTOZ craniotomy was used and to review the steps of surgery along with its advantages.
METHODS: A total of 11 cases of skull base lesions were operated over a period of 30 months and followed up for a minimum period of 6 months. They were analysed for intraoperative benefits, requirement of cerebral retraction, surgical difficulties, post op recovery, complications faced and post-op cosmetic appearance.
RESULT: A total of nine cases had tumours of skull base including Spheno-Petro-Clival meningiomas, Trigeminal schwannomas, Solitary fibrous histiocytoma and two had giant aneurysms of P1 segment. Intraoperative cerebral retraction was significantly less. There were two post-op deaths. Three patients had temporary and 1 patient had permanent third nerve deficit. There was no injury to periorbital fat and post op cosmetic appearance was good.
CONCLUSION: Single piece FTOZ craniotomy is no more difficult than two or three piece craniotomy, rather it facilitates a rapid craniotomy closure with excellent handling of single piece of bone. It provides a wide, multidirectional access to skull base. Lesions become shallow and their access easier. Benefits far outweigh the difficulties if any, and its use should be encouraged even at centres outside of the specialised units.

PMID: 29693472 [PubMed - as supplied by publisher]

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Identification of Pathogenic Genes of Nonsyndromic Hearing Loss in Uyghur Families Using Massively Parallel DNA Sequencing Technique.

Identification of Pathogenic Genes of Nonsyndromic Hearing Loss in Uyghur Families Using Massively Parallel DNA Sequencing Technique.

Dis Markers. 2018;2018:5298057

Authors: Chen Y, Lu Y, Kuyaxi P, Cheng J, Zhao J, Zhao Q, Musha P, Zhang H, Yuan H

Abstract
We aim to identify the mutations of deafness genes using massively parallel DNA sequencing in the 12 Uyghur families. SNPscan method was used to screen against the 124 sites in the common deafness genes in probands. Subjects with SNPscan negativity were subject to massively parallel DNA sequencing for the sequencing of 97 genes known to be responsible for hearing loss. Eight families (66.7%) showed biallelic mutations in probands, including MYO15A mutation (6892C>T in J02 family, 9514C>T/7894G>T in J07 family, and 9514C>T in J16 family), MYO7A mutation (1258A>T in J03 family), TMC1 mutation (773G>A in J09 family and 1247T>G/1312G>A in J11 family), and PCDH15 mutation (4658delT in J08 and J13 families). Six novel types of mutation were identified including 6892C>T, 9514C>T/7894G>T, and 9514C>T in MYO15A gene, 1258A>T in MYO7A, 773G>A in TMC1, and 4658delT in PCDH15. The ratio of nonsense mutation and frameshift mutation was comparatively high. All these indicated that the mutation types reported in this study were rare. In conclusion, rare deafness genes were identified in the Uyghur families using massively parallel DNA sequencing, part of which were suggested to be related to the pathogenesis of the disease.

PMID: 29692870 [PubMed - in process]

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Prostate Cancer Metastasis — Fueled by Fat?

Obesity is approaching epidemic proportions worldwide and is having an effect on many chronic illnesses, including cancer. The physiological consequences of obesity include a state of chronic inflammation, which has been associated with an increased risk of development of cancer or of progression…

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Retraction Note: SNPs in genes implicated in radiation response are associated with radiotoxicity and evoke roles as predictive and prognostic biomarkers

The authors are retracting this article [1] because the data have already been published in [2] making this a redundant publication. Ghazi Alsbeih, Najla Al-Harbi, Khaled Al-Hadyan, Mohamed Shoukri and Nasser Al-Rajhi agree with this retraction. Medhat El-Sebaie did not respond to our correspondence.

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Efficacy and safety of midazolam and ketamine in paediatric upper endoscopy.

Related Articles

Efficacy and safety of midazolam and ketamine in paediatric upper endoscopy.

Arab J Gastroenterol. 2017 Jun;18(2):80-82

Authors: Basturk A, Artan R, Yılmaz A

Abstract
BACKGROUND AND STUDY AIM: Upper endoscopy can be successfully carried out in children under deep sedation and anaesthesia. However, the best method of upper endoscopy for children who require gastrointestinal intervention has yet to be defined. The aim of this study is to investigate the efficacy and safety of the sedation induced by intravenous midazolam and ketamine during upper endoscopy in children.
PATIENTS AND METHODS: This study included patients ages 3-18years who had undergone upper endoscopy. All subjects received IV midazolam and ketamine. During the intervention, hypoxia, tachycardia, bradycardia, hypertension, and hypotension were recorded. After the intervention, euphoria, dysphoria, vertigo, visual problems (such as diplopia and nystagmus), and emergencies (such as arrhythmia, convulsion, and hallucination), among other findings, were recorded. Older children who were capable of expressing themselves were questioned to help determine these conditions.
RESULTS: The mean age of the study group was was 11.9±3.42years; 54% of the patients were females, and 46% were males. During the upper endoscopy, hypoxia occurred in 9% of patients, mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, bradycardia in 8%, and flushing-urticaria in 2%. After the upper endoscopy, one of the most common complications was sore throat, which occurred in 24% of patients. Vomiting was observed in 14% of patients, dizziness in 24%, diplopia in 27%, euphoria in 3% (5 patients), dysphoria in 4%, and hallucination in 4%. Of the total patients, 4% required oxygen supply with a face mask.
CONCLUSION: The results of our study showed that the use of IV midazolam and ketamine during upper endoscopy in children was safe and effective.

PMID: 28579345 [PubMed - indexed for MEDLINE]

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