The nuclear factor E2-related factor 2 (Nrf2)/antioxidant response element signaling pathway plays a substantial role in preventing oxidative stress-related diseases. Aspirin has been shown to exert several pharmacological effects by inducing the expression of the heme oxygenase-1 (HO-1) protein. However, the effects of aspirin on spinal cord injury (SCI) have rarely been studied. Therefore, we sought to investigate the neuroprotective effects of aspirin after SCI. We employed a spinal cord contusion model in Sprague-Dawley rats, and aspirin was administered intraperitoneally for 7 days. Nissl staining showed that the aspirin treatment significantly reduced the loss of motor neurons after SCI compared with vehicle-treated animals. The expression of Nrf2, quinine oxidoreductase 1, and HO-1 proteins was increased in aspirin-treated animals after SCI compared with the vehicle group. In addition, aspirin simultaneously decreased the expression of inflammation-related proteins, such as tumor necrosis factor-α and interleukin-6 after SCI. Moreover, the ratio of apoptotic neurons in the anterior horn and the levels of the apoptosis-related proteins caspase-3, cleaved caspase-3, and Bax were significantly decreased in the aspirin group compared with the vehicle group. Immunofluorescence staining was used to detect the colocalization of NeuN and HO-1, and the results showed that aspirin significantly increased expression of the HO-1 protein in neurons. In addition, western blots and immunofluorescence staining showed aspirin restrained astrocyte activation. In conclusion, aspirin induces neuroprotective effects by inhibiting astrocyte activation and apoptosis after SCI through the activation of the Nrf2/HO-1 signaling pathway. Correspondence to Xifan Mei, MD, Department of Orthopedics,First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000 Liaoning Province, China Tel: +86 416 467 3086; e-mail: meixifan1971@163.com Received October 13, 2017 Accepted November 23, 2017 © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nndtV1
Δευτέρα 29 Ιανουαρίου 2018
The Evolving Dilemma of Factor XI in Pregnancy: Suggestions for Management
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fun82R
Sex Difference of Angiotensin IV–, LVV-Hemorphin 7–, and Oxytocin-Induced Antiallodynia at the Spinal Level in Mice With Neuropathic Pain
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUbLnR
A Systematic Review of Outcomes Associated With Withholding or Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Before Noncardiac Surgery
BACKGROUND: The global rate of major noncardiac surgical procedures is increasing annually, and of those patients presenting for surgery, increasing numbers are taking either an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin receptor blocker (ARB). The current recommendations of whether to continue or withhold ACE-I and ARB in the perioperative period are conflicting. Previous meta-analyses have linked preoperative ACE-I/ARB therapy to the increased incidence of postinduction hypotension; however, they have failed to correlate this with adverse patient outcomes. The aim of this meta-analysis was to determine whether continuation or withholding ACE-I or ARB therapy in the perioperative period is associated with mortality and major morbidity. METHODS: This meta-analysis was prospectively registered on PROSPERO (CRD42017055291). A comprehensive search of MEDLINE (PubMed), CINAHL (EBSCO host), ProQuest, Cochrane database, Scopus, and Web of Science was conducted on December 6, 2016. We included adult patients >18 years of age on chronic ACE-I or ARB therapy who underwent noncardiac surgery in which ACE-I or ARB was either withheld or continued on the morning of surgery. Primary outcomes included all-cause mortality and major cardiac events (MACE). Secondary outcomes included the risk of congestive heart failure, acute kidney injury, stroke, intraoperative/postoperative hypotension, and the length of hospital stay. RESULTS: After abstract review, the full text of 25 studies was retrieved, of which 9 fulfilled the inclusion criteria: 5 were randomized control trials, and 4 were cohort studies. These studies included a total of 6022 patients on chronic ACE-I/ARB therapy before noncardiac surgery. A total of 1816 patients withheld treatment the morning of surgery and 4206 continued their ACE-I/ARB. Preoperative demographics were similar between the 2 groups. Withholding ACE-I/ARB therapy was not associated with a difference in mortality (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.62–1.52; I2 = 0%) or MACE (OR, 1.12; 95% CI, 0.82–1.52; I2 = 0%). However, withholding therapy was associated with significantly less intraoperative hypotension (OR, 0.63; 95% CI, 0.47–0.85; I2 = 71%). No effect estimate could be pooled concerning length of hospital stay and congestive heart failure. CONCLUSIONS: This meta-analysis did not demonstrate an association between perioperative administration of ACE-I/ARB and mortality or MACE. It did, however, confirm the current observation that perioperative continuation of ACE-I/ARBs is associated with an increased incidence of intraoperative hypotension. A large randomized control trial is necessary to determine the appropriate perioperative management of ACE-I and ARBs. Accepted for publication December 19, 2017. Funding: No outside funding was utilized in the search and retrieval of all articles. All funding was from departmental resources. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). PROSPERO registry: CRD42017055291. Reprints will not be available from the authors. Address correspondence to Caryl Hollmann, MBChB, DA (SA), Department of Anaesthesia and Perioperative Medicine, D23, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town 7925, South Africa. Address e-mail to carylhollmann@gmail.com. © 2018 International Anesthesia Research Society
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuY8Z5
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuY8Z5
Activation of Melatonin Receptors by Ramelteon Induces Cardioprotection by Postconditioning in the Rat Heart
Activation of melatonin receptors protects the heart against ischemia-reperfusion injury. Ramelteon, a clinically used drug for insomnia, acts via activation of melatonin receptors. We investigated whether ramelteon induces acute infarct size reduction by postconditioning. Male Wistar rats were randomized to 6 groups. Hearts were treated with melatonin and ramelteon at the beginning of reperfusion. The melatonin receptor inhibitor luzindole was administered with and without melatonin and ramelteon, respectively. Ramelteon reduced infarct size to the same extent as melatonin. Both effects were completely abolished by luzindole. The results show for the first time that ramelteon induces cardioprotection by postconditioning. Accepted for publication September 27, 2017. Funding: This work was supported by departmental funding only. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Ragnar Huhn, MD, PhD, Department of Anesthesiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany. Address e-mail to Ragnar.Huhn@med.uni-duesseldorf.de. © 2018 International Anesthesia Research Society
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E0YERw
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E0YERw
In Response
Flupirtine: A Less-Explored, Neglected Nonopioid Analgesic
Misguided by INR in Liver Disease Patients? Implications for Clinicians Including Pain Proceduralists
ABC of Clinical Leadership, 2nd ed
Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fq1Mnh
Intermediate-dose cytarabine plus mitoxantrone versus standard-dose cytarabine plus daunorubicine for acute myeloid leukemia in elderly patients
Abstract
Background
The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) can induce high complete remission rates with acceptable toxicity in elderly patients with acute myeloid leukemia (AML). We present the final results of a randomized-controlled trial comparing IMA with the standard 7 + 3 induction regimen consisting of continuous infusion daunorubicin plus cytarabine (DA). Patients and methods
Patients with newly diagnosed AML >60 years were randomized to receive either intermediate-dose cytarabine (1000 mg/m2 BID days 1,3,5,7) plus mitoxantrone (10 mg/m2 days 1-3) (IMA) or standard induction therapy with cytarabine (100 mg/m2 continuously days 1-7) plus daunorubicin (45 mg/m2 days 3-5) (DA). Patients in complete remission after DA received intermediate-dose cytarabine plus amsacrine as consolidation treatment, whereas patients after IMA were consolidated with standard-dose cytarabine plus mitoxantrone. Results
Between February 2005 and October 2009, 485 patients were randomized; 241 for treatment arm DA and 244 for IMA; 76% of patients were >65 years. The CR rate after DA was 39% (95%-CI; 33-45) versus 55% (95%-CI; 49-61) after IMA (OR 1.89, p=0.001). The six-week early-death rate was 14% in both arms. Relapse-free survival (RFS) curves were superimposable in the first year, but separated afterwards, resulting in 3-year RFS rates of 29% versus 14% in the DA versus IMA arms, respectively (p=0.042). The median OS was 10 months in both arms (p=0.513). Conclusion
The dose escalation of cytarabine in induction therapy lead to improved remission rates in the elderly AML patients. This did not translate into a survival advantage, most likely due to differences in consolidation treatment. Thus, effective consolidation strategies need to be further explored. In combination with an effective consolidation strategy, the use of intermediate dose cytarabine in induction may improve curative treatment for elderly AML patients.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMbt2V
Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC
Ann Oncol 2017; 28: 1339–1345 (doi: 10.1093/annonc/mdx075)
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nraoTg
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nraoTg
Detection of alternative subpleural lymph flow pathways using indocyanine green fluorescence
Abstract
Purpose
Pulmonary lymphatic fluid predominately flows along the bronchi. However, there are reports suggesting that an alternative lymphatic pathway exist, which may result in skip metastases. The aim of this study was to evaluate the subpleural lymph flow in vivo using indocyanine green (ICG) fluorescence.
Methods
One hundred cases were enrolled. ICG was injected into the macroscopically healthy subpleural space. Intraoperative fluorescence images were then observed in real time.
Results
ICG fluorescence was observed moving through subpleural channels in 58/100 cases. ICG flowed into adjacent lobes over interlobar lines in 18 cases and flowed from the visceral pleura directly into the mediastinum in 5 cases. The frequency of mediastinal detection without hilar lymph node detection was significantly higher in the left lung compared to the right (p < 0.05). The subpleural lymph flow detection rates were significantly lower in patients with smoking pack-years ≥ 40 than those with < 40 (p < 0.05).
Conclusions
The flow of lymphatic fluid directly into the mediastinum suggests one mechanism of skip metastasis. In addition, the reduction of the subpleural lymph flows in smokers with ≥ 40 pack-years suggests that smoking might modify lymph flow patterns. These findings may assist in selecting the optimal therapy for patients with possible skip metastasis.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DNyXET
Reply: The Value of Secondary Intention Healing in Eyelid Reconstruction Response to Recent CME Article by Chang, Esmaeli, and Butler - Content Needs to be Evidence-Based
Comments on “Sural nerve splitting in reverse sural artery perforator flap: Anatomical study in 40 cadaver legs.”
Vectra 3D Imaging for Suprapubic Lymphedema and Volume Change of the Lower Abdomen Associated with Lower Extremity Lymphedema
The Value of Secondary Intention Healing in Eyelid Reconstruction: Response to Recent CME Article by Chang, Esmaeli and Butler — Content Needs to be Evidence-Based
Reply to Letter to the Editor “Vectra 3D Imaging for Quantitative Volumetric Analysis of the Upper Limb: A Feasibility Study for Tracking Outcomes of Lymphedema Treatment”
Normalization of ADC does not improve correlation with overall survival in patients with high-grade glioma (HGG)
Abstract
Mixed reports leave uncertainty about whether normalization of apparent diffusion coefficient (ADC) to a within-subject white matter reference is necessary for assessment of tumor cellularity. We tested whether normalization improves the previously reported correlation of resection margin ADC with 15-month overall survival (OS) in HGG patients. Spin-echo echo-planar DWI was retrieved from 3 T MRI acquired between maximal resection and radiation in 37 adults with new-onset HGG (25 glioblastoma; 12 anaplastic astrocytoma). ADC maps were produced with the FSL DTIFIT tool (Oxford Centre for Functional MRI). 3 neuroradiologists manually selected regions of interest (ROI) in normal appearing white matter (NAWM) and in non-enhancing tumor (NT) < 2 cm from the margin of residual enhancing tumor or resection cavity. Normalized ADC (nADC) was computed as the ratio of absolute NT ADC to NAWM ADC. Reproducibility of nADC and absolute ADC among the readers' ROI was assessed using intra-class correlation coefficient (ICC) and within-subject coefficient of variation (wCV). Correlations of ADC and nADC with OS were compared using receiver operating characteristics (ROC) analysis. A p value 0.05 was considered statistically significant. Both mean ADC and nADC differed significantly between patients subgrouped by 15-month OS (p = 0.0014 and 0.0073 respectively). wCV and ICC among the readers were similar for absolute and normalized ADC. In ROC analysis of correlation with OS, nADC did not perform significantly better than absolute ADC. Normalization does not significantly improve the correlation of absolute ADC with OS in HGG, suggesting that normalization is not necessary for clinical or research ADC analysis in HGG patients.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuX3jZ
Immunohistochemical assessment of the diagnostic utility of PD-L1: a preliminary analysis of anti-PD-L1 antibody (SP142) for lymphoproliferative diseases with tumour and nonmalignant Hodgkin/Reed-Sternberg (HRS)-like cells
Abstract
Aims
The programmed death 1 (PD1)/PD1 ligand (PD-L1) axis plays an important role in tumour cells escape from immune control. PD-L1 immunohistochemistry is a useful predictor of immunotherapy response, but is still not widely used in the diagnostic setting. Here we describe results using PD-L1 immunohistochemistry during routine diagnostics in lymphoma.
Methods and results
Ninety-one lymphoproliferative disease cases sharing tumour and nonmalignant Hodgkin/Reed-Sternberg (HRS)-like cells with and without Epstein-Barr virus (EBV) association were investigated by immunohistochemistry for PD-L1 (clone SP142). PD-L1 expression was present in more than 5% of tumour or nonmalignant HRS-like cells in 100% of EBV+ classical (C) Hodgkin lymphoma (HL) (n=10) and EBV-negative nodular sclerosis CHL (n=8); 40% of EBV+ diffuse large B-cell lymphoma, not otherwise specified (DLBCL-NOS) (n= 20); and 4% of nodal peripheral T-cell lymphoma of follicular helper T-cell type (PTCL-TFH) (n=22). In contrast, nodular lymphocyte predominant HL (n=4), lymphocyte-rich CHL (n=6), EBV+ hyperplasia (n=8), plasmablastic lymphoma (n= 3), and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (n=5) seldom exhibited PD-L1 in their large cells. Assessing PD-L1 positivity in tumour and nonmalignant large cells was helpful in differentiating between CHL vs nodal PTCL-TFH (P<0.0001) or EBV+ DLBCL-NOS (P=0.0052) and between EBV+ DLBCL-NOS vs nodal PTCL-TFH (P=0.0052), with PD-L1 expression indicating the first diagnosis in each of those sets.
Conclusion
Immunohistochemical evaluation of PD-L1 expression in tumour and nonmalignant HRS-like large cells may be useful for assessing either immune escape or immunodeficiency in their pathogenesis.
This article is protected by copyright. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Gx3WD2
Novel TOF-MS means of quantifying apoAI amyloid protein load following combined liver kidney transplantation
Gender, Race and Disease Etiology Predict De Novo Malignancy Risk following Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance
AbstractBackgroundMalignancy after liver transplant (LT) is a leading cause of mortality, but data is limited. The aim of this study was to identify patients at higher risk for de novo malignancies after LT in a large multicenter database.MethodsThe Scientific Registry of Transplant Recipients database comprising all 108,412 liver transplant recipients across the U.S. between 1987 and March 2015 was analyzed with a median follow-up of 6.95 years. Potential risk factors for malignancies after LT were assessed using Cox regression analysis for the outcome of time to first malignancy.ResultsMean age 51.9 ± 10.8 years, 64.6% male, 74.5% Caucasian, and 15.8% with previous malignancy. Malignancies during follow-up were 4,483 (41.3%) skin, 1,519 (14.0%) hematologic, and 4,842 (44.7%) solid organ. The 10-year probability of de novo malignancy was 11.5% (11.3-11.8%). On multivariable analysis, age by decade (HR 1.52; p
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMKRuy
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMKRuy
Incidence of Cytomegalovirus DNAemia in Pediatric Kidney Transplant Recipients after Cessation of Antiviral Prophylaxis
AbstractBackgroundLate cytomegalovirus (CMV) infection can occur after cessation of viral prophylaxis in kidney transplant recipients, yet, timing of infection is unclear and longer duration of prophylaxis may be warranted.MethodsWe conducted a retrospective cohort study of 86 children (35 CMV donor seropositive, recipient seronegative [D+R-] and 51 CMV recipient seropositive [R+])
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EnqPYQ
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EnqPYQ
Successful sequential liver and haematopoietic stem cell transplantation in a child with CD40 ligand deficiency and Cryptosporidium-induced liver cirrhosis
ABSTRACTBACKGROUNDHematopoietic stem cell transplantation (HSCT) is curative in patients with primary immunodeficiencies. However, pre-HSCT conditioning entails unacceptably high risks if the liver is compromised. The presence of a recurrent opportunistic infection affecting the biliary tree and determining liver cirrhosis with portal hypertension posed particular decisional difficulties in a seven-year-old child with X-linked CD40-ligand deficiency. We aim at adding to the scanty experience available on such rare cases, as successful management with sequential liver transplantation (LT) and HSCT has been reported in detail only in one young adult to date.METHODSa closely sequential strategy, with a surgical complication-free LT, followed by reduced-intensity conditioning, allowed HSCT to be performed only one month after LT, preventing Cryptosporidium parvum recolonization of the liver graft.RESULTScombined sequential LT and HSCT resolved the cirrhotic evolution and corrected the immunodeficiency so that the infection responsible for the progressive sclerosing cholangitis did not recur.CONCLUSIONShopefully this report of the successful resolution of a potentially fatal combination of immunodeficiency and chronic opportunistic infection with end-stage organ damage in a child, will encourage others to adopt a sequential transplant approach to this highly complex pathology. However, caution is to be exercised to carefully balance the risks intrinsic to transplant surgery and immunosuppression in primary immunodeficiencies. BACKGROUND Hematopoietic stem cell transplantation (HSCT) is curative in patients with primary immunodeficiencies. However, pre-HSCT conditioning entails unacceptably high risks if the liver is compromised. The presence of a recurrent opportunistic infection affecting the biliary tree and determining liver cirrhosis with portal hypertension posed particular decisional difficulties in a seven-year-old child with X-linked CD40-ligand deficiency. We aim at adding to the scanty experience available on such rare cases, as successful management with sequential liver transplantation (LT) and HSCT has been reported in detail only in one young adult to date. METHODS a closely sequential strategy, with a surgical complication-free LT, followed by reduced-intensity conditioning, allowed HSCT to be performed only one month after LT, preventing Cryptosporidium parvum recolonization of the liver graft. RESULTS combined sequential LT and HSCT resolved the cirrhotic evolution and corrected the immunodeficiency so that the infection responsible for the progressive sclerosing cholangitis did not recur. CONCLUSIONS hopefully this report of the successful resolution of a potentially fatal combination of immunodeficiency and chronic opportunistic infection with end-stage organ damage in a child, will encourage others to adopt a sequential transplant approach to this highly complex pathology. However, caution is to be exercised to carefully balance the risks intrinsic to transplant surgery and immunosuppression in primary immunodeficiencies. Corresponding Author: Pier Luigi Calvo, MD, Paediatrician, Gastroenterologist & Hepatologist, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Piazza Polonia, 94, 10126 Turin, ITALY. pcalvo@cittadellasalute.to.it AUTHORSHIP PAGE QP, DOD and CPL had the patient under their care and conceived, designed and wrote the article. TF, RR, SM planned and performed liver transplant and critically reviewed the paper. DE performed liver histological analysis. CF, VE, FF performed haematopoietic stem cell transplantation and critically reviewed the paper. PM followed the patient after liver transplant and critically reviewed the paper. All authors listed contributed to writing the manuscript and are responsible for the content of the paper. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMKRe2
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMKRe2
The Lateral Femoral Cutaneous Nerve: Description of the Sensory Territory and a Novel Ultrasound-Guided Nerve Block Technique
Background and Objectives Nerve blockade of the lateral femoral cutaneous (LFC) nerve provides some analgesia after hip surgery. However, knowledge is lacking about the extent of the cutaneous area anesthetized by established LFC nerve block techniques, as well as the success rate of anesthetic coverage of various surgical incisions. Nerve block techniques that rely on ultrasonographic identification of the LFC nerve distal to the inguinal ligament can be technically challenging. Furthermore, the branching of the LFC nerve is variable, and it is unknown if proximal LFC nerve branches are anesthetized using the current techniques. The primary aim of this study was to investigate a novel ultrasound-guided LFC nerve block technique based on injection into the fat-filled flat tunnel (FFFT), which is a duplicature of the fascia lata between the sartorius and the tensor fasciae latae muscle, in order to assess the success rate of anesthetizing the proximal LFC nerve branches and covering of the different surgical incisions used for hip surgery. Methods First, a cadaveric study was conducted in order to identify an FFFT injection technique that would provide adequate injectate spread to the proximal LFC nerve branches. Second, a clinical study was conducted in a group of 20 healthy volunteers over 2 consecutive days. On trial day 1, successful complete anesthesia of the LFC nerve was defined by performing a suprainguinal fascia iliaca block bilaterally in each subject. On trial day 2, a triple-blind randomized controlled trial compared the effect of the novel ultrasound-guided LFC nerve block technique for bupivacaine versus placebo. The primary end point was the success rate of anesthesia of the proximal cutaneous area innervated by the LFC nerve for the FFFT injection with bupivacaine versus placebo. Results Adequate spread of injectate to the proximal LFC nerve branches in cadavers was obtained by injecting 10 mL with dynamic needle-tip tracking in the FFFT. Application of this technique in the randomized controlled trial provided anesthesia of the lateral thigh with a success rate of 95% (95% confidence interval, 73.9%–99.8%) for the active side and 0% for placebo (P
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nlsaI9
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nlsaI9
Efficacy and Safety of Lidocaine Infusion Treatment for Neuropathic Pain: A Randomized, Double-Blind, and Placebo-Controlled Study
Background and Objectives Lidocaine infusion therapy (LIT) is an effective treatment for relieving neuropathic pain (NeP). However, it remains unclear whether pain relief can be sustained through repeated lidocaine infusions. This study aimed to determine whether repeated intravenous administration of low-dose lidocaine could provide prolonged pain relief in patients with specific NeP conditions. Methods This is a prospective, randomized, double-blind, placebo-controlled, parallel study. We compared the efficacy and safety of lidocaine infusions (3 mg/kg) in the LIT group and normal saline infusions in the control group once a week for 4 consecutive weeks in patients with postherpetic neuralgia or complex regional pain syndrome type II. The primary outcome was the difference in the percentage change in the 11-point numerical rating scale (NRS) pain score from baseline to after the final infusion. Secondary outcomes included pain scores during 4 weeks of follow-up and any complications. Results Forty-two patients completed this study protocol. The percentage reduction in NRS pain scores after the final infusion was significantly greater in the LIT group compared with the control group (P = 0.011). However, this pain reduction was not detectable at the 4-week follow-up. The difference in the percentage change in NRS pain scores was especially prominent in the LIT group after the third and fourth infusions. None of the study participants experienced serious complications from the treatment. Conclusions Lidocaine infusion therapy (3 mg/kg of lidocaine administered over 1 hour) provided effective short-term pain relief, which was substantially prominent after repeated infusions were administered to patients with refractory NeP. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02597257. Accepted for publication September 2, 2017. Address correspondence to: Jee Youn Moon, MD, PhD, FIPP, CIPS, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 110 Daehang-ro, Jongno-gu, Seoul 110-744, Korea (e-mail: jymoon0901@gmail.com). This research was supported by a grant (14172MFDS178) from Korean Ministry of Food and Drug Safety in 2014. The agency was not involved in conduct of this study or its submission. The authors declare no conflict of interest. Y.-C.K., A.M.C., and C.-S.L. contributed equally to this study. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BD5UOq
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BD5UOq
Dexamethasone as an Adjuvant to Femoral Nerve Block in Children and Adolescents Undergoing Knee Arthroscopy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial
Background and Objectives Perineural dexamethasone has been demonstrated to extend postsurgical analgesia after peripheral nerve blockade in adults. The mechanism of action of dexamethasone as a regional anesthetic adjuvant is unclear as intravenous dexamethasone has been shown to have similar analgesic efficacy as perineural dexamethasone. The efficacy of perineural dexamethasone has not been previously explored in the pediatric population. Methods After obtaining informed consent, children (aged 10–18 years) presenting for arthroscopic knee surgery with a femoral nerve block were randomized to 1 of 3 groups: ropivacaine 0.5% and intramuscular saline (group R), ropivacaine 0.5% plus perineural dexamethasone 0.1 mg/kg (maximum 4 mg) and intramuscular saline (group D), and ropivacaine 0.5% and intramuscular dexamethasone 0.1 mg/kg (maximum 4 mg) (group M). The primary outcome was the number of doses of analgesic agents in the first 48 hours after hospital discharge. The number of doses was compared across study groups using Wilcoxon rank sum tests. Results Seventy-seven patients were enrolled in the study, of whom 4 were withdrawn because of additional surgical repair being performed, emergence delirium requiring unblinding, or loss to follow-up. The remaining 36 boys and 37 girls (aged 15 ± 2 years) included 23 patients randomized to group D, 23 patients randomized to group M, and 27 patients randomized to group R. The median number of pain medication doses within 48 hours of discharge was 2, 3, and 2 in groups D, M, and R, respectively. There were no significant differences in this outcome between groups D and M (difference in medians, 1; 95% confidence interval [CI] of difference in medians, −1 to 2; P = 0.475), groups D and R (difference in medians, 0; 95% CI of difference, −2 to 1; P = 0.821), or groups M and R (difference in medians, −1; 95% CI of difference, −2 to 1; P = 0.594). Other secondary outcomes, including time to first analgesic consumption after discharge, visual analog scale pain score, and subjective intensity of motor block, did not evince statistically significant differences among the study groups. Conclusions In the pediatric population, perineural or intramuscular dexamethasone did not improve analgesia after femoral nerve blockade for knee arthroscopy. Whether the observed lack of benefit reflects a true adult-pediatric difference or a limitation of the study could not be determined. Future pediatric studies are needed to evaluate dexamethasone for other block types and other types of surgery. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT01971645. Accepted for publication October 4, 2017. Address correspondence to: Giorgio Veneziano, MD, Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (e-mail: Giorgio.Veneziano@Nationwidechildrens.org). This project was supported by The Clinical and Translational Intramural Funding Program (award grant number UL1TR001070), through the Research Institute at Nationwide Children's Hospital (Columbus, OH). The content is solely the responsibility of the authors and does not necessarily represent the official views of Nationwide Children's Hospital. This work was presented in part at moderated abstract presentations at the Society of Pediatric Pain Medicine's CCAS 2017 Annual Meeting on March 2 and the SPA-AAP Pediatric Anesthesiology 2017, on March 3, 2017, both in Austin, TX. The authors declare no conflict of interest. This study was registered with the Food and Drug Administration as an investigational new drug (IND 120188). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nlDwMp
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nlDwMp
Evaluation of the tumor movement and the reproducibility of two different immobilization setups for image-guided stereotactic body radiotherapy of liver tumors
The purpose of this study is to evaluate the tumor movement and accuracy of patient immobilization in stereotactic body radiotherapy of liver tumors with low pressure foil or abdominal compression.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2El45bM
HyperArc VMAT planning for single and multiple brain metastases stereotactic radiosurgery: a new treatment planning approach
The HyperArc VMAT (HA-VMAT) planning approach was newly developed to fulfill the demands of dose delivery for brain metastases stereotactic radiosurgery. We compared the dosimetric parameters of the HA-VMAT pl...
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DLqw9b
Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control
Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for superficial esophageal cancer involving the muscularis mucosae (T1a-MM) or upper third of the submucosa (T1b-SM1). Add...
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EjF4h7
Two Paths Diverged in the Brain, Ray Guillery Chose the One Less Studied
Abstract
Ray Guillery profoundly affected my work as a theorist studying the neocortex. What I treasured about Ray was that he didn't just report his experimental findings, he promoted bold new interpretations of them. He challenged conventional wisdom, and, therefore, challenged all neuroscientists to think differently. In this essay, I describe one of Ray's bold ideas, the critical role of the thalamus in how information flows from region to region in the neocortex.
This article is protected by copyright. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DMwfLI
Early Blindness is Associated with Increased Volume of the Uncinate Fasciculus
Abstract
Growing evidence demonstrates dramatic structural and functional neuroplastic changes in individuals born with early onset blindness. For example, crossmodal sensory processing at the level of the occipital cortex appears to be associated with adaptive behaviors in the blind. However, detailed studies examining the structural properties of key white matter pathways in other regions of the brain remain limited. Given that blind individuals rely heavily on their sense of hearing, we examined the structural properties of two important pathways involved with auditory processing namely, the uncinate and arcuate fasciculi. High angular resolution diffusion imaging (HARDI) tractography was used to examine structural parameters (i.e. tract volume and quantitative anisotropy, or QA) of these two fasciculi in a sample of 13 early blind individuals and 14 normally sighted controls. Compared to controls, early blind individuals showed a significant increase in the volume of the left uncinate fasciculus. A small area of increased QA was also observed half way along the right arcuate fasciculus in the blind group. These findings contribute to our knowledge regarding the broad neuroplastic changes associated with profound early blindness.
This article is protected by copyright. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EnHtYb
When neuroscience met clinical pathology: partitioning experimental variation to aid data interpretation in neuroscience
Abstract
In animal experiments, neuroscientists typically assess the effectiveness of interventions by comparing the average response of groups of treated and untreated animals. While providing useful insights, focusing only on group effects risks overemphasis of small, statistically significant but physiologically unimportant differences. Such differences can be created by analytical variability or physiological within-individual variation, especially if the number of animals in each group is small enough that one or two outlier values can have considerable impact on the summary measures for the group.
This article is protected by copyright. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DKuPl2
High-Fidelity Measures of Whole-Brain Functional Connectivity and White Matter Integrity Mediate Relationships between Traumatic Brain Injury and Post-Traumatic Stress Disorder Symptoms
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nmUaev
A Novel Method for Quantifying Human In Situ Whole Brain Deformation under Rotational Loading Using Sonomicrometry
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BBJDRc
Rapamycin Exacerbates Cardiovascular Dysfunction after Complete High-Thoracic Spinal Cord Injury
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2noski7
The differences on efficacy of oxaliplatin in locally advanced colon cancer between mucinous and nonmucinous adenocarcinoma
Abstract
Until now, it remains unclear how to best use the histological subtype in clinical practice. This study aimed to compare differences in the efficacy of postoperative chemotherapy among different histological subtypes of colon adenocarcinomas. Using the Surveillance, Epidemiology, and End Results-Medicare database, 51,200 patients with stage II or III primary colon carcinomas who underwent resection for curative intent between 1992 and 2008 were included. The survival benefit was evaluated using a Cox proportional hazards model, interaction analyses, and propensity score-matched techniques. There was no significant difference in survival for low-risk stage II mucinous adenocarcinoma (MA) or nonmucinous adenocarcinoma (NMA) between 5-FU and oxaliplatin-treated groups (P = 0.387 for MA, P = 0.629 for NMA). Patients with high-risk stage II NMA who received the oxaliplatin chemotherapy regimen had significantly improved cancer-specific survival (CSS) compared with the 5-FU group (P = 0.004), while those with MA saw no improvement (P = 0.690). For stage III tumors, patients with NMA who received the oxaliplatin chemotherapy regimen had significantly improved CSS compared with the 5-FU group (P < 0.001), while those with MA saw no improvement (P = 0.300). There were significant interactions between chemotherapy regimen and histological subtype. For patients with resected colon cancer who received 5-FU-based postoperative chemotherapy, oxaliplatin chemotherapy prolongs CSS for stage III and high-risk stage II NMA. Conversely, there was no similar improvement with addition of oxaliplatin for patients with stage III or stage II MA.
Until now, it remains unclear how to best use the histological subtype in clinical practice. For patients with resected colon cancer who received 5-FU-based postoperative chemotherapy, adding oxaliplatin can improve CSS for patients with stage III or high-risk stage II NMA. Conversely, there was no similar improvement for patients with stage III or high-risk stage II MA.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GtzfON
Distinct predictive impact of FISH abnormality in proteasome inhibitors and immunomodulatory agents response: redefining high-risk multiple myeloma in Asian patients
Abstract
For risk-adaptive therapeutic approaches in multiple myeloma (MM) treatment, we analyzed treatment outcome according to in situ hybridization (FISH) profiles to investigate the prognostic and predictive values of structural variations in a large series of Asian population. A total of 565 newly diagnosed patients with multiple myeloma between January 2005 and June 2015 were evaluated. FISH results showed del(17p13) in 8.8% (29/331), del(13q14) in 35.5% (184/519), t(14;16) in 2.5% (8/326), t(4;14) in 27.9% (109/390), IgH rearrangement in 47.7% (248/520), and +1q21 in 40.8% (211/517). The presence of del(17p13), IgH rearrangement, and t(14;16) was associated with worse overall survival. Interestingly, however, the presence of t(4;14) conferred little prognostic impact. Treatment-specific analysis revealed the presence of del(17p13), t(14;16), IgH rearrangement, and trisomy 1q21 was predictive of unsatisfactory response to bortezomib. On the other hand, patients with del(13q14) and del(9p21) were less likely to benefit from lenalidomide. Autologous stem cell transplantation (autoSCT) was less effective in patients with del(17p13), t(14;16), and trisomy 1q21. Predictive values of del(17p13) and t(14;16) to bortezomib and autoSCT are seemingly universal, but predictive marker del(13q14) and del(9p21) for lenalidomide response appears ethnicity-specific. Thus, FISH profiles in MM treatment should be interpreted with regards to patient's ethnicity.
Treatment-specific analysis revealed the presence of del(17p13), t(14;16), IgH rearrangement, and trisomy 1q21 was predictive of unsatisfactory response to bortezomib. On the other hand, patients with del(13q14) and del(9p21) were less likely to benefit from lenalidomide. Autologous stem cell transplantation was less effective in patients with del(17p13), t(14;16), and trisomy 1q21.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rOO4sh
Identification of a small-molecule ligand of β-arrestin1 as an inhibitor of stromal fibroblast cell migration accelerated by cancer cells
Abstract
Stromal fibroblasts, which occupy a major portion of the tumor microenvironment, play an important role in cancer metastasis. Thus, targeting of these fibroblasts activated by cancer cells (carcinoma-associated fibroblasts; CAFs) might aid in the improved treatment of cancer metastasis. NIH3T3 fibroblasts cocultured with MCF7 cells displayed enhanced migration compared to NIH3T3 fibroblasts cultured alone. We used this system to identify the small-molecule inhibitors responsible for their enhanced migration, a characteristic of CAFs. We selected β-arrestin1, which showed high expression in cocultured cells, as a molecular target for such inhibitors. Cofilin, a protein downstream of β-arrestin1, is activated/dephosphorylated in this condition. The small-molecule ligands of β-arrestin1 obtained by chemical array were then examined using a wound healing coculture assay. RKN5755 was identified as a selective inhibitor of activated fibroblasts. RKN5755 inhibited the enhanced migration of fibroblasts cocultured with cancer cells by binding to β-arrestin1 and interfering with β-arrestin1-mediated cofilin signaling pathways. Therefore, these results demonstrate the role of β-arrestin1 in the activation of fibroblasts and inhibiting this protein by small molecule inhibitor might be a potential therapeutic target for the stromal fibroblast activation (cancer–stroma interaction).
NIH3T3 fibroblasts cocultured with MCF7 cells displayed enhanced migration compared to NIH3T3 fibroblasts cultured alone. Using this system, we identified RKN5755, a selective inhibitor of activated fibroblasts. This small molecule binds to β-arrestin1 and interferes with β-arrestin1-mediated cofilin signaling pathways.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Gwo4VF
Assessment of the American Joint Commission on Cancer 8th Edition Staging System for Patients with Pancreatic Neuroendocrine Tumors: A Surveillance, Epidemiology, and End Results analysis
Abstract
Although several staging systems have been proposed for pancreatic neuroendocrine tumors (pNETs), the optimal staging system remains unclear. Here, we aimed to assess the application of the newly revised 8th edition American Joint Committee on Cancer (AJCC) staging system for exocrine pancreatic carcinoma (EPC) to pNETs, in comparison with that of other staging systems. We identified pNETs patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2014). Overall survival was analyzed using Kaplan–Meier curves with the log-rank test. The predictive accuracy of each staging system was assessed by the concordance index (c-index). Cox proportional hazards regression was conducted to calculate the impact of different stages. In total, 2424 patients with pNETs, including 2350 who underwent resection, were identified using SEER data. Patients with different stages were evenly stratified based on the 8th edition AJCC staging system for EPC. Kaplan–Meier curves were well separated in all patients and patients with resection using the 8th edition AJCC staging system for EPC. Moreover, the hazard ratio increased with worsening disease stage. The c-index of the 8th edition AJCC staging system for EPC was similar to that of the other systems. For pNETs patients, the 8th edition AJCC staging system for EPC exhibits good prognostic discrimination among different stages in both all patients and those with resection.
The purpose of our study was to discuss whether the new N category (N0, N1, N2) or the 8th staging systems for PDAC is suitable for pNETs, and the results showed that the 8th staging systems for PDAC are more suitable for pNETs compared with the 8th staging systems for pNETs/ENETS.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rQTeUw
Global named patient use program of afatinib in advanced non-small-cell lung carcinoma patients who progressed following prior therapies
Future Oncology, Ahead of Print.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DXYP04
A case report and a literature review of primary retroperitoneal mucinous cystadenoma: the importance of imaging in diagnosis and management
Future Oncology, Ahead of Print.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FsR7bB
Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman
Abstract
Background
Standard fluoroscopic guidance (C-arm fluoroscopy) has been routinely used for intraoperative localization of spinal level for surgical removal of intraspinal tumour, while it is not suitable for selected patients, e.g. pregnant women, who need to avoid radiation exposure. Fusion imaging of real-time ultrasound (US) and magnetic resonance imaging (MRI) is a radiation-free technique which has been reported to have good localization accuracy in managing several conditions.
Clinical presentation
A 37-year-old pregnant patient, presented with a progressively aggravating lower back pain for 20 days and was incapable of lying supine with lower extremities swelling for 1 week, was referred to our hospital in her 18th week of gestation. Lumbar MRI identified an L1 level intraspinal lesion, and surgery was planned. To avoid the ionizing radiation generated by fluoroscopy, volume navigation technique (VNT) based fusion imaging of US and MRI was used to localize the intraspinal lesion, which was removed entirely via minimally invasive interlaminar approach. Pathological examination confirmed the diagnosis of ependymoma of the conus medullaris. Her symptoms were largely relieved after the operation, and a healthy baby was delivered at the 40th week of pregnancy.
Conclusion
We presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EjwNtz
Androstadienone, a Chemosignal Found in Human Sweat, Increases Individualistic Behavior and Decreases Cooperative Responses in Men
Abstract
A growing body of evidence suggests that humans can communicate socially relevant information, such as aggression, dominance and readiness for competition, through chemosensory signals. Androstadienone (androsta-4,16,-dien-3-one), a testosterone-derived compound found in men's axillary sweat, is a main candidate for a human pheromone that may convey such information. The current study aimed to investigate whether androstadienone serves as a chemosignaling threat cue to men, thus triggering avoidance behavior during competitive interaction with another man. In a double-blind, placebo-controlled, within-subject study design, 30 healthy, normosmic, heterosexual male participants completed the Social Orientation Paradigm (SOP), a monetary game played against a fictitious partner that allows three types of responses to be measured in the context of provocation: an aggressive response, an individualistic withdrawal response, and a cooperative response. Participants completed the SOP task twice, once under exposure to androstadienone and once under exposure to a control solution. The results indicate that androstadienone increased individualistic responses while it decreased cooperative responses. These findings support the role of androstadienone as a threatening signal of dominance that elicits behavioral avoidance and social withdrawal tendencies, possibly as a submissive response.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nljnpL
It is time to move forward into the era of Theranostics
Abstract
Radionuclide therapy, which until 15 years ago included only a few approved therapies, is gaining importance in the treatment of various malignancies. The future of oncology will not be limited to surgery, chemo-, antibody therapies or external radiation; it will include targeted therapy with radionuclides, which will become the standard of care for a variety of malignant diseases in combination or as an alternative to other therapies. Therefore there is a need to train Nuclear Oncologists, who are able to approach oncological diseases, promote development of radiopharmacy, understand the biology of radionuclide treatment, apply radionuclide treatments and be able to use molecular imaging such as PET/CT and SPECT/CT for treatment planning and dosimetry.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DYIlog
Effect of Different Laser Treatments on the Bond Strength of Intracanal Fiber Posts Cemented with a Self-Adhesive Resin Cement
Abstract
Purpose
To evaluate the influence of laser-activated irrigation by Er:YAG and Er:YSGG (LAI) protocols and Nd:YAG laser irradiation on the bond strength of self-adhesively cemented fiber posts to root canal dentine.
Materials and Methods
The study sample consisted of 84 human single-rooted permanent teeth instrumented with ProTaper Next technique. After obturation, post space preparations were created for fiber-reinforced composite posts. The prepared specimens were divided according to the laser treatment of the post space preparations: group 1: LAI (Er:YAG) + saline solution (pulse energy: 20 mJ, repetition rate: 15 Hz); group 2: LAI (Er:YAG) + QMiX solution (pulse energy: 20 mJ, repetition rate: 15 Hz); group 3: LAI (Er,Cr:YSGG) + saline solution (pulse energy: 62.5 mJ, 20 Hz); group 4: LAI (Er,Cr:YSGG) + QMiX (pulse energy: 62.5 mJ, 20 Hz); Nd:YAG laser (pulse energy: 100 mJ, 10 Hz). Fiber-reinforced posts were cemented with a self-adhesive cement. The bond strength was evaluated by the push-out bond strength test, and the mode of failure was determined under a stereomicroscope. Kruskal-Wallis test was used for the intergroup comparative analysis with 5% level of significance.
Results
The highest bond strength was recorded in the Er:YAG + QMiX group (mean 3.401 MPa) (p < 0.05), followed by the Er,Cr:YSGG and the Er:YAG + saline solution (mean 1.111 MPa and 1.094 MPa, respectively), which did not differ significantly (p = 0.232). The irradiation with the Nd:YAG laser caused similar bond strength as the Er,Cr:YSGG + QMiX (p = 0.942).
Conclusion
All laser protocols enhanced the bond strength of the self-adhesive cement in root canals compared to only saline irrigation. The bond strength of the self-adhesive cement depended on the laser parameters and irrigant used for the LAI.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuEzAr
Longitudinal Assessment of Denture Maintenance Needs in an Overdenture Population
Abstract
Purpose
To evaluate the longitudinal denture maintenance needs of a tooth-supported overdenture population.
Materials and Methods
This prospective cohort study was composed of patients who had received tooth-supported overdentures from 1974 to 1994 in the Department of Prosthodontics, University of Iowa. There were 272 persons with 662 abutments who fulfilled the inclusion criteria. To simplify analysis and reduce the number of confounding variables, only those participants wearing complete maxillary dentures and opposing complete mandibular overdentures supported by teeth #22 and #27 were included in this analysis. The denture maintenance needs of these participants were identified and related to age, gender, length of time wearing overdentures, number of medications, and denture-wearing habits. Descriptive statistics and bivariate analyses were used for the statistical analysis (α = 0.05).
Results
Of the 91 participants (mean age = 59.5 ± 10.1 years; 63.7% male) who fulfilled the inclusion criteria at baseline, 48.4% took 1 to 3 medications daily, and 84.6% wore their dentures day and night. The percentages of participants who needed one or more of the following denture treatments were: 91.2% denture base adjustments, 76.9% laboratory processed relines, 61.5% denture remakes, 33% laboratory remount and occlusal adjustment, 22% repaired bases, and 19.8% needed denture teeth replaced. Bivariate analyses indicated that participants who were 65 years and older needed more denture adjustments than patients younger than 65 years (p = 0.0343). Participants who had worn overdentures for more than 5 years were more likely to require denture remakes (p = 0.0304). Participants who wore their dentures only during the day were less likely to require repairs (p = 0.0403). Participants who did not take any medications were significantly less likely to require denture base repairs (p = 0.0258). For the 35 participants who returned for recalls at all 4 time points, males were more likely to need denture teeth repaired or replaced (p = 0.0335) and those aged 50 to 64 were more likely to need 2 or more adjustments (p = 0.0311). No overdenture abutments were lost by the participants in this study.
Conclusions
According to the results of this study, age, medication usage, denture-wearing habits, and age of the overdentures were significant factors associated with denture maintenance needs. Persons wearing overdentures need regular recalls, because they have continuing maintenance needs.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DXGd01
Effect of Silane Heat Treatment by Laser on the Bond Strength of a Repair Composite to Feldspathic Porcelain
Abstract
Purpose
Ceramic restoration fracture may occur in the oral cavity. Intraoral repair of fractured porcelain could be advantageous to both patient and dentist. The aim of this study was to evaluate the effect of heat treatment of the silane coupling agent by Er:YAG and CO2 lasers on the microshear bond strength of a repair composite to feldspathic porcelain.
Materials and Methods
Sixty ceramic blocks were prepared and randomly divided into six groups (n = 10): (i) HF + silane (HS); (ii) silane + CO2 laser (SC); (iii) CO2 laser + silane (CS); (iv) silane + Er:YAG laser (SE); (v) Er:YAG laser + silane (ES); (vi) bur + HF + silane (BuHS). An adhesive resin was applied to the prepared ceramic surfaces and light-cured. Two transparent plastic tubes were placed perpendicularly to each ceramic block. The composite resin was then placed on the treated ceramic surface and light-cured for 40 seconds. The bonded blocks were stored in distilled water at 37°C for 24 hours and subjected to 3000 thermocycles. Microshear bond strength (μSBS) tests were performed using a wire and loop method. Data were analyzed using one-way ANOVA and Duncan's multiple range tests (p ≤ 0.05).
Results
The comparison of the mean μSBS values showed no significant differences between the ES and HS groups (p = 0.914). On the other hand, the specimens in these groups exhibited significantly higher bond strengths than those in the other groups (p < 0.01). The mean μSBS of the BuHS group was statistically similar to that of CS and SE groups (p > 0.05). The μSBS for the SC group was significantly lower than that of the other groups (p < 0.01), with the exception of the CS group (p = 0.674).
Conclusions
Treatment with Er:YAG laser prior to silane application can be as effective as HF etching. Heat treatment of silane by CO2 or Er:YAG lasers does not improve the bond strength between feldspathic porcelain and composite resin.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FsGy8k
Management of Challenging Esthetic Anterior Cases with Limited Restorative Space: A Clinical Report
Abstract
With careful restorative planning and surgical placement, dental implants can be used to support and retain a wide range of esthetic prostheses. When implant planning or surgical executions are less than ideal, however, the resulting restorative space can be a significant obstacle to successful treatment. The aim of this article is to describe the use of a customized anterior bar to support a partial overdenture prosthesis for a youthful patient with a high smile line and a limited restorative space of 6 mm. Details of the treatment and an illustration of the customized design are also presented.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DXG7Wd
Pathological response in a triple negative breast cancer cohort treated with neoadjuvant carboplatin and docetaxel according to Lehmann's refined classification
Purpose: Triple-negative breast cancer (TNBC) requires the identification of reliable predictors of response to neoadjuvant chemotherapy (NACT). For this purpose, we aimed to evaluate the performance of the TNBCtype-4 classifier in a cohort of TNBC patients treated with neoadjuvant carboplatin and docetaxel (TCb). Methods: TNBC patients were accrued in a non-randomized trial of neoadjuvant carboplatin AUC 6 and docetaxel 75 mg/m2 for 6 cycles. Response was evaluated in terms of pathological complete response (pCR, ypT0/is ypN0) and residual cancer burden by Symmans et al. Lehmann's subtyping was performed using the TNBCtype online tool from RNAseq data, and germline sequencing of a panel of 7 DNA damage repair genes was conducted. Results: 94 out of the 121 patients enrolled in the trial had RNAseq available. The overall pCR rate was 44.7%. Lehmann subtype distribution was: 34.0% BL1, 20.2% BL2, 23.4% M, 14.9% LAR and 7.4% were classified as ER+. Response to NACT with TCb was significantly associated with Lehmann subtype (p=0.027), even in multivariate analysis including tumor size and nodal involvement, with BL1 patients achieving the highest pCR rate (65.6%), followed by BL2 (47.4%), M (36.4%) and LAR (21.4%). BL1 was associated with a significant younger age at diagnosis and higher ki67 values. Among our 10 germline mutation carriers, 30% were BL1, 40% were BL2 and 30% were M. Conclusions: TNBCtype-4 is associated with a significantly different pCR rates for the different subtypes, with BL1 and LAR displaying the best and worse responses to NACT respectively.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DXr2Eh
Intra-Arterial Thrombolytic Therapy Is Not a Therapeutic Option for Filler-Related Central Retinal Artery Occlusion
Facial plast Surg
DOI: 10.1055/s-0037-1621730
Cosmetic facial filler-related central retinal artery occlusion (CRAO) is a devastating complication of facial hyaluronic acid (HA) injection and can be managed by intra-arterial thrombolytic therapy (IATT). The authors report on a 20-year-old woman who developed unilateral CRAO due to facial HA injection and who, despite prompt IATT, lost vision. A review of the related literature found 14 other female patients who developed cosmetic facial filler-related CRAO and accepted IATT management. In no case was vision loss clinically improved. IATT is not an effective preventive treatment of dermal filler-associated CRAO. The authors suggest careful preprocedural patient selection to prevent this complication.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BBKdyj
miR-3928v is induced by HBx via NF-κB/EGR1 and contributes to hepatocellular carcinoma malignancy by down-regulating VDAC3
Hepatitis B virus (HBV) plays a critical role in the tumorigenic behavior of human hepatocellular carcinoma (HCC). MicroRNAs (miRNAs) have been reported to participate in HCC development via the regulation of ...
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EnJx2D
Unerwartete Folgen einer HNO-Standardtherapie
Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-100257
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rSrfUq
Intraosseous papillary intralymphatic angioendothelioma (PILA): one new case and review of the literature
Abstract
Background
Papillary intralymphatic angioendothelioma (PILA) is a locally aggressive, rarely metastasizing vascular tumor, generally occurring in the soft tissues, with less than 40 cases described in the literature and only three cases reported in bone.
Case presentation
We describe the case of a 51-year-old male with an intraosseous PILA of the proximal edge of his left clavicle and two other lesions evident on imaging. The patient was treated with marginal resection of the clavicle lesion but was lost to follow-up 1 month after surgery.
Conclusions
PILA can also occur in bone, albeit very rarely, and has to be considered in the differential diagnosis of vascular bone tumors.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BDNtZT
Anti-Mullerian Hormone and Inhibin B Levels in Obese Boys; Relations with Cardiovascular Risk Factors
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0044-101141
Objective Obesity may reduce sertoli cell functions in men. The aim of the study was to investigate antimullerian hormone (AMH) and inhibin B levels (sertoli cell markers) in obese boys and their relations to cardiovascular risk factors such as insulin sensitivity index, aortic intima media thickness (aIMT) and high sensitive c-reactive protein (hsCRP). Patients, methods 121 obese and 38 healthy lean adolescents were included in the study. Serum AMH, inhibin B, gonadotropins, total testosterone, lipids, hsCRP, glucose and insulin levels were detected and analyzed. Insulin resistance was analyzed using the homeostasis model assessment (HOMA-IR). aIMT was measured by high-resolution B-mode ultrasonography. Results Serum AMH, inhibin B and total testosterone levels were lower in the obese adolescents (p=0.01, p=0.009 and p=0.002, respectively). aIMT measurements (p<0.001, 0.63±0.09 and 0.47±0.06 mm, respectively) and hsCRP levels (p<0.001, 2.5±0.4 and 0.66±0.69 mg/L, respectively) were significantly increased in the obese group. Obese with IR group had decreased AMH levels (p=0.02, 53.0±20.5 and 66.7±19.5 ng/mL, respectively) and increased triglycerides, HOMA-IR, aIMT measurements than non-IR obese group. AMH levels were correlated negatively with body mass index (r:−0.108, p=0.03), HOMA-IR (r:−0.358, p=0.003) and fasting insulin levels (r:−0.389, p=0.001) in obese group with IR. Conclusion We found that concentrations of both sertoli cell markers (AMH and inhibin B) were significantly lower in obese pubertal boys especially in obese with IR. Obesity and IR might be important factors for the sertoli cell impairment in pubertal boys.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GuDl9y
The Variation of Disulfides in the Progression of Type 2 Diabetes Mellitus
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0044-100376
Aim The purpose of this study was to examine thiol-disulfide balance in patients with type 2 diabetes mellitus. Methods This study included 32 subjects with known type 2 diabetes mellitus without complications, 30 patients with type 2 diabetes mellitus with complications, 28 newly diagnosed patients with type 2 diabetes mellitus, and 45 healthy individuals. Thiol-disulfide profile tests were quantified in all groups. Results Compared to the control group, patients in each of the diabetic groups had significantly lower native and total thiol levels, higher disulfide levels, and higher disulfide/native thiol and disulfide/total thiol ratios (p<0.05 for all). Disulfide levels were significantly lower in the newly diagnosed group than in other diabetic groups (p<0.05). There were significant associations between glycemic parameters and thiol-disulfide tests (p<0.05). Conclusions A disequilibrium between thiol-disulfide pairs occurs in patients with type 2 diabetes mellitus, and a gradual increase to disulfide levels may contribute to the disease's severity. Deteriorated thiol-disulfide homeostasis may be relevant to the pathophysiology of type 2 diabetes mellitus.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rSKddu
Biological response to self-etch adhesive after partial caries removal in rats
Abstract
Objectives
The purposes of this study were to evaluate a model of slow caries progression and to investigate the performance of a self-etch adhesive system for partial caries removal.
Materials and methods
Rat molars were infected with Streptococcus sobrinus 6715 culture. Different time points were analyzed: days 78, 85, and 95 (± 2). After this, the samples were processed for morphological analysis. Additionally, the first molars were restored with zinc oxide and eugenol (IRM™; Dentsply; Brazil) or adhesive system (Clearfil SE Bond™; Kuraray Medical; Japan) 78 days after caries induction. After, 3 or 15 days post-treatment, the animals were euthanized, and their mandibles were processed for morphological analysis, classified by means of scores, and submitted to statistical analysis. Subsequently, immunohistochemical analysis was performed for osteonectin (OSN) and transforming growth factor-ß1 (TGF-ß1) expression.
Results
According to the caries induction model used, on day 95 greater inflammatory infiltration (p < 0.001), and more extensive degradation of secondary/primary dentin were demonstrated than on day 78 (p < 0.05). Furthermore, the restorative materials presented similar performance (p > 0.05) and proved to be fundamental to control the carious lesion. The TGF-ß1 and OSN were shown to be active during the caries process.
Conclusions
The slow caries lesion model was feasible for morphological analysis of the dentin-pulp complex. The self-etch adhesive system triggered no acute inflammatory infiltration or pulp necrosis, instead it seemed to stimulate early pulp repair.
Clinical relevance
Clearfil SE Bond™ applied directly on caries-affected dentin did not predispose to pulp inflammation; instead, it appeared to provide early biological benefits.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DZQZDm
Dr. Avina Paranjpe selected for leadership training program
Dr. Avina Paranjpe, Associate Professor in the Department of Endodontics, has received a fellowship to attend the 2018-19 American Dental Education Association (ADEA) Leadership Institute.
The post Dr. Avina Paranjpe selected for leadership training program appeared first on UW School of Dentistry.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Gqhi3M
Olaparib Approved for Treating Some Breast Cancers with BRCA Gene Mutations
The drug olaparib (Lynparza®) is the first treatment approved by the Food and Drug Administration for patients with metastatic breast cancer who have inherited mutations in the BRCA1 or BRCA2 genes.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BBO921
Sound changes that lead to seeing longer-lasting shapes
Abstract
To survive, people must construct an accurate representation of the world around them. There is a body of research on visual scene analysis, and a largely separate literature on auditory scene analysis. The current study follows up research from the smaller literature on audiovisual scene analysis. Prior work demonstrated that when there is an abrupt size change to a moving object, observers tend to see two objects rather than one—the abrupt visual change enhances visible persistence of the briefly presented different-sized object. Moreover, if a sequence of tones accompanies the moving object, visible persistence is enhanced if the tone frequency suddenly changes at the same time that the object's size changes. Here, we show that although a sound change must occur at roughly the same time as a visual change to enhance visible persistence, there is a fairly wide time frame during which the sound change can occur. In addition, the impact of a sound change on visible persistence is not simply matter of the physical pattern: The same pattern of sound can enhance visible persistence or not, depending on how the pattern is itself perceived. Specifically, a change in a tone's frequency can enhance visible persistence when it accompanies a visual size change, but the same frequency change will not do so if the shift is embedded in a larger pattern that makes the change merely a continuation of alternating frequencies. The current study supports a scene analysis process that is both multimodal and actively constructive.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DKTlCt
Self-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions
Purpose
This study explored experiences of self-stigma among older persons with age-related hearing loss (ARHL) using Corrigan's conceptualization of self-stigma process formation and the attribution model as its theoretical framework. Method
In-depth semistructured interviews were conducted with 11 older persons (mean age = 81 years) with ARHL. Results
Self-stigma was present in the lives of the participants. Analysis revealed the existence of 3 stages of self-stigma in which the 3 core dimensions of stigma (cognitive attributions: being old, stupid, and crippled; emotional reactions: shame, pity, and feeling ridiculed; and behavioral reactions: concealment, distancing, and adapting to hearing aids) were observed. Hearing devices emerged as having a significant influence on stigmatic experiences in all stages and dimensions of self-stigma. Conclusion
The study contributes to the theoretical and practical understanding of self-stigma regarding ARHL as well as to the understanding of the role of hearing devices in the development of this stigma.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FoV5lp
Thyroid Hormone Promotes β-Catenin Activation and Cell Proliferation in Colorectal Cancer
Abstract
Thyroid hormone status has long been implicated in cancer development. Here we investigated the role of thyroxine (T4) in colorectal cancer cell lines HCT 116 (APC wild type) and HT-29 (APC mutant), as well as the primary cultures of cancer cells derived from patients. Cell proliferation was evaluated with standard assay and proliferation marker expression. β-Catenin activation was examined according to nuclear β-catenin accumulation and β-catenin target gene expression. The results showed that T4 increased colorectal cancer cell proliferation while cell number and viability were elevated by T4 in both established cell lines and primary cells. Moreover, the transcriptions of proliferative genes PCNA, CCND1, and c-Myc were enhanced by T4 in the primary cells. T4 induced nuclear β-catenin accumulation, as well as high cyclin D1 and c-Myc levels compared to the untreated cells. In addition, the β-catenin-directed transactivation of CCND1 and c-Myc promoters was also upregulated by T4. CTNNB1 transcription was raised by T4 in HCT 116, but not in HT-29, while the boosted β-catenin levels were observed in both. Lastly, the T4-mediated gene expression could be averted by the knockdown of β-catenin. These results suggested that T4 promotes β-catenin activation and cell proliferation in colorectal cancer, indicating that an applicable therapeutic strategy should be considered.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUOvpM
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis
Abstract
Background
Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients.
Methods
A systematic literature search for studies reporting postoperative outcomes after CRS plus HIPEC for elderly patients was performed in the MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Web of Knowledge Conference Proceedings Citation Index-Science, and Google Scholar databases. The included studies evaluated the overall 30-day postoperative morbidity, 90-day postoperative mortality, grade 3 or higher postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay.
Results
The inclusion criteria were met by 13 retrospective studies involving 2544 patients. Considering only comparative studies, the 90-day postoperative mortality was significantly increased for elderly patients [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27–0.88; I 2 = 79%]. The 30-day grade 3 or higher postoperative morbidity was increased in the patients 70 years of age or older (14.5%; 95% CI 8.1–24.4 vs. 32.3%; 95% CI 22.4–44.0%; p = 0.004; I 2 = 85%). The overall 30-day postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay were not affected by age.
Conclusions
Treatment of the elderly with CRS plus HIPEC was associated with increased severe postoperative morbidity and mortality. However, these conclusions should be weighted given the existence of major biases in the included studies. Age alone probably would not be a formal contraindication, but frailty should be taken into account. Further prospective studies are needed.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ep7mXT
Perioperative Risk Calculator Predicts Long-Term Oncologic Outcome for Patients with Esophageal Carcinoma
Abstract
Background
Few risk models have been provided to predict long-term prognosis after esophagectomy. This study investigated the reliability of a risk calculator as well as classification and regression trees analysis for predicting long-term prognosis after esophagectomy for esophageal cancer.
Methods
The study enrolled 438 patients who underwent esophagectomy at Keio University Hospital, Tokyo, Japan, between July 2000 and June 2016. Patients who underwent R0 or R1 resection or esophagectomy with combined resection of other organs were included. The authors investigated the usefulness of a risk model for 30-day mortality and operative mortality described in their previous report for predicting long-term prognosis after esophagectomy.
Results
The 438 patients (377 men and 61 women) in this study had a 5-year overall survival (OS) rate of 62.8% and a disease-free survival rate of 54.3%. The OS was higher for the patients with 30-day mortality risk model values lower than 0.675% than for those with values higher than 0.675% (p < 0.001). The cutoff values for prediction were shown to be significant risk factors in the multivariate analysis. The risk calculator was validated by comparing the cutoff values with Harrell's C-index values of clinical stage. For overall risk, the C-index of operative mortality was 0.697, and the C-index of cStage was 0.671.
Conclusions
The risk calculator was useful for predicting recurrence and death after esophagectomy. Furthermore, because the C-index of the risk model for operative mortality was higher than for clinical tumor-node-metastasis stage, this risk-scoring system may be more useful clinically.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DISVMU
PCI is Not Predictive of Survival After Complete CRS/HIPEC in Peritoneal Dissemination from High-Grade Appendiceal Primaries
Abstract
Background
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option in patients with carcinomatosis from high-grade appendiceal (HGA) primaries. It is unknown if there is a Peritoneal Carcinomatosis Index (PCI) upper limit above which a complete CRS/HIPEC does not assure long-term survival.
Methods
Retrospective analysis from three centers was performed. The PCI was used to grade volume of of disease. Survival in relation to PCI was studied on patients with complete cytoreduction.
Results
Overall, 521 HGA patients underwent CRS/HIPEC from 1993 to 2015, with complete CRS being achieved in 50% (260/622). Mean PCI was 14.8 (standard deviation 8.7, range 0–36). Median survival for the complete CRS cohort was 6.1 years, while 5- and 10-year survival was 51.7% (standard error [SE] 4.6) and 36.1% (SE 6.3), respectively. Arbitrary cut-off PCI limits with 5-point splits (p = 0.63) were not predictive of a detrimental effect on survival as long as a complete CRS was achieved. A linear effect of the PCI on survival (p = 0.62) was not observed, and single-point PCI cohort splits within a PCI range of < 5 to > 10 were not predictive of survival for complete CRS patients. The PCI correlated with the ability to achieve a complete CRS, with a mean PCI of 14.7 (8.7) for completeness of cytoreduction (CC)0, 22.3 (7.8) for CC1 and 26.1 (9.5) for CC2/3 resections (p = 0.0001, hazard ratio 1.12, 95% confidence interval 1.09), with an HR of 1.15 for each 1-unit increase in the PCI score. Only 21% of the cohort achieved a complete CRS with a PCI ≥ 21.
Conclusions
The PCI correlates with the ability to achieve a complete CRS in carcinomatosis from HGA. PCI is not associated with survival as long as a complete CRS can be achieved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EkK6tT
Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study
Abstract
Objective
This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications.
Methods
A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i.e., ALT only and DFF, were created. Incidence and subsequent management strategies for postoperative plate exposure were evaluated along with complications, overall survival, and postoperative quality of life (QoL).
Results
Sixty-two patients were 1:1 propensity matched (31 per group). The DFF group had a significantly larger soft tissue and bone defect than the single-flap group. The 5-year probability of not having a plate exposure was 45.5 and 47.4% for the double-flaps and single-flap groups, respectively (p = 0.186). The ALT-only group had a significantly higher rate of wound infections (38.7% vs. 12.9%, p = 0.02). The incidence of flap loss, reexploration, inpatient mortality, plate fracture, medical complications, and overall survival were not significantly different. Although mean score for pain was significantly worse in the ALT-only group (75.2 vs. 88.5, p < 0.001), the remainder of our QoL assessments (cosmesis, swallow, employment, and speech) were comparable.
Conclusions
The utilization of an ALT with plate strategy is associated with competitive rates of plate exposure and overall survival relative to DFF but higher wound infections and long-term pain. These results have considerable salience for patient-counseling regarding expectations for functional and clinical outcomes.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DIGOzC
Core Body Temperature but Not Intraabdominal Pressure Predicts Postoperative Complications Following Closed-System Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Administration
Abstract
Background
Hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery (CRS), performed using closed-abdomen technique (CAT), may affect intraabdominal pressure (IAP). High IAP may increase postoperative complications due to decreased venous return and hypoperfusion to vital organs. Elevated core body temperature (CBT) may cause multiorgan dysfunction. Low IAP or CBT could result in suboptimal HIPEC and potentially translate into early disease recurrence. The aim of the present study is to identify possible correlations between IAP or CBT and postoperative complications.
Patients and Methods
Continuous intraabdominal pressure measurement was performed by intraabdominal catheter. Inflow temperature was set at 44 °C, and mean perfusate temperature was 42 °C. CBT was measured continuously in the distal esophagus. We compared the rate of postoperative complications between the low IAP group (2–10 mmHg, n = 28), target IAP group (10–20 mmHg, n = 71), and high IAP group (20–34 mmHg, n = 16) as well as with CBT as a continuous variable.
Results
115 patients were included in the study. There was no difference between IAP groups in terms of age, gender, primary diagnosis, operative peritoneal cancer index, CBT, or operative time. There was no correlation between IAP and postoperative complications or with prolonged hospital stay. On multivariate analysis, elevated mean CBT was a positive predictor of postoperative complications (p = 0.035).
Conclusions
IAP level during closed-abdomen technique HIPEC is not associated with postoperative complications. However, elevated CBT may increase postoperative complications.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EmRZPw
Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer
Abstract
Background
Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients.
Methods
The study used the Nationwide Inpatient Sample for years 1998–2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume.
Results
The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63–0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70–0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13).
Conclusion
In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EleDI7
Histologic Predictors of Recurrence in Mucinous Appendiceal Tumors with Peritoneal Dissemination after HIPEC
Abstract
Background
Mucinous appendiceal tumors (MAT) are rare neoplasms that can metastasize to the peritoneum and often are treated with cytoreductive surgery (CRS) and HIPEC. Pathologic classification and outcomes vary, but standardized histologic definitions are emerging. We sought to evaluate outcomes in this disease after CRS/HIPEC using standardized pathologic criteria.
Method
Outcomes of MAT with peritoneal metastases (PM) after CRS/HIPEC from 2007 to 2015 were reviewed at our institution. Standardized histologic categories per WHO and consensus definitions were used: low-grade appendiceal mucinous neoplasm (LAMN), low-grade adenocarcinoma (LGAC), or high-grade adenocarcinoma (HGAC) primary tumors; and acellular mucin (AM), low-grade mucinous carcinoma peritonei (LGMCP), or high-grade mucinous carcinoma peritonei (HGMCP) peritoneal metastases. Cox proportional hazards model was used identify predictors of progression-free survival (PFS) by univariate and multivariate analyses.
Results
A total of 183 patients undergoing 197 CRS/HIPECs were included. Among 75 patients with primary histology review, there were 33 (44.0%) LAMNs, 28 (37.3%) LGACs, and 14 (18.7%) HGACs. Peritoneal histology was benign in 6 (3.0%), AM in 33 (16.8%), LGMCP in 114 (57.9%), and HGMCP in 44 (22.3%). PFS was not reached for AM, 34.3 months for LGMCP, and 16.8 months for HGMCP (p < 0.001). Peritoneal histology predicted PFS on multivariate analysis (hazard ratio 9.82 and 24.60 for LGMCP and HGMCP, respectively, vs. AM, p < 0.001). Among the LGMCP group, CEA and completeness of cytoreduction (CC score) predicted PFS on multivariate analysis.
Conclusions
Standardized peritoneal histology in patients with PM from MAT predicts PFS and patients with low-grade histology can be further discriminated by CEA and CC score.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DKxBGR
Benefit of Adjuvant Radiotherapy for Local Control, Distant Metastasis, and Survival Outcomes in Patients with Localized Soft Tissue Sarcoma: Comparative Effectiveness Analysis of an Observational Cohort Study
Abstract
Background
This study aimed to quantify the benefit of adjuvant radiotherapy (AXRT) for local control, distant metastasis, and long-term survival outcomes in patients with localized soft tissue sarcoma (STS).
Methods
This single-center retrospective observational study enrolled 433 STS patients who underwent surgery with curative intent. An inverse probability of treatment-weighted (IPTW) analysis was implemented to account rigorously for imbalances in prognostic variables between the adjuvant treatment groups.
Results
During a median follow-up period of 5.5 years, the study observed 38 local recurrences (9%), 73 occurrences of distant metastasis (17%), 63 STS-related deaths (15%), and 57 deaths from other causes (13%). As expected, patients receiving AXRT (n = 258, 60%) were more likely to have high-grade G3 tumors (p < 0.0001) than patients not receiving AXRT. A crude analysis showed that AXRT was not associated with improved recurrence-free survival [hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.72–1.38; p = 0.98]. However, after IPTW, AXRT was associated with a 38% relative reduction in the risk of recurrence or death (HR 0.62; 95% CI 0.39–1.00; p = 0.05). This benefit was driven by a strong reduction in the risk of local recurrence (HR 0.42; 95% CI 0.19–0.91; p = 0.03), whereas the relative risk of distant metastasis (HR 0.69; 95% CI 0.39–1.25; p = 0.22) and overall survival (HR 0.76; 95% CI 0.44–1.30; p = 0.32) were only nonsignificantly in favor of AXRT. An exploratory analysis showed an overall survival benefit of AXRT for patients with high-grade G3 tumors (HR 0.51; 95% CI 0.33–0.78; p = 0.002). However, this finding may have been attributable to residual confounding.
Conclusion
In this observational cohort, AXRT was associated with a 58% reduction in the relative risk of local recurrence. No consistent association between AXRT and lower risks of distant metastasis or death was observed.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wVAn9C
Εγγραφή σε:
Αναρτήσεις (Atom)