The effect of statins on periodontal treatment—a systematic review with meta-analyses and meta-regression

Abstract

Objective

This study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical attachment level, and intrabony defects, in comparison to mechanical periodontal therapy alone or in association with placebo.

Material and methods

Three databases were searched for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment. Weighted mean differences between baseline and 6 months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated. A high heterogeneity was detected. Therefore, a meta-regression adjusted for type of statin and year of publication was performed.

Results

Fifteen studies were included in the systematic review, and ten studies were included in the meta-analysis. In the meta-regression, the adjunct use of simvastatin, rosuvastatin, and atorvastatin additionally reduced PPD in comparison to mechanical periodontal therapy and a placebo gel (2.90 ± 0.35, 3.90 ± 0.77, 3.06 ± 0.71 mm, respectively; p < 0.05). Regarding the resolution of IBD, simvastatin and rosuvastatin significantly improved in comparison to control group (0.89 ± 0.35 and 1.93 ± 0.77 mm, respectively; p < 0.05). No statistically significant difference was found between the statins for both PPD and IBD (p < 0.05). Regarding CAL gain, simvastatin provided a statistically significant improvement as compared to the control group (2.02 ± 0.79 mm; p = 0.043).

Conclusions

The use of statins, used as sole adjuncts to mechanical periodontal treatment, improved the periodontal parameters. In the quantitative analyses, simvastatin was the only drug that showed additional benefits in all evaluated parameters.

Clinical relevance

Statins promote significantly clinical periodontal improvements when administered in association with non-surgical scaling and root planning (SRP), when compared to SRP alone or in association with a placebo.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BNMLJG

Eosinophil Counts in the Small Intestine and Colon of Children Without Apparent Gastrointestinal Disease-a Meta-analysis

ABSTRACTObjectives:The aim of the current study was to review the available data regarding eosinophil density in healthy tissue specimen originating from lower gastrointestinal segments to support suggested diagnostic cut-offs widely used in clinical practice.Methods:A systematic search was performed in three different databases. Calculations were made with Comprehensive MetaAnalysis software using random effects model. Cell number measurements were pooled using the random effects model and displayed on forest plots. Summary point estimations, 95% Confidence Intervals (CIs), and 95% Prediction Intervals (PIs) were calculated.Results:The cumulative mean cell numbers were 8.26 (95% CI: 3.49, 13.03) with PI of 0–25.32 for the duodenum, 11.51 (95% CI: 7.21, 15.82) with PI of 0–60.59 for the terminal ileum, and 11.10/HPF (95% CI: 9.11, 13.09) with PI of 0.96–21.23 in the large intestine and the rectum (HPF area = 0.2 mm2). Previous studies included control patients with irritable bowel syndrome (IBS) and functional GI disorders. As mucosal eosinophils have a role in their pathomechanism, those patients should have been excluded. A critical point of interpreting reported data is that HPF is relative to the technical parameters of the microscopes, therefore it is important to report findings in cell/mm2.Conclusions:The present meta-analysis does not support the higher (>20) or lower (20) or lower (

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DXcwJC

NMDA-receptor Antagonism in Pediatric Pancreatitis: Use of Ketamine and Methadone in a Teenager With Refractory Pain

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EwLWIa

Practice Differences in the Diagnosis and Management of Eosinophilic Esophagitis among Adult and Pediatric Gastroenterologists in Israel

ABSTRACTObjectives:Eosinophilic esophagitis (EoE) guidelines call for similar practices in adults and children with EoE. We compared the diagnostic and management practices of gastroenterologists treating adult and pediatric patients suspected of having, or diagnosed with, EoE.Methods:A 19 question multiple choice questionnaire was given to gastroenterologists treating either adults or children. Questions explored four areas of interest: Physician demographics, diagnosis and tissue sampling practices, management, and the need for societal publications on EoE.Results:Completed questionnaires were returned by 85/180 adult and 30/40 pediatric gastroenterologists. Compared to pediatric gastroenterologists, adult gastroenterologists took esophageal biopsies significantly less frequently in the following scenarios: endoscopy without esophageal symptoms or macroscopic endoscopic findings (10% vs. 57%; p 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DSnIHf

Should Giant Cell Hepatitis With Autoimmune Hemolytic Anemia Be Considered a Pediatric Autoimmune Liver Disease?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExcxVz

Should Giant Cell Hepatitis With Autoimmune Hemolythic Anemia Be Considered A Pediatric Autoimmune Liver Disease?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DW5zIN

Survey on the Adherence to the 2009 NASPGHAN-ESPGHAN Gastroesophageal Reflux Guidelines by Brazilian Paediatricians

ABSTRACTObjective:To evaluate the management of gastroesophageal reflux in children among Brazilian pediatricians and adherence to the 2009 North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), and European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Guideline in Brazil.Methods:An observational cross-sectional study was conducted, applying a standard questionnaire with 12 questions about gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) management in infants, children, and adolescents to the pediatricians during the 37th Brazilian Pediatrics Congress in October, 2015. Adherence to the 2009 NASPGHAN-ESPGHAN Guideline was verified through analyses of interviewees' answers. Pediatricians' demographic and professional characteristics were screened.Results:390 Brazilian pediatricians answered the questionnaire. None showed complete adherence to Guideline recommendations. GERD diagnosis by history alone was reported by 67%, irrespective of the child's age. The mean score for diagnostic adherence to the guidelines was 0.94 ± 0.86 (range 0–4). Working in public health services (p = 0.026) was the only variable retained as a significant predictor of poor adherence for GER/GERD diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (p = 0.774). Proton pump inhibitors (PPIs) were prescribed by 28.4% of the pediatricians independent of child's age, and 59% use PPI to treat babies with unexplained crying and/or distressed behavior.Conclusions:2009 NASPGHAN-ESPGHAN Guideline recommendations had poor adherence by Brazilian pediatricians. Studies evaluating the reasons for the poor adherence to NASPGHAN/ESPGHAN guidelines are urgently needed. Objective: To evaluate the management of gastroesophageal reflux in children among Brazilian pediatricians and adherence to the 2009 North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), and European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Guideline in Brazil. Methods: An observational cross-sectional study was conducted, applying a standard questionnaire with 12 questions about gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) management in infants, children, and adolescents to the pediatricians during the 37th Brazilian Pediatrics Congress in October, 2015. Adherence to the 2009 NASPGHAN-ESPGHAN Guideline was verified through analyses of interviewees' answers. Pediatricians' demographic and professional characteristics were screened. Results: 390 Brazilian pediatricians answered the questionnaire. None showed complete adherence to Guideline recommendations. GERD diagnosis by history alone was reported by 67%, irrespective of the child's age. The mean score for diagnostic adherence to the guidelines was 0.94 ± 0.86 (range 0–4). Working in public health services (p = 0.026) was the only variable retained as a significant predictor of poor adherence for GER/GERD diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (p = 0.774). Proton pump inhibitors (PPIs) were prescribed by 28.4% of the pediatricians independent of child's age, and 59% use PPI to treat babies with unexplained crying and/or distressed behavior. Conclusions: 2009 NASPGHAN-ESPGHAN Guideline recommendations had poor adherence by Brazilian pediatricians. Studies evaluating the reasons for the poor adherence to NASPGHAN/ESPGHAN guidelines are urgently needed. Address correspondence and reprint requests to Sarah Cristina Fontes Vieira, Rua Claudio Batista, SN, Bairro Cidade Nova, ZIP code 49060-108, Aracaju-SE, Brazil (E-mail: sarahcfv@yahoo.com.br). Received 20 May, 2017 Accepted 22 December, 2017 Conflicts of interest and source of funding: None to declare. Institution: Federal University of Sergipe, Aracaju-Sergipe, Brazil. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EwiNwG

Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography

Summary

Objective

Selective laser amygdalohippocampotomy (SLAH) using magnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is emerging as a treatment option for drug-resistant mesial temporal lobe epilepsy (MTLE). SLAH is less invasive than open resection, but there are limited series reporting its safety and efficacy, particularly in patients without clear evidence of mesial temporal sclerosis (MTS).

Methods

We report seizure outcomes and complications in our first 30 patients who underwent SLAH for drug-resistant MTLE between January 2013 and December 2016. We compare patients who required stereoelectroencephalography (SEEG) to confirm mesial temporal onset with those treated based on imaging evidence of MTS.

Results

Twelve patients with SEEG-confirmed, non-MTS MTLE and 18 patients with MRI-confirmed MTS underwent SLAH. MTS patients were older (median age 50 vs 30 years) and had longer standing epilepsy (median 40.5 vs 5.5 years) than non-MTS patients. Engel class I seizure freedom was achieved in 7 of 12 non-MTS patients (58%, 95% confidence interval [CI] 30%-86%) and 10 of 18 MTS patients (56%, 95% CI 33%-79%), with no significant difference between groups (odds ratio [OR] 1.12, 95% CI 0.26-4.91, P = .88). Length of stay was 1 day for most patients (range 0-3 days). Procedural complications were rare and without long-term sequelae.

Significance

We report similar rates of seizure freedom following SLAH in patients with MTS and SEEG-confirmed, non-MTS MTLE. Consistent with early literature, these rates are slightly lower than typically observed with surgical resection (60%-80%). However, SLAH is less invasive than open surgery, with shorter hospital stays and recovery, and severe procedural complications are rare. SLAH may be a reasonable first-line surgical option for patients with both MTS and SEEG confirmed, non-MTS MTLE.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUdOsF

Three-dimensional mobility and muscle attachments in the pectoral limb of the Triassic cynodont Massetognathus pascuali (Romer, 1967)

Abstract

The musculoskeletal configuration of the mammalian pectoral limb has been heralded as a key anatomical feature leading to the adaptive radiation of mammals, but limb function in the non-mammaliaform cynodont outgroup remains unresolved. Conflicting reconstructions of abducted and adducted posture are based on mutually incompatible interpretations of ambiguous osteology. We reconstruct the pectoral limb of the Triassic non-mammaliaform cynodont Massetognathus pascuali in three dimensions, by combining skeletal morphology from micro-computed tomography with muscle anatomy from an extended extant phylogenetic bracket. Conservative tests of maximum range of motion suggest a degree of girdle mobility, as well as substantial freedom at the shoulder and the elbow joints. The glenoid fossa supports a neutral pose in which the distal end of the humerus points 45° posterolaterally from the body wall, intermediate between classically 'sprawling' and 'parasagittal' limb postures. Massetognathus pascuali is reconstructed as having a near-mammalian complement of shoulder muscles, including an incipient rotator cuff (m. subscapularis, m. infraspinatus, m. supraspinatus, and m. teres minor). Based on close inspection of the morphology of the glenoid fossa, we hypothesize a posture-driven scenario for the evolution of the therian ball-and-socket shoulder joint. The musculoskeletal reconstruction presented here provides the anatomical scaffolding for more detailed examination of locomotor evolution in the precursors to mammals.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E5zuBv

Case report: Calcium pyrophosphate dihydrate deposition of the temporomandibular joint diagnosed by fine-needle aspiration cytology

Calcium pyrophosphate dihydrate deposition (CPDD) is the accepted name for a disease that mainly occurs in elderly patients. This disease affects many joints in particular the knee joint. CPDD is extremely rare in the temporomandibular joint (TMJ) with only few cases reported in the English literature. Herein, we present a case of an 89 years old woman with a radiological diagnosis of chondrosarcoma of TMJ. Fine-needle aspiration cytology however showed crystals, multinucleated giant cells and macrophages which allowed a correct diagnosis of CPDD.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FCwzxn

Leiomyoma of the soft palate: Case report and review of articles

Publication date: Available online 1 February 2018
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Fahd Alharbi
Leiomyomas are benign tumors arising from smooth muscle, most commonly seen in uterine myometrium, gastrointestinal tract, skin and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity and leiomyomas of head and neck region account for less than 1% of all leiomyomas. The purpose of this article is to present a case of 18 years old male patient with a history of several months of oral leiomyoma on the right side of the soft palate. The clinical features, differential diagnosis and management of leiomyoma are discussed with review of the literatures.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nr7kHG

Phase II trial of combination treatment with paclitaxel, carboplatin and cetuximab (PCE) as first-line treatment in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (CSPOR-HN02)

Abstract

Background

The standard of care for first-line treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) is combination treatment with platinum, 5-FU and cetuximab (PFE). However, this regimen requires hospitalization to ensure proper hydration and continuous infusion of 5-FU, and causes severe nausea and anorexia. We evaluated the efficacy and safety of paclitaxel, carboplatin and cetuximab (PCE) as first-line treatment in patients with R/M SCCHN.

Patients and methods

Eligibility criteria included recurrent and/or metastatic, histologically proven SCC of the oropharynx, oral cavity, hypopharynx or larynx; PS 0-1; adequate organ function; no suitable local therapy for R/M SCCHN; and no prior systemic chemotherapy for R/M SCCHN. Chemotherapy consisted of paclitaxel 100mg/m² on days 1, 8; carboplatin AUC 2.5 on days 1, 8, repeated every 3 weeks for up to 6 cycles; and cetuximab at an initial dose of 400mg/m², followed by 250mg/m² weekly until disease progression or unacceptable toxicities. Primary endpoint was overall response rate (ORR). Secondary endpoints were safety, treatment completion rate, progression-free survival, overall survival, and clinical benefit rate. Planned sample size was 45 patients.

Results

Forty-seven subjects were accrued from July 2013 to Oct 2014. Of 45 evaluable, 40 were male; median age was 63 years; ECOG PS was 0/1 in 23/22 cases; site was the hypopharynx/oropharynx/oral cavity/larynx in 17/11/10/7 cases; and 36/9 cases were smokers/non-smokers, respectively. ORR, the primary end point, was 40%. Median overall survival was 14.7 months and progression-free survival was 5.2 months. Grade 3/4 adverse events included neutropenia (68%), skin reaction (15%), fatigue (9%) and febrile neutropenia (9%). A potentially treatment-related death occurred in one patient with intestinal pneumonia.

Conclusions

The PCE regimen shows promising activity with acceptable toxicity in the outpatient clinic. Further studies are needed to compare PCE with PFE in this population.

Registered clinical trial numbers

UMIN000010507

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BNuHiY

Impact of genomic alterations on lapatinib treatment outcome and cell-free genomic landscape during HER2 therapy in HER2-positive gastric cancer patients

Abstract

Background

To identify predictive markers for responders in lapatinib-treated patients and to demonstrate molecular changes during lapatinib treatment via cell-free genomics.

Patients and Methods

We prospectively evaluated the efficacy of combining lapatinib with capecitabine and oxaliplatin as first line neoadjuvant therapy in patients with previously untreated, HER2-overexpressing advanced gastric cancer (AGC). A parallel biomarker study was conducted by simultaneously performing immunohistochemistry (IHC) and next-generation sequencing with tumor and blood samples.

Results

Complete response (CR) was confirmed in 7/32 patients (21.8%), 2 of whom received radical surgery with pathologic-confirmed CR. Fifteen partial responses (46.8%) were observed, resulting in a 68.6% overall response rate. Next-generation sequencing (NGS) of the 16 tumor specimens demonstrated that the most common co-occurring copy number alteration was CCNE1 amplification, which was present in 40% of HER2-positive tumors. The relationship between CCNE1 amplification and lack of response to HER2 targeted therapy trended toward statistical significance (66.7% of non-responders versus 22.2% of responders harbored CCNE1 amplification; p = 0.08). Patients with high level ERBB2 amplification by NGS were more likely to respond to therapy, compared to patients with low level ERBB2 amplification (p = 0.02). Analysis of cfDNA showed that detectable ERBB2 copy number amplification in plasma was predictive to the response (100%, response rate) and changes in plasma-detected genomic alterations were associated with lapatinib sensitivity and/or resistance. The follow-up cfDNA genomics at disease progression demonstrated that there are emergences of other genomic aberrations such as MYC, EGFR, FGFR2 and MET amplifications.

Conclusions

The present study showed that HER2+ GC patients respond differently according to concomitant genomic aberrations beyond ERBB2, high ERBB2 amplification by NGS or cfDNA can be a positive predictor for patient selection, and tumor genomic alterations change significantly during targeted agent therapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nyCltl

A rotation flap does not rotate

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BOczW6

Intermittent Catheterization: The Devil Is in the Details

Journal of Neurotrauma , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nw2GYK

Alterations of the Gut Microbiota in Hashimoto's Thyroiditis Patients

Thyroid , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2E9IbdZ

Issue Information

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BO7Jbo

Preexisting cognitive impairment in intracerebral hemorrhage: Methodological issues

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nvYuIu

Cover Image

The cover image, by C. Hedberg-Oldfors et al., is based on the Original Article Polyglucosan myopathy and functional characterization of a novel GYG1 mutation, DOI: 10.1111/ane.12865.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BNU2ZV

Response to the letter by Safiri et al

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nw72yY

Schottenfeld and Fraumeni Cancer Epidemiology and Prevention, Fourth Edition Oxford University Press, (2018).

Publication date: Available online 1 February 2018
Source:Cancer Epidemiology
Author(s): Freddy Sitas




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rZwSAb

Exploring Sleep Quality of Young Children with Autism Spectrum Disorder and Disruptive Behaviors

Publication date: Available online 1 February 2018
Source:Sleep Medicine
Author(s): Cynthia R. Johnson, Tristam Smith, Alexandra DeMand, Luc Lecavalier, Victoria Evans, Matthew Gurka, Naomi Swiezy, Karen Bearss, Lawrence Scahill
Backgroundand purpose: Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning and add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances.Participants and methodsParticipants were 177 with complete data of 180 children (mean age 4.7) with ASD who had participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into "poor sleepers" (upper quartile on the total score of the CSHQ-ASD) and "good sleepers" (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress.ResultsThe two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress.ConclusionsThe finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents. .



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EyAoEv

MicroRNA-1246 is an exosomal biomarker for aggressive prostate cancer

Due to high heterogeneity, molecular characterization of prostate cancer (PCa) based on biopsy sampling is often challenging. Hence, a minimally invasive method to determine the molecular imprints of a patient's tumor for risk stratification would be advantageous. In this study, we employ a novel, digital amplification-free quantification method using the nCounter technology (Nanostring Technologies) to profile exosomal serum miRNAs (ex-miRNA) from aggressive PCa cases, benign prostatic hyperplasia (BPH), and disease-free controls. We identified several dysregulated miRNAs, one of which was the tumor suppressor miR-1246. miR-1246 was downregulated in PCa clinical tissues and cell lines and was selectively released into exosomes. Overexpression of miR-1246 in a PCa cell line significantly inhibited xenograft tumor growth in vivo and increased apoptosis and decreased proliferation, invasiveness, and migration in vitro. miR-1246 inhibited N-cadherin and vimentin activities, thereby inhibiting epithelial-mesenchymal transition. Ex-miR-1246 expression correlated with increasing pathological grade, positive metastasis, and poor prognosis. Our analyses suggest ex-miR-1246 as a promising PCa biomarker with diagnostic potential that can predict disease aggressiveness.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GFg3ha

Stapedectomy Versus Stapedotomy

Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates. Modified stapes mobilization procedures may represent the next major development in stapes surgery in a selected patient population.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GGdMlM

Pretreatment with minocycline improves neurogenesis and behavior performance after midazolam exposure in neonatal rats

Laboratory studies suggested that general anesthetics induce neuroapoptosis and inhibit neurogenesis in developing brains of animals. Minocycline exerts neuroprotection against a wide range of toxic insults in neurodegenerative diseases models. Here, we investigate whether minocycline can alleviate neurogenetic damage and improve cognition following midazolam exposure in neonatal rats. Postnatal 7 days rats were divided randomly into three groups: control group (C), midazolam group (M), and minocycline pretreatment group (MP). After exposure to midazolam, the cell proliferation in the subventricular zone (SVZ) and the subgranular zone (SGZ) of the hippocampus in pups was analyzed by bromodeoxyuridine immunochemistry at 7 days after the administration of anesthesia. Cognitive function was assessed using the Morris water-maze test at 35 days after midazolam exposure. Compared with the control, midazolam reduced cell proliferation both in the SVZ and in the SGZ of the hippocampus of neonatal rats, and decreased spatial learning and memory ability of rats in adulthood significantly. Pretreatment with minocycline increased cell proliferation both in the SVZ and in the SGZ of the hippocampus and improved spatial learning and memory ability compared with midazolam, but it did not mitigate the changes to the normal levels compared with the controls. Our results indicated that pretreatment with minocycline can alleviate midazolam-induced damage in neural stem cell proliferation of neonatal rats and improve spatial learning and memory ability of rats in adulthood.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ew7SD9

Abnormalities of P300 before and after antidepressant treatment in depression: an ERP-sLORETA study

Despite a wide range of reports on depression-induced P300 changes, it is still debatable whether P300 can return to a pattern characteristic of healthy individuals following antidepressant treatment. Thus, the present study aims to compare P300 and its underlying neural activation in depressed patients before and after antidepressant treatment to explore the brain regions related to pathogenesis and to evaluate the prognosis after treatment. P300 was evoked by the oddball auditory paradigm and collected from 14 sex-matched, age-matched, and education level-matched patients and controls. P300 was also collected in the same patients after treatment. sLORETA was used to explore the source activation of P300 components. Depressed patients before and after antidepressant treatment tended to show lower P300 amplitudes compared with healthy controls, and their P300 amplitudes of F3 electrodes were correlated negatively to their scores on the 24-item Hamilton Depression Rating Scale, the Snaith-Hamilton Pleasure Scale, and the nine-item Patient Health Questionnaire. P300 amplitudes of P4 electrodes were correlated negatively with their scores on the Dysfunctional Attitude Scale. P300 source activation of depressed patients before antidepressant treatment was reduced in the left superior parietal lobule and the precuneus compared with healthy controls and depressed patients after treatment. No difference was found between healthy controls and depressed patients after treatment. The left superior parietal lobule and the precuneus might be therapeutic targets of depression.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ew7C79

Inhibition of myeloperoxidase by N-acetyl lysyltyrosylcysteine amide reduces experimental autoimmune encephalomyelitis-induced injury and promotes oligodendrocyte regeneration and neurogenesis in a murine model of progressive multiple sclerosis

It is known that oxidative stress produced by proinflammatory myeloid cells plays an important role in demyelination and neuronal injury in progressive multiple sclerosis (MS). Myeloperoxidase (MPO) is a pro-oxidative enzyme released from myeloid cells during inflammation. It has been shown that MPO-dependent oxidative stress plays important roles in inducing tissue injury in many inflammatory diseases. In this report, we treated NOD experimental autoimmune encephalomyelitis (EAE) mice, a murine model of progressive MS, with N-acetyl lysyltyrosylcysteine amide (KYC), a novel specific MPO inhibitor. Our data showed that KYC treatment not only attenuated MPO-mediated oxidative stress but also reduced demyelination and axonal injury in NOD EAE mice. More importantly, we found that KYC treatment increased oligodendrocyte regeneration and neurogenesis in NOD EAE mice. Taken together, our data suggests that targeting MPO should be a good therapeutic approach for reducing oxidative injury and preserving neuronal function in progressive MS patients.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DVFb1o

Difference in phase modulation of corticospinal excitability during the observation of the action of walking, with and without motor imagery

The aim of the current study was to clarify how corticospinal excitability (CSE) is modulated during the observation of the action of walking, combined with motor imagery (MI). We examined the difference in phase modulation of CSE with and without MI during the observation of the action of walking. We measured motor-evoked potentials in tibialis anterior and soleus muscles using transcranial magnetic stimulation under the following conditions: (1) baseline, (2) action observation (AO), and (3) AO and MI. Our results showed that, compared with AO alone, AO and MI of walking increased motor-evoked potentials. Our results suggest that CSE may be facilitated during AO and MI of walking, rather than during AO alone. Further, we postulated that AO and MI of walking may facilitate CSE in the tibialis anterior in a manner such as that evoked during actual walking.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExThaE

Mirror imaging of finger mechanical stimulation affects secondary somatosensory response

The aim of this study was to investigate the effect of finger-tip touch on the somatosensory cortex under mirror imaging conditions. Magnetoencephalographic recordings of somatosensory-evoked field responses to mechanical tactile stimulation of the index finger in both hands were obtained for the right-handed healthy participants as part of the following mirror or nonmirror tasks. Both hands were screened and mechanical stimuli were delivered to the right index finger pulp. A mirror was placed in front of the patient with the right hand facing the reflective surface, as if it were the left side (mirror task). Another task comprised the screening of right hands behind a partition, after which mechanical stimuli were delivered to the right index finger pulp without a mirror (nonmirror task). The same tasks for the left hand were also examined. The estimated current dipoles were identified and analyzed. In the measurements following all the tasks, the equivalent current dipoles (ECDs) were estimated in the corresponding contralateral primary somatosensory area (cSI). The other ECDs were estimated in the secondary somatosensory area both contralateral (cSII) and ipsilateral (iSII) to the stimulus side. The amplitudes of ECDs in the cSII area following the left index stimuli in the mirror task were significantly larger than those in the nonmirror task (P=0.043). The mirror effect on the somatosensory cortex in this study may be small, but a positive variation was shown in the form of a response to the actual stimulation in the hand opposite to the hand which was hidden behind the mirror.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUnkYV

Expression of tissue inhibitor of metalloproteinases and matrix metalloproteinases in the ischemic brain of photothrombosis model mice

Middle cerebral artery occlusion (MCAO) is the most widely used animal model of ischemic stroke. This model well recapitulates the pathological features of most human cases; however, MCAO is technically difficult to achieve in mice and has some disadvantages for investigating the molecular mechanisms of pathological progression in stroke. The recently developed photothrombosis model may be more suitable for research on the molecular mechanisms of ischemic stroke in mice. Yet, similarities and differences between the photothrombosis and MCAO models are not well characterized. In the present study, we examined the expression of tissue inhibitor of metalloproteinases (TIMPs) and matrix metalloproteinases (MMPs) in the brains of photothrombosis model mice. Our results indicated that the gene expression of TIMP-1 was upregulated in endothelial cells in the pathological area surrounding the infarction, similar to the MCAO model. Yet, pathologically induced changes in TIMP-1 were not affected by treatment with aspirin or etodolac. Whereas MMP-2 and MMP-8 mRNA were upregulated after infarction in both models, MMP-9 expression, which is induced in the infarct area in the MCAO model, was unchanged in the photothrombosis model. These findings suggest that the expression patterns of TIMP-1 and MMP-9 are regulated independently in photothrombosis model mice.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EzWDda

Efficacy of tenuigenin and β-asarone as augmentations for memantine in the treatment of Alzheimer’s disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease that has no cure at present. This study was carried out to evaluate whether the combination of β-asarone and tenuigenin could improve the efficacy of memantine as a monotherapy in the treatment of AD. Patients with AD were recruited and assigned to two groups. Patients in the control group received memantine (5–20 mg/day) and those in the experimental group received memantine (5–20 mg/day), β-asarone (20 mg/day), and tenuigenin (20 mg/day). The Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Clinical Dementia Rating Scale (CDR) scores and drug-related side-effects were assessed. Treatment was continued for 12 weeks. In total, 93 AD patients (45 in the control group and 48 in the experimental group) were recruited. Before treatment, both the groups had similar average MMSE scores, ADL scores, and CDR scores, whereas all the average scores improved significantly after treatment. However, compared with the control group, the experimental group had a significantly higher average MMSE score (P=0.00001) and lower average ADL (P=0.00604) and CDR (P=0.00776) scores after treatment. Moreover, the two groups had similar rates of drug-related side-effects. These results indicated that the combination of β-asarone and tenuigenin was an effective augmentation for memantine in the treatment of AD and did not cause more drug-related side-effects. This novel method is worthy of further investigation.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DSUND2

Electrophysiological evidence of language switching for bidialectals: an event-related potential study

Language switching is an important issue in the study of bilinguals. However, how the nontarget language affects the production of the target language under the language switch condition is still unclear, especially for bilinguals who speak two dialects (bidialectals). In the present study, we investigate this issue by a picture-naming task and using an event-related potential (ERP) technique. Two groups of proficient bidialectals, Mandarin (L1)–Cantonese (L2) and Cantonese (L1)–Mandarin (L2), participated in the study. They were required to name pictures with Mandarin or Cantonese under language switching conditions and language nonswitching conditions. The results showed that participants of both groups showed significant longer reaction time, larger P200, and smaller N400 under language switching conditions than that under language nonswitching conditions, which reflects the language switching costs. Moreover, participants of the two groups showed different P200 and N400 between Mandarin–Cantonese (MC) switching conditions and Cantonese–Mandarin (CM) switching conditions. Specifically, MC bidialectals showed larger P200 under the CM condition than that under the MC condition, whereas CM bidialectals showed an opposite P200 pattern (CM conditionCM condition). These findings supported the language-unspecific selection theory. Overall, our study is the first to provide electrophysiological evidence of language switching between two dialects.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EuMCOd

The change of motor cortical excitability between eyes open and closed conditions

The effect of the eyes closed and eyes open states on transcranial magnetic stimulation (TMS)-induced motor cortex response remains unclear. This study evaluated the difference in TMS-induced motor cortical responses between the eyes open and eyes closed states. Ten healthy right-handed participants participated in three experiments. The stimulation–response curve of motor-evoked potential, short-interval intracortical inhibition, intracortical facilitation, and cortical silent period were determined in both the eyes open and eyes closed states, in random order. The order of performance of the eyes open and eyes closed states was also random. The stimulation–response curve obtained in the eyes open state was steeper than that obtained in the eyes closed state. The resting and active motor thresholds, cortical silent period, short-interval intracortical inhibition, and intracortical facilitation were similar in the eyes open and eyes closed states. These data demonstrate that the eyes closed state may affect the recruitment of cortical circuits and thus diminish the TMS-evoked motor output.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DTx5X8

Spinal manipulative therapy reduces peripheral neuropathic pain in the rat

Spinal manipulative therapy, including low-velocity variable-amplitude spinal manipulation (LVVA-SM), relieves chronic low back pain, especially in patients with neuropathic radiating leg pain following peripheral nervous system insult. Understanding the underlying analgesic mechanisms requires animal models. The aim of the current study was to develop an animal model for the analgesic actions of LVVA-SM in the setting of peripheral neuropathic pain. Adult male Sprague-Dawley rat sciatic nerve tibial and common peroneal branches were transected, sparing the sural branch (spared nerve injury, SNI). After 15–18 days, rats were assigned randomly to one of three groups (n=9 each group): LVVA-SM at 0.15-or 0.16-Hz or Control. LVVA-SM (20° flexion at the L5 vertebra with an innovative motorized treatment table) was administered in anesthetized rats for 10 min. Control rats were administered anesthesia and positioned on the treatment table. After 10, 25, and 40 min, the plantar skin of the hindpaw ipsilateral to SNI was tested for mechanical sensitivity (paw withdrawal threshold to a logarithmic series of Semmes–Weinstein monofilaments) and cold sensitivity (duration of paw lifting, shaking, and/or licking to topical acetone application). SNI produced behavioral signs of mechanical and cold allodynia. LVVA-SM reduced mechanical, but not cold, hypersensitivity compared with Control (0.15-Hz: P=0.04 at 10 min; 0.16-Hz: P

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExT5rW

Reliable new measures capturing low-frequency fluctuations from resting-state functional MRI

Resting-state functional MRI (rsfMRI) is one of the most important neuroimaging modalities for investigating alterations in the resting-state networks of the human brain, given that abnormal neural activity during the resting state is associated with neurological disorders. However, neuroimaging results obtained from rsfMRI have rarely been replicated with repeated measurements. Therefore, we aimed to develop new measures to extract highly reliable and reproducible functional neuroimaging metrics from rsfMRI data. Preprocessed rsfMRI data from 30 patients with 10 sessions of rsfMRI scans taken within 1 month were obtained from the Consortium for Reliability and Reproducibility. We developed a time-domain measure to capture low-frequency fluctuation (LFF) using a general linear model with three different periodic regressors: boxcar, triangular, and sinusoidal functions. Then, test–retest reliability for the proposed methods was evaluated using the intraclass correlation (ICC). Our approaches for evaluating LFF from rsfMRI data significantly identified the default mode network areas (corrected P

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExSt5C

Macroscopic and microscopic diversity of missplicing in the central nervous system of patients with myotonic dystrophy type 1

Myotonic dystrophy type I (DM1) is a multiorgan disease caused by CTG-repeat expansion in the DMPK gene. Sequestration of the splicing factor MBNL1 results in aberrant splicing in many genes in DM1 skeletal muscle, whereas MBNL2 plays a leading role in missplicing in the central nervous system (CNS) of patients with DM1. Splicing misregulation of most MBNL2-regulated genes occurs in the temporal cortex but not in the cerebellum of autopsied patients with DM1. To understand the diversity at macroscopic and microscopic levels in CNS of patients with DM1. Using autopsied brain tissues, we examined alternative splicing ratios of MBNL2-regulated genes and expression levels of potential splicing factors. We found differences in splicing abnormalities among tested regions of the CNS from patients with DM1. In the frontal and temporal cortices and the hippocampus, many genes were aberrantly spliced, but severity differed among the brain regions. By contrast, there were no significant differences in the ratio of splicing variants for most of the genes in the cerebellar cortex and spinal cord between DM1 and control samples. We failed to find any change in the amount of potential factors (MBNL and CUGBP proteins and DMPK mRNA) which explain the modest missplicing in the cerebellum. LASER capture microdissection demonstrated splicing misregulation in the molecular layer of the cerebellum but not in the granular layer. This is the first study to reveal missplicing in a functional cell layer of DM1 and to compare splicing misregulation in a wide region of the CNS using statistical analysis.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DVY30b

Radiomic Biomarkers to Refine Risk Models for Distant Metastasis in HPV-related Oropharyngeal Carcinoma

Publication date: Available online 1 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jennifer Yin Yee Kwan, Jie Su, Shao Hui Huang, Laleh S. Ghoraie, Wei Xu, Biu Chan, Kenneth W. Yip, Meredith Giuliani, Andrew Bayley, John Kim, Andrew J. Hope, Jolie Ringash, John Cho, Andrea McNiven, Aaron Hansen, David Goldstein, John de Almeida, Hugo J. Aerts, John N. Waldron, Benjamin Haibe-Kains, Brian O'Sullivan, Scott V. Bratman, Fei-Fei Liu
PurposeDistant metastasis (DM) is the main cause of death for patients with human papillomavirus (HPV)-related oropharyngeal cancers (OPC); yet there are few reliable predictors of DM in this disease. The role of quantitative imaging (i.e. radiomic) analysis was examined to determine whether there are primary tumor features discernible on imaging studies that associate with a higher risk of developing DM.MethodsRadiotherapy planning CT scans were retrieved for all non-metastatic p16-positive OPC patients treated with radiotherapy or chemoradiotherapy at a single institution between 2005 and 2010. Radiomic biomarkers were derived from each gross tumor volume (GTV). Biomarkers included four representative radiomic features from tumor first order statistics, shape, texture, and wavelet groups as well as a combined four-feature signature. Univariable Cox proportional hazards models for DM risk were identified. Discriminative performance of prognostic univariable and multivariable models was compared using the concordance index (C-index). Subgroup analyses were performed.ResultsThere were 300 HPV-related OPC patients who were eligible for the analysis. A total of 36 DM events occurred within a median follow-up of five years. On univariable analysis, top results included the four representative radiomic features (C-index=0.670-0.686; p<0.001), the radiomic signature (C-index=0.670; p<0.001), tumor stage (C-index=0.633; p<0.001), tumor diameter (C-index=0.653; p<0.001), and tumor volume (C-index=0.674; p<0.001); which demonstrated moderate discrimination of DM risk. Combined clinical-radiomic models yielded significantly improved performance (C-index=0.701-0.714; p<0.05). In subgroup analyses, the radiomic biomarkers consistently stratified patients for DM risk, particularly for those cohorts with greater risks (C-index=0.663-0.796), such as patients with stage III disease.ConclusionsRadiomic biomarkers appear to classify DM risk for patients with non-metastatic HPV-related OPC. Radiomic biomarkers could be used either alone or with other clinical characteristics in assignment of DM risk in future HPV-related OPC clinical trials.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nz4wXX

The impact of HIV infection on survival and acute toxicities from chemoradiation therapy for cervical cancer patients in a limited resource setting

Publication date: Available online 1 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Surbhi Grover, Memory Bvochora-Nsingo, Alyssa Yeager, Sebathu Chiyapo, Rohini Bhatia, Emily MacDuffie, Priya Puri, Dawn Balang, Sarah Ratcliffe, Mohan Narasimhamurthy, Elliphine Gwangwava, Sylvia Tsietso, Mukendi K.A. Kayembe, Doreen Ramogola-Masire, Scott Dryden-Peterson, Umesh Mahantshetty, Akila N. Viswanathan, Nicola M. Zetola, Lilie L. Lin
PurposeCervical cancer is the leading cause of cancer death for women in sub-Saharan Africa. Human immunodeficiency virus (HIV) infection increases the risk of cervical cancer. However, prospective data on the outcomes of cervical cancer patients with HIV infection treated with curative intent are limited.MethodsWomen with locally advanced cervical cancer with or without HIV infection initiating radical chemoradiation therapy (CRT) in Botswana were enrolled in a prospective observational cohort study from July 2013 through January 2015.ResultsOf 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study. Eighty-five percent of the participants (122/143) had stage II/III cervical cancer, and 67% (96/143) were HIV-infected. All HIV-infected patients were on anti-retroviral treatment (ART) at the time of curative cervical cancer treatment initiation. We found no difference in toxicities between HIV-infected and HIV-uninfected women. The two-year overall survival (OS) rates were 65% for HIV-infected women (95% confidence interval [CI] 54-74%) and 66% for HIV-uninfected women (95% CI 49-79%) (p=0.70). Factors associated with better two-year OS on multivariate analyses included baseline hemoglobin >10 g/dL (hazard ratio [HR] 0.37, 95% CI 0.19-0.72, p=0.003), total radiation dose ≥75 Gy (HR 0.52, 95% CI 0.27-0.97, p=0.04), and age <40 years vs. 40-59 years (HR 2.17, 95% CI 1.05-4.47, p=0.03).ConclusionsHIV status had no effect on two-year OS or on acute toxicities in women with well-managed HIV infection who initiated curative CRT in Botswana. In our cohort, we found that baseline hemoglobin levels, total radiation dose, and age were associated with survival, regardless of HIV status.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DTfFhi

Effect of Radiation Treatment Volume Reduction on Lymphopenia in Patients Receiving Chemoradiotherapy for Glioblastoma

Publication date: Available online 1 February 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Soumon Rudra, Caressa Hui, Yuan Rao, Pamela Samson, Alexander Lin, Xiao Chang, Christina Tsien, Sandra Fergus, Dan Mullen, Deshan Yang, Dinesh Thotala, Dennis Hallahan, Jian Li Campian, Jiayi Huang
ObjectiveAcute severe lymphopenia (ASL) in glioblastoma (GBM) patients after radiation therapy (RT) and concurrent temozolomide (TMZ) predicts for poorer overall survival (OS). This study aims to evaluate whether reduction in radiation treatment volume can reduce risk of ASL.MethodsA total of 210 patients with supratentorial/non-metastatic GBM were treated with RT+TMZ from 2007-2016 and had laboratory data on total lymphocyte counts (TLC). Before 2015, 164 patients were treated with standard-field RT (SFRT), and limited-field RT (LFRT) was implemented thereafter for 46 patients to reduce treatment volume. TLCs were evaluated at baseline, during RT, and at approximately week 12 from initiating RT. ASL was defined as any TLC<500 cells/μL within 3 months (by week 12) of initiating RT. Multivariate analysis (MVA) for OS was performed with Cox regression and with logistic regression for ASL. Propensity-score matching was performed to adjust for variability between cohorts. ASL, progression-free survival (PFS), and OS were compared using Kaplan-Meier method.ResultsLFRT patients had higher gross tumor volume (GTV) than SFRT patients yet lower brain dose-volume parameters including volume receiving 25Gy (V25Gy: 41% vs 53%, respectively, P<0.01). TLC at week 12 was significantly higher for LFRT than SFRT (median: 1100 cells/μL vs. 900 cells/μL, respectively, P=0.02). On MVA, ASL was an independent predictor of OS, and brain V25Gy was an independent predictor of ASL. ASL rate at 3 months was 15.5% for LFRT and 33.8% for SFRT (P=0.12). In a propensity-matched comparison of 45 pairs of LFRT and SFRT patients, PFS (median: 5.9 vs 6.2 months, respectively, P=0.58) and OS (median: 16.2 vs 13.9 months, respectively, P=0.69) were not significantly different.ConclusionLFRT is associated with less lymphopenia after RT+TMZ and does not adversely affect PFS or OS. Brain V25Gy is confirmed as an important dosimetric predictor for ASL.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nAMd4L

Corrigendum to “Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology” [Br J Oral Maxillofac Surg 2017;55(November (9)):946–51]

The authors regret missing the below supplementary video clip from their above referenced manuscript.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUlcAp

Report of transient events in a cocaine-dependent volunteer who received iTBS

Publication date: Available online 31 January 2018
Source:Brain Stimulation
Author(s): Vaughn R. Steele, Andrea M. Maxwell, Thomas J. Ross, Khaled Moussawi, Osama O. Abulseoud, Elliot A. Stein, Betty Jo Salmeron




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GB3t2y

Pallidal deep brain stimulation modulates excessive cortical high β phase amplitude coupling in Parkinson disease

Publication date: Available online 31 January 2018
Source:Brain Stimulation
Author(s): Mahsa Malekmohammadi, Nicholas AuYong, Joni Ricks-Oddie, Yvette Bordelon, Nader Pouratian
ObjectiveDeep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) are equally efficacious in the management of Parkinson disease (PD). Studies of STN-DBS have revealed a therapeutic reduction in excessive cortical β-γ phase-amplitude coupling (PAC). It is unclear whether this is specific to STN-DBS and potentially mediated by modulation of the hyperdirect pathway or if it is a generalizable mechanism seen with DBS of other targets. Moreover, it remains unclear how cortical signals are differentially modulated by movement versus therapy. To clarify, the effects of GPi-DBS and movement on cortical β power and β-γ PAC were examined.MethodsRight sensorimotor electrocorticographic signals were recorded in 10 PD patients undergoing GPi-DBS implantation surgery. We evaluated cortical β power and β-γ PAC during blocks of rest and contralateral hand movement (finger tapping) with GPi-DBS off and on.ResultsMovement suppressed cortical low β power (P = 0.008) and high β-γ PAC (P = 0.028). Linear mixed effect modeling (LMEM) showed that power in low and high β bands are differentially modulated by movement (P = 0.022). GPi-DBS also results in a significant suppression of high β-γ PAC but without power modulation in either β sub-band (P = 0.008). Cortical high β-γ PAC is significantly correlated with severity of bradykinesia (Rho = 0.59, P = 0.045) and changes proportionally with therapeutic improvement (Rho = 0.61, P = 0.04).ConclusionsSimilar to STN-DBS, GPi-DBS reduces motor cortical β-γ PAC, like that also reported with dopaminergic mediations, suggesting it is a generalizable symptom biomarker in PD, independent of therapeutic target or proximity to the hyperdirect pathway.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2s0GQRP

Post-operative deep brain stimulation assessment: Automatic data integration and report generation

Publication date: Available online 1 February 2018
Source:Brain Stimulation
Author(s): Andreas Husch, Mikkel V. Petersen, Peter Gemmar, Jorge Goncalves, Niels Sunde, Frank Hertel
BackgroundThe gold standard for post-operative deep brain stimulation (DBS) parameter tuning is a monopolar review of all stimulation contacts, a strategy being challenged by recent developments of more complex electrode leads.ObjectiveProviding a method to guide clinicians on DBS assessment and parameter tuning by automatically integrating patient individual data.MethodsWe present a fully automatic method for visualization of individual deep brain structures in relation to a DBS lead by combining precise electrode recovery from post-operative imaging with individual estimates of deep brain morphology utilizing a 7T-MRI deep brain atlas.ResultsThe method was evaluated on 20 STN DBS cases. It demonstrated robust automatic creation of 3D-enabled PDF reports visualizing electrode to brain structure relations and proved valuable in detecting miss placed electrodes.DiscussionAutomatic DBS assessment is feasible and can conveniently provide clinicians with relevant information on DBS contact positions in relation to important anatomical structures.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GEjxAF

Frequency of Breast Biopsies After Surgery? Finally, Answers

Remarkably, the medical literature has been unclear -- until now -- about how often patients treated for invasive breast cancer will need biopsies during follow-up.
Medscape Medical News

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GAsBXl

Breast Implants Tied to Increased Risk of Rare Blood Cancer

Women who get breast implants may be more likely to develop anaplastic large-cell lymphoma, a small Dutch study suggests.
Reuters Health Information

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nv3wFn

Steady Increase in Eyelid Cancer Found in England

Since 2000, the incidence of squamous cell carcinoma of the eyelid in England has increased by around 2% per year, with men affected nearly twice as often as women.
Medscape Medical News

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rFLc0u

Radiomics as a Quantitative Imaging Biomarker: Practical Considerations and the Current Standpoint in Neuro-oncologic Studies

Abstract

Radiomics utilizes high-dimensional imaging data to discover the association with diagnostic, prognostic, predictive endpoint or radiogenomics. It is an emerging field of study that potentially depicts the intratumoral heterogeneity from quantitative and classified high-throughput data. The radiomics approach has an analytic pipeline where the imaging features are extracted, processed and analyzed. At this point, special data handling is essential because it faces issues of a high-dimensional biomarker compared to a single biomarker approach. This article describes the potential role of radiomics in oncologic studies, the basic analytic pipeline and special data handling with high-dimensional data to facilitate the radiomics approach as a tool for personalized medicine in oncology.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DWJ6uM

Post-Operative Radiotherapy for Oral SCC with Histologic Risk Factors: Are We Over-Treating?

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Timothy Liu, Benjamin Chua, Martin Batstone
PurposeThe role of post-operative radiotherapy (PORT) remains controversial for patients with low-risk oral squamous cell carcinoma (OSCC) and adverse histologic features. The aim of this study is to examine the survival benefits in the role of PORT, when compared to surgery alone, among these patients.MethodsIn a systematic review, relevant published literature was identified in the PubMed database and eligible studies were included. Predictor variables were perineural invasion (PNI), lymphovascular invasion (LVI), and unfavourable grade. Primary outcomes were patient survival and recurrence rates. Due to the heterogeneity and insufficiency of the reported data, quantitative meta-analysis was precluded. Qualitative analysis and pooled analysis on overall survival (OS) were performed on study subjects.ResultsSix eligible studies were included with a median study period of 10 years. All studies evaluated the role of PORT in pN0 OSCC subjects with PNI, and three studies on subjects with PNI in isolation. Overall, study subjects had similar treatment outcomes between PORT and non-PORT groups. In the pooled analysis of 325 subjects, PORT was not associated with an improved OS compared to surgery alone (70.3 vs. 80.2%; p = 0.059).ConclusionNo evidence was found to support the application of PORT given the indication of histologic risk factors alone. The prescription of PORT for PNI, LVI, and unfavourable grading among otherwise low-risk OSCC needs to be approached with caution in order to avoid unnecessary harm of radiation exposure.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DU8wxf

Corrigendum to “Oral cancer-derived exosomal NAP1 enhances cytotoxicity of natural killer cells via the IRF-3 pathway” [Oral Oncol. 76 (2018) 34–41]

Publication date: Available online 1 February 2018
Source:Oral Oncology
Author(s): Yingnan Wang, Xing Qin, Xueqin Zhu, Wanjun Chen, Jianjun Zhang, Wantao Chen




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nAze31

Allogeneic Stem-Cell Transplantation — A T-Cell Balancing ACT

Success in the bone marrow transplantation clinic has always depended on scientific discovery. Before the discovery of histocompatibility antigens, for example, allogeneic hematopoietic stem-cell transplantation (HSCT) was uniformly fatal as a result of overwhelming immunologic catastrophe and…

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GF06I4

eNOS Uncoupling, A Therapeutic Target For Ischemic Foot of Diabetic Rat

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-124763

Aim To determine the relationship between eNOS uncoupling and diabetic ischemic foot and whether reversing eNOS uncoupling by Dihydrofolate reductase (DHFR) transfection or folic acid (FA) supplementation can be beneficiary in diabetic ischemic foot. Methods The bilateral common iliac artery of diabetic rats were ligated to establish the diabetic ischemic foot animal model. DHFR transfection was implemented via femoral artery and muscle injection of in vivo transfection reagent mixture (GenEscortIII) every 4 days during the 2 weeks intervention. The color doppler flow imaging (CDFI) of femoral artery for RI measurement, triceps and quadriceps structure and histology, eNOS coupling status, DHFR expression level, superoxide, peroxynitrite (ONOO– ) and nitric oxide (NO) production in the presence or absence of L-NAME (eNOS inhibitor) were examined among wild type rats (WT), diabetic sham rats (DM), rats of diabetic ischemic foot (DF) or DF with DHFR transfection (DFT) or DF with FA supplementation (DFF). Results Dihydroethidium (DHE) fluorescence, as an index of superoxide production was enhanced in the femoral arteries of diabetic rats and even more in those of ischemic foot from diabetic rats. However, the DHE fluorescence was diminished in the presence of L-NAME suggesting eNOS uncoupling is the source of superoxide overproduction which further led to increased peroxynitrite production and decreased NO. bioavailability. Subsequently, the hind limb muscle became atrophic and the local collateral circulation was defective due to endothelial dysfunction related to eNOS uncoupling. However, all of the above and hemodynamic index (RI) of femoral artery were resumed via restoration of DHFR protein expression by folic acid treatment or DHFR transfection. Conclusions eNOS uncoupling is involved in diabetic ischemic foot due to DHFR suppression. DHFR restoration can reverse eNOS uncoupling and resume the endothelial dysfunction and pathological changes (increased vasculature resistance, hind limb muscle atrophy and defective collateral circulation) associated with eNOS uncoupling in diabetic ischemic foot. All of which enlightens a novel therapeutic strategy for future diabetic ischemic foot treatments.
[...]

© 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/2nuTrs1

Should platelet-rich plasma be activated in fat grafts? An animal study

The adjunction of platelet-rich plasma with graft fat has been the subject of a few clinical trials which have demonstrated its value in adipocyte survival. The aim of this study was to assess the different efficacies between activated and non-activated PRP on adipose cells in vitro and for adipose tissue graft survival in vivo.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BO4tfX

Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method

EEG-reactivity (EEG-R) has been defined as a change in EEG activity to stimulation (Hirsch et al., 2013). The most well-known type of EEG-R is the blocking of alpha activity to eye opening, which is most often present in healthy subjects. EEG-R is regarded as an important prognostic marker in comatose patients. In several studies, EEG-R predicts the comatose patient's awakening and recovery. This has been shown in patients with cardiac arrest (Wennervirta et al., 2009; Crepeau et al., 2013; Sandroni et al., 2013), after severe brain injury (Logi et al., 2011) and in ICU patients who are comatose due to anoxia, trauma, metabolic or infectious diseases (Young et al., 1999).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2s0UBzR

One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Christianto, A. Lau, K.Y. Li, W.F. Yang, Y.X. Su
Venous compromise is still the most common cause of free flap failure. The use of two venous anastomoses has been advocated to reduce venous compromise. However, the effectiveness of this approach remains controversial. A systematic review and cumulative meta-analysis was performed to assess the effect of one versus two venous anastomoses on venous compromise and free flap failure in head and neck microsurgical reconstruction. A total of 27 articles reporting 7389 flaps were included in this study. On comparison of one versus two venous anastomoses, the odds ratio (OR) for flap failure was 1.66 (95% confidence interval 1.11–2.50; P=0.014) and for venous compromise was 1.50 (95% confidence interval 1.10–2.05; P=0.011), suggesting a significant increase in the flap failure rate and venous compromise rate in the single venous anastomosis group. These results show that the execution of two venous anastomoses has significant effects on reducing the vascular compromise and free flap failure rate in head and neck reconstruction.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BOHly0

Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Saenthaveesuk, S.-e. Zhang, G.-s. Zheng, Y.-j. Liang, Y.-x. Su, G.-q. Liao
The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. Sensory-motor functions of the upper arm donor site were recorded before and after surgery. Four flaps were successfully transferred. One flap was abandoned during surgery because of a lack of perforators, and a forearm flap was used instead. All patients survived without loco-regional recurrence or distant metastasis. Functional outcomes, especially swallowing and speech, were satisfactory. The donor site scar was well hidden, with no functional impairment. This initial experience shows that the medial upper arm free flap represents an alternative perforator flap for oral cavity microsurgical reconstruction. The well-hidden scar and better texture match compared with other flaps make it suitable for oral cavity reconstruction.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nqjoJe

EGFR amplification and expression in oral squamous cell carcinoma in young adults

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V. Costa, L.P. Kowalski, C.M. Coutinho-Camillo, M.D. Begnami, V.F. Calsavara, J.I. Neves, E. Kaminagakura
The aim of this study was to investigate epidermal growth factor receptor (EGFR) gene alterations in two groups of patients with oral squamous cell carcinoma (OSCC) (a test group of subjects aged ≤40 years and a control group of subjects aged ≥50 years) and to associate the results with EGFR immunostaining, clinicopathological features, and the prognosis. Sixty cases of OSCC were selected (test group, n=21; control group, n=39). The tissue microarray technique was applied to ensure the uniformity of results. Gene amplification was analyzed by fluorescence in situ hybridization (FISH), and immunohistochemical staining for EGFR was analyzed using an automated imaging system. EGFR amplification was higher in the test group than in the control group (P=0.018) and was associated with advanced clinical stage (P=0.013), regardless of age. Patients with EGFR overexpression had worse survival rates, as did patients who had T3–T4 tumours and positive margins. EGFR overexpression has a negative impact on disease progression. Despite the higher amplification of EGFR in young adults, it does not significantly impact the survival rates of affected patients.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2BNpYxN

Setting the stage: Creating a social pragmatic environment for toddlers with ASD and their caregivers

Publication date: Available online 1 February 2018
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Pamela Rosenthal Rollins
Data from a 12-week randomized control trial of the Pathways Early Autism Intervention were analyzed. Pathways provides coaching to parents to facilitate early development of pragmatic skills for shared emotions with their toddlers. Thirty-four culturally and socioeconomically diverse toddlers with suspected or confirmed ASD were randomized into one of three groups: Pathways with an innovative protocol (IP) to facilitate social eye gaze, a similar intervention without the IP, and a business-as-usual group. Pre- and post-analyses of caregiver–child interactions and the Vineland Social subscale were used. A two-way mixed ANOVA tested response to treatment for the dependent variables. There was a significant group-by-time interaction for the sharing emotions measures of social eye gaze, F(2, 31)=7.34, p=.002, partial η²=.321, vocal-verbal reciprocity, F(2, 31)=3.753, p=.035, partial η²=.195; Vineland social, F(2, 31)=3.48, p=.043, partial η²=.183. Social eye gaze and Vineland scores favored the Pathways group, and vocal-verbal reciprocity favored Pathways and the intervention without the IP. There was a significant main effect of post-intervention Vineland social on pragmatic diversity, F(1, 30)=5.84, p=.022, partial η²=.163, and on rate of communication, F(1, 30)=5.63, p=.024, partial η²=.158. The Pathways group, with its protocol for social eye gaze, was more effective at facilitating the shared emotion skills than the other two groups, suggesting that eye gaze may be a pivotal skill for the development of early pragmatic skills in children with ASD.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2s0Oc80

La pragmática: un marco teórico para interpretar la comunicación

Publication date: Available online 1 February 2018
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ignasi Ivern




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GE5ZVF

Pragmática y desarrollo metalingüístico

Publication date: Available online 1 February 2018
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Ignasi Ivern
La pragmática constituye un marco teórico para interpretar la comunicación humana que en términos generales centra su atención en el estudio del uso del lenguaje de manera contextualizada. Entre otros aspectos, la pragmática está relacionada con las intuiciones e inquietudes de los hablantes sobre cómo deben usar el lenguaje. En toda conversación se da intrínsecamente reflexión metalingüística y metacomunicativa, de forma más o menos consciente y más o menos evidente. El objetivo de este artículo ha sido revisar el papel que desempeña la metacognición y algunas de las categorías metalingüísticas más significativas que por razones distintas indican mejor el nivel de desarrollo pragmático de los niños: la imitación y las autocorrecciones espontáneas. La perspectiva pragmática subraya la importancia que tiene para la adquisición del lenguaje aprender a captar la intencionalidad más allá de la literalidad de las palabras. En este sentido, los procesos metalingüísticos y metacognitivos son procesos recursivos que contribuyen a entender cómo llegamos a ser capaces de captar intenciones y compartir significados.Pragmatics provides a theoretical framework to interpret human communication, which generally focuses its attention on the study of contextualized use of language. Among other aspects, pragmatics is related to the intuitions and concerns of the speakers on how they should use the language. Intrinsically metalinguistic and metacommunicative reflection occurs in every conversation, in a more or less conscious and more or less evident manner. The aim of this article has been to review the role played by metacognition and some of the most significant metalinguistic categories that, for different reasons, better indicate the level of pragmatic development of children: Imitation and spontaneous self-corrections. Pragmatic perspective emphasizes the importance of learning to catch intentionality beyond the literality of words in the process of language acquisition. Metalinguistic and metacognitive processes are recursive processes that contribute to understand how we become capable of grasping intentions and sharing meanings.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2rZWnS6

Prevalencia de disfagia orofaríngea en ancianos institucionalizados y su relación con síndromes geriátricos

Publication date: Available online 1 February 2018
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Cristina Fernández-Getino Sallés
Antecedentes y objetivoLa disfagia orofaríngea es un síntoma, a menudo infravalorado, con una gran trascendencia clínica por las graves complicaciones que puede provocar. El objetivo general de este estudio es estimar la prevalencia de disfagia orofaríngea en adultos mayores institucionalizados y, específicamente, conocer su relación con síndromes geriátricos.Pacientes y métodoLa población de estudio estaba compuesta por 30 sujetos mayores de 80 años institucionalizados en una residencia geriátrica. Todas las variables analizadas se extrajeron de la valoración clínica multidisciplinar. Las herramientas de valoración usadas han sido el Mini-Nutritional Assessment^®, el Índice de Barthel, la Escala de depresión geriátrica, el Método de exploración clínica volumen-viscosidad y el Short Portable Mental Status Questionnaire. Los datos se han gestionado con SAS^® 9.4 y han sido importados desde la base de datos original en Excel mediante SAS^® Enterprise 6.1.ResultadosLa prevalencia de disfagia orofaríngea en esta población es de 41,5%. Existe una relación estadísticamente significativa entre el Índice de Barthel y la presencia de disfagia orofaríngea (p=.0279), al contrario del estado cognitivo (p=.8951), nutricional (p=.1470) o a la presencia de depresión (p=.999).ConclusionesLa disfagia orofaríngea es muy prevalente en ancianos institucionalizados. La situación funcional puede ser un factor de riesgo a padecer disfagia orofaríngea. La presencia de depresión no parece influir en la aparición de este síntoma. Se observa una tendencia a presentar disfagia orofaríngea cuando el estado cognitivo o nutricional es peor.Background and objectiveoropharyngeal dysphagia is often an underestimated symptom, with clinical significance because of the severe complications it may cause. The main objective of this project is to estimate the prevalence of oropharyngeal dysphagia among institutionalized elderly people and, specifically, to determine its relationship with geriatric syndromes or giants.Patients and methodthe study population was composed of 30 subjects older than 80 years institutionalized in a Nursing Home. All variables analyzed were obtained from a multidisciplinary clinical assessment. The assessment tools used were: the Mini-Nutritional Assessment^®, the Barthel Scale, the Geriatric Depression Scale, the Volume-Viscosity Swallow Test and the Short Portable Mental Status Questionnaire. The data were managed with SAS^® 9.4 and imported from the original database into Excel using SAS^® Enterprise 6.1.Resultsprevalence of oropharyngeal dysphagia in this population is 41.5%. There is a statistically significant relationship between the Barthel Index and the presence of oropharyngeal dysphagia (P=.0279), unlike the cognitive status (P=.8951), nutrition (P=.1470) or the presence of depression (P=.999).Conclusionsoropharyngeal dysphagia is highly prevalent among elderly institutionalized patients. Functional health status may be a risk factor for suffering oropharyngeal dysphagia. The presence of depression does not appear to influence the onset of this symptom. Worse cognitive and nutritional status is significantly related to the incidence of oropharyngeal dysphagia.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2GDyyCB

A Bacteria-Specific Antibiotic Gel to Improve Wound Healing

What benefits might a bacteria-specific topical antibiotic gel offer over standard therapy for chronic wounds?
Wounds

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nzDf7Z

Photodegradation of Scopoletin in Organic Solvents and Aqueous Solutions: Kinetics and Degradation Pathways

Abstract

Scopoletin (hereafter SCO), an excellent candidate of acaricides, was discovered and developed in China. Photolysis kinetics of SCO in organic solvents and different aqueous media were investigated under 500W Xe lamp. Effects of five surfactants, nitrate (NO₃⁻), nitrite (NO₂⁻), and H₂O₂ on SCO photolysis and photodegradation pathways of SCO in aqueous were also studied. The results indicated that photolysis rate of SCO in organic solvents was in the sequence of acetone > ethyl acetate > methanol, and the corresponding half-lives were 9.63, 36.47, and 49.50 h, respectively. Photolysis rate of SCO in different aqueous media was in the sequence of pure water > river water > natural seawater, and the half-lives were 5.68, 6.66, and 7.79 h, respectively. The five kinds of surfactants, NO₃⁻, and NO₂⁻ had significant photoquenching effects on photolysis of SCO, and H₂O₂ had photosensitization effects on photolysis of SCO. By separation and identification of photoproducts using LC/ESI-MS, it could be concluded that SCO was photolyzed through photorearrangement, photohydrolysis, and photooxidation of the molecule itself.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DVyBvW

Reply to: professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUvJLO

History of anaesthesia: Nurse anaesthesia practice in the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America)

Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of Seven (G7) countries (Canada, France, Germany, Italy, Japan, the United Kingdom and the United States of America) and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other G7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EvMSfU

Reply to: emergency medicine is about collaboration, not monopolisation

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DTGiyP

Anaesthesiology and ethics: Can the anaesthesiologist ameliorate simply and rapidly the assessment of decision-making capacity in the elderly?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUquf3

Standardised noxious stimulation-guided individual adjustment of remifentanil target-controlled infusion to prevent haemodynamic responses to laryngoscopy and surgical incision: A randomised controlled trial

BACKGROUND The surgical plethysmographic index (SPI) is one of the available indexes of the nociception–antinociception (NAN) balance. Individually adjusting the NAN balance to prevent somatic responses to noxious stimulation remains a challenge. OBJECTIVES To assess whether guiding remifentanil administration according to the SPI response to a calibrated noxious stimulus (NANCAL) can blunt the haemodynamic response to tracheal intubation and surgical incision. DESIGN Randomised multicentre study. SETTING Two Belgian university hospitals from January 2014 to April 2015. PATIENTS After ethic review board approval and informed consent, 48 American Society of Anesthesiologists I or II adult patients scheduled for surgery under general anaesthesia were enrolled. INTERVENTIONS Patients were randomly assigned to a SPI group, where remifentanil effect-site concentration was adjusted according to NANCAL, or a control group, where it was fixed at 4 ng ml−1. Propofol concentration was always adjusted to maintain the bispectral index close to 40. NANCAL consisted of a 100 Hz, 60 mA electrical tetanic stimulation during 30 s at the wrist before tracheal intubation and before surgical incision. MAIN OUTCOME MEASURES The primary endpoint was the efficacy of the NANCAL-guided remifentanil administration to prevent the haemodynamic response to tracheal intubation and surgical incision. The secondary aim was to compare the ability of SPI, analgesia nociception index, pupil diameter and mean arterial pressure response to NANCAL to predict the haemodynamic response to tracheal intubation and surgical incision. RESULTS Our SPI response to NANCAL-based correcting scheme for remifentanil administration was not superior to a fixed remifentanil concentration at blunting the haemodynamic response to tracheal intubation or surgical incision. Among all tested NAN balance indices, only mean arterial pressure had significant predictive ability with regard to the haemodynamic response to surgical incision. CONCLUSION Further research is needed to define the best NANCAL stimulus and the best remifentanil correcting scheme to help individualised tailoring of antinociception for each specific subpopulation of surgical patients. TRIAL REGISTRATION Clinicaltrials.gov NCT: 02884310; http://ift.tt/2B2PCiQ.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EvagtS

Reply to: who takes the lead in critical illness?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExkN7V

Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review

BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) 25% of baseline), or that a recovery time longer than 15 min be accepted.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DT9R3o

Reply to: collaboration in emergency medical care in Europe the ten principles of CRitical Emergency Medicine (CREM)

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EvaeCg

Emergency medicine is about collaboration, not monopolisation

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EvGBAL

Effects of propofol on wound closure and barrier function of cultured endothelial cells: An in vitro experimental study

BACKGROUND Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells. DESIGN An in vitro investigation. SETTING Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. MATERIALS In vitro cultures of primary human umbilical vein endothelial cells (HUVECs). INTERVENTIONS Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 μmol l-1). MAIN OUTCOME MEASURES Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation. RESULTS Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 μmol l-1 (P 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DW20SL

Who takes the lead in critically ill patients?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EvJkdF

Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUwOU3

Professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExkMkn

Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial

BACKGROUND In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. OBJECTIVES To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Sixty women undergoing breast cancer surgery between April 2014 and February 2015. INTERVENTIONS The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. MAIN OUTCOME MEASURES Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. RESULTS PECS block combined with propofol–remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P = 0.018]. PECS block also reduced propofol mean (± SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (± 0.52) vs. Control group 3.08 (± 0.41) μg ml−1; P 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DUx45t

Collaboration in emergency medical care in Europe: the patient is the winner

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2EwAhcv

Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial. SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min. RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DVeBpr

Ultrasound in Anesthesia, Critical Care, and Pain Management

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ey4fgi

Erratum

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ea2esZ

Effects of Thyrotropin on Peripheral Thyroid Hormone Metabolism and Serum Lipids

Thyroid , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2DX5wQL

The Iconography of Goiter: Five Sculptures in the Sacred Mountains of Varallo, Orta, and Varese in Italy

Thyroid , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2nzlYMb

Spatial legend compatibility within versus between graphs in multiple graph comprehension Eva Riechelmann, Lynn Huestegge

Abstract

Previous research has shown that spatial compatibility between the data region and the legend of a graph is beneficial for comprehension. However, in multiple graphs, data–legend compatibility can come at the cost of spatial between-graph legend incompatibility. Here we aimed at determining which type of compatibility is most important for performance: global (legend–legend) compatibility between graphs, or local (data–legend) compatibility within graphs. Additionally, a baseline condition (incompatible) was included. Participants chose one out of several line graphs from a multiple panel as the answer to a data-related question. Compatibility type and the number of graphs per panel were varied. Whereas Experiment 1 involved simple graphs with only two lines/legend entries within each graph, Experiment 2 explored more complex graphs. The results indicated that compatibility speeds up comprehension, at least when a certain threshold of graph complexity is exceeded. Furthermore, we found evidence for an advantage of local over global data–legend compatibility under specific conditions. Taken together, the results further support the idea that compatibility principles strongly determine the ease of integration processes in graph comprehension and should thus be considered in multiple-panel design.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ExT6Mu