OtoRhinoLaryngology News: 02/16/18

Παρασκευή 16 Φεβρουαρίου 2018

Surgical resection for clinical stage I high-grade neuroendocrine carcinoma of the lung

Abstract

Background

There are few reports about the factor influencing the prognosis of high-grade neuroendocrine carcinoma. In this study, we evaluated surgical outcome of clinical stage I high-grade neuroendocrine carcinoma.

Methods

Patients who underwent curative surgery for high-grade neuroendocrine tumors of the lung in clinical stage I were included in this study. We retrospectively analyzed 27 consecutive patients. The aim of this study was to clarify the clinical course of the disease after surgery and what factors influence the prognosis.

Results

Twenty-two patients have small cell carcinoma, and 5 patients have large cell neuroendocrine carcinoma. Patients who could undergo surgery within 60 days after the first visit (p < 0.01) and undergo lobectomy (p < 0.01) and whose pro-gastrin-releasing peptide ≦ 72 pg/ml (p = 0.04) performed good prognosis after surgery. In multivariate analysis, surgery within 60 days and operative procedure were independent factors associated with OS.

Conclusion

Surgical resection for clinical stage I high-grade neuroendocrine carcinoma of the lung should be performed as early as possible, and better outcome can be obtained with lobectomy than partial resection.

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Progressive Supranuclear Palsy: an Update

Abstract

Purpose of review

Progressive supranuclear palsy (PSP) is a 4R tau neuropathologic entity. While historically defined by the presence of a vertical supranuclear gaze palsy and falls in the first symptomatic year, clinicopathologic studies identify alternate presenting phenotypes. This article reviews the new PSP diagnostic criteria, diagnostic approaches, and treatment strategies.

Recent findings

The 2017 International Parkinson and Movement Disorder Society PSP criteria outline 14 core clinical features and 4 clinical clues that combine to diagnose one of eight PSP phenotypes with probable, possible, or suggestive certainty. Evidence supports the use of select imaging approaches in the classic PSP-Richardson syndrome phenotype. Recent trials of putative disease-modifying agents showed no benefit.

Summary

The new PSP diagnostic criteria incorporating the range of presenting phenotypes have important implications for diagnosis and research. More work is needed to understand how diagnostic evaluations inform phenotype assessment and identify expected progression. Current treatment is symptomatic, but tau-based therapeutics are in active clinical trials.

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Quality of partner support moderates positive affect in cancer patients

Abstract

Objective

In the present study we examined whether four support quality-related characteristics moderate the impact of received partner support on cancer patients' positive affect. The support quality-related characteristics were: patients' perception regarding the willingness of their partners to offer support, patients' perception that partner support is certain, patients' satisfaction with partner relationship and overall patients' satisfaction with partner support.

Method

Seventy seven recently diagnosed cancer patients were assessed at two time points, during chemotherapy treatment (baseline) and seven months later (follow-up). Two types of received support were examined, emotional support and advice-guidance from partner. Multiple regression analyses were performed to determine the moderating effect of the quality-related variables on the relationship between received support at baseline and patient positive affect at seven-month follow-up.

Results

Results showed that all four quality-related characteristics had a moderating role (f² ranged between .06 and .16, p < .05). Emotional support predicted positive affect only when patients reported high partner willingness to offer support, considered the partner support certain, were satisfied with the partner relationship (a trend), and were satisfied with the received support. In contrast, when patients perceived their partners as unwilling to provide support and were dissatisfied with the relationship, support (both emotional and advice-guidance and advice-guidance, respectively) exhibited a negative impact on positive affect.

Conclusions

The findings suggest that only when the quality of support is high, does social support have a positive impact on patients' positive affect.

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Extensive intraneural fascicular dissection of a lipofibromatous hamartoma of the ulnar digital nerve of the thumb

Abstract

Lipofibromatous hamartoma (LFH) is a rare, benign fibrofatty tumor of the peripheral nerves. Only a handful of cases have been reported in the literature, together with cases of LFH of the digital branches of the median nerve. The median nerve is the most commonly affected site. Different treatment approaches to LFH have been described according to the clinical presentation. A case of LFH of the ulnar digital nerve of the left thumb that underwent extensive intraneural fascicular dissection and mass excision is described in this paper. Good results were obtained, i.e., pain relief and good cosmesis. Extensive intraneural fascicular dissection and mass excision are considered to be a good management option for LFH of the digital branches of the median nerve, without the requirement of nerve excision or nerve grafting.

Level of evidence: Level V, therapeutic study.

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Ketamine induces apoptosis in lung adenocarcinoma cells by regulating the expression of CD69

Abstract

Ketamine, an anesthetic, analgesic, or sedative, is widely used for the treatment of cancer pain. Recently, ketamine has been also reported to be tumor repressor for inhibiting proliferation, invasion, and migration, and inducing apoptosis in many cancers. However, whether ketamine can induce the apoptosis of lung adenocarcinoma (LUAD) and which downstream molecular mediates its function remain largely unknown. A LUAD cell line A549 was incubated with ketamine at 0, 1, 10, and 100 μmol/L for 24 h. Trypan blue staining was used to detect the cell viability. Flow cytometry (FACS) was applied to evaluate cell apoptosis proportion. The expression of CD69 was quantitated by western blotting. Ketamine induced the A549 cell apoptosis in a concentration-dependent manner. CD69 was downregulated in LUAD patients' cancer tissue compared with the normal tissue. CD69 can be upregulated in ketamine treating A549 cells and induce the A549 cell apoptosis. Rescue experiment showed that downregulation of CD69 significantly blocked the function of ketamine on inducing apoptosis. Taken together, our results demonstrated that ketamine induced LUAD cells apoptosis by upregulating the CD69 expression. This study suggests that the ketamine can be potential drug for LUAD treatment, and the ketamine/CD69 signaling may be the new potential therapeutic target LUAD therapy.

Whether ketamine can induce the apoptosis of lung adenocarcinoma (LUAD) and which downstream molecular mediates its function remain largely unknown. Our study in A549 demonstrated that ketamine induced LUAD cells apoptosis by upregulating the CD69 expression. This study suggests that the ketamine can be potential drug for LUAD treatment, and the ketamine/CD69 signaling may be the new potential therapeutic target LUAD therapy.

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The brigatinib experience: a new generation of therapy for ALK-positive non-small-cell lung cancer

Future Oncology, Ahead of Print.

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A novel suction/coagulation integrated probe for achieving better hemostasis: development and clinical use

Abstract

Purposes

Modern electrosurgical tools have a specific coagulation mode called "soft coagulation". However, soft coagulation has not been widely accepted for surgical operations. To optimize the soft coagulation environment, we developed a novel suction device integrated with an electrosurgical probe, called the "Suction ball coagulator" (SBC). In this study, we aimed to optimize the SBC design with a prototyping process involving a bench test and preclinical study; then, we aimed to demonstrate the feasibility, safety, and potential effectiveness of the SBC for laparoscopic surgery in clinical settings.

Methods

SBC prototyping was performed with a bench test. Device optimization was performed in a preclinical study with a domestic swine bleeding model. Then, SBC was tested in a clinical setting during 17 clinical laparoscopic colorectal surgeries.

Results

In the bench tests, two tip hole sizes and patterns showed a good suction capacity. The preclinical study indicated the best tip shape for accuracy. In clinical use, no device-related adverse event was observed. Moreover, the SBC was feasible for prompt hemostasis and blunt dissections. In addition, SBC could evacuate vapors generated by tissue ablation using electroprobe during laparoscopic surgery.

Conclusions

We successfully developed a novel, integrated suction/coagulation probe for hemostasis and commercialized it.

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Targeted Temperature Management After Cardiac Arrest: Systematic Review and Meta-analyses

BACKGROUND: Targeted temperature management (TTM) with therapeutic hypothermia is an integral component of postarrest care for survivors. However, recent randomized controlled trials (RCTs) have failed to demonstrate the benefit of TTM on clinical outcomes. We sought to determine if the pooled data from available RCTs support the use of prehospital and/or in-hospital TTM after cardiac arrest. METHODS: A comprehensive search of SCOPUS, Elsevier's abstract and citation database of peer-reviewed literature, from 1966 to November 2016 was performed using predefined criteria. Therapeutic hypothermia was defined as any strategy that aimed to cool post–cardiac arrest survivors to a temperature ≤34°C. Normothermia was temperature of ≥36°C. We compared mortality and neurologic outcomes in patients by categorizing the studies into 2 groups: (1) hypothermia versus normothermia and (2) prehospital hypothermia versus in-hospital hypothermia using standard meta-analytic methods. A random effects modeling was utilized to estimate comparative risk ratios (RR) and 95% confidence intervals (CIs). RESULTS: The hypothermia and normothermia strategies were compared in 5 RCTs with 1389 patients, whereas prehospital hypothermia and in-hospital hypothermia were compared in 6 RCTs with 3393 patients. We observed no difference in mortality (RR, 0.88; 95% CI, 0.73–1.05) or neurologic outcomes (RR, 1.26; 95% CI, 0.92–1.72) between the hypothermia and normothermia strategies. Similarly, no difference was observed in mortality (RR, 1.00; 95% CI, 0.97–1.03) or neurologic outcome (RR, 0.96; 95% CI, 0.85–1.08) between the prehospital hypothermia versus in-hospital hypothermia strategies. CONCLUSIONS: Our results suggest that TTM with therapeutic hypothermia may not improve mortality or neurologic outcomes in postarrest survivors. Using therapeutic hypothermia as a standard of care strategy of postarrest care in survivors may need to be reevaluated.

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Perioperative Cardiac Arrest: Focus on Anaphylaxis

No abstract available

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Cardiac Arrest in the Operating Room: Part 2—Special Situations in the Perioperative Period

As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA. There is a growing body of literature describing the incidence, causes, treatment, and outcomes of common causes of PPCA (eg, malignant hyperthermia, massive trauma, and local anesthetic systemic toxicity) and the need for a better awareness of these topics within the anesthesiology community at large. As noted in part 1 of this series, these events are always witnessed by a member of the perioperative team, frequently anticipated, and involve rescuer–providers with knowledge of the patient and the procedure they are undergoing or have had. Formulation of an appropriate differential diagnosis and rapid application of targeted interventions are critical for good patient outcome. Resuscitation algorithms that include the evaluation and management of common causes leading to cardiac in the perioperative setting are presented. Practicing anesthesiologists need a working knowledge of these algorithms to maximize good outcomes.

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Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist Part 1

Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be formulation of a differential diagnosis and a directed intervention that treats the likely underlying cause(s) of the crisis while concurrently managing the crisis itself. Management of cardiac arrest of the perioperative patient is predicated on expert opinion, physiologic rationale, and an understanding of the context in which these events occur. Resuscitation algorithms should consider the evaluation and management of these causes of crisis in the perioperative setting.

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Cancers, Vol. 10, Pages 53: A Phase I/II Study Targeting Angiogenesis Using Bevacizumab Combined with Chemotherapy and a Histone Deacetylase Inhibitor (Valproic Acid) in Advanced Sarcomas

Cancers, Vol. 10, Pages 53: A Phase I/II Study Targeting Angiogenesis Using Bevacizumab Combined with Chemotherapy and a Histone Deacetylase Inhibitor (Valproic Acid) in Advanced Sarcomas

Cancers doi: 10.3390/cancers10020053

Authors: Varun Monga Umang Swami Munir Tanas Aaron Bossler Sarah L. Mott Brian J. Smith Mohammed Milhem

Epigenetic events and genetic alterations under the control of the tumor microenvironment potentially mediate tumor induced angiogenesis involved in soft tissue sarcoma (STS) metastasis. Addition of antiangiogenic agent, such as bevacizumab, to standard chemotherapy in treatment of sarcoma has been studied in clinical trials, but most of the findings have not supported its use. We hypothesized the existence of an epigenetically mediated "angiogenic switch", and the tumor microenvironment, prevents bevacizumab from truly blocking angiogenesis. The addition of valproic acid (VPA), a weak histone deacetylase inhibitor, and bevacizumab, a monoclonal antibody against vascular endothelial growth factor, together with the cytotoxic effects of gemcitabine and docetaxel, may enhance responses and alter chemoresistance. This was designed as a phase I/II trial with primary endpoints including safety of the treatment combination and tumor response. Unresectable or metastatic sarcoma patients >18 years of age, irrespective of number of prior treatments, received VPA 40 mg/kg orally for 5 days prior to day 1, bevacizumab at 15 mg/kg IV on day 1, gemcitabine 900 mg/m2 (day 1, day 8), and docetaxel 75 mg/m2 (day 8). Cycles were of 28 day duration. Bevacizumab and VPA were continued as maintenance after 6 cycles, until disease progression. A standard 3 + 3 phase I dose de-escalation design was utilized to evaluate safety. Gain of function p53 gene mutation testing was performed on available archival tissue specimens. A total of 46 patients (30 female, 16 male) with median age of 60 (range 24–81) years were enrolled; 34 (73.9%) patients received prior chemotherapy, 14 (30%) of which received prior gemcitabine and docetaxel. Patients received a median of 5.5 cycles (range 0–24 of treatment (min 0, one patient died prior to completing the first cycle; max: 24, one patient received 6 cycles and 18 maintenance cycles before progressing). Seventeen patients underwent dose reduction, of which VPA was reduced in 6 patients. Forty-one patients were evaluable for response. There was a confirmed complete response in 1 (epithelioid sarcoma), and a partial response (PR) in 6 (1 carcinosarcoma, 2 extrauterine leiomyosarcoma (LMS), 2 undifferentiated pleomorphic sarcoma, and 1 uterine LMS) patients. Stable disease (SD) was seen in 21 patients for at least 2 months. One subject with prior gemcitabine and docetaxel had PR, and 7 had SD. Median progression-free survival (PFS) was 5.7 months (95% CI: 2.1–8.0), and overall survival (OS) was 12.9 months (95% CI: 8.3–14.5). Three patients died due to tumor progression while on the study. The combination of VPA, bevacizumab, gemcitabine, and docetaxel appears to be moderately safe and well tolerated. Given that there are very limited options for patients with relapsed refractory STS, this drug combination may be an important therapy to consider. This combination treatment deserves further investigation in epithelioid and carcinosarcoma subtypes.

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Hard and soft tissue changes around implants activated using plasma of argon: A histomorphometric study in dog

Abstract

Objective

To histologically assess the hard and soft tissue changes after insertion of cleaned and activated titanium implants using plasma of argon.

Materials and methods

Eight dogs were included in this study. The mandibular premolars and first molars were extracted. For each hemi-mandible, four implants, 7 mm long and 3.3 mm of diameter, with a ZirTi surface were used. The surface of two implants was randomly treated with argon plasma (test), while the other two implants were left untreated (control). After 1 month, the same procedure was performed in the contralateral hemi-mandible. The amount of old bone, new bone, overall value of old bone plus new bone, and soft tissue was histologically evaluated.

Results

After 1 month of healing, high percentages of new bone in close contact with the implant surface were found at both the treated (60.1% ± 15.6%; 95% CI 56.5%–78.0%) and untreated (57.2% ± 13.1%; 95% CI 49.3%–67.5%) implants. Low percentages of old bone were found at this stage of healing, at both the treated (4.4% ± 3.0%; 95% CI 1.2%–5.4%) and untreated (3.4% ± 3.1%; 95% CI 0.6%–4.9%) implants. Not statistically significant differences were found between groups (p > .05). After 2 months of healing, treated implants presented a significantly higher (p = .012) new bone formation (72.5% ± 12.4%; 95% CI 69.6%–86.8%) compared to untreated sites (64.7% ± 17.3%; 95% CI 59.4%–83.3%). Controversially, no difference (p = .270) in terms of old bone was present between treated (3.1% ± 1.7%, 95% CI 1.8%–4.2%) and untreated implants (3.8% ± 1.9%, 95% CI 3.2%–5.8%). Significant differences (p = .018) in terms of total mineralized bone were found between treated (75.6% ± 13.0%, 95% CI 73.3%–91.3%) and untreated implants (68.4% ± 16.8%; 95% CI 64.2%–87.6%).

Conclusions

Implants treated using plasma of argon was demonstrated to reach a higher bone-to-implant contact when compared to untreated implants.

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Effect of incision design on interproximal bone loss of teeth adjacent to single implants. A randomized controlled clinical trial comparing intrasulcular vs paramarginal incision

Abstract

Purpose

To evaluate the effect of incision design in implant surgery on interproximal bone loss of posterior teeth adjacent to interdental single implants, comparing intrasulcular and paramarginal incision. A further aim was to assess the influence of the incision technique on peri-implant bone remodeling.

Materials and methods

A controlled randomized clinical trial was carried out in a University Clinic. All the patients received an interdental posterior single implant. The incision type was randomly divided into two groups: (a) intrasulcular or (b) paramarginal. Standardized periapical digital radiographs were made with the parallel technique and a silicone index individualized in each patient. Radiographs were made immediately after implant placement, at abutment connection, 6 and 12 months post-loading. Two radiographic reference points were detected at the interproximal aspect of the adjacent teeth: (A) the cementoenamel junction and (B) the most coronal aspect of the bone crest. The interproximal bone loss of the adjacent teeth was calculated as the difference from A to B between the different follow-up periods and baseline. Two different examiners evaluated the radiographic measurements twice.

Results

Sixty patients, each with one implant, were included, 30 in each group. A mean interproximal bone loss in teeth of 0.09 mm in the intrasulcular and 0.10 mm in the paramarginal group was found at 12 months post-loading. Mean peri-implant bone remodeling was 0.17 mm in the intrasulcular group and 0.15 mm in the paramarginal group. Differences between incision types were not statistically significant (p > .05).

Conclusions

Both incision designs used to place interdental single implants resulted in minimum bone loss at the interproximal aspect of adjacent teeth. The incision design did not significantly influence the radiographically assessed interproximal bone loss nor peri-implant bone remodeling.

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Bone-conditioned medium modulates the osteoconductive properties of collagen membranes in a rat calvaria defect model

Abstract

Objectives

Collagen membranes are not limited to be occlusive barriers as they actively support bone regeneration. However, the impact of bone-derived growth factors on their osteoconductive competence has not been examined.

Methods

Twenty adult Sprague Dawley rats were included in the study. Calvaria defects with a diameter of five millimeter were created. The defect was covered with one layer of a collagen membrane previously soaked in conditioned medium of porcine bone chips or in culture medium alone. After 4 weeks, microcomputed tomography was performed. Undecalcified thin-ground sections were subjected to light and scanning electron microscopy. Primary outcome parameter was the bone volume in the defect. Unit of analysis was the bone-conditioned medium (BCM).

Results

In the central defect area of the control and the BCM group, median new bone connected to the host bone was 0.54 and 0.32 mm³, respectively (p = .10). In the ectocranial defect area, the control group showed significantly more bone than the BCM group (0.90 and 0.26 mm³; p = .02). Based on an exploratory interpretation, the control group had smaller bony islands than the BCM group. Scanning electron microscopy and histology indicate the formation of bone but also the collagen membrane to be mineralized in the defect site.

Conclusions

These results demonstrate that the commercial collagen membrane holds an osteoconductive competence in a rat calvaria defect model. Soaking collagen membranes with BCM shifts bone formation toward the formation of bony islands rather than new bone connected to the host bone.

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Lower pole approach in retroperitoneal laparoscopic radical nephrectomy: a new approach for the management of renal vascular pedicle

Abstract

Background

The objective of this study was to examine the effectiveness and safety of lower pole (LP) approach in retroperitoneal laparoscopic radical nephrectomy (LRN).

Methods

One hundred thirty-two renal cancer patients were scheduled for selective retroperitoneal LRN. The surgery parameters and outcomes were compared. Out of 132 patients, 78 (59.1%) patients underwent LRN via LP approach, while 54 (40.9%) patients underwent LRN via lateroposterior space (LPS) approach.

Results

Compared to LPS group, the LP group had a higher body mass index (27.0 ± 1.7 kg/m² vs. 24.5 ± 1.8 kg/m², P < 0.0001) and a larger tumor size (6.9 ± 3.5 cm vs. 4.1 ± 3.3 cm, P < 0.0001). The LP approach reduced the volumes of blood loss and transfusion significantly (135.3 ± 17.2 mL vs. 219.6 ± 30.9 mL, P < 0.0001; 55.6 ± 28.3 vs. 141.1 ± 50.4 mL, P < 0.0001) as compared to the LPS approach. The LP approach also decreased the risk of conversion to open procedure (1.3 vs. 7.4%, P < 0.05).

Conclusions

The LP approach is an effective and safe alternative to the LPS approach for retroperitoneal LRN and might be more suitable for patients with obesity, large tumors, tumors located at the medial part of the kidney, or renal pedicular adhesion.

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SGEF is a potential prognostic and therapeutic target for lung adenocarcinoma

Abstract

Background

SH3-containing guanine nucleotide exchange factor (SGEF), a RhoG-specific guanine nucleotide exchange factor (GEF), was consider as a key signal that determines cancer cell invasion. Although SGEF has been considered to highly express in glioma and prostate cancer. However, it is not well illustrated in LAC.

Methods

In this experiment, expression of SGEF was detected in 92 LAC and corresponding normal tissue samples by immunohistochemistry. In addition, we evaluated the invasion and migration of lung adenocarcinoma cells by the gain and loss of SGEF expression. Furthermore, RhoG activity was measured by GST pull-down assay.

Results

SGEF is highly expressed in LAC tissues than in normal lung tissues and was associated with the TNM stage. Lung adenocarcinoma patients with low SGEF subgroup had longer overall survival compared to those with high expression. Furthermore, univariate analysis showed that SGEF expression was an independent prognostic factor for overall survival in lung adenocarcinoma. Silencing of SGEF effectively suppressed the invasion and migration of human lung adenocarcinoma cells in vitro by inhibiting RhoG activity, and over-expression of SGEF could reverse this phenomena.

Conclusion

SGEF is a novel prognostic target in human lung adenocarcinoma.

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Targeted next-generation-sequencing for reliable detection of targetable rearrangements in lung adenocarcinoma—A single center retrospective study

Publication date: Available online 16 February 2018
Source:Pathology - Research and Practice
Author(s): Nadezda P. Velizheva, Markus P. Rechsteiner, Nadejda Valtcheva, Sandra Nicole Freiberger, Christine E. Wong, Bart Vrugt, Qing Zhong, Ulrich Wagner, Holger Moch, Sven Hillinger, Isabelle Schmitt-Opitz, Alex Soltermann, Peter J. Wild, Verena Tischler
Oncogenic rearrangements leading to targetable gene fusions are well-established cancer driver events in lung adenocarcinoma. Accurate and reliable detection of these gene fusions is crucial to select the appropriate targeted therapy for each patient. We compared the targeted next-generation-sequencing Oncomine Focus Assay (OFA; Thermo Fisher Scientific) with conventional ALK FISH and anti-Alk immunohistochemistry in a cohort of 52 lung adenocarcinomas (10 ALK rearranged, 18 non-ALK rearranged, and 24 untested cases). We found a sensitivity and specificity of 100% for detection of ALK rearrangements using the OFA panel. In addition, targeted NGS allowed us to analyze a set of 23 driver genes in a single assay. Besides EML4-ALK (11/52 cases), we detected EZR-ROS1 (1/52 cases), KIF5B-RET (1/52 cases) and MET-MET (4/52 cases) fusions. All EML4-ALK, EZR-ROS1 and KIF5B-RET fusions were confirmed by multiplexed targeted NGS assay (Oncomine Solid Tumor Fusion Transcript Kit, Thermo Fisher Scientific). All cases with EML4-ALK rearrangement were confirmed by Alk immunohistochemistry and all but one by ALK FISH. In our experience, targeted next-generation sequencing is a reliable and timesaving tool for multiplexed detection of targetable rearrangements. Therefore, targeted next-generation sequencing represents an efficient alternative to time-consuming single target assays currently used in molecular pathology.

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Editorial Board

Publication date: February 2018
Source:Sleep Medicine, Volume 42

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The hearing of rural workers exposed to noise and pesticides

Tereza R. R. Sena, Solano S.F Dourado, Lucas V Lima, Ângelo R Antoniolli

Noise and Health 2018 20(92):23-26

In work environments, different physical and chemical agents that may pose a risk to workers' hearing health coexist. In this context, occupational hearing loss stands out. It has mostly been attributed to only noise exposure, although there are other agents, that is, pesticides that might contribute to occupational hearing loss. In this report, two cases will be presented that consider rural workers exposed to pesticides and intense noise generated by an adapted rudimentary vehicle. The noise measured in this vehicle was 88.3 dBA up to 93.4 dBA. Pure-tone audiometry, distortion product otoacoustic emissions, and high-frequency audiometry tests were performed. This report is unusual because of the short time of exposure to noise and pesticides and the hearing loss found, indicating a synergy between those agents.

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Influences of combined traffic noise on the ability of learning and memory in mice

Guo-Qing Di, Zhao-Qi Qin

Noise and Health 2018 20(92):9-15

Objective: The present study aimed to evaluate the influences of combined traffic noise (CTN) on the ability of learning and memory in mice. Materials and Methods: The Institute of Cancer Research (ICR) mice were exposed to CTN from highways and high-speed railways for 42 days, whose day–night equivalent continuous A-weighted sound pressure level (Ldn) was 70 dB(A). On the basis of behavioral reactions in Morris water maze (MWM) and the concentrations of amino acid neurotransmitters in the hippocampus, the impacts of CTN on learning and memory in mice were examined. Results: The MWM test showed that the ability of learning and memory in mice was improved after short-term exposure (6–10 days, the first batch) to 70 dB(A) CTN, which showed the excitatory effect of stimuli. Long-term exposure (26–30 days, the third batch; 36–40 days, the fourth batch) led to the decline of learning and memory ability, which indicated the inhibitory effect of stimuli. Assays testing amino acid neurotransmitters showed that the glutamate level of the experimental group was higher than that of the control group in the first batch. However, the former was lower than the latter in the third and fourth batches. Both, behavioral reactions and the concentrations of amino acid neurotransmitters, testified that short-term exposure and long-term exposure resulted in excitatory effect and inhibitory effect on the ability of learning and memory, respectively. Conclusion: The effects of 70 dB(A) CTN on the ability of learning and memory were closely related to the exposure duration. Furthermore, those effects were regulated and controlled by the level of glutamate in the hippocampus.

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Public mnline information about tinnitus: A cross-sectional study of youtube videos

Corey H Basch, Jingjing Yin, Betty Kollia, Adeyemi Adedokun, Stephanie Trusty, Felicia Yeboah, Isaac Chun-Hai Fung

Noise and Health 2018 20(92):1-8

Purpose: To examine the information about tinnitus contained in different video sources on YouTube. Materials and Methods: The 100 most widely viewed tinnitus videos were manually coded. Firstly, we identified the sources of upload: consumer, professional, television-based clip, and internet-based clip. Secondly, the videos were analyzed to ascertain what pertinent information they contained from a current National Institute on Deafness and Other Communication Disorders fact sheet. Results: Of the videos, 42 were consumer-generated, 33 from media, and 25 from professionals. Collectively, the 100 videos were viewed almost 9 million times. The odds of mentioning "objective tinnitus" in professional videos were 9.58 times those from media sources [odds ratio (OR) = 9.58; 95% confidence interval (CI): 1.94, 47.42; P = 0.01], whereas these odds in consumer videos were 51% of media-generated videos (OR = 0.51; 95% CI: 0.20, 1.29; P = 0.16). The odds that the purpose of a video was to sell a product or service were nearly the same for both consumer and professional videos. Consumer videos were found to be 4.33 times as likely to carry a theme about an individual's own experience with tinnitus (OR = 4.33; 95% CI: 1.62, 11.63; P = 0.004) as media videos. Conclusions: Of the top 100 viewed videos on tinnitus, most were uploaded by consumers, sharing individuals' experiences. Actions are needed to make scientific medical information more prominently available and accessible on YouTube and other social media.

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Examination of previously published data to identify patterns in the social representation of “Loud music” in young adults across countries

Vinaya Manchaiah, Fei Zhao, Susan Oladeji, Pierre Ratinaud

Noise and Health 2018 20(92):16-22

Purpose: The current study was aimed at understanding the patterns in the social representation of loud music reported by young adults in different countries. Materials and Methods: The study included a sample of 534 young adults (18–25 years) from India, Iran, Portugal, United Kingdom, and United States. Participants were recruited using a convince sampling, and data were collected using the free association task. Participants were asked to provide up to five words or phrases that come to mind when thinking about "loud music." The data were first analyzed using the qualitative content analysis. This was followed by quantitative cluster analysis and chi-square analysis. Results: The content analysis suggested 19 main categories of responses related to loud music. The cluster analysis resulted in for main clusters, namely: (1) emotional oriented perception; (2) problem oriented perception; (3) music and enjoyment oriented perception; and (4) positive emotional and recreation-oriented perception. Country of origin was associated with the likelihood of participants being in each of these clusters. Conclusion: The current study highlights the differences and similarities in young adults' perception of loud music. These results may have implications to hearing health education to facilitate healthy listening habits.

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Cathodal neuromodulation of dominant temporoparietal cortex with transcranial direct current stimulation for tinnitus: A case series

Rohit Verma, Nand Kumar, Rakesh Kumar, Saurabh Kumar, Preethy Kathiresan

Noise and Health 2018 20(92):27-29

There is scant literature on the effectiveness of using transcranial direct current stimulation (tDCS) as an intervention modality for managing tinnitus. The current case series reflects the use of tDCS as an effective intervention for tinnitus while inhibiting the dominant temporoparietal cortex and simultaneous stimulating the non-dominant dorsolateral prefrontal cortex.

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Operative Time and Flap Failure in Unilateral and Bilateral Free Flap Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0038-1627445

Background There is an increasing trend toward bilateral breast reconstruction. Using the National Surgical Quality Improvement Program (NSQIP) database, we sought to understand the association between unilateral and bilateral free flap breast reconstruction and operative time and flap failure. Methods We selected a cohort of patients undergoing free flap breast reconstruction using the 2005 to 2010 NSQIP database. Cases were divided into unilateral and bilateral reconstruction. Subgroup analyses were performed dividing cases into delayed and immediate reconstruction. The effect of patient characteristics including age, body mass index (BMI), history of diabetes, and the American Society of Anesthesiologists' classification on operative time and flap failure was examined using univariable and multivariable regression models. Rates and odds ratios (OR) were reported using the multivariable gamma and logistic regression models, respectively. Results There were 691 free flap breast reconstructions performed in the cohort and 29.1% were bilateral cases. There was a 78-minute increase in the median operative time when comparing unilateral and bilateral reconstruction (p = 0.005). Patients undergoing bilateral reconstructions were generally younger and had fewer comorbidities compared with unilateral reconstructions. There was no significant association between bilateral reconstruction and flap failure. Immediate bilateral reconstructions had a significant increase in median operative time compared with immediate unilateral reconstructions (563 versus 480 minutes, p = 0.002) but no significant increase in operative time was noted when comparing delayed unilateral and delayed bilateral reconstructions. Prolonged operative time was associated with flap failure after adjusting for age and BMI (OR 1.17, p < 0.001). Conclusions Bilateral free flap breast reconstruction can be performed safely despite an increase in operative time when compared with unilateral reconstruction.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Simplifying Arterial Coupling in Microsurgery—A Preclinical Assessment of an Everter Device to Aid with Arterial Anastomosis

J reconstr Microsurg
DOI: 10.1055/s-0038-1626691

Background A novel arterial everter device was engineered to simplify microvascular coupling of arteries by reliably securing the stiff, muscular wall of arteries over coupler pins. We compare microvascular coupling with the everter device to manual suturing for arterial anastomoses in a live large animal model. Methods In this preliminary study, bilateral external femoral arteries of five male swine were exposed and sharply divided. Arteries were anastomosed using either interrupted sutures (n = 5) or the everter device and Synovis Coupler (n = 5). The efficiency in engaging coupler pins, the time taken to perform the anastomosis, and vessel patency immediately post-op and at 1-week postanastomosis were evaluated. Vessel wall injury and luminal stenosis were compared between groups using histomorphometric analyses. Results On an average, 80% of coupler pins engaged the vessel walls after a single pass of the everter. The average time to perform the anastomosis was significantly less when using the everter/coupler compared with manual suturing (6:35 minute versus 25:09 minute, p < 0.001). Immediately post-op, 100% patency was observed in both groups. At 1 week post-op, four of five (80%) of coupled arteries and all five (100%) of hand-sewn arteries were patent. The degree of arterial wall injury, neointimal formation, and luminal stenosis for patent arteries were similar between groups. Conclusions Successful arterial anastomoses using the everter device with the Synovis Coupler was easier and significantly more efficient when compared with a standard hand-sewn technique. Both techniques had acceptable patency rates and similar effects on the vessel wall and intima.
[...]

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Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale

J reconstr Microsurg
DOI: 10.1055/s-0037-1621736

Background Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1–5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey. Methods A retrospective chart review was conducted at a single academic medical center of 101 consecutive free flaps, from 2011 to 2016. Of the flaps that met inclusion criteria, 39 had completed LEFS surveys. Mean LEFS scores were calculated, and the effects of risk factors such as diabetes, age, and smoking status were analyzed. Results The mean LEFS score after free tissue transfer was 50.3 (SD ± 21.1), with a mean follow up survey time of 3.0 years (SD ± 1.3). The score correlated with Stage 4 function, or "independent community ambulation," and age was the only demographic factor associated with decreased functionality in this group. This is compared with mean LEFS score of 43.1 (SD ± 18.4) in cohort of 55 below knee amputations (BKAs), and 38.3 (SD ± 14.9) in 28 above knee amputations (AKAs), both correlating with Stage 3 function: "limited community ambulation." Conclusions Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.
[...]

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Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

J reconstr Microsurg
DOI: 10.1055/s-0037-1621726

Background Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. Methods A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed. Patients were matched into groups based on PNC utilization. The use of intravenous narcotics including patient-controlled analgesia (PCA), oral narcotics, antiemetics, length of stay (LOS), associated pain scores, flap-related performance, and patient morbidity was recorded. Results Of 48 patients who underwent lower extremity free tissue transfer, 35 satisfied criteria for comparison. Of these, PNC was utilized in 83%. The mean pain score in the immediate postoperative period was 3.84 ± 2.47 (10-point Likert scale). PCA and narcotic use were decreased in the PNC group, and no adverse effects of the catheter were identified. Microsurgical outcomes were not adversely affected in comparison. Conclusion PNC utilization for lower extremity free flap transfer significantly reduced concurrent narcotic use and attained a shorter LOS. The technique provided for safe analgesia during lower extremity free flap reconstructions satisfying the microsurgeon and the anesthesiologist.
[...]

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Gender Comparison of Medical Student Microsurgical Skills in a Laboratory Model

J reconstr Microsurg
DOI: 10.1055/s-0038-1626694

Background Perceived gender-related differences in surgical skills could limit opportunities available for any aspiring surgeon. There should be more available literature and logical analysis of these observations. The objective of this study is to evaluate the microsurgical skills of male and female medical students using a standard scale in the laboratory. Methods This study included medical students enrolled in the Kaohsiung Chang Gung Memorial Hospital from 2002 to 2015 who were evaluated by a senior consultant for their microsurgical skills. A standard numeric scale was used to evaluate their suturing technique after basic microsurgical training. Differences in the scores between male and female medical students were evaluated using statistical analysis. Results A total of 578 medical students were included in the study. There were 393 males (68%) and 185 females (32%). Using statistical analysis, there is no significant difference in the distribution of scores (P value = 0.78) and mean scores (P value = 0.75) between the two groups. Conclusions This study shows that microsurgical skills of male and female medical students are similar. Equal opportunities in the eventual pursuit of the surgical specialties should be available regardless of gender.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Algorithmic Approach for Intraoperative Salvage of Venous Congestion in DIEP Flaps

J reconstr Microsurg
DOI: 10.1055/s-0038-1626695

Background Flap congestion is a frequently described intraoperative complication during autologous breast reconstruction with abdominal perforator flaps, which, if not addressed, can lead to detrimental results such as flap failure. Here, we describe our institution's algorithm of intraoperative salvage of congested flaps and present their outcomes. Methods All patient charts from 2002 to 2016 of a single plastic surgeon were reviewed for patients who underwent deep inferior epigastric perforator flap breast reconstruction resulting in 602 patients and 831 flaps. Of those, 38 women (6.3%) with 40 congested flaps (4.8%) were included in this study. Based on the algorithm guiding the selection of additional venous anastomosis, the patients' surgical details, outcomes, as well as their demographic characteristics are evaluated. Results Average age and body mass index of our cohort were 47.0 ± 8.0 years and 26.1 ± 3.9, respectively. Ten patients (26.3%) were current or former smokers while 20 (52.6%) required external radiation. Thirty-two congested flaps (80.0%) were predominantly salvaged with a superficial inferior epigastric vein (SIEV)-to-deep inferior epigastric vein (comitante) anastomosis. An SIEV-to-internal mammary vein comitante anastomosis was the second favorite option (5 flaps, 12.5%). Five patients suffered minor complications within a mean follow-up of 18.8 ± 12.3 months without flap failure, bleeding, or infection. Conclusions Venous flap congestion is an uncommon intraoperative intricacy during free tissue transfer for autologous breast reconstruction. Our proposed algorithm primarily recommends adding an additional venous anastomosis between the superficial and deep drainage system and results and favorable outcomes without major complications.
[...]

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Article in Thieme eJournals:
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Oculosympathetic paresis after selective neck dissection: A ‘distant’ complication

A 76 year old Caucasian lady underwent left sided selective neck dissection as part of her ablative surgery for poorly differentiated squamous cell carcinoma (SCC) of the left lingual mucosa. Postoperatively, the patient had no immediate surgical complications except that she complained of drooping of the left eyelid in the immediate aftermath (see Figs. 1 and 2).

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Editorial Board

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1

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Issue Contents

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1

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Total body irradiation using Helical Tomotherapy®: Treatment technique, dosimetric results and initial clinical experience

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1
Author(s): V. Sarradin, L. Simon, A. Huynh, J. Gilhodes, T. Filleron, F. Izar
PurposeHelical TomoTherapy^® allows precise and homogeneous tumour coverage and excellent sparing of organs at risk. We present here our treatment technique, dosimetric results, and our first clinical data for patients receiving total body irradiation as part of the conditioning regimen before hematopoietic stem cell transplantation.Patients and methodsThe cohort consisted of 11 patients who were treated in our institution between August 2014 and January 2016. The total dose was 12Gy in six fractions in three days. We collected the dose distribution information in the treatment volumes, organs at risk and area of junction. We report retrospectively the clinical events during the first 6 months after the procedure.ResultsMedian age was 31 years (range, 18–57 years). Median D98% was 11.5Gy (range: 6.6–11.9Gy). The median of the mean doses to the lungs was 8.7Gy (range: 8.5–9.3Gy). The mean dose for the junction area was 12Gy (range: 11.9–12.1Gy). All patients had the total procedure, and all underwent successful engraftment. During the first six months, nine patients had at least one grade 3 or 4 toxicity that was due essentially to graft versus host disease. No patient had radiation pneumonitis. The toxicities were both more frequent and of higher grade during the first three months.ConclusionTotal body irradiation using helical TomoTherapy^® is feasible. It allows a very good homogeneity of dose and conformity with an acceptable tolerance. It could deliver higher doses to sites at high risk of recurrence (bone marrow, sanctuary sites), while sparing major normal organs like lungs, liver, and kidneys. This reduction of dose could lead to reduced severity and frequency of late complications.

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Adjuvant radiotherapy for positive lymph nodes of oesophageal squamous cell carcinoma: Can it earn promising benefits at long-term follow-up?

Publication date: Available online 14 February 2018
Source:Cancer/Radiothérapie
Author(s): Y. Ren, J. Ye, W. Xiong, J. Zuo, Y. He, M. Tan, Y. Yuan
PurposeThe value of adjuvant radiotherapy for patients with positive lymph nodes after curative resection of oesophageal squamous cell carcinoma is controversial. This study aims to investigate its long-term benefits in a specific cohort.Patients and MethodsThe charts between 1990 and 2003 from patients with positive lymph nodes were retrospectively reviewed. Those subjects were divided into adjuvant radiotherapy and surgery alone groups, with two subgroups defined by radiation dose (cutoff value: 50Gy). Overall survival, disease-free survival and locoregional recurrence-free survival were compared between two groups, with predictive factors of overall survival analysed meanwhile.ResultsIn sum, 175 matched patients with 1:2 ratios for group balance were enrolled for final analysis. During the follow-up (median: 37.0 months), 143 (81.7%) deaths were recorded, with 70.6% of deaths from cancer progression. The median overall survival time (19.5, 4 to 172 months) was not significantly different between the two groups (18.9 vs. 20.0 months, P=0.179). However, the disease-free survival time was significantly shorter in the adjuvant radiotherapy group than that in the control group (median, 11.5 vs. 14.9 months; P=0.001), with the locoregional recurrence-free survival time impressively prolonged (median: 18.3 vs. 16.5 months; P=0.022). Age (P=0.030), number (P=0.005) and ratio (P=0.002) of positive lymph nodes were associated with overall survival, but radiation dose was not (P=0.204).ConclusionAdjuvant radiotherapy with low- or high-dose did not improve survival compared with surgery alone. However, radiotherapy was effective to control locoregional recurrence, and could be applied as salvage therapy when recurrence event occurred.

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Investigation of electron boost radiotherapy in patients with breast cancer: Is a direct electron field optimal?

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1
Author(s): M. Aghili, M. Barzegartahamtan, A. Alikhassi, R. Mohammadpour
PurposeHistorically, electron boost dose mainly was delivered by a direct field in adjuvant radiotherapy of breast cancer. In this prospective study, we investigated direct electron field, in terms of optimal coverage of tumour bed volume following localization using ultrasound and surgical clips.Material and methodsFirst, for all 24 patients, a breast sonographer drew perimeter of tumour bed on the breast skin. Then an electron boost field was outlined on the demarcated territory, and a lead wire marker compatible with CT scan was placed on the field borders by a 2cm margin. After CT scan simulation, all patients underwent adjuvant whole breast irradiation with 3D-conformal radiotherapy to 50Gy in 25 fractions. Then for boost radiotherapy, lead wire in CT images was countoured as electron boost field. Also, the tumour bed was contoured based on surgical clips (true clinical target volume and true planning target volume). Electron treatment planning was done for electron boost field. Finally isodose coverages for true planning target volume investigated.ResultsOn average, 16.68% of clips planning target volume (true planning target volume; range: 0.00 to 95%) received 90% oor more of the prescribed dose when the electron treatment plan was made. Isodose curves does not provide adequate coverage on the tumour bed (clips planning target volume) when electron boost treatment planning was generated for electron boost field (en face electron field). In fact, a part of target (planning target volume-c) is missed and more doses is absorbed in normal tissue.ConclusionsElectron boost treatment planning (an en face electron field) following tumour bed localization using ultrasonography does not provide an optimized coverage of tumour bed volume.

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Bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for lung cancer: A case report

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1
Author(s): G. Fanetti, F. Bazzani, A. Ferrari, D. Alterio, S.M. Donghi, F.A. Pounou Kamga, R. Orecchia, B.A. Jereczek-Fossa
Bronchiolitis obliterans organizing pneumonia is an interstitial lung disease rarely occurring after radiotherapy probably due to an activation of autoimmune processes. Most cases have been described after postoperative radiotherapy for breast cancer. Corticosteroids represent the main treatment, prognosis is generally favorable. We described a case of bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for a recurrent lung cancer. Antibiotics and steroids were administered to solve the clinical picture. After three years, a new lesion at the right lung was found and treated with stereotactic ablative radiation therapy and concomitant long course of steroids with no recurrence of bronchiolitis obliterans organizing pneumonia. Bronchiolitis obliterans organizing pneumonia is a rare event after radiotherapy with undefined risk factors. In our case, steroids played an important role in management and, maybe, in preventing bronchiolitis obliterans organizing pneumonia recurrence after second course of stereotactic ablative radiation therapy.

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Les big data, généralités et intégration en radiothérapie

Publication date: February 2018
Source:Cancer/Radiothérapie, Volume 22, Issue 1
Author(s): C. Le Fèvre, L. Poty, G. Noël

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Les big data, généralités et intégration en radiothérapie

Chemistry of Sulfur-Contaminated Soil Substrate from a Former Frasch Extraction Method Sulfur Mine Leachate with Various Forms of Litter in a Controlled Experiment

Abstract

The impact of tree litter on soil chemistry leachate and sulfurous substrates of mine soils from former Jeziórko sulfur mine was investigated. Composites were used: soil substrate (less contaminated at mean 5090 mg kg⁻¹ S or high contaminated at 42,500 mg kg⁻¹ S) + birch or pine litter and control substrate (no litter). The composites were rinsed with distilled water over 12 weeks. In the obtained leachate, pH, EC, dissolved organic carbon, N, Ca, Mg, Al, and S were determined. Physicochemical parameters of the substrates and their basal respiration rate were determined. Rinsing and litter application lowered sulfur concentration in high contamination substrates. Pine litter application decreased EC and increased pH of the low-contaminated substrate. The substrate pH remained at low phytotoxic level (i.e., below 3.0), resulting in the low biological activity of the composites. Birch litter application increased leaching of N and Mg, indicating the possibility of an intensification of soil-forming processes in contaminated sites.

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The Fate of 15 N Tracer in Waterlogged Peat Cores from Two Central European Bogs with Different N Pollution History

Abstract

Under low nitrogen (N) input into rain-fed peat bogs, Sphagnum moss efficiently filters incoming N, preventing invasion of vascular plants and peat oxygenation. Elevated atmospheric N deposition, in combination with climatic warming, may cause retreat of bryophytes and degradation of peat deposits. There are concerns that higher emissions of greenhouse gases, accompanying peat thinning, will accelerate global warming. Breakthrough of deposited N below living moss has been quantified for two Central European peat bogs dominated by Sphagnum magellanicum. In the 1990s, the northern site, ZL, received three times more atmospheric N (> 40 kg ha⁻¹ year⁻¹) than the southern site, BS. Today, atmospheric N inputs at both sites are comparable (15 and 11 kg ha⁻¹ year⁻¹, respectively). Replicated peat cores were collected from the wet central segments of both study sites, ¹⁵N-NO₃⁻ tracer was applied on the moss surface, and the peat cores were incubated under water-logged conditions. After 40 weeks, the rate of downcore leaching of the ¹⁵N tracer was assessed. The recent history of high N pollution at ZL did not accelerate ¹⁵N penetration into deeper peat layers, relative to BS. At both sites, less than 3% of the ¹⁵N tracer reached the shallow depth of 9 cm. Analysis of control peat cores, along with a ²¹⁰Pb chronology, revealed removal of the "excess" N from the ZL peat profiles prior to sampling. Following a decrease of atmospheric N pollution in the past two decades, efficient filtering of atmospheric N by Sphagnum at ZL has been renewed.

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Clinical viability of single implant-retained mandibular overdentures: a systematic review and meta-analysis

The aim of this meta-analysis was to verify the clinical viability of single implant-retained mandibular overdentures (SIMO). An electronic search of the PubMed and Cochrane databases was performed (end date July 2017); this was supplemented by a manual search of the literature. Only prospective clinical trials and randomized controlled trials (RCTs) that evaluated SIMO with a minimum follow-up of 12 months were included. The meta-analysis was based on the Mantel–Haenszel method. Dental implant and prosthetic failure were the dichotomous outcome measures; these were evaluated through the risk ratio (RR) and odds ratio (OR), with corresponding 95% confidence intervals (CI).

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Upper airway obstruction induced by non-invasive ventilation using an oronasal interface

Abstract

Background

On initiation of long-term non-invasive ventilation (NIV), intermittent upper airway obstruction has rarely been described as possibly treatment-induced. Inspiratory pressure effects and the use of an oronasal interface may promote obstructive events in some patients with neuromuscular disease (NMD) and amyotrophic lateral sclerosis (ALS) in particular.

Methods

We evaluated clinical data from 212 patients in whom NIV was initiated using an oronasal mask. Treatment-induced upper airway obstruction (TAO) was defined as an AHI > 5/h along with a relative increase of the AHI in the first treatment night compared to diagnostic sleep studies.

Results

Prevalence of TAO was 14.2% in the entire cohort, 17.0% in patients with NMD (n = 165), 20.4% in the ALS subgroup (n = 93), and 4.3% in non-NMD patients (n = 47). Fixed expiratory positive airway pressure (EPAP, n = 192) was significantly correlated with AHI reduction (r = 0.50; p < 0.001). The inspiratory-expiratory pressure interval (∆PAP, n = 191) showed inverse correlation with the AHI change achieved in the first treatment night (r = − 0.28; p < 0.001). However, ∆PAP and the effective pressure range between EPAP and the highest inspiratory PAP achieved were not predictive of TAO. In patients with ALS, TAO was associated with better bulbar function. Study results were limited by initial EPAP being significantly lower in NMD patients reflecting that sleep apnea was less frequent and severe in this subgroup.

Conclusions

Initiation of NIV using an oronasal interface may be associated with TAO in a subset of patients. Since both EPAP and ∆PAP appear to play a causative role, careful titration of ventilator settings is recommended.

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Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study

Abstract

Background

The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency.

Methods

Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5 months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured.

Results

Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed.

Conclusions

SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.

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Upper airway obstruction induced by non-invasive ventilation using an oronasal interface

Abstract

Background

Methods

Results

Conclusions

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Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study

Abstract

Background

Methods

Results

Conclusions

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A new procedure for processing extracted teeth for immediate grafting in post-extraction sockets. An experimental study in American Fox Hound dogs

Publication date: Available online 15 February 2018
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): José Luis Calvo Guirado, Pilar Cegarra del Pino, Lari Sapoznikov, Rafael Arcesio Delgado Ruíz, Manuel Fernández Dominguez, Sérgio Alexandre Gehrke
ObjectivesTo investigate freshly extracted dental particulate used to graft post-extraction sockets in dogs, comparing new bone formation at experimental and control sites.Material and MethodsBilateral premolars P2, P3, P4 and first mandibular molars were extracted atraumatically from six American Fox Hound dogs. The teeth were ground immediately using a 'Smart Dentin Grinder.' The dentin particulate was sieved to ensure a grain size of 300-1200μm and immersed in an alcohol cleanser to dissolve organic debris and bacteria, followed by washing in sterile saline buffer solution.The animals were divided into two groups randomly: group 'A' (control) samples were left to heal without any extraction socket grafting procedure; group 'B' (experimental) sockets were filled with the autogenous dentin particulate graft. The rate of tissue healing and the quantity of bone formation were evaluated using histological and histomorphometric analyses at 60 and 90 days post-grafting. The type of bone generated was categorized as woven (immature bone) or lamellar bone (mature bone).ResultsSubstantially more bone formation was found in Group B (experimental) than Group A (control) at 60 and 90 days (p<0.05). Less immature bone was identified in the dentin grafted group (25.7%) than the control group (5.9%). Similar differences were also observed at 90 days post grafting.ConclusionAutogenous dentin particulate grafted immediately after extractions may be considered a useful biomaterial for socket preservation, protecting both buccal and lingual plates, generating large amounts of new woven bone formation after 60 days, and small amounts of lamellar bone after 90 days healing.

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"Int J Pediatr Otorhinolaryngol"[jour]; +60 new citations

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

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Expanded Endoscopic Transsphenoidal Resection of Tuberculum Sella Meningioma Invading the Optic Canal

J Neurol Surg B
DOI: 10.1055/s-0038-1625944

A 61-year-old male patient presented with recurrent malignant meningioma involving the left optic canal and decreased vision from the left eye. The patient had undergone orbital exenteration on the right 2 years ago. The decision to treat the patient was made based on the significant vision deterioration and rapid tumor growth. Endoscopic transsphenoidal approach considered the most suitable route due to the inferomedial invasion of the optic canal. Gross total removal was achieved and the patient's vision improved postoperatively. The patient developed hydrocephalus 4 weeks postoperatively and cerebrospinal fluid (CSF) leak. Ventriculoperitoneal shunt placement corrected both hydrocephalus and CSF leak.The link to the video can be found at: https://youtu.be/2cOF0pf5gAk.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | open access Full text

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Surgery of Tuberculum Sellae Meningioma: A Technical Purview on Pterional Approach

J Neurol Surg B
DOI: 10.1055/s-0038-1625945

Objective Amidst the raging debate between transnasal and transcranial approaches, the critical factor that dictates success lies in the meticulous dissection of the tumor from the optic apparatus, anterior communicating artery complex, and the pituitary stalk. In this surgical video, we describe the resection of a tuberculum sellae meningioma through the pterional approach highlighting dissection through the appropriate arachnoidal plane. Case Description The patient is a 75-year-old female who presented with optic nerve compression with bitemporal hemianopia and endocrine function abnormalities. A transcranial approach was done to effectively decompress the optic nerve. The video includes a detailed discussion on the surgical techniques including working between the different surgical corridors, working in the arachnoid plane to dissect the neurovascular structures away from the tumor, identification, and preservation of pituitary stalk. Postoperatively, the patient's visual field deficit improved with a remaining isolated right temporal field defect at 2 months follow-up. Her endocrine function improved after the surgery. Conclusion In the era of endoscopic surgery, transcranial approaches for suprasellar tumors like tuberculum sellae meningiomas still have a distinct surgical role. Our discussion extends to reiterate the strengths and weaknesses of the transcranial approach to this region as compared with the endoscopic approach. We believe decompression of optic nerves, separation of Acom complex from the tumor, and preservation of pituitary stalk are better achieved through a transcranial approach.The link to the video can be found at: https://youtu.be/kw5eP3oUd6Q.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | open access Full text

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Gross Total Resection of Chordoid Glioma of the Third Ventricle via Anterior Interhemispheric Transcallosal Transforaminal Approach at Two Stages

J Neurol Surg B
DOI: 10.1055/s-0038-1625967

Suprasellar tumors in particular tumors located in the retrochiasmatic area and anterior third ventricle are challenging cases in terms of optimal surgical exposure. Several approaches have been described including transsylvian, translamina terminalis, endoscopic endonasal, and anterior interhemispheric. Each approach has advantages and disadvantages. In this video, we present a case of retrochiasmatic anterior third ventricular tumor that was operated via anterior interhemispheric transcallosal transforaminal approach. The patient is a 42-year-old female who presented with sudden onset of severe headache and depressed level of consciousness. Computed tomography (CT) scan of the head showed a hemorrhage in the third ventricle and suprasellar cisterns. CT angiogram and magnetic resonance imaging (MRI) confirmed diagnosis of hemorrhagic mass lesion in the third ventricle. Upon further questioning of her family, we found out that she was having excessive urination and short-term memory problems for last 2 weeks. First, ventriculostomy was placed for obstructive hydrocephalus. She then underwent surgical resection via anterior interhemispheric transcallosal transforaminal approach. Foramen of Monro was enlarged by performing transchoroidal dissection. Using transforaminal route, tumor was resected. Due to the narrow surgical corridor and high vascularity of the tumor, decision was made to come back at a second stage. Using same surgical approach, in the second stage, gross total resection was performed. Postoperative MRI confirmed gross total resection. Histopathology was chordoid glioma of the third ventricle. She made excellent recovery with persistent diabetes insipidus. Currently, she is completing radiation therapy. In this video, we demonstrate techniques and pitfalls of anterior interhemispheric transcallosal approach to anterior third ventricular tumor.The link to the video can be found at: https://youtu.be/CI5c6Zup8sY.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | open access Full text

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An innovative virtual reality training tool for orthognathic surgery

Publication date: Available online 15 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Pulijala, M. Ma, M. Pears, D. Peebles, A. Ayoub
Virtual reality (VR) surgery using Oculus Rift and Leap Motion devices is a multi-sensory, holistic surgical training experience. A multimedia combination including 360° videos, three-dimensional interaction, and stereoscopic videos in VR has been developed to enable trainees to experience a realistic surgery environment. The innovation allows trainees to interact with the individual components of the maxillofacial anatomy and apply surgical instruments while watching close-up stereoscopic three-dimensional videos of the surgery. In this study, a novel training tool for Le Fort I osteotomy based on immersive virtual reality (iVR) was developed and validated. Seven consultant oral and maxillofacial surgeons evaluated the application for face and content validity. Using a structured assessment process, the surgeons commented on the content of the developed training tool, its realism and usability, and the applicability of VR surgery for orthognathic surgical training. The results confirmed the clinical applicability of VR for delivering training in orthognathic surgery. Modifications were suggested to improve the user experience and interactions with the surgical instruments. This training tool is ready for testing with surgical trainees.

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Clinical Characteristics of Subtypes of Follicular Variant Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.

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Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study

Thyroid , Vol. 0, No. 0.

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Starkey Introduces Its Smartest, Smallest Rechargeable Hearing Aid

After unveiling it at the Starkey's Hearing Innovation Expo in Las Vegas, Starkey's (https://www.starkey.com/) new Muse iQ Rechargeable hearing aid is now available to consumers through their network of hearing professionals and audiologists. The Muse iQ Rechargeable hearing aid is Starkey's smallest over-the-ear hearing aid to date. Built on Starkey's Synergy platform and Acuity OS operating system, the new hearing aid offers 30 hours of use with streaming, and fast, full-day charging in less than three hours. It also comes with a convenient, transportable charging case for 15-minute and "weekend" charges. This wireless hearing aid features telecoil and a CROS rechargeable system for individuals with single-sided hearing loss. Unlike other lithium-ion rechargeable hearing aids, the Muse iQ Rechargeable offers a user-friendly on/off switch.

Published: 2/16/2018 3:18:00 PM

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The Night Shift Nightmare

No abstract available

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In Response

No abstract available

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Perioperative Inflammation and Its Modulation by Anesthetics

Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. However, not only bacteria might evoke an immune response but also other noninfectious stimuli like the surgical trauma or mechanical ventilation may induce an inflammatory response of varying degree. In these cases, the immune system activation is not always beneficial for the patients and might carry the risk of concomitant, harmful effects on host cells, tissues, or even whole organ systems. Research over the past decades has contributed substantial information in which ways surgical patients may be affected by inflammatory reactions. Modulations of the patient's immune system may be evoked by the use of anesthetic agents, the nature of surgical trauma and the use of any supportive therapy during the perioperative period. The effects on the patient may be manifold, including various proinflammatory effects. This review focuses on the causes and effects of inflammation in the perioperative period. In addition, we also highlight possible approaches by which inflammation in the perioperative may be modulated in the future.

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Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST)

No abstract available

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Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways

BACKGROUND: In the armamentarium of an anesthesiologist, videolaryngoscopy is a valuable addition to secure the airway. However, when the videolaryngoscope (VLS) offers no solution, few options remain. Earlier, we presented an intubation technique combining Macintosh blade VLS and Bonfils intubation endoscope (BIE) for a patient with a history of very difficult intubation. In the present study, we evaluated this technique to establish whether it is a valuable alternative. METHODS: In this single-blinded nonrandomized study, 38 patients with a history of difficult intubation or 1 or more predictors of difficult intubation, scoring a Cormack & Lehane (C&L) grade III or IV using Macintosh blade VLS, were included. Patients were intubated combining the VLS with the BIE. The C&L grade was scored 3 times during (1) direct laryngoscopy; (2) indirect videolaryngoscopy; and (3) using the combined technique (VLS + BIE). Afterward, 2 blinded anesthesiologists assessed the C&L grade using the pictures taken during the procedure. RESULTS: Data of 38 patients were analyzed. An improvement of the C&L grade with the combined technique occurred in 33 of 38 patients (86.8%; 95% confidence interval, 71.9%–95.6%). Reviewer 1 reported an improvement of the C&L grade with the combined technique in 37 of 38 patients. Reviewer 2 reported improvement in 33 and deterioration in 2 of the patients. No complications occurred. CONCLUSIONS: The combined use of a VLS with Macintosh blade and BIE gives the anesthesiologist a valuable alternative intubation option in patients with extremely difficult airways.

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Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH)

No abstract available

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In Response

No abstract available

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Post-Cardiac Arrest Management: Time to Cool It on Cooling?

No abstract available

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Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review

Objective evaluations comparing different techniques and approaches to pediatric procedural sedation studies have been limited by a lack of consistency among the outcome measures used in assessment. This study reviewed those existing measures, which have undergone psychometric analysis in a pediatric procedural sedation setting, to determine to what extent and in what circumstances their use is justified across the spectrum of procedures, age groups, and techniques. The results of our study suggest that a wide range of measures has been used to assess the efficacy and effectiveness of pediatric procedural sedation. Most lack the evidence of validity and reliability that is necessary to facilitate rigorous clinical trial design, as well as the evaluation of new drugs and devices. A set of core pediatric sedation outcome domains and outcome measures can be developed on the basis of our findings. We believe that consensus among all stakeholders regarding appropriate domains and measures to evaluate pediatric procedural sedation is possible and that widespread implementation of such recommendations should be pursued.

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Meta-analysis, Medical Reversal, and Settled Science

No abstract available

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The Effect of Adductor Canal Block on Knee Extensor Muscle Strength 6 Weeks After Total Knee Arthroplasty: A Randomized, Controlled Trial

BACKGROUND: Total knee arthroplasty (TKA) reduces knee extensor muscle strength (KES) in the operated limb for several months after the surgery. Immediately after TKA, compared to either inguinal femoral nerve block or placebo, adductor canal block (ACB) better preserves KES. Whether this short-term increase in KES is maintained several weeks after surgery remains unknown. We hypothesized that 48 hours of continuous ACB immediately after TKA would improve KES 6 weeks after TKA, compared to placebo. METHODS: Patients scheduled for primary unilateral TKA were randomized to receive either a continuous ACB (group ACB) or a sham block (group SHAM) for 48 hours after surgery. Primary outcome was the difference in maximal KES 6 weeks postoperatively, measured with a dynamometer during maximum voluntary isometric contraction. Secondary outcomes included postoperative day 1 (POD1) and day 2 (POD2) KES, pain scores at rest and peak effort, and opioid consumption; variation at 6 weeks of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of hospital stay. RESULTS: Sixty-three subjects were randomized and 58 completed the study. Patients in group ACB had less pain at rest during POD1 and during peak effort on POD1 and POD2, consumed less opioids on POD1 and POD2, and had higher median KES on POD1. There was no significant difference between groups for median KES on POD2, variation of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of stay. There was no difference between groups in median KES 6 weeks after surgery (52 Nm [31–89 Nm] for group ACB vs 47 Nm [30–78 Nm] for group SHAM, P= .147). CONCLUSIONS: Continuous ACB provides better analgesia and KES for 24–48 hours after surgery, but does not affect KES 6 weeks after TKA. Further research could evaluate whether standardized and optimized rehabilitation over the long term would allow early KES improvements with ACB to be maintained over a period of weeks or months.

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Motor Evoked Potential Monitoring During Thoracoabdominal Aortic Surgery: Useful or Not?

No abstract available

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You’re Wrong, I’m Right: Dueling Authors Reexamine Classic Teachings in Anesthesia

No abstract available

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In Response

No abstract available

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Anesthesia Advanced Cardiac Life Support: A Guideline Validated?

No abstract available

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Perioperative Cardiac Arrest: Focus on Anaphylaxis

No abstract available

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Hyperglycemia and Elevated Lactate in Trauma: Where Do We Go From Here?

No abstract available

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A Retrospective Analysis of Clinical Research Misconduct Using FDA-Issued Warning Letters and Clinical Investigator Inspection List From 2010 to 2014

BACKGROUND: The US Food and Drug Administration (FDA) conducts inspections of clinical investigation sites as a component of clinical trial regulation. The FDA describes the results of these inspections in the Clinical Investigator Inspection List (CLIIL). More serious violations are followed up in FDA warning letters issued to investigators. The primary objective of the current study is to qualitatively and quantitatively describe the CLIIL data and contents of FDA-issued warning letters from 2010 to 2014. METHODS: We retrospectively analyzed the CLIIL and FDA warning letters. For the CLIIL, we quantified the frequency of each violation among other data points. We compared recent data (2010–2014) to the previous 5 years (2005–2009). To analyze FDA warning letters, we developed a coding system to quantify the frequency of violations found. RESULTS: We analyzed 3637 inspections in the CLIIL database and 60 warning letters. Overall, there was a decrease or no change in all violations in the CLIIL database. The largest violation code reported was "failure to follow investigational plan" in both the 2005–2009 and 2010–2014 timeframes. Coding of FDA warning letters shows that the most common violations reported were failing to maintain accurate case histories (10.82%), enrolling ineligible subjects (8.85%), and failing to perform required tests (8.52%). CONCLUSIONS: The overall decrease in violations is encouraging. But, the high proportion of violations related to failure to follow the investigational plan is concerning as the complexity of trials increases. We conclude that more detailed information is necessary to accurately evaluate these violations. The current study provides a model for creating more granular data of violations to better inform clinical investigators and improve clinical trials.

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Between a ROCK and an IR Place

No abstract available

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Chinese Anesthesiologists Have High Burnout and Low Job Satisfaction: A Cross-Sectional Survey

BACKGROUND: The Chinese health care system must meet the needs of 19% of the world's population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing–Tianjin–Hebei region focusing on job satisfaction and burnout to determine the incidence and associated factors. METHODS: A large cross-sectional study was performed in the Beijing–Tianjin–Hebei region of China. The anonymous questionnaire was designed to collect and analyze the following information: (1) demographic characteristics and employer information; (2) job satisfaction assessed by Minnesota Satisfaction Questionnaire; (3) burnout assessed by Maslach Burnout Inventory-Human Service Survey; and (4) sleep pattern and physician–patient communication. RESULTS: Surveys were completed and returned from 211 hospitals (response rate 74%) and 2873 anesthesiologists (response rate 70%) during the period of June to August 2015. The overall job satisfaction score of Minnesota Satisfaction Questionnaire was 65.3 ± 11.5. Among the participants, 69% (95% confidence interval [CI], 67%–71%) met the criteria for burnout. The prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment was 57% (95% CI, 55%–59%), 49% (95% CI, 47%–51%), and 57% (95% CI, 55%–58%), respectively. Using multivariable logistic regression analysis, we found that age, hospital category, working hours per week, caseload per day, frequency of perceived challenging cases, income, and sleep quality were independent variables associated with burnout. Anesthesiologists with a high level of depersonalization tended to engage in shorter preoperative conversations with patients, provide less information about pain or the procedure, and to have less empathy with them. CONCLUSIONS: The anesthesiologists in the Beijing–Tianjin–Hebei region of China expressed a below-average level of job satisfaction, and suffered a significant degree of burnout. Improvement in job satisfaction and burnout might create a positive work climate that could benefit both the quality of patient care and the profession of anesthesiology in China.

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Αρχειοθήκη ιστολογίου

Παρασκευή 16 Φεβρουαρίου 2018

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