Associations between sleep duration and physical activity and dietary behaviors in Chinese adolescents: results from the Youth Behavioral Risk Factor Surveys of 2015

Publication date: September 2017
Source:Sleep Medicine, Volume 37
Author(s): Qing Hai Gong, Hui Li, Xiao Hong Zhang, Tao Zhang, Jun Cui, Guo Zhang Xu
ObjectiveTo assess the association between sleep duration and physical activity and dietary behaviors among adolescents in a representative sample.MethodsThe analysis was performed using data from the 2015 Ningbo Youth Risk Behavior Survey. Associations between physical activity and dietary behaviors and sleep duration were examined on weighted data using logistic regression.ResultsOf the 10726 students, roughly 40% reported sleep duration <8 h. Longer sleep duration was associated with higher likelihood of milk intake, fruit consumption, vegetable consumption, water consumption, moderate physical activity, and muscle-strengthening physical activity, and with a lower likelihood of cigarette use, alcohol use, sweets intake, Western fast food intake, and breakfast skipping.ConclusionInsufficient sleep may be common among Chinese adolescents. Sleep duration was associated with dietary behaviors, physical activity, and other health-related behaviors. These findings suggest that sleep duration could be a potential target for many health-risk behaviors in young adolescents.



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QT interval variability index and QT interval duration during different sleep stages in patients with obstructive sleep apnea

Publication date: September 2017
Source:Sleep Medicine, Volume 37
Author(s): Moonika Viigimae, Deniss Karai, Kristjan Pilt, Peeter Pirn, Heini Huhtala, Olli Polo, Kalju Meigas, Jyri Kaik
ObjectivesThe aim of the study was to investigate the impact of obstructive sleep apnea (OSA) on the QT interval variability and duration in patients during different sleep stages.MethodsPolysomnographic recordings of 28 (13 male, 15 female) patients with OSA and 30 (15 male, 15 female) patients without OSA were analyzed. The QT interval variability index (QTVI) and the corrected QT interval (QTc) analyses were performed using two awake, 3–4 non-rapid eye movement (NREM) and three rapid eye movement (REM) sleep episodes (each 300 s). The Bazett formula, linear, and parabolic heart rate correction formulas with two separate α values were used.ResultsQTVI was statistically higher in OSA than in non-OSA patients for males while awake (awake −0.7 ± 0.3 vs −1.2 ± 0.2, p = 0.001; NREM ‒0.9 ± 0.4 vs −1.1 ± 0.3, p = 0.110; REM ‒1.1 ± 0.3 vs −1.3 ± 0.2, p = 0.667) and for females in all wake–sleep stages (awake −0.3 ± 0.7 vs −0.9 ± 0.5, p = 0.001; NREM ‒0.3 ± 0.5 vs −0.8 ± 0.4, p = 0.002; REM −0.3 ± 0.5 vs −1.0 ± 0.4, p < 0.001). QTVI was significantly higher during awake compared to sleep stages in OSA males (p < 0.05); no difference between wake–sleep stages was found in females (p > 0.05). Significant gender differences in QTVI existed in OSA patients during sleep (p < 0.05) but not while awake. No significant differences in QTc between patients groups were observed.ConclusionsOSA is associated with increased QT variability. REM sleep per se does not increase QTVI. In OSA patients, QTVI might be a more useful measure to detect ventricular repolarization abnormality than measures of QTc.



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Epidemiology and ‘big data’

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Recent advances in genomic profiling of adenosquamous carcinoma of the pancreas

Abstract

Adenosquamous carcinoma of the pancreas (ASCP) is a mixed tumor type which contains squamous cell carcinoma and also ductal adenocarcinoma components. Due to the rarity of this malignancy, only very limited genomic profiling has been performed. A recent paper by Fang et al. published in The Journal of Pathology contributed to our knowledge of genomic alterations by performing whole genome and exome sequencing of 17 ASCP tumors. They found major genomic similarities to pancreatic ductal adenocarcinoma; however, the p53 pathway was altered in a greater proportion of cases, while a high frequency of 3p loss was a distinct copy number alteration pattern observed in ASCP. Laser capture microdissection revealed that adenocarcinoma and squamous carcinoma components of ASCP harbor similar genomic variations, indicating that the origin of tumor components is the same or similar. Although the study published by Fang et al. increases our knowledge of this rare mixed tumor type, further investigation, including RNA sequencing, will be needed to fully characterize this malignancy and to aid the development of novel treatment approaches.

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Sublobar resection versus lobectomy in patients aged ≤35 years with stage IA non-small cell lung cancer: a SEER database analysis

Abstract

Purpose

Sublobar resection has been increasingly adopted in elderly patients with stage IA non-small cell lung cancer (NSCLC), but the equivalency of sublobar resection versus lobectomy among young patients with stage IA NSCLC is unknown.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified patients aged ≤35 years who were diagnosed between 2004 and 2013 with pathological stage IA NSCLC and treated with sublobar resection or lobectomy. We used propensity-score matching to minimize the effect of potential confounders that existed in the baseline characteristics of patients in different treatment groups. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of patients who underwent sublobar resection or lobectomy were compared in stratification analysis.

Results

Overall, we identified 188 patients who had stage IA disease, 32 (17%) of whom underwent sublobar resection. We did not identify any difference in OS/LCSS between patients who received sublobar resection versus lobectomy before (log-rank p = 0.6354) or after (log-rank p = 0.5305) adjusting for propensity scores. Similarly, we still could not recognize different OS/LCSS rates among stratified T stage groups or stratified lymph node-removed groups before or after adjusting for propensity scores.

Conclusions

Sublobar resection is not inferior to lobectomy for young patients with stage IA NSCLC. Considering sublobar resection better preserves lung function and has reduced overall morbidity, sublobar resection may be preferable for the treatment of young patients with stage IA NSCLC.

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TLR9 gene polymorphism −1486T/C (rs187084) is associated with uterine cervical neoplasm in Mexican female population

Abstract

Purpose

The aim of this work was to evaluate the association of single nucleotide polymorphisms in TLR9 (−1486 T/C [rs187084], −1237T/C [rs5743836] and G2848A [rs352140]) with HPV infection, squamous intraepithelial lesions, and uterine cervical neoplasm in a Mexican population. Additionally, the peripheral expression of TLR9 was evaluated to evaluate the differences in the TLR9 expression associated with every genotype in the locus −1486 of the TLR9 gene. The serum concentration of TLR9 was evaluated in a randomly selected subsample.

Methods

Genotyping was performed using predesigned 5′ endonuc lease assays and the association of the polymorphisms with the diagnosis groups were assessed by performing multinomial regression models. The relative expression of TLR9 in peripheral blood mononuclear cells was evaluated by real-time polymerase chain reaction and the association of the level of TLR9 expression with the diagnosis was evaluated by performing multinomial regression models. The serum concentration of TLR9 was evaluated in a subsample of patients diagnosed with uterine cervical neoplasm by ELISA.

Results

The results showed that genotype TT in the −1486 locus of TLR9 was significantly associated with HPV infection (OR = 3.25, 95% CI 1.12–9.46), squamous intraepithelial cervical lesion (OR = 3.76, 95% CI 1.36–10.41), and uterine cervical neoplasm (OR = 5.30, 95% CI 1.81–15.55). Moreover, the highest level of TLR9 expression was significantly associated with a greater risk for developing squamous intraepithelial cervical lesion and uterine cervical neoplasm. The serum TLR9 concentration was higher in patients with uterine cervical cancer than in controls.

Conclusion

Our findings indicate that genotype TT in the −1486 locus of the TLR9 gene could comprise a risk genotype for HPV infection, squamous intraepithelial cervical lesion, and uterine cervical neoplasm in Mexican female population. Further studies with larger samples are needed to evaluate if the peripheral expression of TLR9 could be used as a biomarker of uterine cervical neoplasm progression.

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Prof. Helen Carty (1944–2017)

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Central–peripheral differences in audiovisual and visuotactile event perception

Abstract

We examined audiovisual and visuotactile integration in the central and peripheral visual field using visual fission and fusion illusions induced by sounds or taps. The fission illusion occurs when a single flash is perceived as two flashes if paired with two beeps or taps; the fusion illusion, by contrast, occurs when two flashes are perceived as a single flash if the flashes are paired with a single beep or tap. Beeps and taps induced similar patterns of illusions: the fission illusion was larger in the periphery than in the center, whereas the fusion illusion was larger in the center than in the periphery. An analysis based on signal detection theory revealed that both a decline in discriminability and a shift in criterion were associated with the more pronounced fission induced by sounds in the periphery. In contrast, only a shift in criterion was associated with the larger fission induced by taps in the periphery, and the larger fusion induced by a sound or tap in the center. To accommodate these findings, two accounts are proposed: audiovisual signals are more likely to be integrated in peripheral than in central vision, and the interpretation of visual signals favors discontinuous percepts, especially in the periphery.

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Assoziation zwischen Kontrolle der allergischen Rhinitis und Schlafqualität

Zusammenfassung

Hintergrund

Die allergische Rhinitis (AR) gilt mit einem Anteil von über 50 % als die häufigste Manifestation der Erkrankungen aus dem atopischen Formenkreis. In letzter Zeit geriet dieses Krankheitsbild zunehmend in den Fokus intensiver Forschung. Die AR hat u. a. Auswirkungen auf das Schlafverhalten und kann die Schlafqualität beeinträchtigen. Bis zum heutigen Zeitpunkt existieren keine veröffentlichten Studien zur Fragestellung, inwieweit eine Assoziation zwischen dem Ausmaß der AR-Kontrolle und dem Schweregrad der beeinträchtigten Schlafqualität besteht.

Methoden

In unserer prospektiven Querschnittstudie wurde bei Patienten die Verbindung des Grads der AR-Kontrolle mit der Schlafqualität getestet. Eingeschlossen wurden Patienten mit diagnostizierter AR. Sie beurteilten die Schlafqualität anhand von 5 Fragen aus dem etablierten und standardisierten Fragebogen 22-item Sinonasal Outcome Test und die AR-Kontrolle mit dem Fragebogen Rhinitis Control Assessment Test (RCAT). Die gewonnenen Daten wurden mit einer linearen Regressionsanalyse untersucht und ausgewertet.

Ergebnisse

104 Patienten mit einem Durchschnittsalter von 41,4 Jahren (SD: 15,9 Jahre) wurden in die Studie eingeschlossen. Anteilig wurden 54,8 % weibliche und 45,2 % männliche Patienten in die Studie eingeschlossen. Es bestand eine statistisch signifikante Korrelation zwischen der Schlafqualität (als abhängige Variable) und den RCAT-Messungen (als unabhängige Variable; p < 0,001).

Schlussfolgerung

Dank der hohen Fallzahl konnte in der vorliegenden Studie erstmals mit statistischer Signifikanz gezeigt werden, dass die Kontrolle der AR mit der subjektiv wahrgenommenen Schlafqualität korreliert. Dies weist darauf hin, dass eine Verbesserung der AR-Kontrolle wahrscheinlich zur verbesserten subjektiven Schlafqualität führen würde. Es bedarf einer prospektiven interventionellen Studie, um die Ergebnisse zu bestätigen.

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Activity of cabazitaxel in patients with metastatic castration-resistant prostate cancer after treatment with single or dual regimens of novel androgen receptor-targeting agents

Abstract

The purpose of this study was to evaluate the efficacy of cabazitaxel for patients with metastatic castration-resistant prostate cancer (mCRPC) after sequential therapy with docetaxel (DTX) and single or dual regimens of novel androgen receptor-axis-targeted (ARAT) agents. We retrospectively reviewed 84 consecutive patients treated with cabazitaxel at Kobe University Hospital and related hospitals from September 2014 to September 2016. The association of each prognostic parameter with progression-free survival (PFS) was evaluated, including the sequence of therapy. Patients were divided according to their treatment after receiving cabazitaxel as follows: group 1 (after DTX and single regimen of novel ARAT agent) and group 2 (after DTX and dual novel ARAT agents). Median PFS for cabazitaxel treatment was 10.3 months (range 4.5–14.2 months). Prostate-specific antigen (PSA) response rates (≥30%) were 46.8 and 46.1% in group 1 and group 2, respectively [p = 0.96, hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.57–1.80]. PSA response rates (≥50%) were 43.8 and 26.9% in patients of group 1 and group 2, respectively (p = 0.18, HR 1.54, 95% CI 0.78–3.04). Univariate analysis revealed that PFS for cabazitaxel treatment was significantly associated with baseline alkaline phosphatase, bone metastasis, and prior sequential therapy. Multivariate analysis revealed that bone metastasis and prior sequential therapy were independently associated with PFS. Prior sequential therapy with single regimen or dual regimens of novel ARAT agents was independently associated with PFS of patients with mCRPC treated with cabazitaxel. The effect of cabazitaxel after the administration of DTX and single novel ARAT agent was more sustained.

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Epidemiology and ‘big data’

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Impact of Adenoma Detection on the Benefit of Faecal Testing versus Colonoscopy for Colorectal Cancer

Abstract

Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related with patients' post-colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) versus primary colonoscopy screening for colorectal cancer. Using an established microsimulation model, we predicted the lifetime colorectal cancer incidence and mortality benefits of annual FIT versus ten-yearly colonoscopy screening at differing ADR levels (quintiles; averages 15.3-38.7%), with colonoscopy performance assumptions estimated from community-based data on physician ADRs and patients' post-colonoscopy risk of cancer. For patients receiving FIT screening with follow-up colonoscopy by physicians from the highest ADR quintile, simulated lifetime cancer incidence and mortality were 28.8 and 5.4 per 1000, respectively, versus 20.6 and 4.4 for primary colonoscopy screening (risk ratios, RR=1.40; 95% probability interval (PI), 1.19-1.71 for incidence, and RR=1.22; 95%PI, 1.02-1.54 for mortality). With every 5% point ADR decrease, lifetime cancer incidence was predicted to increase on average 9.0% for FIT versus 12.3% for colonoscopy, and mortality increased 9.9% versus 13.3%. In ADR quintile 1, simulated mortality was lower for FIT than colonoscopy screening (10.1 versus 11.8; RR=0.85; 95%PI, 0.83-0.90), while incidences were more similar. This suggests that relative cancer incidence and mortality reductions for FIT versus colonoscopy screening may differ by ADR, with fewer predicted deaths with colonoscopy screening in higher ADR settings and fewer deaths with annual FIT screening in lower ADR settings. This article is protected by copyright. All rights reserved.

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“Histological characteristics of HPV-associated and -independent squamous cell carcinomas of the vulva: A study of 1594 cases”

Abstract

There are at least two different etio-pathogenic pathways for the development of vulvar squamous cell carcinoma (VSCC): one associated with infection by human papillomavirus (HPV) and another independent of HPV. We aimed to describe the histological characteristics of HPV-associated and HPV-independent tumors and to determine the best strategy to identify HPV in VSCC. A single paraffin block was available for review from a series of 1594 VSCCs. In all cases HPV DNA detection was analyzed using the SPF10PCR/DEIA/LiPA25 system and p16 immunohistochemistry (IHC). A tumor was considered as unquestionably HPV-associated if both HPV DNA and p16 IHC were positive. A tumor was considered indisputably HPV-independent if both HPV DNA and p16 IHC were negative. Two groups of tumors were classified as non-conclusive: 1) HPV DNA+/p16-; and 2) HPV DNA-/p16+. WHO typing and a thorough histological evaluation were conducted in all cases.

441 tumors were HPV DNA+ with 367 cases (23.0%) being HPV DNA+/p16+. These HPV DNA+/p16+ tumors were more frequently basaloid or warty (49.8%), but 36.5% were of the keratinizing type. 1153 tumors were HPV DNA-, with 1060 cases (66.5%) being HPV DNA-/p16-. These HPV DNA-/p16- tumors were mostly keratinizing (81.2%) but were occasionally basaloid or warty (5.2%). The features of HPV DNA-/p16+ cases (n=93) were similar to those of the HPV-associated VSCC, and HPV DNA+/p16- (n=74) cases had a more diverse profile, although they were more similar to HPV-independent tumors. Several histological characteristics were more frequently associated with HPV-related VSCC (koilocytotic-like change, necrosis, moderate to marked pleomorphism, invasive front in nests; p<0.001), however, none of these characteristics allowed differentiation between HPV-associated and –independent VSCC. In conclusion, histological criteria do not allow differentiation between HPV-associated and –independent VSCC. p16 alone is a clinically easy strategy to determine HPV status in VSCC. This article is protected by copyright. All rights reserved.

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Prospective Study of Urinary Prostaglandin E2 Metabolite and Pancreatic Cancer Risk

Abstract

The cyclooxygenase 2 (COX-2) pathway is upregulated in many pancreatic cancer cells, and it is believed that carcinogenetic effects of COX2 upregulation are largely through prostaglandin E2 (PGE2) overproduction. We tested this hypothesis by evaluating the association between urinary PGE2 metabolites (PGE-M), a biomarker of in vivo PGE2 overproduction, and pancreatic cancer risk. We conducted a case-control study with 722 subjects (239 cases and 483 controls) nested within two prospective cohort studies, the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS). Pre-diagnosis urine samples were measured for PGE-M using a liquid chromatography/tandem mass spectrometric method. Conditional logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (95%CI), with adjustment for potential confounders. Compared to those with the lowest urine level of PGE-M (the first quartile), individuals with higher urine levels of PGE-M had an increased risk of developing pancreatic cancer, with adjusted ORs (95%CI) of 1.63 (0.98-2.73), 1.55 (0.90-2.69), and 1.94 (1.07-3.51), for the second to the fourth quartile groups, respectively (P for trend=0.054). This dose-response positive association was more evident among those who had BMI < 25 kg/m² than overweight individuals (P for interaction=0.058). After excluding cases diagnosed in the first year of follow-up and their matched controls, this positive association persisted (P for trend=0.037) and the interaction became statistically significant (P for interaction=0.017). This study adds additional evidence that the COX-2 pathway is involved in pancreatic carcinogenesis and suggests that urinary PGE-M may serve as a biomarker for predicting pancreatic cancer risk. This article is protected by copyright. All rights reserved.

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Risk of second primary cancers in women diagnosed with endometrial cancer in German and Swedish cancer registries

Abstract

Along with the increasing incidence and favorable prognosis, more women diagnosed with endometrial cancer may develop second primary cancers (SPCs). We aimed at investigating risk of SPCs after endometrial cancer in Germany and Sweden to provide insight into prevention strategies for SPCs. Endometrial cancer patients diagnosed at age ≥15 years in Germany during 1997-2011 and in Sweden nationwide during 1997-2012 were selected. Standardized incidence ratios (SIRs), calculated as the ratio of observed to expected numbers of cases, were used to assess the risk of a specific second cancer after endometrial cancer for both German and Swedish datasets. Among 46,929 endometrial cancer survivors in Germany and 18,646 in Sweden, overall 2,897 and 1,706 SPCs were recorded, respectively. Significantly elevated SIRs were observed in Germany for ovarian (SIR=1.3; 95%CI:1.1-1.5) and kidney cancers [1.6 (1.3-1.8)], while in Sweden the SIRs were 5.4 (4.6-6.3) and1.4 (1.0-1.9), respectively. Elevated risk for second ovarian endometrioid carcinoma was pronounced after early (<55 years) onset endometrial cancer in Germany [9.0 (4.8-15)] and Sweden [7.7 (5.1-11)]. In Germany elevated risks were found for second ovarian endometrioid carcinoma after endometrioid histology of first endometrial cancer [6.3 (4.0-9.4)] and for second kidney cancer after clear cell histology of endometrial cancer [4.9 (1.6-11)]. We found exceptionally elevated risk of second ovarian endometrioid carcinoma after endometrial cancer of the same histology or of early onset. Risk for second kidney cancer was also increased, particularly after endometrial cancer of clear cell histology. Cancer prevention strategies should focus on these cancers after endometrial cancer diagnosis. This article is protected by copyright. All rights reserved.

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Metastatic melanoma: prognostic factors and survival in patients with brain metastases

Abstract

Brain metastases from malignant melanoma carry a poor prognosis. Novel systemic agents have improved overall survival (OS), but the value of whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) remains uncertain. The melanoma-specific graded prognostic assessment (msGPA) provides useful prognostic information, but the relevance to the modern-day population has not been validated. Since 2011, 53 patients received treatment for brain metastases from malignant melanoma at the Rosemere Cancer Centre medical oncology clinic. Data were collated on demographic factors and survival. Survival analyses were performed using Kaplan–Meier methods. Cox regression was used to identify prognostic factors on univariate and multivariate analysis. OS from the date of diagnosis of brain metastases was 4.83 months (range 0.27–30.4 months). On univariate analysis, BRAF, performance status and msGPA were significant prognostic indicators for OS (p = 0.0056, p = 0.0039 and p = 0.0001 respectively). msGPA remained significant on multivariate analysis (p = 0.0006). OS for BRAF-positive patients receiving targeted treatment (n = 22) was significantly better than for BRAF-negative patients (n = 26), with median survival times of 8.2 and 3.7 months respectively (p = 0.0039, HR 2.36). SRS combined with systemic agents (n = 16) produced an OS of 13.5 months. Patients receiving WBRT alone (n = 21) had a poor prognosis (2.2 months). The msGPA remains a valid prognostic indicator in the era of novel systemic treatments for melanoma. BRAF-positive patients receiving targeted agents during their treatment had favorable survival outcomes. WBRT alone should be use with caution in the active management of melanoma brain metastases.

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Resection of rectal GIST using a novel technique: a report of two cases

Osama Eldamshety, Islam H Metwally, Elsayed Ghoneem and Wagdi F Elkashef

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Effect of Long-term Treatment with TNFα Inhibitors on Single-dose UV-induced Changes in Human Skin

Abstract

Tumor necrosis factor alpha (TNFα) is induced by ultraviolet (UV) light and important in photoinflammation.¹ Although TNFα inhibitors are commonly used for various inflammatory disorders like psoriasis, sometimes in combination with phototherapy, the effect of long-term TNFα inhibitor treatment with UV exposure on skin is unclear. This study was to see if chronic TNFα inhibition affects epidermal responses to UV, inflammatory infiltrate, and collagen composition in vivo.

This article is protected by copyright. All rights reserved.

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Comparison of indirubin concentrations in indigo naturalis ointment for psoriasis treatment: a randomized, double-blind, dosage-controlled trial

Abstract

Background

Indigo naturalis and its refined formulation, Lindioil, are effective in treating psoriatic symptoms topically. Indirubin is the active ingredient in indigo naturalis.

Objectives

To determine the efficacy and safety of different concentrations of indirubin in Lindioil ointment for treating psoriasis.

Methods

In this randomized, double-blind trial, adult patients presenting with chronic plaque psoriasis for >1 year and with <20% of the body surface area (BSA) affected were randomized to apply Lindioil ointment containing 200 μg/g, 100 μg/g, 50 μg/g, or 10 μg/g of indirubin twice daily for 8 weeks followed by an additional 12-week safety/extension period. The primary endpoint was the mean percentage change in Psoriasis Area and Severity Index (PASI) score along with the proportion of subjects achieving 75% and 90% reductions in PASI scores (PASI75 and PASI90, respectively) from baseline to week 8.

Results

The results from week 8 revealed that the 200 μg/g group had the greatest reduction in PASI score (69·2%, 95% confidence interval [CI] 82·8–55·5), followed by the 100 μg/g group (63·1%, 95% CI 73·5–52·8), the 10 μg/g group (53·4%, 95% CI 64·0–42·8), and the 50 μg/g group (50·3%, 95% CI 63·2–37·4), with between-group comparison of P = 0·0445). The highest proportion of the subjects in the 200 μg/g group achieved PASI75 (56·5%, P = 0·0474) and PASI90 (30·4%, P = 0·0098). No severe treatment-related adverse events were reported during the 20-week evaluation.

Conclusions

200 μg/g of indirubin in Lindioil ointment is the most effective concentration studied so far for treating psoriasis topically, and is safe ClinicalTrials . gov Identifier: NCT01735864

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Severe disruption and disorganization of dermal collagen fibrils in early striae gravidarum

Abstract

Background

Striae gravidarum (SG), or stretch marks of pregnancy, begin as erythematous streaks, and mature into hypopigmented atrophic bands.

Objectives

To investigate molecular alterations that may promote atrophy of SG, we investigated dermal type I collagen fibrils, which provide human skin with support.

Methods

We obtained skin samples of recently developed, erythematous abdominal SG from pregnant women. To examine the organization of collagen fibrils, second-harmonic generation imaging was performed using multiphoton microscopy. Immunostaining was used to determine protein expression and localization of type I procollagen, the precursor of type I collagen fibrils. Real-time polymerase chain reaction was used to determine gene expression levels.

Results

In control (hip) and stretched, normal-appearing perilesional abdominal skin, dermal collagen fibrils were organized as tightly packed, interwoven bundles. In SG, collagen bundles appeared markedly separated, especially in the mid-to-deep dermis. In the spaces separating bundles, loosely packed wavy collagen fibrils lacking organization as bundles were present. These disorganized fibrils persisted into the postpartum period and failed to form densely packed bundles. Numerous large fibroblasts displaying type I procollagen expression were in close proximity to the disorganized fibrils, suggesting that the fibrils are newly synthesized. Supporting this possibility, immunostaining and gene expression of type I procollagen were increased throughout the dermis of SG.

Conclusions

Early SG display marked separation of collagen bundles and emergence of disorganized collagen fibrils that fail to form bundles. These alterations may reflect ineffective repair of collagen bundles disrupted by intense skin stretching. Persistent disruption of the collagenous extracellular matrix likely promotes formation and atrophy of SG.

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Three-dimensional assessment of the temporal bone and mandible deformations in patients with congenital aural atresia

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Yaoyao Fu, Chenlong Li, Peidong Dai, Tianyu Zhang
ObjectiveTo investigate the deformations of temporal bone and mandible combined with congenital aural atresia.MethodsA total of 158 patients with congenital aural atresia were included in the study. The raw CT data of the temporal bone was imported into MIMICS v 12 and threshold dissection, region growing and three-dimensional (3D) calculation were used to calculate 3D models. The 3D characteristics of the temporal bone and upper part of mandible were assessed.ResultsThe tympanic part of the temporal bone was all undeveloped. Of all the patients included, 14 patients were found to have severe maxillofacial malformations. Among them, 2 cases have floating arch, 4 cases have interrupted arch, 5 cases have mandibular processes hypoplasia and 3 cases have interrupted arch combined with severe maxillary malformation. Ten of the 14 patients were suffered from dysplasia of the mastoid part of the temporal bone as well.ConclusionMaxillofacial malformations may sometimes coexist with congenital aural atresia. Otolaryngologists should not neglect the coexisted maxillofacial malformations and give timely referral to maxillofacial surgeons.



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Aesthetic and hearing rehabilitation in patients with bilateral microtia-atresia

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Xinmiao Fan, Yibei Wang, Pu Wang, Yue Fan, Yu Chen, Yuanli Zhu, Xiaowei Chen
ObjectivesTo evaluate the safety and efficacy of auricle reconstruction and active transcutaneous bone-conduction implantation in patients with bilateral microtia-atresia.DesignPatients were chosen prospectively, with each being his/her own control.SettingThe setting was a tertiary referral center.ParticipantsTwelve patients, aged 6–18 years, with bilateral microtia-atresia suffering from bilateral conductive hearing loss. All had an upper bone conduction threshold limit of 45 dB HL at frequencies of 0.5–4 kHz.Main outcome measuresPatient satisfaction with the reconstructed auricle was rated as highly satisfactory, basically satisfactory, or unsatisfactory. Mean pure-tone thresholds and speech audiometry test results were compared among patients unaided, with a soft-band Bonebridge, and with an implanted Bonebridge. Subjective satisfaction was analyzed using three questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Glasgow children's benefit inventory (GCBI), and the International Outcome Inventory for Hearing Aids (IOI-HA).ResultsAll patients who underwent auricle reconstruction expressed satisfaction with their appearance. The mean pure-tone thresholds of unaided patients and those with soft-band and implanted Bonebridge were 55.25 ± 3.43 dBHL, 31.37 ± 3.03 dBHL, and 21.25 ± 2.16 dBHL, respectively. The mean speech discrimination scores measured in a sound field with a presentation level of 65 dB SPL under these three conditions were 46.0 ± 0.11%, 80.0 ± 0.09%, and 94.0 ± 0.02%, respectively. Questionnaires demonstrated patients' benefits and satisfaction with this surgery.ConclusionsThe surgical procedure involving auricle reconstruction and Bonebridge implantation was safe and effective for patients with bilateral microtia-atresia, solving both appearance and hearing problems.



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Matthew Baillie's Specimens and Engravings

Abstract

In 1799, Matthew Baillie, William Hunter's nephew, published his famous atlas of pathology. It was entitled A Series of Engravings Accompanied with Explanations which are Intended to Illustrate the Morbid Anatomy of Some of the Most Important Parts of the Human Body. The present study aims to match the illustrations to extant specimens in the collections of William and John Hunter, preserved at the University of Glasgow and at the Royal College of Surgeons of England respectively.

Baillie's book contains 10 fasciculi, consisting of 73 plates and 206 figures. The specimens Baillie illustrated came from his own collection and those of ten others, including his uncles, William and John Hunter. The book was illustrated by William Clift and engraved by James Basire, William Skelton and James Heath.

Excluding eight illustrations of intestinal worms where the provenance of the specimens is uncertain, a total of 98 specimens from William Hunter's collection were illustrated in 104 figures. Eight of the specimens were calculi impossible to identify specifically. Excluding worms and calculi, 72 of William Hunter's specimens illustrated by Baillie are extant in the Hunterian Collection at the University of Glasgow. All but one of the 20 specimens illustrated that had belonged to John Hunter were identified in the on-line catalogue of the Royal College of Surgeons of England. Baillie's own collection was destroyed when the Royal College of Surgeons of England was bombed in 1941. Baillie is credited with being the first to produce an illustrated systematic textbook of morbid anatomy and probably the first to illustrate emphysema and transposition of the great vessels. His book, however, was not comprehensive. It did not cover a number of topics such as muscles and bones and there is little coverage of the nervous system. Baillie's book, however, was an original concept as an atlas of morbid anatomy and showed his deep insight into pathology. This article is protected by copyright. All rights reserved.

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Water Quality and Toxicological Impact Assessment Using the Nematode Caenorhabditis elegans Bioassay in a Long-Term Intensive Agricultural Area

Abstract

Due to intensive agricultural activities to meet the growing needs for food, large volumes of water are consumed and an increasing amount of agrochemicals are released into the environment threatening the aquatic ecosystem. In order to ensure a sustainable agricultural management, it is crucial to develop an integrated water assessment plan that includes not only water quantity and quality but also toxicological assessments. The Pergamino River basin (province of Buenos Aires, Argentina) was selected as a representative case of study to monitor and assess the impact of both the long-term intensification of soybean production and fast-growing urban development on surface and groundwater sources. Physicochemical analyses and a Water Quality Index were determined and showed that water quality falls into the marginal category, compromising the irrigation purposes and threatening aquatic life. Glyphosate and aminomethylphosphonic acid were detected at least once in all sites. Caenorhabditis elegans toxic bioassays were performed and a toxicological ranking was developed. This analysis proved to be useful to detect toxicity even when water parameters met regulatory requirements and water quality seemed to be satisfactory. This research constitutes a valuable model to be replicated in other river basins that have been impacted by intensive agriculture and growing urban development in order to assess water quality conditions and ensure sound water resources management.

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Heavy Metal Uptake by Herbs. V. Metal Accumulation and Physiological Effects Induced by Thiuram in Ocimum basilicum L.

Abstract

Basil (Ocimum basilicum L.) is extensively cultivated as either an important spice and food additive or a source of essential oil crucial for the production of natural phenylpropanoids and terpenoids. It is frequently attacked by fungal diseases. The aim of the study was to estimate the impact of thiuram contact time on the uptake of manganese, cobalt, nickel, copper, zinc, cadmium, and lead by Ocimum basilicum L. The relevant plant physiological parameters were also investigated. Two farmland soils typical for the Polish rural environment were used. Studies involved soil analyses, bioavailable, and total forms for all investigated metals, chlorophyll content, and gas exchange. Atomic absorption spectrometry was used to determine concentration of all elements. Analysis of variance proved hypothesis that thiuram treatment of basil significantly influences metal transfer from soil and their concentration in roots and aboveground parts. This effect is mostly visible on the 14th day after the fungicide administration. Thiuram modifies mycoflora in the rhizosphere zone and subsequently affects either metal uptake from the soil environment or their further migration within the basil plant. Notable, those changes are more evident for basil planted in mineral soil as compared to organic soil with higher buffering capacity.

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Cognitive impairment and chemotherapy: A brief overview

Publication date: Available online 14 August 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Milena Vitali, Carla Ida Ripamonti, Fausto Roila, Claudia Proto, Diego Signorelli, Martina Imbimbo, Giulia Corrao, Angela Brissa, Gallucci Rosaria, Filippo de Braud, Marina Chiara Garassino, Giuseppe Lo Russo
Patients with cancer are experiencing long-term survival following chemotherapy, but the treatment may also be associated with short and long-term toxicity, including the possibility of cognitive dysfunction. A literature overview indicated a significant association between chemotherapy and cognitive impairment but prospective longitudinal research is warranted to examine the degree and persisting nature of this decline. Although chemotherapeutic agents are unlikely to cross the blood-brain barrier, it has been alleged that the occurrence of neurotoxicity is linked to the pro-inflammatory cytokine pathways. Moreover in most cases many other factors could play an ancillary and concomitant role. The contribution of hormone therapy as well as emotional, social, behavioural and genetic factors should always be considered.Especially physical activity and cognitive training appear promising in the management of cognitive impairment but additional studies are required to establish their efficacy.



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Bilateral Giant Retinal Tear and Sequential Vitrectomy

Purpose: To describe the excellent outcome of surgery for bilateral giant retinal tears (GRTs) with better options of endotamponade. Methods: This is a case report of a 62-year-old man who presented with bilateral GRTs and associated retinal detachment. The tear in the right eye was supero-temporal and silicone oil was used as an endotamponade. The tear in the left eye was infero-temporal and perfluorocarbon liquid was used as an endotamponade. Results: The outcome at 6 months after surgery was excellent with visual acuities of 6/6 in both eyes. Conclusion: Improved availability of endotamponade agents allows repair of bilateral GRTs to be done at the same time, with good surgical outcomes.
Case Rep Ophthalmol 2017;8:436–439

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Metastatic melanoma: prognostic factors and survival in patients with brain metastases

Abstract

Brain metastases from malignant melanoma carry a poor prognosis. Novel systemic agents have improved overall survival (OS), but the value of whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) remains uncertain. The melanoma-specific graded prognostic assessment (msGPA) provides useful prognostic information, but the relevance to the modern-day population has not been validated. Since 2011, 53 patients received treatment for brain metastases from malignant melanoma at the Rosemere Cancer Centre medical oncology clinic. Data were collated on demographic factors and survival. Survival analyses were performed using Kaplan–Meier methods. Cox regression was used to identify prognostic factors on univariate and multivariate analysis. OS from the date of diagnosis of brain metastases was 4.83 months (range 0.27–30.4 months). On univariate analysis, BRAF, performance status and msGPA were significant prognostic indicators for OS (p = 0.0056, p = 0.0039 and p = 0.0001 respectively). msGPA remained significant on multivariate analysis (p = 0.0006). OS for BRAF-positive patients receiving targeted treatment (n = 22) was significantly better than for BRAF-negative patients (n = 26), with median survival times of 8.2 and 3.7 months respectively (p = 0.0039, HR 2.36). SRS combined with systemic agents (n = 16) produced an OS of 13.5 months. Patients receiving WBRT alone (n = 21) had a poor prognosis (2.2 months). The msGPA remains a valid prognostic indicator in the era of novel systemic treatments for melanoma. BRAF-positive patients receiving targeted agents during their treatment had favorable survival outcomes. WBRT alone should be use with caution in the active management of melanoma brain metastases.

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Targeting metabolic pathways for head and neck cancers therapeutics

Abstract

Cancer cells have distinctive energy metabolism pathways that support their rapid cell division. The preference for anaerobic glycolysis under the normal oxygen condition is known as the Warburg effect and has been observed in head and neck cancers. These metabolic changes are controlled by cancer-related transcription factors, such as tumor suppressor gene and hypoxia inducible factor 1α. In addition, various metabolic enzymes also actively regulate cancer-specific metabolism including the switch between aerobic and anaerobic glycolysis. For a long time, these metabolic changes in cancer cells have been considered a consequence of transformation required to maintain the high rate of tumor cell replication. However, recent studies indicate that alteration of metabolism is sufficient to initiate tumor transformation. Indeed, oncogenic mutations in the metabolic enzymes, isocitrate dehydrogenase and succinate dehydrogenase, have been increasingly found in various cancers, including head and neck cancers. In the present review, we introduce recent findings regarding the cancer metabolism, including the molecular mechanisms of how they affect cancer pathogenesis and maintenance. We also discuss the current and future perspectives on therapeutics that target metabolic pathways, with an emphasis on head and neck cancer.

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Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma

Abstract

Nasopharyngeal carcinoma (NPC) is very common in southern China and Southeast Asia. In regions where NPC is endemic, undifferentiated subtypes constitute most cases and are invariably associated with Epstein-Barr virus (EBV) infection, whereas the differentiated subtype is more common in other parts of the world. Undifferentiated NPC is a unique malignancy with regard to its epidemiology, etiology, and clinical presentation. Clinically, NPC is highly invasive and metastatic, but sensitive to both chemotherapy and radiotherapy (RT). Overall prognosis has dramatically improved over the past three decades because of advances in management, including the improvement of RT technology, the broader application of chemotherapy, and more accurate disease staging. Despite the excellent local control with modern RT, distant failure remains a challenging problem. Advances in molecular technology have helped to elucidate the molecular pathogenesis of NPC. This article reviews the contribution of EBV gene products to NPC pathogenesis and the current management of NPC.

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CUDC-907, a dual HDAC and PI3K inhibitor, reverses platinum drug resistance

Summary

Platinum (Pt)-based anticancer drugs are the mainstay of treatment for solid cancers. However, resistance to Pt drugs develops rapidly, which can be caused by overexpression of multidrug resistance transporters and activation of DNA repair. CUDC-907 is a potent molecular targeted anticancer agent, rationally designed to simultaneously inhibit histone deacetylase (HDAC) and phosphatidylinositol 3-kinase (PI3K). We investigated the potentiation effect of CUDC-907 on Pt drugs in resistant cancer cells. ABCC2 stably-transfected HEK293 cells and two pairs of parental and Pt-resistant cancer cell lines were used to test for the circumvention of resistance by CUDC-907. Chemosensitivity was assessed by the sulphorhodamine B assay. Drug combinations were evaluated by the median effect analysis. ABCC2 transport activity was examined by flow cytometric assay. Cellular Pt drug accumulation and DNA platination were detected by inductively coupled plasma optical emission spectroscopy. ABCC2, ERCC1 and p21 expression were evaluated by quantitative real-time PCR. Cell cycle analysis and apoptosis assay were performed by standard flow cytometric method. The combination of CUDC-907 with cisplatin were found to exhibit synergistic cytotoxic effect in cisplatin-resistant cancer cells. In Pt-resistant cancer cells, CUDC-907 apparently circumvented the resistance through inhibition of ABCC2 and DNA repair but induction of cell cycle arrest. In the presence of CUDC-907, cellular accumulation of Pt drugs and formation of DNA-Pt adducts were found to be increased whereas expression levels of ABCC2 and ERCC1 was inhibited in Pt-resistant cells. The data advocates further development of CUDC-907 as a resistance reversal agent for use in combination cancer chemotherapy.

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High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience

Abstract

High-dose capsaicin patch is effective in treatment of neuropathic pain in HIV-associated neuropathy and diabetic neuropathy. There are no studies assessing effectiveness of high-dose capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy. We sought to determine the effectiveness of treatment of pain associated with chemotherapy-induced peripheral neuropathy with high-dose capsaicin patch. Our study group consisted of 18 patients with clinically confirmed oxaliplatin-induced neuropathy. Baseline characteristic including underling disease, received cumulative dose of neurotoxic agent, neuropathic symptoms, prior treatment and initial pain level were recorded. Pain was evaluated with Numeric Rating Scale prior to treatment with high-dose capsaicin and after 1.8 day and after 8 and 12 weeks after introducing treatment. Patients were divided into two groups accordingly to the amount of neurotoxic agent that caused neuropathy (high sensitivity and low sensitivity group). Most frequent symptoms of chemotherapy-induced neuropathy were: pain (88.89%), paresthesis (100%), sock and gloves sensation (100%) and hypoesthesis (100%). Initial pain level was 7.45 ± 1.14. Mean cumulative dose of oxaliplatin after which patients developed symptoms was 648.07 mg/m². Mean pain level after 12 weeks of treatment was 0.20 ± 0.41. When examined according to high and low sensitivity to neurotoxic agent patients with low sensitivity had higher pain reduction, especially after 8 days after introducing treatment (69.55 ± 12.09 vs. 49.40 ± 20.34%; p = 0.02) and after 12 weeks (96.96 ± 5.56 vs. 83.93 ± 18.59%; p = 0.04). High-dose capsaicin patch is an effective treatment for pain associated with chemotherapy-induced neuropathy in patients treated with oxaliplatin. Patients with lower sensitivity to neurotoxic agents have better response to treatment and pain reduction.

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Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment – a systematic review

Headache attributed to airplane travel, also named "airplane headache" (AH) is a headache that occurs during take-off and landing. Today, there are still uncertainties about the pathophysiology and treatment o...

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Excessive daytime sleepiness in secondary chronic headache from the general population

Excessive daytime sleepiness (EDS, defined as Epworth sleepiness scale score > 10) is a common symptom, with a prevalence of 10–20% in the general population. It is associated with headache and other chronic p...

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Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond

Abstract

Significant correlations between the response to induction chemotherapy and success of subsequent radiotherapy have been reported and suggest that the response to induction chemotherapy is able to predict a response to radiotherapy. Therefore, induction chemotherapy may be used to tailor the treatment plan to the individual patient with head and neck cancer: following the planned subsequent (chemo)radiation schedule, planning a radiation dose boost, or reassessing the modality of treatment (eg, upfront surgery). Findings from reported trials suggest room for improvement in clinical response assessment after induction chemotherapy, but an optimal method has yet to be identified. Historically, indices of treatment efficacy in solid tumors have been based solely on systematic assessment of tumor size. However, functional imaging (eg, fluorodeoxyglucose-positron emission tomography (FDG-PET) potentially provides an earlier indication of response to treatment than conventional imaging techniques. More advanced imaging techniques are still in an exploratory phase and are not ready for use in clinical practice.

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Circulating tumor cells in patients with head and neck squamous cell carcinoma: Feasibility of detection and quantitation

Abstract

Background

The purpose of this study was to present our findings that because circulating tumor cells (CTCs) exist in extremely low numbers, their detection and quantification are challenging.

Methods

Peripheral blood samples were collected from 32 patients with head and neck squamous cell carcinoma (HNSCC), and were subjected to the CellSieve Microfiltration Assay using a low-pressure filtration system. The CTCs captured by the filter were stained with an antibody cocktail (anti-cytokeratin (CK) 8, 18, and 19, anti-epithelial cell adhesion molecule (EpCAM), and anti-CD45 antibodies).

Results

The CTCs were detected in 29 of 32 patients (90.6%). Although patients with advanced disease had a significantly higher number of CTCs, the clinical N classification was not associated with the CTC count. After treatment, the CTC count showed a significant decrease.

Conclusion

The CTCs were successfully detected and quantified in patients with HNSCC by using a low-pressure filtration system equipped with precision microfilters. Further studies using a larger number of patient samples and/or molecular analysis of CTCs are warranted.

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Prognostic significance of E-cadherin and β-catenin expression in HPV-negative oropharyngeal squamous cell carcinomas

Abstract

Background

The purpose of this work was to investigate the prognostic significance of E-cadherin and β-catenin expression in surgically treated human papillomavirus (HPV)-negative patients with oropharyngeal squamous cell carcinoma (SCC).

Methods

Consecutive patients with oropharyngeal SCC who underwent surgical treatment between 1990 and 2009 were retrospectively collected. Immunohistochemical analysis of E-cadherin and β-catenin expression was performed on tissue microarrays.

Results

E-cadherin and β-catenin expression was evaluable in 232 cases. Low membranous E-cadherin, low membranous β-catenin expression, and nuclear β-catenin expression were associated with a poorer disease-specific and overall survival, although the differences were only significant for β-catenin membranous expression (P = .024 and P = .016, respectively). In multivariate analysis, nodal metastasis and low membranous β-catenin expression were significant independent predictors of reduced disease-specific and overall survival.

Conclusion

Low membranous β-catenin expression is a significant independent predictor of both reduced disease-specific and overall survival in patients with HPV-negative oropharyngeal SCC.

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Editorial Board/Reviewing Committee

Publication date: September 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 9





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Precise osteotomies for mandibular distraction in infants with Robin sequence using virtual surgical planning

Publication date: Available online 16 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.M. Resnick
Mandibular distraction osteogenesis (MDO) has become the first-line operation in many centers for the management of obstructive sleep apnea (OSA) in infants with (Pierre) Robin sequence (RS) not relieved by non-surgical approaches. Preoperative virtual surgical planning (VSP) may improve precision and decrease complications for this operation. This article reports a retrospective study of RS infants who underwent MDO for OSA using preoperative VSP and three-dimensionally printed cutting guides performed by one surgeon. Seventeen subjects who had MDO at a mean age of 87±96days were included. Maxillofacial computed tomography scans were obtained 15±7days prior to MDO. Osteotomy designs included linear (n=4, 23.5%), inverted-L (n=11, 64.7%), and multi-angular (n=2, 11.8%). Cutting guides were used successfully and osteotomies were created as planned in all cases. Devices were removed 67±15.6days after placement. Bone formation in the distraction gap was seen in all cases at device removal. All patients had successful airway outcomes. There were no major and four minor complications during the follow-up period of 458±267 days. In conclusion, MDO is a successful procedure for the management of OSA associated with RS in infants, and VSP facilitates its precise design and execution.



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Signs of disease occur in the majority of third molars in an adult population

Publication date: Available online 16 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I. Ventä, M.M. Vehkalahti, S. Huumonen, A.L. Suominen
The purpose of this study was to assess clinical and radiographic signs of disease in third molars within a population that is representative of the Finnish adult population aged 30 years and older. A two-stage stratified cluster sampling method was used to collect the 6005 subjects, who were examined clinically and also by panoramic radiography. The state of impaction, presence of dentinal caries and/or restorations, presence of root canal fillings, periodontal pocket depth, and additional pathological findings such as over-eruption and widened follicle were assessed. Signs of disease in the third molars were found in 47% of the adult population and in 97% of those subjects with third molars. At least one sign of disease occurred in 82% of erupted third molars compared to 74% of those impacted in soft tissue and 33% impacted in bone (P<0.001). A diseased third molar was more often located in the mandible (60%) than in the maxilla (40%) (P<0.001), and was more often found in men (57%) than in women (43%) (P<0.05). It is concluded that signs of disease in third molars in the target population are more common than has been reported previously.



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The value of cone beam computed tomography in the detection of salivary stones prior to sialendoscopy

Publication date: Available online 16 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E.H. van der Meij, K.H. Karagozoglu, J.G.A.M. de Visscher
This study aimed to assess the value of cone beam computed tomography (CBCT) in the detection of salivary stones in patients with signs and symptoms of salivary gland obstruction. A total of 142 major salivary glands were analysed in a cohort of 127 patients with signs and symptoms of salivary gland obstruction. CBCT scans were performed in order to determine the presence of one or more salivary stones. All glands were also investigated by sialendoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the submandibular gland, the parotid gland, and the whole group, based on the observers' abilities to diagnose the presence or absence of calculi in the CBCT scan using the sialendoscopy data as the gold standard. Fifty salivary stones were detected in the CBCT scans of the 142 glands analysed: 34 in the submandibular gland and 16 in the parotid gland. The sensitivity (94%), specificity (90%), positive predictive value (84%), and negative predictive value (97%) for the whole group were good to excellent, with an overall accuracy of 92%. CBCT appears to be an ideal first-line imaging modality for patients with signs and symptoms of obstructed major salivary glands.



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Pernambuco index: predictability of the complexity of surgery for impacted lower third molars

Publication date: Available online 14 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.W.F. de Carvalho, B.C. Vasconcelos
This study aimed to develop and validate an index of surgical difficulty for the removal of impacted lower third molars. The study was performed in two steps. The first was a cross-sectional analysis of clinical, demographic, and radiographic variables collected from patients undergoing the removal of an impacted lower third molar between 2008 and 2012. The second step was a prospective cohort study involving the same surgical procedures to validate the index; this was performed between 2013 and 2016. Univariate regression analysis was applied, followed by multiple linear regression analysis. A total of 753 surgical procedures were analyzed in the first stage, which led to the identification of the most important variables and their levels of significance. The index was then applied to 280 surgical procedures. The preoperative difficulty was in concordance with the index results in all cases. Among cases with a low level of difficulty, 93.1% had been indexed as low difficulty; likewise, among cases with a high level of difficulty, there was 87.9% concordance with the index. With the use of reference statistics in the development and quality assurance processes, this validated index has proven to be a reliable and easily applicable instrument, with high sensitivity, specificity, and accuracy.



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The expression of endogenous hydrogen sulfide signal during distraction osteogenesis in a rabbit model

Publication date: Available online 14 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X.-W. Jiang, Y. Zhang, Y.-Z. Cheng, X.-S. Fan, X. Deng, H.-Y. Peng
The hydrogen sulfide (H2S) signal system plays an important role in bone metabolism. However, the role of endogenous H2S during distraction osteogenesis (DO) remains unclear. Sixty-two male New Zealand White rabbits were subjected to right mandibular DO. Before distraction, the animals were divided randomly into two groups: group A, 0.5mm twice/day for 10 days; group B, 1.25mm twice/day for 4 days. Plasma and distraction gap tissue were harvested to determine the H2S signal. The osteogenesis effect was also evaluated. The newly regenerated bone in group A presented a higher level of mineralization and biomechanical strength than that in group B. The bone mineralization density in group A was 1.95-fold that in group B (P=0.028), while the biomechanical strength in group A was 1.26-fold that in group B (P=0.042) at the end of the experiment. The H2S signal was detected during the whole process of DO. The relative plasma H2S concentrations in group A were noticeably higher than those in group B at the middle of distraction (P<0.001), at the end of the distraction (P=0.034), and 2 weeks after the end of distraction (P=0.002). The results suggest that the endogenous H2S signal system plays a major role during DO.



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Cerebral pseudo-tumoral neuro-Behcet: histological demonstration of an inflammatory and vascular disease

Publication date: Available online 12 August 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Fleur Cohen-Aubart, Dimitri Psimaras, Damien Galanaud, Franck Bielle, Valérie Touitou, Julien Haroche, Zahir Amoura




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Athletes Intending to Use Sports Supplements Are More Likely to Respond to a Placebo

Purpose: We investigated associations between athletes' use of sport supplements and their responsiveness to placebo and nocebo interventions. Methods: Participants (n = 627) reported their intention to use, and actual use of, sport supplements. They then completed a 5 × 20 m repeat sprint protocol in the baseline condition, before being randomized to one of three treatments. Participants in the positive-belief treatment were administered an inert capsule described as a potent supplement which would improve sprint performance. Participants in the negative-belief treatment were administered an inert capsule described as a potent supplement which would negatively affect sprint performance. Participants in the control treatment received neither instruction nor capsule. Twenty minutes after baseline trials, all participants completed the same repeat sprint protocol in the experimental condition. Results: Compared with controls, no mean differences in performance were observed between baseline and experimental conditions for the positive-belief treatment (−0.07% ± 0.27%, d = 0.02), but mean differences were observed for the negative-belief treatment (−0.92% ± 0.31%, d = 0.32), suggesting a moderate nocebo effect. In the positive-belief treatment, however, a relationship between intention to use supplements and performance was observed. Performance worsened by −1.10% ± 0.30% compared with baseline for participants not intending to use supplements, worsened by −0.64% ± 0.43% among those undecided about supplement use, but improved by 0.19% ± 0.24% among those participants intending to use supplements. Conclusions: Information about a harmful supplement worsened repeat sprint performance (a mean nocebo effect), whereas information about a beneficial supplement did not improve performance (no mean placebo effect was observed). However, participants' intention to use sport supplements influenced the direction and magnitude of subsequent placebo responses, with participants intending to use supplements more likely to respond to the positive intervention.

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Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction

Introduction: Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. Methods: Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=V˙O2/HR). Results: Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R2 = 0.30, 0.36, 0.67), but not controls (R2 = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R2 = 0.70, 0.53, 0.70) and controls (R2 = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R2 = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R2 = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. Conclusions: Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.

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Technical Alterations during an Incremental Field Test in Elite Male Tennis Players

Purpose: We investigated technical and physiological responses along with their relationships during an incremental field test to exhaustion specific to tennis (TEST) in elite players. Methods: Twenty male elite tennis players completed TEST, which consisted of hitting alternatively forehand and backhand strokes at increasing ball frequency (ball machine) every minute. Ball accuracy (BA), ball velocity (BV), and tennis performance (TP) index (TP = BA × BV) were determined by radar and video analysis for each stroke, in addition to cardiorespiratory responses and blood lactate concentrations. Results: At low intensities (less than 80% of maximal oxygen uptake [V˙O2max]), technical performance was steady. From 80% to 100% of V˙O2max, significant and steady decreases in BV (−9.0% and −13.3%; P = 0.02 and P = 0.002), BA (−19.4% and −18.4%; both P 80% of V˙O2max), presumably because of the use of compensatory strategies to overcome fatigue. Above this intensity, all technical indices decreased steadily until exhaustion, independently of the stroke nature.

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Angiopoietin-like 4 Enhances the Proliferation and Migration of Tendon Fibroblasts

Purpose: Angiopoietin-like 4 (ANGPTL4) is known to play a variety of roles in the response to exercise, and more recently has been shown to enhance the healing of tendon, a fibrous load-bearing tissue required for efficient movement. The objective of the current study was to further explore the mechanisms of ANGPTL4's effect on tendon cells using a gene array approach. Methods: Human tendon fibroblasts were treated with recANGPTL4 and their global transcriptome response analyzed after 4 and 24 h. We also conducted functional studies using tendon fibroblasts derived from human subjects, cultured in the presence or absence of applied cyclic stretch and/or siRNA for ANGPTL4, and as confirmation we also used tendon cells from wild type (ANGPTL4 +/+) or knockout (ANGPTL4−/−) mice. Results: The leading functions of ANGPTL4 predicted by the resulting pathway analysis were cell movement and proliferation. The experiments demonstrated that ANGPTL4 significantly enhanced tendon cell proliferation and the cell cycle progression, as well as adhesion and migration. Conclusion: Taken together, these findings provide novel molecular insights into the effect of ANGPTL4, a multifunctional protein that regulates the physiological response to exercise, on fundamental tendon cell functions.

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Sildenafil: Possible Prophylaxis against Swimming-induced Pulmonary Edema

ABSTRACT: Swimming-induced pulmonary edema (SIPE) occurs during swimming and scuba diving, usually in cold water, in susceptible healthy individuals, especially military recruits and triathletes. We have previously demonstrated that pulmonary artery (PA) pressure and PA wedge pressure are higher during immersed exercise in SIPE-susceptible individuals versus controls, confirming that SIPE is a form of hemodynamic pulmonary edema. Oral sildenafil 50 mg 1 h before immersed exercise reduced PA pressure and PA wedge pressure, suggesting that sildenafil may prevent SIPE. We present a case of a 46-yr-old female ultratriathlete with a history of at least five SIPE episodes. During a study of an exercise submerged in 20°C water, physiological parameters before and after sildenafil 50 mg orally were as follows: O2 consumption 1.75, 1.76 L·min−1; HR 129, 135 bpm; arterial pressure 189/88 (mean 121.5), 172/85 (mean 114.3) mm Hg; mean PA pressure 35.3, 28.8 mm Hg; and PA wedge pressure 25.3, 19.7 mm Hg. She has had no recurrences during 20 subsequent triathlons while taking 50 mg sildenafil before each swim. This case supports sildenafil as an effective prophylactic agent against SIPE during competitive surface swimming.

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Effects of Dopamine and Norepinephrine on Exercise-induced Oculomotor Fatigue

Introduction: Fatigue-induced impairments in the control of eye movements are detectable via reduced eye movement velocity after a bout of prolonged, strenuous exercise. Slower eye movements caused by neural fatigue within the oculomotor system can be prevented by caffeine, and the upregulation of central catecholamines may be responsible for this effect. This study explored the individual contribution of dopamine and norepinephrine to fatigue-related impairments in oculomotor control. Methods: The influence of a dopamine reuptake inhibitor (methylphenidate) and a norepinephrine reuptake inhibitor (reboxetine) was assessed in 12 cyclists performing 180 min of stationary cycling within a placebo-controlled crossover design. Eye movement kinematics (saccades, smooth pursuit, and optokinetic nystagmus) were measured using infrared oculography. Visual attention was assessed with overt and covert spatial attention tasks. Results: Exercise-induced fatigue was associated with a 6% ± 8% reduction in the peak velocity of visually guided, reflexive prosaccades. Importantly, both dopamine reuptake inhibition and norepinephrine reuptake inhibition prevented fatigue-related decrements in the peak velocity of prosaccades. Pursuit eye movements, optokinetic nystagmus, and visual attention tasks were unaffected by exercise or drug treatments. Conclusion: Overall, our findings suggest that alterations in norepinephrinergic and dopaminergic neurotransmission are linked with the development of fatigue within circuits that control eye movements. Psychiatric medications that target central catecholamines can exert a protective effect on eye movements after prolonged exercise.

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Acidosis, but Not Alkalosis, Affects Anaerobic Metabolism and Performance in a 4-km Time Trial

Purpose: This study aimed to determine the effect of preexercise metabolic acidosis and alkalosis on power output (PO) and aerobic and anaerobic energy expenditure during a 4-km cycling time trial (TT). Methods: Eleven recreationally trained cyclists (V˙O2peak 54.1 ± 9.3 mL·kg−1·min−1) performed a 4-km TT 100 min after ingesting in a double-blind matter 0.15 g·kg−1 of body mass of ammonium chloride (NH4Cl, acidosis), 0.3 g·kg−1 of sodium bicarbonate (NaHCO3, alkalosis), or 0.15 g·kg−1 of CaCO3 (placebo). A preliminary study (n = 7) was conducted to establish the optimal doses to promote the desirable preexercise blood pH alterations without gastrointestinal distress. Data for PO, aerobic and anaerobic energy expenditure, and blood and respiratory parameters were averaged for each 1 km and compared between conditions using two-way repeated-measures ANOVA (condition and distance factors). Gastrointestinal discomfort was analyzed qualitatively. Results: Compared with placebo (pH 7.37 ± 0.02, [HCO3−]: 27.5 ± 2.6 mmol·L−1), the NaHCO3 ingestion resulted in a preexercise blood alkalosis (pH +0.06 ± 0.04, [HCO3−]: +4.4 ± 2.0 mmol·L−1, P 0.05). Minimal gastrointestinal distress was noted in all conditions. Conclusion: Preexercise acidosis, but not alkalosis, affects anaerobic metabolism and PO during a 4-km cycling TT.

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A Ketone Ester Drink Increases Postexercise Muscle Glycogen Synthesis in Humans

Introduction: Physical endurance can be limited by muscle glycogen stores, in that glycogen depletion markedly reduces external work. During carbohydrate restriction, the liver synthesizes the ketone bodies, D-β-hydroxybutyrate, and acetoacetate from fatty acids. In animals and in the presence of glucose, D-β-hydroxybutyrate promotes insulin secretion and increases glycogen synthesis. Here we determined whether a dietary ketone ester, combined with plentiful glucose, can increase postexercise glycogen synthesis in human skeletal muscle. Methods: After an interval-based glycogen depletion exercise protocol, 12 well-trained male athletes completed a randomized, three-arm, blinded crossover recovery study that consisted of consumption of either a taste-matched, zero-calorie control or a ketone monoester drink, followed by a 10-mM glucose clamp or saline infusion for 2 h. The three postexercise conditions were control drink then saline infusion, control drink then hyperglycemic clamp, or ketone ester drink then hyperglycemic clamp. Skeletal muscle glycogen content was determined in muscle biopsies of vastus lateralis taken before and after the 2-h clamps. Results: The ketone ester drink increased blood D-β-hydroxybutyrate concentrations to a maximum of 5.3 versus 0.7 mM for the control drink (P

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Evolutionary Thinking in Medicine: From Research to Policy and Practice

No abstract available

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A Mechanism Underlying Preventive Effect of High-Intensity Training on Colon Cancer

Introduction: We examined effects of high-intensity training on chemically induced aberrant crypt foci (ACF) in rat colon. We also investigated mechanisms that may underlie the results obtained, with a focus on secreted protein acidic and rich in cysteine (SPARC), which has been proposed as an exercise-related factor of colon cancer prevention. Methods: After an administration of 1,2-dimethylhydrazine, F344 rats executed high-intensity intermittent swimming training (HIIST) (twelve 20-s swimming with a weight [16% body weight] with 10-s pauses between the bouts) 5 d·wk−1 for 4 wk. The acute and chronic effects of the HIIST on SPARC were evaluated in rats. We evaluated the in vitro and in vivo effects of 5′ AMP-activated protein kinase (AMPK) activator on SPARC in rat serum and epitrochlearis muscle. In human subjects, we determined serum SPARC after exhaustive bicycling consisting of six to seven bouts of exercise at 170% V˙O2max with 10-s rests between the bouts (high-intensity intermittent bicycling [HIIB]). The SPARC mRNA in human vastus lateralis was measured before and after the HIIB for 4 d·wk−1 for 6 wk (HIIB-training [HIIBT]). Results: The numbers of ACF were lower in the HIIST (47 ± 22) compared with the control (122 ± 47) rats (P

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Objective Measures of Physical Activity and Cardiometabolic and Endocrine Biomarkers

Purpose: Although physical activity is an established risk factor for chronic disease prevention, the specific mechanisms underlying these relationships are poorly understood. We examined the associations between total activity counts and moderate-vigorous physical activity (MVPA) measured by accelerometer, and physical activity energy expenditure measured by doubly labeled water, with plasma levels of proinsulin, insulin, c-peptide, insulin growth factor binding protein-3, insulin growth factor-1, adiponectin, leptin, and leptin-sR. Methods: We conducted a cross-sectional analysis of 526 healthy US women in the Women's Lifestyle Validation Study, 2010 to 2012. We performed multiple linear regression models adjusting for potential lifestyle and health-related confounders to assess the associations between physical activity, measured in quartiles (Q) and biomarkers. Results: Participants in Q4 versus Q1 of total activity counts had lower proinsulin (−20%), c-peptide (−7%), insulin (−31%), and leptin (−46%) levels, and higher adiponectin (55%), leptin-sR (25%), and insulin growth factor-1 (9.6%) levels (all P trend ≤ 0.05). Participants in Q4 versus Q1 of MVPA had lower proinsulin (−26%), c-peptide (−7%), insulin (−32%), and leptin (−40%) levels, and higher adiponectin (31%) and leptin-sR (22%) levels (all P trend ≤ 0.05). Further adjustment for body mass index (BMI) attenuated these associations, but the associations with adipokines remained significant. Those in Q4 versus Q1 of physical activity energy expenditure had lower leptin (−21%) and higher leptin-sR (10%) levels (all P trend ≤ 0.05), after additional adjustment for BMI. In the sensitivity analysis, the associations were similar but attenuated when physical activity was measured using the subjective physical activity questionnaire. Conclusions: Our data suggest that greater physical activity is modestly associated with favorable levels of cardiometabolic and endocrine biomarkers, where the strongest associations were found with accelerometer-measured physical activity. These associations may be only partially mediated through BMI, further supporting the role of physical activity in the reduction of cardiometabolic and endocrine disease risk, independent of adiposity.

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Information Acquisition Differences between Experienced and Novice Time Trial Cyclists

Purpose: To use eye-tracking technology to directly compare information acquisition behavior of experienced and novice cyclists during a self-paced, 10-mile (16.1 km) time trial (TT). Method: Two groups of novice (n = 10) and experienced cyclists (n = 10) performed a 10-mile self-paced TT on two separate occasions during which a number of feedback variables (speed, distance, power output, cadence, HR, and time) were projected within their view. A large RPE scale was also presented next to the projected information and participants. Participants were fitted with a head-mounted eye tracker and HR monitor. Results: Experienced cyclists performed both TT quicker than novices (F1,18 = 6.8, P = 0.018) during which they primarily looked at speed (9 of 10 participants), whereas novices primarily looked at distance (6 of 10 participants). Experienced cyclists looked at primary information for longer than novices across the whole TT (24.5% ± 4.2% vs 34.2% ± 6.1%; t18 = 4.2; P

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Cardiometabolic Correlates of Physical Activity and Sedentary Patterns in U.S. Youth

Introduction: Daily or weekly averages of physical activity and sedentary behavior could mask patterns of behavior throughout the week that independently affect cardiovascular health. We examined associations between day-to-day physical activity and sedentary behavior latent classes and cardiovascular disease (CVD) risk factors in U.S. youth. Methods: Data were from 3984 youth ages 6–17 yr from the National Health and Nutrition Examination Survey (2003–2006) and from previously published accelerometry latent classes characterizing average counts per minute and percent of wear time in moderate-to-vigorous physical activity (MVPA) and sedentary behavior. Multiple linear regression was used to examine associations of the classes with waist circumference, systolic and diastolic blood pressure, HDL-C and LDL-C, triglycerides, glucose, and insulin. Results: Participants spent 50.4% of the day in sedentary behavior and 5.3% of the day in moderate-to-vigorous physical activity. Average counts per minute were 516.4 for a 7-d period. Significant differences in CVD risk factors were between extreme classes with few differences observed in intermediate classes. Youth in latent class 4 (highest average counts per minute) had lower systolic blood pressure (−4.11 mm Hg, 95% confidence interval [CI] = −7.74 to −0.55), lower glucose (−4.25 mg·dL−1, 95% CI = −7.84 to −0.66]), and lower insulin (−6.83 μU·mL−1, 95% CI = −8.66 to −4.99]) compared with youth in class 1 (lowest average counts per minute). Waist circumference was lower for the least sedentary class (−2.54 cm, 95% CI = −4.90 to −0.19) compared with the most sedentary class. Some associations were attenuated when classes were adjusted for mean physical activity or sedentary level. Conclusions: There is some indication that patterns, in addition to the total amount of physical activity and sedentary behavior, may be important for cardiovascular health in youth. Longitudinal studies are needed to examine associations between physical activity and sedentary behavior patterns and changes in CVD risk factors.

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The Gas Sampling Interval Effect on V˙O2peak Is Independent of Exercise Protocol

Introduction: There is a plethora of gas sampling intervals available during cardiopulmonary exercise testing to measure peak oxygen consumption (V˙O2peak). Different intervals can lead to altered V˙O2peak. Whether differences are affected by the exercise protocol or subject sample is not clear. The purpose of this investigation was to determine whether V˙O2peak differed because of the manipulation of sampling intervals and whether differences were independent of the protocol and subject sample. Methods: The first subject sample (24 ± 3 yr; V˙O2peak via 15-breath moving averages: 56.2 ± 6.8 mL·kg−1·min−1) completed the Bruce and the self-paced V˙O2max protocols. The second subject sample (21.9 ± 2.7 yr; V˙O2peak via 15-breath moving averages: 54.2 ± 8.0 mL·kg−1·min−1) completed the Bruce and the modified Astrand protocols. V˙O2peak was identified using five sampling intervals: 15-s block averages, 30-s block averages, 15-breath block averages, 15-breath moving averages, and 30-s block averages aligned to the end of exercise. Differences in V˙O2peak between intervals were determined using repeated-measures ANOVAs. The influence of subject sample on the sampling effect was determined using independent t-tests. Results: There was a significant main effect of sampling interval on V˙O2peak (first sample Bruce and self-paced V˙O2maxP

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Acute Metabolic Response, Energy Expenditure, and EMG Activity in Sitting and Standing

Purpose: While merely standing up interrupts sedentary behavior, it is important to study acute metabolic responses during single bouts of sitting and standing to understand the physiological processes affecting the health of office workers. Methods: Eighteen healthy middle-age women 49.4 ± 7.9 yr old (range: 40–64) with a body mass index of 23.4 ± 2.8 kg·m−2 volunteered for this laboratory-based randomized crossover trial where they performed 2 h desk work in either sitting or standing postures after overnight fasting. Muscle activity (normalized to walking at 5 km·h−1), respiratory gas exchange, and blood samples were assessed after glucose loading (75 g). Results: Compared with seated work, continuous standing resulted in greater activity in the thigh muscles (mean of biceps femoris and vastus lateralis: 17% ± 8% vs 7% ± 2%, P

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Effect of Group Exercising and Adjusting the Brace at Shorter Intervals on Cobb Angle and Quality of Life of Patients With Idiopathic Scoliosis.

Objective: The aim of the study was to evaluate the effect of group exercise with brace adjustment at shorter intervals than used in routine practice in late-onset idiopathic scoliosis patients. Design: This was a quasi-experimental study. Thirty patients with progressive scoliosis curves of 15-50 degrees and a prescription for a brace were divided into experimental and control groups, both of which participated in an 11-wk treatment program. Those in the experimental group underwent brace adjustment twice per week and performed group exercise, whereas those in the control group received a routine protocol. The quality of life and Cobb angle of patients in both groups were evaluated based on baseline and final results of the 22-item Scoliosis Research Society questionnaire and primary and secondary radiographs. Results: In the experimental group, the improvement in Cobb angle and patient satisfaction was greater than that in the control group (P

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Combined anatomical variations: The mylohyoid bridge, retromolar canal and accessory palatine canals branched from the canalis sinuosus

Publication date: Available online 16 August 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): M.C. Rusu, M. Săndulescu, C. Bichir, L.A.S. Muntianu
The study of anatomical variations is important not only for collecting anthropometric data, but also for improving clinical protocols and understanding why a particular clinical procedure sometimes does not yield the expected results. We report the case of a 74 year-old patient, in which we observed combined anatomical variants of the mandible and maxillary bone. One of these was the unilateral mylohyoid bridge (MB) of the uncommon, lingular type. This MB extended posteriorly to the spine of Spix, over the sulcus colli behind the spine. It thus formed a common mandibular canal (MC) which further divided into a retromolar canal and the MC proper. This combination of variants in the mandible has not, to our knowledge, previously been reported, at least in studies using cone beam computed tomography (CBCT). Additionally we found multiple accessory canals (ACs) deriving from the canalis sinuosus, which opened opposite to each frontal tooth, presumably carrying either dental fibers of the palatine nerves, or palatine fibers of the anterior superior alveolar nerve. Although the ACs in the anterior palate are well established anatomical variants, the MB appears in publications rather as an anthropological identifier. However, when present, it can impede anaesthesia of the lower teeth and thus deserves to be included in anatomical descriptions. The evaluation of patients in CBCT should observe the anatomical features on a case-by-case basis and it also provide data for studies of MB prevalence in large numbers of patients.



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Modulation of macrophage phagocytosis in vitro – a role for cholinergic stimulation?

Publication date: Available online 16 August 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Amira-Talaat Moussa, Andrea Rabung, Sandra Reichrath, Stefan Wagenpfeil, Thai Dinh, Gabriela Krasteva-Christ, Carola Meier, Thomas Tschernig
Acetylcholine is synthetized and released from neural cells, but also by non-neuronal cells such as epithelial cells or keratinocytes. Cholinergic agonists enhance the phagocytosis of zymosan particles in primary peritoneal macrophages. The aim of this study was to investigate the effect of carbachol stimulation on phagocytosis in a macrophage cell line using microspheres. The murine cell line MH-S was used in a phagocytosis assay with fluorescent latex beads. The amount of the ingested beads was determined using flow cytometry. Gene expression was investigated using polymerase chain reaction. Gene expression of the muscarinic receptors M1, M3, M4 and M5 but not M2 was found. Carbachol slightly increased the phagocytosis of microspheres in the macrophages. A co-stimulation using lipopolysaccharide and carbachol did not increase the effect of lipopolysaccharide alone. In conclusion, cholinergic stimulation in vitro only moderately modulates the phagocytosis of microspheres. M2 might have a role in stimulation of macrophage phagocytosis.



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Neurological Complications of Therapeutic Monoclonal Antibodies: Trends from Oncology to Rheumatology

Abstract

Purpose of Review

This review is to describe the scope of neurological complications associated with monoclonal antibody-based therapies, applied across medical specialties, to demonstrate the common and rare neurological syndromes that may be encountered in clinical practice according to the therapeutic agent being receive, and to explain appropriate work-up, diagnosis, and management of drug complications, as supported by the literature.

Recent Findings

The number of commercially available, evidence-based therapeutic monoclonal antibodies continues to expand. In oncology, immune checkpoint inhibitors are particularly important, as a wide range of central and peripheral nervous system complications are described. In rheumatology, anti-TNF alpha drugs remain associated with demyelinating syndromes.

Summary

The number of therapeutic monoclonal antibodies encountered in practice continues to grow, as does the number of described neurological complications. Recognition of a possible drug complication is key, as these are typically complex patients at risk of other causes of neurological injury. Identification of a complication of therapy often leads to intervention and a change in management.

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Optical Coherence Tomography to Differentiate Papilledema from Pseudopapilledema

Abstract

Purpose of Review

Mild papilledema may be difficult to distinguish by clinical observation from pseudopapilledema. An accurate diagnosis is critical to avoid invasive workup and unwarranted treatment. In this review, we focus on the development and subsequent role of optical coherence tomography (OCT) in detecting and differentiating optic nerve head drusen (ONHD) from papilledema and other causes of acquired swelling of the optic disc.

Recent Findings

Newer OCT technologies which permit deeper penetration to improve detection of ONHD were also reviewed. Enhanced depth imaging (EDI) spectral-domain OCT and swept-source (SS) OCT are currently recognized as the most reliable and sensitive tools to diagnose ONHD.

Summary

OCT devices currently available provide a means to quantify drusen dimensions, to evaluate the integrity of neighboring structures and to monitor axonal and neuronal damage, yielding additional information to better understand the relationship between the morphological features of drusen, and their effects on the structure and function of the optic nerve.

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Ocular Motor Manifestations of Multiple Sclerosis

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders. Evidence Acquisition: This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility. Results: Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus. Conclusions: The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.

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Patient Safety: Its History and Relevance to Neuro-Ophthalmology

No abstract available

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Ocular and Cerebral Emboli From an Atrial Myxoma

Abstract: Emboli from an atrial myxoma resulted in asymptomatic segmental retinal and choroidal arterial hyperfluorescent lesions on retinal angiography, mimicking an arteritis. The retinal lesions disappeared after removal of the atrial myxoma. Endothelial trauma by embolic material appears to be the mechanism of the angiographic findings.

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The Utility of Magnetic Resonance Imaging in Assessing Patients With Pituitary Tumors Compressing the Anterior Visual Pathway

Background: Pituitary tumors are one of the most common types of intracranial neoplasms, and can cause progressive visual loss. An ongoing challenge in the management of patients with pituitary tumors is the cost, availability, and reliability of current magnetic resonance imaging (MRI) techniques to capture clinically significant incremental tumor growth. The purpose of this study was to evaluate the various MRI-based structural analyses and to explore the relationship between measures of structure and function in the afferent visual pathway of patients with pituitary tumors. Methods: We performed a critical review of literature on MRI-based structural analyses of pituitary adenomas using PubMed, Embase, Cochrane Library, and Google Scholar. In addition, preoperative structural characteristics of the optic apparatus, optic nerve compression, and optic chiasm elevation identified as important in the literature review, were examined in 18 of our patients from October 2010 to January 2014. Results: In our review of literature, a total of 443 citations were obtained from our search strategy and review of bibliographies. Eight of these studies met inclusion/exclusion criteria and were retrieved for critical review. Of the 8 included studies, only 2 studies examined the relationship between MRI-based structural measurements and postoperative visual recovery. In our small case-series, MRI analysis of chiasm elevation, severity of optic nerve compression, chiasm position, height of chiasm, tumor height, and tumor volume failed to differentiate patients with postoperative visual dysfunction vs those with visual recovery (P > 0.05). Conclusions: Although MRI-based structural analysis is an important and useful tool for managing patients with pituitary tumors, there are limited objective measures shown to be predictive of postoperative visual recovery.

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Limitations of Current Methodology for Assessment of Compression of the Optic Chiasm by Macroadenoma: The Neuroradiologic Perspective

No abstract available

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Neuro-Ophthalmology and Stroke

No abstract available

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The QuantiFERON-TB Gold In-Tube Assay in Neuro-Ophthalmology

Background: Although QuantiFERON-TB Gold In-Tube (QFT-GIT) testing is regularly used to detect infection with Mycobacterium tuberculosis, its utility in a patient population with a low risk for tuberculosis (TB) has been questioned. The following is a cohort study analyzing the efficacy of QFT-GIT testing as a method for detection of active TB disease in low-risk individuals in a neuro-ophthalmologic setting. Methods: Ninety-nine patients from 2 neuro-ophthalmology centers were identified as having undergone QFT-GIT testing between January 2012 and February 2016. Patients were divided into groups of negative, indeterminate, and positive QFT-GIT results. Records of patients with positive QFT-GIT results were reviewed for development of latent or active TB, as determined by clinical, bacteriologic, and/or radiographic evidence. Results: Of the 99 cases reviewed, 18 patients had positive QFT-GIT tests. Of these 18 cases, 12 had documentation of chest radiographs or computed tomography which showed no evidence for either active TB or pulmonary latent TB infection (LTBI). Four had chest imaging which was indicative of possible LTBI. None of these 18 patients had symptoms of active TB and none developed active TB within the follow-up period. Conclusions: Based on our results, we conclude that routine testing with QFT-GIT in a low-risk cohort did not diagnose active TB infection. We do not recommend routine QFT-GIT testing for TB low-risk individuals, as discerned through patient and exposure history, ocular examination, and clinical judgment, in neuro-ophthalmology practice.

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