Abstract Polymerization shrinkage stress of resin-based materials have been related to several unwanted clinical consequences, such as enamel crack propagation, cusp deflection, marginal and internal gaps, and decreased bond strength. Despite the absence of strong evidence relating polymerization shrinkage to secondary caries or fracture of posterior teeth, shrinkage stress has been associated with post-operative sensitivity and marginal stain. The latter is often erroneously used as a criterion for replacement of composite restorations. Therefore, an indirect correlation can emerge between shrinkage stress and the longevity of composite restorations or resin-bonded ceramic restorations. The relationship between shrinkage and stress can be best studied in laboratory experiments and a combination of various methodologies. The objective of this review article is to discuss the concept and consequences of polymerization shrinkage and shrinkage stress of composite resins and resin cements. Literature relating to polymerization shrinkage and shrinkage stress generation, research methodologies, and contributing factors are selected and reviewed. Clinical techniques that could reduce shrinkage stress and new developments on low-shrink dental materials are also discussed.
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Δευτέρα 28 Αυγούστου 2017
Polymerization shrinkage stress of composite resins and resin cements – What do we need to know?
ERAS: Safety checklists, antibiotics, and VTE prophylaxis
The concept rested on several components that many of us have now tried to adopt or improve on, inclusive of a multidisciplinary team, a multimodal approach to anesthesia and preoperative preparedness, evidence-based approach to care protocols; and a change in management using interactive and continuous audit prior to and post-procedure. This article describes the development of ERAS protocols relative to checklist implementation, antibiotic use, and venous thromboembolism (VTE) prevention, how these ideas are developed and operationalized as well as how they are evolving and spreading across the care continuum to achieve sustained outcome improvements.
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Enhanced recovery after surgery—Preoperative fasting and glucose loading—A review
In this review, we explore the rationale and history behind the practice of preoperative fasting in elective surgery including the gradual move toward longer fasting and the more recent change in direction of practice. Gastric emptying physiology and the metabolic effects of prolonged fasting and carbohydrate loading are examined. Most recent guidelines related to these topics are discussed and practical recommendations for implementing these guidelines are suggested.
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Impact of age on intermittent hypoxia in obstructive sleep apnea: a propensity-matched analysis
Abstract
Purpose
To determine independent relationship of aging with chronic intermittent hypoxia, we compared hypoxia-related polysomnographic variables of geriatric patients (aged ≥ 65 years) with an apnea–hypopnea index (AHI)-, gender-, body mass index (BMI)-, and neck circumference-matched cohort of non-geriatric patients.
Methods
The study was conducted using clinical and polysomnographic data of 1280 consecutive patients who underwent complete polysomnographic evaluation for suspected sleep-disordered breathing (SDB) at a single sleep disorder center. A propensity score-matched analysis was performed to obtain matched cohorts of geriatric and non-geriatric patients, which resulted in successful matching of 168 patients from each group.
Results
Study groups were comparable for gender (P = 0.999), BMI (P = 0.940), neck circumference (P = 0.969), AHI (P = 0.935), and severity of SDB (P = 0.089). The oximetric variables representing the duration of chronic intermittent hypoxia such as mean (P = 0.001), the longest (P = 0.001) and total apnea durations (P = 0.003), mean (P = 0.001) and the longest hypopnea durations (P = 0.001), and total sleep time with oxygen saturation below 90% (P = 0.008) were significantly higher in the geriatric patients as compared with younger adults. Geriatric patients had significantly lower minimum (P = 0.013) and mean oxygen saturation (P = 0.001) than non-geriatric patients.
Conclusions
The study provides evidence that elderly patients exhibit more severe and deeper nocturnal intermittent hypoxia than the younger adults, independent of severity of obstructive sleep apnea, BMI, gender, and neck circumference. Hypoxia-related polysomnographic variables in geriatric patients may in fact reflect a physiological aging process rather than the severity of a SDB.
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Synergistic activity of sorafenib and betulinic acid against clonogenic activity of non-small cell lung cancer cells
Summary
The highly selective multi-targeted agent – sorafenib – is an inhibitor of a number of intracellular signaling kinases with anti-proliferative, anti-angiogenic and pro-apoptotic effects in various types of tumors, including human non-small cell lung cancer (NSCLC). Betulin displays a broad spectrum of biological and pharmacological properties, including the anticancer and chemopreventive activity. Combination of drugs with different targets is a logical approach to overcome multilevel cross-stimulation among key signaling pathways in NSCLC progression. NSCLC cell lines: A549, H358 and A427, with different KRAS mutations, and normal human PBL cells, were treated with sorafenib and betulinic acid alone and in combination. We examined the effect of different combined treatments on viability (MTS test), proliferation and apoptotic susceptibility analyzed by flow cytometry, alterations in signaling pathways by Western blotting and colony-forming ability. The combination of sorafenib with betulinic acid had a strong effect on the induction of apoptosis of different non-small cell lung cancer cell lines. Also, this combination was not toxic for human peripheral blood lymphocytes (PBL). Combination treatment changed the expression of proteins involved in the mitochondrial apoptosis pathway and induced apoptotic death by caspase activation. Importantly, combination treatment with low drug concentrations tremendously reduced colony-forming ability of A549, H358 and A427 cells, as compared to both compounds alone. In this study, we showed that combination therapy with low concentrations of sorafenib and betulinic acid had the capacity to induce high levels of cell death and abolish clonogenic activity in some non-small cell lung cancer cell lines independently on KRAS mutations.
This article is protected by copyright. All rights reserved.
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Different properties of skin of different body sites: the root of keloid formation?
Abstract
The purpose of this study was to examine extra cellular matrix composition, vascularization and immune cell population of skin sites prone to keloid formation.
Keloids remain a complex problem, posing esthetical as well as functional difficulties for those affected. These scars tend to develop at anatomic sites of preference. Mechanical properties of skin vary with anatomic location and depend largely on extra cellular matrix composition. These differences in extra cellular matrix composition, but also vascularization and resident immune cell populations might play a role in the mechanism of keloid formation.
To examine this hypothesis, skin samples of several anatomic locations were taken from 24 human donors within zero to 36 hours after they had deceased. Collagen content and cross-links were determined through high-performance liquid chromatography. The expression of several genes, involved in extra cellular matrix production and degradation, was measured by means of real-time PCR. (Immuno) histochemistry was performed to detect fibroblasts, collagen, elastin, blood vessels, Langerhans cells and macrophages. Properties of skin of keloid predilections sites were compared to properties of skin from other locations (non-predilection sites).
The results indicated that there are site specific variations in extracellular matrix properties (collagen and cross-links) as well as macrophage numbers. Moreover, predilection sites for keloid formation contain larger amounts of collagen compared to non-predilection sites, but decreased numbers of macrophages, in particular classically activated CD40 positive macrophages.
In conclusion, the altered (histological, protein and genetic) properties of skin of keloid predilection sites may cause a predisposition for and contribute to keloid formation. This article is protected by copyright. All rights reserved.
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Wound healing outcomes; Using big data and a modified intent to treat method as a metric for reporting healing rates
Abstract
Introduction: Chronic wounds are increasing in prevalence and are a costly problem for the US healthcare system and throughout the world. Typically outcomes studies in the field of wound care have been limited to small clinical trials, comparative effectiveness cohorts and attempts to extrapolate results from claims data-bases. As a result, outcomes in real world clinical settings may differ from these published studies.
Objectives: This study presents a modified intent-to-treat framework for measuring wound outcomes and measures the consistency of population based outcomes across two distinct settings.
Methods: In this retrospective observational analysis, we describe the largest to date, cohort of patient wound outcomes derived from 626 hospital based clinics and one academic tertiary care clinic. We present the results of a modified intent-to-treat analysis of wound outcomes as well as demographic and descriptive data. After applying the exclusion criteria, the final analytic sample includes the outcomes from 667,291 wounds in the national sample and 1,788 wounds in the academic sample.
Results: We found a consistent modified intent to treat healing rate of 74.6% from the 626 clinics and 77.6% in the academic center. We recommend that a standard modified intent to treat healing rate be used to report wound outcomes to allow for consistency and comparability in measurement across providers, payers and healthcare systems. This article is protected by copyright. All rights reserved.
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Mannequin-based telesimulation: Increasing access to simulation-based education
The 2017 Academic Emergency Medicine Consensus Conference, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes," highlights how simulation can improve the delivery of health care across larger systems; however, how can systems change when valuable educational interventions reach only limited populations? Studies have demonstrated the benefit of simulation education1,2 but have questioned the use of simulation in a system with limited financial resources.3 Most academic medical centers have mannequin-based simulation technology;4 yet, it is unclear from the literature how many community hospitals, especially in rural areas, have a simulation center or mannequins.
This article is protected by copyright. All rights reserved.
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“What do people do if they don't have insurance?”: ED to ED Referrals
Abstract
Objective
Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits.
Methods
This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached.
Results
143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain.
Conclusions
The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety.
This article is protected by copyright. All rights reserved.
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Growth-induced stress enhances epithelial-mesenchymal transition induced by IL-6 in clear cell renal cell carcinoma via the Akt/GSK-3β/β-catenin signaling pathway
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E6/E7 oncogenes in epithelial suprabasal layers and estradiol promote cervical growth and ear regeneration
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Endoplasmic reticulum stress signaling and chemotherapy resistance in solid cancers
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A retrospective study of amrubicin monotherapy for the treatment of relapsed small cell lung cancer in elderly patients
Abstract
Purpose
Amrubicin is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). Previous studies reported its effectiveness and severe hematological toxicity. However, the efficacy of amrubicin monotherapy in elderly patients with SCLC has not been described. The objective of this study was to investigate the feasibility of amrubicin monotherapy in elderly patients and its efficacy for relapsed SCLC.
Methods
A retrospective cohort study design was used. We retrospectively evaluated the clinical effects and adverse events of amrubicin treatment in elderly (≥70 years) SCLC patients with relapsed SCLC.
Results
Between November 2003 and September 2015, 86 patients (aged ≥70 years) received amrubicin monotherapy for relapsed SCLC at four institutions. There were 42 cases of sensitive relapse (S) and 44 of refractory relapse (R). S cases with median age of 75 years (range 70–85 years) and R cases with median age of 74 years (range 70–84 years) were included in our analysis. The median number of treatment cycles was three (range 1–9), and the response rate was 33.7% (40.5% in the S and 27.2% in the R cases). Median progression-free survival time was 4.0 months in the S and 2.7 months in the R patients (p = 0.013). Median survival time from the start of amrubicin therapy was 7.6 months in the S and 5.5 months in the R cases (p = 0.26). The frequencies of grade ≥3 hematological toxicities were as follows: leukopenia, 60.4%; neutropenia, 74.4%; anemia, 11.6%; thrombocytopenia, 16.2%; and febrile neutropenia, 17.4%. Treatment-related death was observed in one patient.
Conclusion
Although hematological toxicities, particularly neutropenia, were severe, amrubicin showed favorable efficacy, not only in the S but also in the R cases, as shown in previous studies. Amrubicin could be a preferable standard treatment in elderly patients with relapsed SCLC. These results warrant further evaluation of amrubicin in elderly patients with relapsed SCLC by a prospective trial.
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Survival data for postoperative adjuvant chemotherapy comprising cisplatin plus vinorelbine after complete resection of non-small cell lung cancer
Abstract
Purpose
Despite the efficacy of postoperative adjuvant cisplatin (CDDP)-based chemotherapy for patients who have undergone surgical resection of non-small cell lung cancer (NSCLC), few reports have presented survival data for Asian patients treated with adjuvant chemotherapy involving a combination of CDDP and vinorelbine (VNR). This study was performed to evaluate the survival of patients with NSCLC who received postoperative adjuvant chemotherapy comprising CDDP + VNR.
Methods
We retrospectively evaluated patients with NSCLC who received adjuvant chemotherapy comprising CDDP + VNR at the Shizuoka Cancer Center between February 2006 and October 2011.
Results
One hundred patients who underwent surgical resection of NSCLC were included in this study. The patients' characteristics were as follows: median age 63 years (range 36–74 years), female 34%, never-smokers 20%, and non-squamous NSCLC 73%. Pathological stages IIA, IIB, and IIIA were observed in 31, 22, and 47% of patients, respectively. The 5- and 2-year overall survival rates were 73 and 93%, respectively. The 5- and 2-year relapse-free survival rates were 53 and 62%, respectively. Univariate analysis of prognostic factors showed that patient characteristics (sex, histology, and pathological stage) and CDDP dose intensity were not significantly associated with survival. In 48 patients who developed NSCLC recurrence, the 5-year survival rate after recurrence was 29%, and the median survival time after recurrence was 37 months.
Conclusions
Our results suggest that the prognosis after surgical resection of NSCLC and adjuvant chemotherapy comprising CDDP + VNR might be improving compared with previous survival data of adjuvant chemotherapy for NSCLC.
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sIL-24 peptide, a human interleukin-24 isoform, induces mitochondrial-mediated apoptosis in human cancer cells
Abstract
Purpose
Interleukin-24 (IL-24) is a unique cytokine in the IL-10 family that reveals tumor-suppressive activity against a broad range of cancers. Alternative splicing of human IL-24 generates several isoforms with different pro-apoptotic activities. In the current study, we aimed to investigate the cytotoxic properties of a recombinant smallest isoform of IL-24 (sIL-24) and the underlying molecular mechanisms in PC-3, A549, U937, and Raji cancer cells as well as normal cell line MRC-5.
Methods
Following treatment of the cells with recombinant sIL-24 peptide and full-length IL-24 protein, cytotoxicity was determined by MTT assay. Apoptosis induction was evaluated using annexin-V/PI double staining flow cytometry and Hoechst 33342 staining. The expression of Bax, Bcl-2, cytochrome c, and caspase-3 was analyzed by Western blotting.
Results
MTT assay exhibited that sIL-24 dose and time dependently inhibited the proliferation of IL-24 receptor-positive PC-3, U937, and Raji cells more effectively than full-length IL-24. In contrast, sIL-24 had little cytotoxic effect on A549 cells lacking the IL-24 receptor, or on MRC-5 normal cells. Flow cytometric analysis and morphological observation revealed an efficient apoptosis induction in the receptor-positive cells. Furthermore, Western blot assay demonstrated that cell death induced by sIL-24 was associated with upregulation of the Bax/Bcl-2 ratio, cytochrome c release, and the expression of cleaved caspase-3, suggesting that sIL-24 induced apoptosis mainly through the mitochondrial pathway. Notably, among the tested cells, induction of apoptosis was more significant in PC-3 cells.
Conclusion
Our results suggest that the sIL-24 peptide is a promising candidate for potential treatment of human cancers.
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Unusual osteolytic lesion of the jaw.
Unusual osteolytic lesion of the jaw.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jul 10;:
Authors: da Silva KD, Flores IL, Etges A, Vasconcelos ACU, Mesquita RA, Gomes APN, Tarquinio SBC
PMID: 28843477 [PubMed - as supplied by publisher]
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Mitteilungen der GÄCD
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Statistical verification on the effect of hearing loss on speech-evoked auditory brainstem response.
Statistical verification on the effect of hearing loss on speech-evoked auditory brainstem response.
Int J Pediatr Otorhinolaryngol. 2017 Aug 22;:
Authors: Zakaria MN
PMID: 28843698 [PubMed - as supplied by publisher]
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Reply to the letter to the editor regarding "Comment on an evaluation of oxidative and nitrosative stress in children-who-stutter and its relationship to severity".
Reply to the letter to the editor regarding "Comment on an evaluation of oxidative and nitrosative stress in children-who-stutter and its relationship to severity".
Int J Pediatr Otorhinolaryngol. 2017 Aug 22;:
Authors: Bilal N
PMID: 28843697 [PubMed - as supplied by publisher]
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Cysticercosis: Reiterating the role of cytodiagnosis
Background
Cysticercosis is a common parasitic infection in many Asian countries. The histopathological features of this parasitic infection are well established, however, the subtle cytological features and their importance in diagnosing this condition need more elaboration. In this case series we have reiterated the role of fine-needle aspiration cytology (FNAC) in the diagnosis of cysticercosis in clinically unsuspected cases, thereby obviating the need for a biopsy.
Methods
Sixteen patients presented with palpable subcutaneous swellings. The clinical diagnosis varied from tubercular/reactive lymphadenitis, lipoma to neurofibromatosis. These patients were subjected to FNAC of the swellings.
Result
In all 16 cases, a definitive diagnosis of cysticercosis was made on FNAC on the basis of characteristic features like parasite tegument/bladder wall and occasional hooklets. Features suggestive of host reaction were also observed, which included multinucleated giant cells, mixed inflammatory infiltrate with conspicuous eosinophils, histiocytes, and palisading granulomas. These findings were correlated with histopathology and patients were followed up. We noticed spontaneous resolution of the nodules after the FNAC in six patients.
Conclusion
The cytological diagnosis of cysticercosis is quite straightforward in cases where the actual parasitic structures are identified in the smears. However, in the absence of parasitic fragments, features suggestive of host reaction should alert the cytologist to search for the evidence of cysticercosis in the smear, which can help in early and timely diagnosis and treatment of the disease. We also postulate that injury to certain parts of the larval form during FNAC procedure would result in degeneration of the parasite.
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AMP-activated protein kinase and cAMP response element-binding protein activity are associated with distinct postoperative behavioral changes in rats
Abstract
Purpose
To explore the association of AMP-activated protein kinase (AMPK) and cAMP response element-binding protein (CREB) activity with distinct postoperative behavioral changes in rats.
Methods
We performed partial hepatolobectomy in adult rats and aged rats. The learning and memory ability of rats was evaluated by the Barnes maze test on postoperative days 1–4. The expressions of AMPK and phosphorylated CREB (p-CREB) in the CA1 and DG regions of the hippocampus were detected by immunohistochemical assay at 3, 6, 12 and 24 h postoperatively.
Results
Surgery impaired the memory of aged rats but not that of adult rats on postoperative days 2 and 3 (both p < 0.05). Surgery synergistically increased the expressions of AMPK and p-CREB in the CA1 region of hippocampus in aged rats but not in adult rats at 3 and 6 h postoperatively.
Conclusion
Our data suggest that surgery induces cognitive impairment in aged rats. Surgery-induced expression of AMPK and p-CREB in the CA1 region of hippocampus may be involved in this cognitive impairment.
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Transcriptome comparison identifies potential biomarkers of spine and skull base chordomas.
Transcriptome comparison identifies potential biomarkers of spine and skull base chordomas.
Virchows Arch. 2017 Aug 27;:
Authors: Bell AH, DeMonte F, Raza SM, Rhines LD, Tatsui CE, Prieto VG, Fuller GN, Bell D
Abstract
Chordomas are rare, slowly growing, locally aggressive bone neoplasms that arise from embryonic remnants of the notochord, showing dual epithelial-mesenchymal differentiation. The high plasticity probably is the main reason for the high variety in phenotypes of chordoma, from its high heterogeneity on a cellular level to its subtype variations depending on tissue location, with its potential to develop from an inactive quiescent form to an aggressive cancer with extreme adaptability and resistance to drugs and other treatments. Gene expression profiles of formalin-fixed, paraffin-embedded skull chordoma, spine chordoma, and normal tissue specimens were generated and compared. Using strict criteria, we identified 222 differentially expressed transcripts unique to skull base chordoma, 261 unique to spine chordoma, and 192 common to both chordoma subtypes. Further analysis of these three groups of transcripts allowed the selection of three subsets of highly differentially expressed genes as potential biomarkers, disease drivers, and therapeutic targets in both chordoma subtypes. Immunohistochemistry revealed LMX1A to be dominant in skull base chordoma, SALL3 to be unique to spine chordoma, and T to be common to both chordoma subtypes. In both chordoma subtypes, the genes with the highest expression were predominantly development-related genes, mostly transcription factors. Our findings indicate that these developmental genes play important oncogenic roles in chordoma, mainly causing high plasticity and resistance to therapy in both these cancer subtypes but also determining their differentiation status and proliferation activity, pointing to features expected of heterogeneous stem cell-like tissues with similarities to their notochord origins.
PMID: 28844110 [PubMed - as supplied by publisher]
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Percutaneous biopsy of lesions in the cavernous sinus: a systematic review.
Percutaneous biopsy of lesions in the cavernous sinus: a systematic review.
World Neurosurg. 2017 Aug 23;:
Authors: Dellaretti M, de Almeida JC, da Silva Martins WC, Faria MP
Abstract
BACKGROUND: A wide variety of lesions may develop in the cavernous sinus region, such as tumors or pseudotumors of inflammatory origin. Sometimes imaging is insufficient to ascertain a pathological diagnosis. Percutaneous biopsy through the foramen ovale route may then be performed to aid therapeutic decision, thus avoiding unnecessary open surgery when lesions are confirmed to be nonsurgical or unresectable. We conducted a systemic review to determine the efficacy of percutaneous biopsy of lesions in the cavernous sinus.
METHOD: A systematic search in PubMed, Lilacs, the Web of Science and Scopus yielded 4.495 potentially eligible abstracts. Review was conducted on 14 studies describing 75 biopsy procedures for lesions in the cavernous sinus region. The primary outcome measure was diagnostic success. Data were analyzed according to standard a systemic review techniques.
RESULTS: A diagnosis was obtained in 65 of the 75 cases described in the literature. In all series, only three patients had permanent deficits. No individual studies reported mortality. The histopathological evaluation revealed neoplastic diseases in 58 lesions. Meningiomas were found in 26 biopsy samples. Non-neoplastic diseases, originating from infectious, inflammatory or deposition diseases, accounted for six biopsy samples.
CONCLUSION: Percutaneous biopsy of lesions in the cavernous sinus region is effective for diagnosis. A biopsy can be performed in patients with cavernous sinus masses especially when neuroimaging fails to provide sufficient information of a histopathological nature.
PMID: 28843761 [PubMed - as supplied by publisher]
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Doping in Two Elite Athletics Competitions Assessed by Randomized-Response Surveys
Abstract
Background
Doping in sports compromises fair play and endangers health. To deter doping among elite athletes, the World Anti-Doping Agency (WADA) oversees testing of several hundred thousand athletic blood and urine samples annually, of which 1–2% test positive. Measures using the Athlete Biological Passport suggest a higher mean prevalence of about 14% positive tests. Biological testing, however, likely fails to detect many cutting-edge doping techniques, and thus the true prevalence of doping remains unknown.
Methods
We surveyed 2167 athletes at two sporting events: the 13th International Association of Athletics Federations Word Championships in Athletics (WCA) in Daegu, South Korea in August 2011 and the 12th Quadrennial Pan-Arab Games (PAG) in Doha, Qatar in December 2011. To estimate the prevalence of doping, we utilized a "randomized response technique," which guarantees anonymity for individuals when answering a sensitive question. We also administered a control question at PAG assessing past-year use of supplements.
Results
The estimated prevalence of past-year doping was 43.6% (95% confidence interval 39.4–47.9) at WCA and 57.1% (52.4–61.8) at PAG. The estimated prevalence of past-year supplement use at PAG was 70.1% (65.6–74.7%). Sensitivity analyses, assessing the robustness of these estimates under numerous hypothetical scenarios of intentional or unintentional noncompliance by respondents, suggested that we were unlikely to have overestimated the true prevalence of doping.
Conclusions
Doping appears remarkably widespread among elite athletes, and remains largely unchecked despite current biological testing. The survey technique presented here will allow future investigators to generate continued reference estimates of the prevalence of doping.
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PulmCrit- Brain death, mimics, and flow scans
As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation. Critical care practitioners must develop a firm grasp of this diagnosis. This post will explore some diagnostic conundrums in brain death diagnosis. The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.
EMCrit by Josh Farkas.
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Total and free cortisol levels during 1 μg, 25 μg, and 250 μg cosyntropin stimulation tests compared to insulin tolerance test: results of a randomized, prospective, pilot study
Abstract
Purpose
The appropriate cosyntropin dose during cosyntropin stimulation tests remains uncertain. We conducted a prospective, randomized pilot study to compare 1 μg IV low dose cosyntropin test, 25 μg IM medium dose cosyntropin test, and 250 μg IM standard dose cosyntropin test to evaluate secondary adrenal insufficiency. Insulin tolerance test was used as the gold standard.
Method
The study included patients with hypothalamic/pituitary disease (n = 10) with at least one pituitary axis deficiency other than ACTH deficiency and controls (n = 12). All tests were done in random order. Sensitivity and specificity were calculated for total cortisol and serum free cortisol cut-off levels during cosyntropin stimulation tests.
Results
The median (range) age and F/M sex ratios for patients and controls were 54 years (23–62), 2/8, and 33 years (21–51), 6/6, respectively. The best total cortisol cut-off during low dose cosyntropin test, medium dose cosyntropin test, 30 min and 60 min standard dose cosyntropin test were 14.6 μg/dL (100% sensitivity & specificity), 18.7 μg/dL (100% sensitivity, 88% specificity), 16.1 (100% sensitivity & specificity), and 19.5 μg/dL (100% sensitivity & specificity), respectively. There was no difference in the ROC curve for cortisol values between the cosyntropin stimulation tests (p > 0.41). Using a cortisol cut-off of 18 μg/dL during cosyntropin stimulation tests, only cortisol level at 30 min during standard dose cosyntropin test provided discrimination similar to insulin tolerance test. The best peak free cortisol cut-off levels were 1 μg/dL for insulin tolerance test, 0.9 μg/dL for low dose cosyntropin test, 0.9 μg/dL for medium dose cosyntropin test, and 0.9 μg/dL and 1.3 μg/dL for 30 min and 60 min standard dose cosyntropin test, respectively.
Conclusion
All cosyntropin stimulation tests had excellent correlations with insulin tolerance test, when appropriate cut-offs were used. This pilot study does not suggest an advantage in using 25 μg cosyntropin dose during the cosyntropin stimulation test. A serum free cortisol cut-off of 0.9 μg/dL may be used as pass criterion during low dose cosyntropin test, standard dose cosyntropin test cosyntropin test, and 30 min standard dose cosyntropin test.
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Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study
Abstract
Purpose
Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue.
Methods
We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated.
Results
In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11–1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40–64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20–2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism.
Conclusions
Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40–64 years, female sex, and past history of goiter.
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Erratum to: Preliminary data of VEGF-A and VEGFR-2 polymorphisms as predictive factors of radiological response and clinical outcome in iodine-refractory differentiated thyroid cancer treated with sorafenib
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLDjIW
Plasma levels of relaxin-2 are higher and correlated to C-peptide levels in early gestational diabetes mellitus
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFMbvL
Circulating neuregulin 4 concentrations in patients with newly diagnosed type 2 diabetes: a cross-sectional study
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLBAmM
12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules
Abstract
Purpose
Radiofrequency ablation has been advocated as an alternative to radioiodine and/or surgery for the treatment of autonomously functioning benign thyroid nodules. However, only a few studies have measured radiofrequency ablation efficacy on autonomously functioning benign thyroid nodules. The aim of this work was to evaluate the 12-month efficacy of a single session of radiofrequency ablation (performed with the moving shot technique) on solitary autonomously functioning benign thyroid nodules.
Methods
Thirty patients with a single, benign autonomously functioning benign thyroid nodules, who were either unwilling or ineligible to undergo surgery and radioiodine, were treated with radiofrequency ablation between April 2012 and May 2015. All the patients underwent a single radiofrequency ablation, performed with the 18-gauge needle and the moving shot technique. Clinical, laboratory, and ultrasound evaluations were scheduled at baseline, and after 1, 3, 6, and 12 months from the procedure.
Results
A single radiofrequency ablation reduced thyroid nodule volume by 51, 63, 69, and 75 % after 1, 3, 6, and 12 months, respectively. This was associated with a significant improvement of local cervical discomfort and cosmetic score. As for thyroid function, 33 % of the patients went into remission after 3 months, 43 % after 6 months, and 50 % after 12 months from the procedure. This study demonstrates that a single radiofrequency ablation allowed us to withdraw anti-thyroid medication in 50 % of the patients, who remained euthyroid afterwards.
Conclusion
This study shows that a single radiofrequency ablation was effective in 50 % of patients with autonomously functioning benign thyroid nodules. Patients responded gradually to the treatment. It is possible that longer follow-up studies might show greater response rates.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFPYJy
Autoimmune hypothyroidism is three times more frequent in female prolactinoma patients compared to healthy women: data from a cross-sectional case-control study
Abstract
Background
The potent immunomodulatory action of prolactin has been demonstrated in many experimental in vitro studies. In accordance with these data, our retrospective analyses revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population.
Purpose
A cross-sectional case-control study was carried out in a single tertiary referral centre. The main aim was to assess the frequency of newly diagnosed autoimmune thyroid diseases in female patients with prolactinomas.
Methods
The study population consisted of 260 females (154 patients and 106 sex-matched, ethnicity-matched, and age-matched healthy controls) enroled in a prospective manner. Physical exam, thyroid ultrasound, and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor, serum TSH and FT4 levels) were performed in all study participants.
Results
Autoimmune thyroid diseases were diagnosed in 29.9% of the patients and 10.4% of the healthy subjects (p = 0.0002). Subclinical hypothyroidism was found in 9.7% of the patients versus 2.8% of the controls (p = 0.044). Autoimmune hyperthyroidism was observed in 1.3% of all patients.
Conclusions
The prevalence of newly diagnosed autoimmune thyroid diseases, and especially the subclinical hypothyroidism, was significantly higher in our female prolactinoma patients in comparison to age-matched healthy women. Based on our results, we suggest routine screening for autoimmune thyroid diseases (thyroid function, immunology and ultrasound examination) in all female patients with prolactinoma at the time of diagnosis. We also recommend a close follow-up of thyroid function in these women in case of pregnancy and after delivery.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLMcSP
Sirtuins 1–7 expression in human adipose-derived stem cells from subcutaneous and visceral fat depots: influence of obesity and hypoxia
Abstract
The sirtuin family comprises seven NAD+-dependent deacetylases which control the overall health of organisms through the regulation of pleiotropic metabolic pathways. Sirtuins are important modulators of adipose tissue metabolism and their expression is higher in lean than obese subjects. At present, the role of sirtuins in adipose-derived stem cells has not been investigated yet. Therefore, in this study, we evaluated the expression of the complete panel of sirtuins in adipose-derived stem cells isolated from both subcutaneous and visceral fat of non-obese and obese subjects. We aimed at investigating the influence of obesity on sirtuins' levels, their role in obesity-associated inflammation, and the relationship with the peroxisome proliferator-activated receptor delta, which also plays functions in adipose tissue metabolism. The mRNA levels in the four types of adipose-derived stem cells were evaluated by quantitative polymerase chain reaction, in untreated cells and also after 8 h of hypoxia exposure. Correlations among sirtuins' expression and clinical and molecular parameters were also analyzed. We found that sirtuin1–6 exhibited significant higher mRNA expression in visceral adipose-derived stem cells compared to subcutaneous adipose-derived stem cells of non-obese subjects. Sirtuin1–6 levels were markedly reduced in visceral adipose-derived stem cells of obese patients. Sirtuins' expression in visceral adipose-derived stem cells correlated negatively with body mass index and C-reactive protein and positively with peroxisome proliferator-activated receptor delta. Finally, only in the visceral adipose-derived stem cells of obese patients hypoxia-induced mRNA expression of all of the sirtuins. Our results highlight that sirtuins' levels in adipose-derived stem cells are consistent with protective effects against visceral obesity and inflammation, and suggest a transcriptional mechanism through which acute hypoxia up-regulates sirtuins in the visceral adipose-derived stem cells of obese patients.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFFRod
Circulating levels of PTEN and KLLN in papillary thyroid carcinoma: can they be considered as novel diagnostic biomarkers?
Abstract
Purpose
PTEN and KLLN are two tumor suppressor genes located in 10q23, share a bidirectional promoter and have roles in carcinogenesis. Formerly, the role of PTEN mutations and KLLN epimutations were identified in incidence of thyroid lesions in individuals with Cowden syndrome, a rare autosomal dominant inherited disorder. This study is the first of its type to assess PTEN and KLLN circulating levels in patients with sporadic papillary thyroid carcinoma (PTC) and compare to patients with multinodular goiter (MNG) and healthy individuals.
Methods
Plasma levels of PTEN and KLLN were determined by enzyme-linked immunosorbent assay in three groups consisted of PTC (n = 33), MNG (n = 26) and healthy persons (n = 30). The association of demographic/pathological characteristics with the levels of PTEN and KLLN were evaluated.
Results
A significant lower plasma levels of PTEN and KLLN were observed in PTC patients compared with those of healthy persons (PTEN, 9.43 ± 3.20 vs. 16.96 ± 1.28 ng/ml, P = 0.000; KLLN, 1.81 ± 0.83 vs. 2.57 ± 1.09 ng/ml, P = 0.005), while no statistical difference was found between PTC and MNG groups. Patients with MNG lesion had significantly lower levels of PTEN/KLLN (PTEN, 9.62 ± 2.97 vs. 16.96 ± 1.28 ng/ml, P = 0.000; KLLN, 1.34 ± 0.86 vs. 2.57 ± 1.09 ng/ml, P = 0.000) compared to the healthy controls. The demographic/pathological characteristics did not demonstrate an association with the levels of PTEN and KLLN.
Conclusions
The study suggests that the lowered levels of PTEN and KLLN are associated with both sporadic PTC and MNG tumorigenesis, but they cannot be considered as circulating biomarkers for differential diagnosis between malignancy and benignity in indeterminate thyroid nodules.
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Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection
Abstract
To compare the clinical efficacy of tablet and oral liquid L-thyroxine (LT4) formulation in naïve hypothyroid subjects with Helicobacter pylori infection. Forty-seven adult naïve hypothyroid subjects with dyspeptic symptoms were investigated with upper endoscopy and divided into: 28 patients with Helicobacter pylori infection (Group A); 15 patients without gastric alterations (group B); 4 patients with autoimmune gastritis were excluded from the study. Subjects were randomly treated with a same dose of LT4 tablet (TAB) or oral liquid formulation (SOL), for 9 months on group A and 6 months on group B. Helicobacter pylori infection was eradicated after 3 months of LT4 treatment. On group A, after 3 months (before Helicobacter pylori eradication), subjects treated with SOL showed a greater thyroid-stimulating hormone reduction (ΔTSH3–0: TAB = −4.1 ± 4.6 mU/L; SOL = −7.7 ± 2.5 mU/L; p = 0.029) and a greater homogeneity in the thyroid-stimulating hormone values (TSH3mo: TAB = 5.7 ± 4.9 mU/L; SOL = 4.1 ± 2.0 mU/L; p = 0.025), compared to LT4 tablet. At 9 months (after 6 months of Helicobacter pylori eradication) mean thyroid-stimulating hormone values were lower in subjects treated with LT4 tablet (TSH9mo: TAB = 1.8 ± 1.2 mU/L; SOL = 3.2 ± 1.7 mU/L; p = 0.006). On group B no difference were observed, at each time point, in the mean thyroid-stimulating hormone values and thyroid-stimulating hormone variations between two LT4 formulations. LT4 liquid formulation may produce a better clinical response compared to the tablet formulation in hypothyroid subjects with Helicobacter pylori infection.
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Glucagon stimulation test: has its time come?
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLInNl
KI-67 heterogeneity in well differentiated gastro-entero-pancreatic neuroendocrine tumors: when is biopsy reliable for grade assessment?
Abstract
Purpose
Ki-67 heterogeneity can impact on gastroenteropancreatic neuroendocrine tumor grade assignment, especially when tissue is scarce. This work is aimed at devising adequacy criteria for grade assessment in biopsy specimens.
Method
To analyze the impact of biopsy size on reliability, 360 virtual biopsies of different thickness and lengths were constructed. Furthermore, to estimate the mean amount of non-neoplastic tissue component present in biopsies, 28 real biopsies were collected, the non-neoplastic components (fibrosis and inflammation) quantified and the effective area of neoplastic tissue calculated for each biopsy.
Results
Heterogeneity of Ki-67 distribution, G2 tumors and biopsy size all play an important role in reducing the reliability of biopsy samples in Ki-67-based grade assignment. In particular in G2 cases, 59.9% of virtual biopsies downgraded the tumor and the smaller the biopsy, the more frequent downgrading occurs. In real biopsies the presence of non-neoplastic tissue reduced the available total area by a mean of 20%.
Conclusions
By coupling the results from these two different approaches we show that both biopsy size and non-neoplastic component must be taken into account for biopsy adequacy. In particular, we can speculate that if the minimum biopsy area, necessary to confidently (80% concordance) grade gastro-entero-pancreatic neuroendocrine tumors on virtual biopsies ranges between 15 and 30 mm2, and if real biopsies are on average composed of only 80% of neoplastic tissue, then biopsies with a surface area not <12 mm2 should be performed; using 18G needles, this corresponds to a minimum total length of 15 mm.
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Loss of succinate dehydrogenase subunit B (SDHB) as a prognostic factor in advanced ileal well-differentiated neuroendocrine tumors
Abstract
Purpose
Abnormal expression of succinate dehydrogenase, (SDH), in particular of the B subunit (SDHB), is implicated in the pathogenesis of neuroendocrine tumors. This study evaluates the distribution of SDHB in WHO grading G1 and G2 intestinal, well-differentiated neuroendocrine tumors and corresponding lymph node or liver metastases.
Methods
We collected ileal well-differentiated neuroendocrine tumors specimens from consecutive patients with prior primary resection and distant synchronous or metachronous liver metastases. We obtained 195 specimens from primary tumors (n = 106) and metastases (n = 89). The expression (E) of SDHB and the immunostaining intensity (I) were evaluated semiquantitatively and combined into a single score. SDHB score was evaluated in primitive tumor and metastatic specimens.
Results
SDHB was found in all tumor cells. Mean SDHB expression was 72.7 % ± 17.1 % in primitive specimens and 27.9 % ± 24.6 % in metastatic specimens (p < 0.0001). SDH intensity was higher in primitive specimens (p < 0.0001). SDHB score was 9–12 in 96 specimens of the primitive group and 2 metastatic specimens (p < 0.0001). None of the analyzed parameters was predictive of overall survival in the primitive subset. In the metastatic subset, loss of SDHB expression, intensity, and score were prognostic factors for survival. Lower expression and intensity of SDHB in metastatic lesions were associated with longer overall survival. When combining SDHB score and Ki-67 % in the metastatic subset, a lower SDHB score was associated with prolonged overall survival, independently from Ki-67 %.
Conclusions
SDHB score was different in primitive and metastatic specimens. The combination of SDHB score and Ki-67 % was a stronger predictor of overall survival than Ki-67 % alone. This stratification might help predict survival.
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Toward predictive biomarkers of response to kinase inhibitor therapies in differentiated thyroid cancer
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Management of gastric neuro-endocrine tumours in a large French national cohort (GTE)
Abstract
Introduction
Gastric neuro-endocrine tumours are rare. European guidelines for the management of neuro-endocrine tumours have been published in 2012. The aim of our survey was to study the management of gastric neuro-endocrine tumours registered in the national cohort. A prospective national cohort registers the Neuro-endocrine tumours in France since January 2003 (GTE network). We reviewed all the individual medical reports of gastric neuro-endocrine tumours in order to collect data on treatment.
Results
One hundred and ninety seven gastric neuro-endocrine tumours diagnosed between 1964 and 2013 in 20 centres were registered. For 181 cases data were considered complete for our survey. Eighty four tumours were type 1 (46.4%); five types 2 (2.8%); 52 types 3 (28.7%) and 40 types 4 (22.1%). Types 1 and 2 were first endoscopically managed in 93 and 60% of cases, respectively, whereas surgery was first done in 45 and 42%, respectively, of types 3 and 4. Systemic treatment, chemotherapy and/or somatostatin analogue, was first administered exclusively for types 3 and 4. Near 3% of types 1 and 40% of types 2 received at a time somatostatin analogue treatment. Five-year survival rates were 98.3, 100, 63.2 and 31.8% for types 1, 2, 3 and 4, respectively.
Conclusion
The great majority of gastric neuro-endocrine tumours registered in this national cohort are treated in accordance with the current guidelines. The survival rates we reported must be interpreted with caution, because this cohort registered preferentially selected patients eligible for treatment. The registration of all the gastric neuro-endocrine tumours, in particular type 1 considered as benign and type 4 not eligible for specific anti-cancer treatment must be encouraged.
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Improved survival using specialized multidisciplinary board in sarcoma patients
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Total and free cortisol levels during 1 μg, 25 μg, and 250 μg cosyntropin stimulation tests compared to insulin tolerance test: results of a randomized, prospective, pilot study
Abstract
Purpose
The appropriate cosyntropin dose during cosyntropin stimulation tests remains uncertain. We conducted a prospective, randomized pilot study to compare 1 μg IV low dose cosyntropin test, 25 μg IM medium dose cosyntropin test, and 250 μg IM standard dose cosyntropin test to evaluate secondary adrenal insufficiency. Insulin tolerance test was used as the gold standard.
Method
The study included patients with hypothalamic/pituitary disease (n = 10) with at least one pituitary axis deficiency other than ACTH deficiency and controls (n = 12). All tests were done in random order. Sensitivity and specificity were calculated for total cortisol and serum free cortisol cut-off levels during cosyntropin stimulation tests.
Results
The median (range) age and F/M sex ratios for patients and controls were 54 years (23–62), 2/8, and 33 years (21–51), 6/6, respectively. The best total cortisol cut-off during low dose cosyntropin test, medium dose cosyntropin test, 30 min and 60 min standard dose cosyntropin test were 14.6 μg/dL (100% sensitivity & specificity), 18.7 μg/dL (100% sensitivity, 88% specificity), 16.1 (100% sensitivity & specificity), and 19.5 μg/dL (100% sensitivity & specificity), respectively. There was no difference in the ROC curve for cortisol values between the cosyntropin stimulation tests (p > 0.41). Using a cortisol cut-off of 18 μg/dL during cosyntropin stimulation tests, only cortisol level at 30 min during standard dose cosyntropin test provided discrimination similar to insulin tolerance test. The best peak free cortisol cut-off levels were 1 μg/dL for insulin tolerance test, 0.9 μg/dL for low dose cosyntropin test, 0.9 μg/dL for medium dose cosyntropin test, and 0.9 μg/dL and 1.3 μg/dL for 30 min and 60 min standard dose cosyntropin test, respectively.
Conclusion
All cosyntropin stimulation tests had excellent correlations with insulin tolerance test, when appropriate cut-offs were used. This pilot study does not suggest an advantage in using 25 μg cosyntropin dose during the cosyntropin stimulation test. A serum free cortisol cut-off of 0.9 μg/dL may be used as pass criterion during low dose cosyntropin test, standard dose cosyntropin test cosyntropin test, and 30 min standard dose cosyntropin test.
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Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study
Abstract
Purpose
Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue.
Methods
We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated.
Results
In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11–1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40–64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20–2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism.
Conclusions
Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40–64 years, female sex, and past history of goiter.
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Erratum to: Preliminary data of VEGF-A and VEGFR-2 polymorphisms as predictive factors of radiological response and clinical outcome in iodine-refractory differentiated thyroid cancer treated with sorafenib
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLDjIW
Plasma levels of relaxin-2 are higher and correlated to C-peptide levels in early gestational diabetes mellitus
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFMbvL
Circulating neuregulin 4 concentrations in patients with newly diagnosed type 2 diabetes: a cross-sectional study
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLBAmM
12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules
Abstract
Purpose
Radiofrequency ablation has been advocated as an alternative to radioiodine and/or surgery for the treatment of autonomously functioning benign thyroid nodules. However, only a few studies have measured radiofrequency ablation efficacy on autonomously functioning benign thyroid nodules. The aim of this work was to evaluate the 12-month efficacy of a single session of radiofrequency ablation (performed with the moving shot technique) on solitary autonomously functioning benign thyroid nodules.
Methods
Thirty patients with a single, benign autonomously functioning benign thyroid nodules, who were either unwilling or ineligible to undergo surgery and radioiodine, were treated with radiofrequency ablation between April 2012 and May 2015. All the patients underwent a single radiofrequency ablation, performed with the 18-gauge needle and the moving shot technique. Clinical, laboratory, and ultrasound evaluations were scheduled at baseline, and after 1, 3, 6, and 12 months from the procedure.
Results
A single radiofrequency ablation reduced thyroid nodule volume by 51, 63, 69, and 75 % after 1, 3, 6, and 12 months, respectively. This was associated with a significant improvement of local cervical discomfort and cosmetic score. As for thyroid function, 33 % of the patients went into remission after 3 months, 43 % after 6 months, and 50 % after 12 months from the procedure. This study demonstrates that a single radiofrequency ablation allowed us to withdraw anti-thyroid medication in 50 % of the patients, who remained euthyroid afterwards.
Conclusion
This study shows that a single radiofrequency ablation was effective in 50 % of patients with autonomously functioning benign thyroid nodules. Patients responded gradually to the treatment. It is possible that longer follow-up studies might show greater response rates.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFPYJy
Autoimmune hypothyroidism is three times more frequent in female prolactinoma patients compared to healthy women: data from a cross-sectional case-control study
Abstract
Background
The potent immunomodulatory action of prolactin has been demonstrated in many experimental in vitro studies. In accordance with these data, our retrospective analyses revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population.
Purpose
A cross-sectional case-control study was carried out in a single tertiary referral centre. The main aim was to assess the frequency of newly diagnosed autoimmune thyroid diseases in female patients with prolactinomas.
Methods
The study population consisted of 260 females (154 patients and 106 sex-matched, ethnicity-matched, and age-matched healthy controls) enroled in a prospective manner. Physical exam, thyroid ultrasound, and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor, serum TSH and FT4 levels) were performed in all study participants.
Results
Autoimmune thyroid diseases were diagnosed in 29.9% of the patients and 10.4% of the healthy subjects (p = 0.0002). Subclinical hypothyroidism was found in 9.7% of the patients versus 2.8% of the controls (p = 0.044). Autoimmune hyperthyroidism was observed in 1.3% of all patients.
Conclusions
The prevalence of newly diagnosed autoimmune thyroid diseases, and especially the subclinical hypothyroidism, was significantly higher in our female prolactinoma patients in comparison to age-matched healthy women. Based on our results, we suggest routine screening for autoimmune thyroid diseases (thyroid function, immunology and ultrasound examination) in all female patients with prolactinoma at the time of diagnosis. We also recommend a close follow-up of thyroid function in these women in case of pregnancy and after delivery.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLMcSP
Sirtuins 1–7 expression in human adipose-derived stem cells from subcutaneous and visceral fat depots: influence of obesity and hypoxia
Abstract
The sirtuin family comprises seven NAD+-dependent deacetylases which control the overall health of organisms through the regulation of pleiotropic metabolic pathways. Sirtuins are important modulators of adipose tissue metabolism and their expression is higher in lean than obese subjects. At present, the role of sirtuins in adipose-derived stem cells has not been investigated yet. Therefore, in this study, we evaluated the expression of the complete panel of sirtuins in adipose-derived stem cells isolated from both subcutaneous and visceral fat of non-obese and obese subjects. We aimed at investigating the influence of obesity on sirtuins' levels, their role in obesity-associated inflammation, and the relationship with the peroxisome proliferator-activated receptor delta, which also plays functions in adipose tissue metabolism. The mRNA levels in the four types of adipose-derived stem cells were evaluated by quantitative polymerase chain reaction, in untreated cells and also after 8 h of hypoxia exposure. Correlations among sirtuins' expression and clinical and molecular parameters were also analyzed. We found that sirtuin1–6 exhibited significant higher mRNA expression in visceral adipose-derived stem cells compared to subcutaneous adipose-derived stem cells of non-obese subjects. Sirtuin1–6 levels were markedly reduced in visceral adipose-derived stem cells of obese patients. Sirtuins' expression in visceral adipose-derived stem cells correlated negatively with body mass index and C-reactive protein and positively with peroxisome proliferator-activated receptor delta. Finally, only in the visceral adipose-derived stem cells of obese patients hypoxia-induced mRNA expression of all of the sirtuins. Our results highlight that sirtuins' levels in adipose-derived stem cells are consistent with protective effects against visceral obesity and inflammation, and suggest a transcriptional mechanism through which acute hypoxia up-regulates sirtuins in the visceral adipose-derived stem cells of obese patients.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xFFRod
Circulating levels of PTEN and KLLN in papillary thyroid carcinoma: can they be considered as novel diagnostic biomarkers?
Abstract
Purpose
PTEN and KLLN are two tumor suppressor genes located in 10q23, share a bidirectional promoter and have roles in carcinogenesis. Formerly, the role of PTEN mutations and KLLN epimutations were identified in incidence of thyroid lesions in individuals with Cowden syndrome, a rare autosomal dominant inherited disorder. This study is the first of its type to assess PTEN and KLLN circulating levels in patients with sporadic papillary thyroid carcinoma (PTC) and compare to patients with multinodular goiter (MNG) and healthy individuals.
Methods
Plasma levels of PTEN and KLLN were determined by enzyme-linked immunosorbent assay in three groups consisted of PTC (n = 33), MNG (n = 26) and healthy persons (n = 30). The association of demographic/pathological characteristics with the levels of PTEN and KLLN were evaluated.
Results
A significant lower plasma levels of PTEN and KLLN were observed in PTC patients compared with those of healthy persons (PTEN, 9.43 ± 3.20 vs. 16.96 ± 1.28 ng/ml, P = 0.000; KLLN, 1.81 ± 0.83 vs. 2.57 ± 1.09 ng/ml, P = 0.005), while no statistical difference was found between PTC and MNG groups. Patients with MNG lesion had significantly lower levels of PTEN/KLLN (PTEN, 9.62 ± 2.97 vs. 16.96 ± 1.28 ng/ml, P = 0.000; KLLN, 1.34 ± 0.86 vs. 2.57 ± 1.09 ng/ml, P = 0.000) compared to the healthy controls. The demographic/pathological characteristics did not demonstrate an association with the levels of PTEN and KLLN.
Conclusions
The study suggests that the lowered levels of PTEN and KLLN are associated with both sporadic PTC and MNG tumorigenesis, but they cannot be considered as circulating biomarkers for differential diagnosis between malignancy and benignity in indeterminate thyroid nodules.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLBvPR
Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection
Abstract
To compare the clinical efficacy of tablet and oral liquid L-thyroxine (LT4) formulation in naïve hypothyroid subjects with Helicobacter pylori infection. Forty-seven adult naïve hypothyroid subjects with dyspeptic symptoms were investigated with upper endoscopy and divided into: 28 patients with Helicobacter pylori infection (Group A); 15 patients without gastric alterations (group B); 4 patients with autoimmune gastritis were excluded from the study. Subjects were randomly treated with a same dose of LT4 tablet (TAB) or oral liquid formulation (SOL), for 9 months on group A and 6 months on group B. Helicobacter pylori infection was eradicated after 3 months of LT4 treatment. On group A, after 3 months (before Helicobacter pylori eradication), subjects treated with SOL showed a greater thyroid-stimulating hormone reduction (ΔTSH3–0: TAB = −4.1 ± 4.6 mU/L; SOL = −7.7 ± 2.5 mU/L; p = 0.029) and a greater homogeneity in the thyroid-stimulating hormone values (TSH3mo: TAB = 5.7 ± 4.9 mU/L; SOL = 4.1 ± 2.0 mU/L; p = 0.025), compared to LT4 tablet. At 9 months (after 6 months of Helicobacter pylori eradication) mean thyroid-stimulating hormone values were lower in subjects treated with LT4 tablet (TSH9mo: TAB = 1.8 ± 1.2 mU/L; SOL = 3.2 ± 1.7 mU/L; p = 0.006). On group B no difference were observed, at each time point, in the mean thyroid-stimulating hormone values and thyroid-stimulating hormone variations between two LT4 formulations. LT4 liquid formulation may produce a better clinical response compared to the tablet formulation in hypothyroid subjects with Helicobacter pylori infection.
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Glucagon stimulation test: has its time come?
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wLInNl
KI-67 heterogeneity in well differentiated gastro-entero-pancreatic neuroendocrine tumors: when is biopsy reliable for grade assessment?
Abstract
Purpose
Ki-67 heterogeneity can impact on gastroenteropancreatic neuroendocrine tumor grade assignment, especially when tissue is scarce. This work is aimed at devising adequacy criteria for grade assessment in biopsy specimens.
Method
To analyze the impact of biopsy size on reliability, 360 virtual biopsies of different thickness and lengths were constructed. Furthermore, to estimate the mean amount of non-neoplastic tissue component present in biopsies, 28 real biopsies were collected, the non-neoplastic components (fibrosis and inflammation) quantified and the effective area of neoplastic tissue calculated for each biopsy.
Results
Heterogeneity of Ki-67 distribution, G2 tumors and biopsy size all play an important role in reducing the reliability of biopsy samples in Ki-67-based grade assignment. In particular in G2 cases, 59.9% of virtual biopsies downgraded the tumor and the smaller the biopsy, the more frequent downgrading occurs. In real biopsies the presence of non-neoplastic tissue reduced the available total area by a mean of 20%.
Conclusions
By coupling the results from these two different approaches we show that both biopsy size and non-neoplastic component must be taken into account for biopsy adequacy. In particular, we can speculate that if the minimum biopsy area, necessary to confidently (80% concordance) grade gastro-entero-pancreatic neuroendocrine tumors on virtual biopsies ranges between 15 and 30 mm2, and if real biopsies are on average composed of only 80% of neoplastic tissue, then biopsies with a surface area not <12 mm2 should be performed; using 18G needles, this corresponds to a minimum total length of 15 mm.
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Loss of succinate dehydrogenase subunit B (SDHB) as a prognostic factor in advanced ileal well-differentiated neuroendocrine tumors
Abstract
Purpose
Abnormal expression of succinate dehydrogenase, (SDH), in particular of the B subunit (SDHB), is implicated in the pathogenesis of neuroendocrine tumors. This study evaluates the distribution of SDHB in WHO grading G1 and G2 intestinal, well-differentiated neuroendocrine tumors and corresponding lymph node or liver metastases.
Methods
We collected ileal well-differentiated neuroendocrine tumors specimens from consecutive patients with prior primary resection and distant synchronous or metachronous liver metastases. We obtained 195 specimens from primary tumors (n = 106) and metastases (n = 89). The expression (E) of SDHB and the immunostaining intensity (I) were evaluated semiquantitatively and combined into a single score. SDHB score was evaluated in primitive tumor and metastatic specimens.
Results
SDHB was found in all tumor cells. Mean SDHB expression was 72.7 % ± 17.1 % in primitive specimens and 27.9 % ± 24.6 % in metastatic specimens (p < 0.0001). SDH intensity was higher in primitive specimens (p < 0.0001). SDHB score was 9–12 in 96 specimens of the primitive group and 2 metastatic specimens (p < 0.0001). None of the analyzed parameters was predictive of overall survival in the primitive subset. In the metastatic subset, loss of SDHB expression, intensity, and score were prognostic factors for survival. Lower expression and intensity of SDHB in metastatic lesions were associated with longer overall survival. When combining SDHB score and Ki-67 % in the metastatic subset, a lower SDHB score was associated with prolonged overall survival, independently from Ki-67 %.
Conclusions
SDHB score was different in primitive and metastatic specimens. The combination of SDHB score and Ki-67 % was a stronger predictor of overall survival than Ki-67 % alone. This stratification might help predict survival.
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Toward predictive biomarkers of response to kinase inhibitor therapies in differentiated thyroid cancer
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Management of gastric neuro-endocrine tumours in a large French national cohort (GTE)
Abstract
Introduction
Gastric neuro-endocrine tumours are rare. European guidelines for the management of neuro-endocrine tumours have been published in 2012. The aim of our survey was to study the management of gastric neuro-endocrine tumours registered in the national cohort. A prospective national cohort registers the Neuro-endocrine tumours in France since January 2003 (GTE network). We reviewed all the individual medical reports of gastric neuro-endocrine tumours in order to collect data on treatment.
Results
One hundred and ninety seven gastric neuro-endocrine tumours diagnosed between 1964 and 2013 in 20 centres were registered. For 181 cases data were considered complete for our survey. Eighty four tumours were type 1 (46.4%); five types 2 (2.8%); 52 types 3 (28.7%) and 40 types 4 (22.1%). Types 1 and 2 were first endoscopically managed in 93 and 60% of cases, respectively, whereas surgery was first done in 45 and 42%, respectively, of types 3 and 4. Systemic treatment, chemotherapy and/or somatostatin analogue, was first administered exclusively for types 3 and 4. Near 3% of types 1 and 40% of types 2 received at a time somatostatin analogue treatment. Five-year survival rates were 98.3, 100, 63.2 and 31.8% for types 1, 2, 3 and 4, respectively.
Conclusion
The great majority of gastric neuro-endocrine tumours registered in this national cohort are treated in accordance with the current guidelines. The survival rates we reported must be interpreted with caution, because this cohort registered preferentially selected patients eligible for treatment. The registration of all the gastric neuro-endocrine tumours, in particular type 1 considered as benign and type 4 not eligible for specific anti-cancer treatment must be encouraged.
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Role of Ammonia-Oxidizing Archaea in Ammonia Removal of Wetland Under Low-Temperature Condition
Abstract
Ammonia-oxidizing archaea (AOA) have aroused great attention since it can supplement nitrogen cycle and show extensive existence relative to its bacterial counterpart, ammonia-oxidizing bacteria (AOB). This study compared the abundance and community compositions of AOA and AOB between natural and constructed wetlands under low temperature. More complex community structures were obtained in the constructed wetland, which may be ascribed to the differences in available nutrient contents. Nitrosospira-like organisms predominated AOB communities in both wetlands. Nitrososphaera cluster dominated the AOA community in the constructed wetland, while both Nitrososphaera and Nitrosopumilus clusters were dominant in the natural wetland. AOA dominated over AOB in both the natural and constructed wetlands, and AOA to AOB ratio ranged from 1.47 to 8.13. The natural wetland showed higher nitrification potential at low temperature, mainly due to its higher AOA to AOB ratio. This also explained why a better ammonia treatment performance was observed in the natural wetland even when it had high influent concentrations. The present results provided some new insights to ammonia removal in the wetlands under low temperature.
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Robotic assisted radical prostatectomy for localised prostate cancer in thalidomide generation
Abstract
Thalidomide was used in the late 1950s and early 1960s as a sedative for morning sickness in pregnant women. It resulted in thousands of babies being born with various congenital anomalies, such as phocomelia. Subsequently, the drug was banned for this indication. Most of the survivors have become thalidomide adults and now they are in their fifties. We report the first case of a robot-assisted radical prostatectomy in a 54-year-old male with prostate cancer and phocomelia as a result of thalidomide embryopathy. He presented with a PSA of 3.3 and was diagnosed with Gleason 3 + 4 prostate cancer. An extra peritoneal approach was chosen due to his body habitus and to avoid extreme Trendelenburg tilt. Side docking with the da Vinci robot was employed and the prostatectomy was carried out in the standard extra peritoneal fashion. At 6 months' follow-up his PSA is unrecordable and he is voiding well with minimal urinary incontinence, requiring 1 pad/day. We aim to outline our approach and highlight the technical modifications in this rare physically disabling condition.
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Buckled Thyroid Cartilage: An Anatomic Variant.
Buckled Thyroid Cartilage: An Anatomic Variant.
J Voice. 2017 Aug 23;:
Authors: Chang BA, Luu K, Newton EK, Morrison MD
Abstract
OBJECTIVE: Anatomic abnormalities in the larynx can cause significant and bothersome symptoms. Identified here is an anatomical variant of the thyroid cartilage.
STUDY DESIGN: This study is a retrospective case series of 11 subjects diagnosed with an anatomic variant of the thyroid cartilage.
METHODS: Patients with an anatomic inward buckling of the thyroid cartilage, termed here as buckled thyroid cartilage, were identified through a 20-year retrospective chart review of a tertiary care laryngology practice.
RESULTS: We describe 11 patients with fullness or asymmetry in the area of the false vocal fold and an associated inward buckling of the thyroid cartilage on computed tomography scan. All patients presented with a bothersome voice-related complaint. The most common presenting complaints were hoarseness (54%), globus sensation (45%), or vocal fatigue (27%). One patient was found to have a history of known laryngeal trauma. Surgical correction through an external approach on one patient was successfully performed with subsequent resolution of symptoms.
CONCLUSION: We postulate that deformity and protrusion of the false vocal fold can result in a dampening effect on the vibratory capacity of the vocal fold that can lead to symptomatic hoarseness and vocal fatigue. Buckled thyroid cartilage is, therefore, an important anatomical variant to be aware of and be able to recognize.
PMID: 28843975 [PubMed - as supplied by publisher]
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Survivin: a novel marker and potential therapeutic target for human angiosarcoma
Summary
Human angiosarcoma is a rare malignant vascular tumor associated with extremely poor clinical outcome and generally arising in the skin of head and neck. However, little is known about the molecular pathogeneses and useful immunohistochemical markers of angiosarcoma. To investigate the mechanisms of angiosarcoma progression, we collected 85 cases of human angiosarcoma specimens with clinical records and used ISO-HAS-B patient derived angiosarcoma cells. As control subjects, 54 cases of hemangioma and 34 of pyogenic granuloma were collected. Remarkably, consistent with our recent observations regarding the involvement of Survivin expression following Hippo pathway inactivation in the neoplastic proliferation of murine hemangioendothelioma cells and human infantile hemangioma, nuclear Survivin expression was observed in all cases of angiosarcoma but not in hemangiomas and pyogenic granulomas and Hippo pathway was inactivated in 90.3% of YAP-positive angiosarcoma cases. However, Survivin expression modes and YAP localization (Hippo pathway activation modes) were not correlated with survival. In addition, we confirmed that Survivin small interference RNA (siRNA) transfection and YM155, an anti-Survivin drug, elicited decreased nuclear Survivin expression and cell proliferation in ISO-HAS-B cells which expressed Survivin consistently. Conclusively, these findings support the importance of Survivin as a good marker and critical regulator of cellular proliferation for human angiosarcoma and YM155 as a potential therapeutic agent.
This article is protected by copyright. All rights reserved.
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Mutational analysis using Sanger and Next Generation Sequencing in sporadic spindle cell hemangiomas: A study of 19 cases
Abstract
Spindle cell hemangioma (SCH) is a distinct vascular soft tissue lesion characterized by cavernous blood vessels and a spindle cell component mainly occurring in the distal extremities of young adults. The majority of cases harbor heterozygous mutations in IDH1/2 sporadically or rarely in association with Maffucci syndrome. However, based on mosaicism and accordingly a low percentage of lesional cells harboring a mutant allele, detection can be challenging. We tested 19 sporadic SCHs by Sanger sequencing, Multiplex Ligation-dependent Probe Amplification (MLPA), conventional Next Generation Sequencing (NGS) and NGS using a Single Molecule Molecular Inversion Probes (smMIP) based library preparation in order to compare their diagnostic value. Four out of ten cases tested by Sanger sequencing and one of the two cases analyzed using MLPA revealed a mutation in IDH1 (p.R132C). The seven remaining negative cases and additional six cases were investigated using smMIP/NGS, showing hot spot mutations in IDH1 (p.R132C) (eight cases) and IDH2 (three cases; twice p.R172S and once p.R172G, respectively). One case was negative. Due to insufficient DNA quality and insufficient coverage, two cases were excluded. In total, in 16 out of 17 cases successfully tested an IDH1/2 mutation was found. Given that IDH1/2 mutations were absent in 161 other vascular lesions tested by smMIP/NGS, the mutation can be considered as highly specific for SCH. This article is protected by copyright. All rights reserved.
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Robotic repair of symptomatic Spigelian hernias: a series of three cases and surgical technique review
Abstract
Spigelian hernias are a rare defect in the Spigelian aponeurosis, comprising of 0.1–2% of all hernias. These rare hernias can contain intra-abdominal tissue, and rarely bladder. Spigelian hernias pose a high risk for incarceration or strangulation of its herniated content if not repaired promptly. There are a number of routinely employed operative techniques to repair Spigelian hernias, including open or laparoscopic, suture or mesh repair, transabdominal pre-peritoneal approach or totally extraperitoneal approach. Robotic Spigelian repairs have been rarely reported in the literature. We report three cases of incarcerated Spigelian hernias that were successfully repaired robotically with mesh.
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A phase II study of modified docetaxel, cisplatin, and S-1 (mDCS) chemotherapy for unresectable advanced gastric cancer
Abstract
Purpose
Triplet therapy using docetaxel, cisplatin, and S-1 (DCS) against unresectable gastric cancer as previously reported by us showed high clinical efficacy, with a 87.1% total response rate; however, it also showed a high incidence of grade 3/4 toxicity. With the aim of reducing toxicities, we conducted a phase II study of modified DCS (mDCS), using a reduced dose of docetaxel, and evaluated the clinical efficacy and adverse events of this regimen.
Methods
Patients with unresectable gastric cancer received chemotherapy with S-1 (40 mg/m2 b.i.d) on days 1–14, and docetaxel (50 mg/m2) plus cisplatin (60 mg/m2) on day 8 every 3 weeks. The primary endpoint was the response rate (RR). Overall (OS) and progression-free survival (PFS), and toxicities were also evaluated.
Results
Forty-nine patients were enrolled from November 2011 to April 2014, and 43 were eligible. The overall RR was 79.1%, including two cases of a complete response (4.7%), and 32 cases of a partial response (74.4%). Nine cases had stable disease (20.9%) but none showed progressive disease. Of the 43 cases, 15 cases (34.9%) underwent curative conversion surgery. The median PFS was 350 days (95% CI 240–416 days) and median OS was 722 days (95% CI 411 days–not reached). Grade 3/4 neutropenia developed in 79.1%, and febrile neutropenia in 34.9%, of patients. Non-hematological grade 3/4 adverse events were anorexia (25.6%), nausea (4.7%), and diarrhea (9.3%).
Conclusion
Modified DCS therapy showed high clinical efficacy sufficient enough to attempt conversion therapy against unresectable gastric cancer. Modified DCS showed fewer toxicities, but careful management of these is still essential.
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Aktuelles aus der Ästhetischen Chirurgie und Ästhetischer Medizin
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The insufficient prognostic power of stenosis in patients with esophageal cancer
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Disparities in cancer incidence by area-level socioeconomic status in the French West Indies
Abstract
Purpose
Social inequalities in cancer incidence and mortality have been reported in France, but no data are available for the French overseas territories. Our objective was to explore the association between cancer incidence and the socioeconomic level of the residence area in the French West Indies.
Methods
Cancer incidence data were obtained from the cancer registries of Guadeloupe and Martinique (2009–2010). To assess socioeconomic status, we developed a specific index of social deprivation from census data at a small area level. We used Bayesian methods to evaluate the association between cancer incidence and the deprivation index, for all cancers combined and for the major cancer sites.
Results
There was no clear association between area-based deprivation and the incidence of all cancers combined. In men, higher area deprivation was associated with a higher incidence of prostate cancer (relative risk (RR) 1.25, 95% credible interval (CI) 1.04–1.49; RR 1.08, CI 0.91–1.29 in the categories of intermediate and high deprivation, respectively, compared to low deprivation), but was not associated with respiratory cancer. Women living in the most deprived areas had a higher incidence of stomach (RR 1.77, CI 1.12–2.89), breast (RR 1.15, CI 0.90–1.45), and cervical (RR 1.13, CI 0.63–2.01) cancers and a lower incidence of respiratory cancer (RR 0.65, CI 0.38–1.11).
Conclusion
These first results in the French West Indies suggest specific patterns for some cancer sites that need to be further investigated.
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Recombinant Enaction: Manipulatives Generate New Procedures in the Imagination, by Extending and Recombining Action Spaces
Abstract
Manipulation of physical models such as tangrams and tiles is a popular approach to teaching early mathematics concepts. This pedagogical approach is extended by new computational media, where mathematical entities such as equations and vectors can be virtually manipulated. The cognitive and neural mechanisms supporting such manipulation-based learning—particularly how actions generate new internal structures that support problem-solving—are not understood. We develop a model of the way manipulations generate internal traces embedding actions, and how these action-traces recombine during problem-solving. This model is based on a study of two groups of sixth-grade students solving area problems. Before problem-solving, one group manipulated a tangram, the other group answered a descriptive test. Eye-movement trajectories during problem-solving were different between the groups. A second study showed that this difference required the tangram's geometrical structure, just manipulation was not enough. We propose a theoretical model accounting for these results, and discuss its implications.
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Pubertal growth and adult height in relation to breast cancer risk in African American women
Abstract
Adult height has been positively associated with breast cancer risk. The timing of pubertal growth – as measured by age at menarche and age at attained height – may also influence risk. We evaluated associations of adult height, age at attained height, and age at menarche with incidence of invasive breast cancer in 55,687 African American women in the prospective Black Women's Health Study. Over 20 years, 1,826 invasive breast cancers [1,015 estrogen receptor (ER) positive; 542 ER negative] accrued. We used multivariable Cox proportional hazards regression to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) for associations with breast cancer overall and by ER status, mutually adjusted for the three factors of interest. Adult height was associated with increased risk of ER+ breast cancer (HR for ≥70 inches vs. ≤63 inches: 1.44; 95% CI: 1.09, 1.89) but not ER- (corresponding HR: 1.16; 95% CI: 0.78, 1.71) (P-heterogeneity=0.34). HRs for attained height before age 13 vs. age >17 were 1.30 (95% CI: 0.96, 1.76) for ER+ and 1.25 (95% CI: 0.80, 1.96) for ER- breast cancer. Results for age at menarche (≤11 years vs. ≥14 years) were similar for ER+ and ER- breast cancer (HR for breast cancer overall: 1.30; 95%CI: 1.12, 1.50). We confirmed height as a strong risk factor for ER+ breast cancer in African American women and identified early age at attained height as a risk factor for both ER+ and ER- breast cancer, albeit without statistical significance of the latter associations. While adult height and timing of pubertal growth are inter-related, our findings suggest that they may be independent risk factors for breast cancer. This article is protected by copyright. All rights reserved.
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Toxic Assessment of Cadmium Based on Online Swimming Behavior and the Continuous AChE Activity in the Gill of Zebrafish ( Danio rerio )
Abstract
The cadmium (Cd) contamination in the aquatic environment has attracted more and more attention due to its toxicity characteristics, e.g., accumulation in the environment, non-degradability, and the potential threat to the ecosystem. In this research, in order to illustrate the potential threat of heavy metal Cd to aquatic organisms, the online swimming behavior and the continuous acetylcholinesterase (AChE) activity in the gill of Zebrafish (Danio rerio) in 48 h exposure of cadmium chloride (CdCl2) (4.26 mg/L (0.1 TU, toxic unit), 42.6 mg/L (1.0 TU), and 85.2 mg/L (2.0 TU)) are investigated. The behavior responses of D. rerio based on behavior strength (BS) have obvious dose-effect relationship, and lower BS values could be observed in the dark period at 13–21 h and 37–45 h in all treatments. The circadian rhythm could be observed even in all treatments (0.1, 1.0, and 2.0 TU), and the rhythm was disrupted with 1.0 TU at the end of the experiment whereas the lower (0.1 TU) and higher (2.0 TU) levels showed clear rhythms. These results suggested that the online BS values could illustrate the toxicity of CdCl2 directly. The AChE activity in the gill is strongly inhibited by CdCl2 based on the continuous sample results during 48 h exposure. The cross-correlation results using DCCA show a high correlation (r > 0.5) with extreme significance (p < 0.01), which suggest that the exposure in CdCl2 can affect the AChE activity of D. rerio, and then damage the transduction signal due to neurotoxicity, which may induce decrease of swimming behavior, loss of coordination, and other kinds of behavior changes.
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Κυριακή 27 Αυγούστου 2017
Long-term outcomes of narrow diameter implants in posterior jaws: A retrospective study with at least 8-year follow-up
Abstract
Objective
The aim of this study was to evaluate the long-term survival, complications, peri-implant conditions, marginal bone loss, and patient satisfaction of fixed dental prostheses supported by narrow diameter implants (NDIs) in the posterior jaws.
Materials and methods
This study was designed as a retrospective cohort study with a mean follow-up time of 10.1 years (SD: 2.5 years). Patients receiving NDIs in posterior jaw were reviewed. Implant survival, hardware complication, modified plaque index (mPI), peri-implant probing depth (PPD), percentage of bleeding on probing (BOP%), marginal bone loss (MBL), and patient satisfaction were evaluated. Log-rank test and t test were used to detect the influence of implant location and restoration type.
Results
Sixty-seven patients with 98 NDIs (Premolar site: 81, Molar site: 17, Single crowns: 33, Splinted restorations: 65) were included. The overall implant survival rates were 96.9% at implant level and 97.0% at patient level. Veneer chipping was the most common hardware complication. The veneer chipping rates were 19.4% at patient level and 18.4% at implant level. All patients showed acceptable oral hygiene. Thus, the average MBL was 1.19 mm at implant level and 1.15 mm at patient level. Eight implants (8.5%) and six patients (9.2%) were diagnosed with peri-implantitis. Fifty-eight patients (89.2%) were satisfied with the esthetics of the restorations, while 55 patients (84.6%) were satisfied with the function of the restorations.
Conclusion
Narrow diameter implants could be a predictable treatment option in the long term. High survival rates, high patient satisfaction, acceptable complication rates and marginal bone loss could be achieved. Further long-term studies are needed to evaluate the predictability of NDIs in molar sites.
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Adipochemokines induced by ultraviolet irradiation contribute to impaired fat metabolism in subcutaneous fat cells
Abstract
Background
Adipose tissue is now appreciated as the pivotal regulator of metabolic and endocrine functions. Subcutaneous (SC) fat, in contrast to visceral fat, may protect against metabolic syndrome and systemic inflammation. We demonstrated that chronic as well as acute UV exposure to the skin induces loss of underlying SC fat. UV-irradiated SC fat may produce chemokines or cytokines which modulate lipid homeostasis and secretion of adipokines.
Objectives
We aim to elucidate UV-induced specific adipochemokines implicated in UV-induced modulation of SC fat.
Methods
Primary cultured adipocytes were treated with conditioned media from UV- or sham-irradiated skin cells. Young and old healthy subjects provided SC fat from sun-exposed and sun-protected skin. Another sun-protected skin was irradiated with UV. Differentially expressed adipochemokines were screened by cytokine array, and confirmed in vitro and in vivo. The functions of select adipochemokines involved in lipid metabolism were examined via siRNA-mediated knockdown of cognate receptors.
Results
Specific adipochemokines, including C-X-C chemokines such as ENA-78/CXCL5, and C-C chemokines such as MIP-3α/CCL20 and RANTES/CCL5, were greatly induced in SC fat by UV exposure. They could impair triglyceride synthesis via down-regulation of lipogenic enzymes and sterol regulatory element-binding protein-1 (SREBP-1) through their respective cognate receptors, CXC-chemokine receptor (CXCR)2, CC-chemokine receptor (CCR)6, and CCR5. In addition, UV irradiation induced infiltration of adipose tissue macrophages responsible for the secretion of several chemokines into SC fat.
Conclusions
These UV-induced adipochemokines may be implicated in the reduction of lipogenesis in SC fat, leading to impairment of fat homeostasis and associated comorbidities such as obesity.
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