Inferring the effects of saliva on liquid bolus flow using computer simulation.

Inferring the effects of saliva on liquid bolus flow using computer simulation.

Comput Biol Med. 2017 Jul 29;89:304-313

Authors: Ho A, Affoo R, Rogus-Pulia N, Nicosia M, Inamoto Y, Saitoh E, Green S, Fels S

Abstract
Computer simulation of liquid bolus flow is used to test the assumption that a slip boundary condition approximates a healthy swallow due to the presence of saliva lubricating the bolus. Six dynamic, 320-row area detector CT (ADCT) sequences of normal subjects swallowing thin, nectar, and honey-thick liquids are used in this work. The aerodigestive tract is segmented from the images in order to create a dynamic 3D geometry, which is subsequently used to drive a Smoothed Particle Hydrodynamics (SPH) fluid simulation of the bolus. The results show that the no-slip simulation, approximating no-lubrication, provides a closer match to the ADCT bolus images than the slip simulation, particularly in the oral phase. This finding suggests that the role of saliva in swallowing liquid boluses is not to lubricate the aerodigestive tract, and that there is another reason for its importance in normal swallowing of liquids.

PMID: 28858646 [PubMed - as supplied by publisher]

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The Criteria of Thickened Liquid for Dysphagia Management in Japan.

The Criteria of Thickened Liquid for Dysphagia Management in Japan.

Dysphagia. 2017 Aug 30;:

Authors: Watanabe E, Yamagata Y, Fujitani J, Fujishima I, Takahashi K, Uyama R, Ogoshi H, Kojo A, Maeda H, Ueda K, Kayashita J

Abstract
In Japan, the viscosity of thickened liquids is different among hospitals and nursing homes. In order to standardize viscosity of thickened liquids, the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation developed the Japanese Dysphagia Diet 2013 (JDD2013). To decide on a definition of thickened liquids, the committee reviewed categories from other countries. Especially, the criteria of the USA and Australia were used as references. The definition had three levels: mildly thick, moderately thick, and extremely thick. Then a sensory evaluation by health care workers was carried out to decide the viscosity range of each level, and a draft document was made. After collecting public comments, follow-up experiments using thickened water with thickeners using xanthan gum were performed, and the JDD2013 (Thickened Liquid) was determined. The JDD2013 (Thickened Liquid) evaluated the drinking properties, visual properties, and viscosity values of each level. The shear rate of 50 s(-1) was adopted to measure the viscosity with a cone and plate type viscometer to duplicate the measurement criteria used by the USA. We also set the values of the JDD2013 with the Line Spread Test to promote the use of guidelines in clinical practice. We believe the JDD2013 standards help hospitals and other settings that care for people with dysphagia to use the same thickness level and the same labels. In the future, the JDD2013 levels will be compared with new international guidelines to help with international understanding of the JDD2013 levels.

PMID: 28856459 [PubMed - as supplied by publisher]

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The effect of expiratory muscle strength training on the oral and respiratory functions of community-dwelling older people: An analysis using the swallowing, oral, phonatory, and respiratory muscle function indices.

The effect of expiratory muscle strength training on the oral and respiratory functions of community-dwelling older people: An analysis using the swallowing, oral, phonatory, and respiratory muscle function indices.

Nihon Ronen Igakkai Zasshi. 2017;54(3):364-374

Authors: Ito N, Watanabe S

Abstract
PURPOSE: This study was performed to determine the effects of expiratory muscle strength training (EMST) on the oral and respiratory functions of community-dwelling older people.
METHODS: Older people using a visiting-rehabilitation center were divided into an intervention group of 31 subjects and a control group of 15 subjects. Those in the intervention group were assigned home training for 8 weeks, which included 5 sets of 5 breaths per day with a 75% load of the maximum expiratory pressure using an EMST device. The outcome indices included (1) oral functions, evaluated by the cumulative time spent swallowing three times and the maximum phonation time (MPT) and (2) respiratory functions, evaluated by the maximum expiratory pressure and maximum inspiratory pressure (MEP/MIP). An independent t-test and paired t-test were used to analyze the data.
RESULTS: The cumulative time spent swallowing three times was lower in the intervention group than in the control group. This difference remained significant even after adjusting for sex, age, and baseline values. The MPT was 2.1 seconds higher than baseline in the intervention group but 0.4 seconds lower than baseline in the control group. An average increase of 5.7 cmH2O in the PEmax was observed in the intervention group compared with an average decrease of 4.6 cmH2O in the control group, indicating a significant difference.
CONCLUSION: These results suggest that EMST improves the oral and respiratory functions of community elderly subjects. This may be explained by the fact that the pathway for swallowing is partially shared with that for phonation, which contributes to a shortened swallowing time by repeated suprahyoid muscle contractions.

PMID: 28855461 [PubMed - in process]

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Ability of High-Resolution Manometry to Determine Feeding Method and to Predict Aspiration Pneumonia in Patients With Dysphagia.

Related Articles

Ability of High-Resolution Manometry to Determine Feeding Method and to Predict Aspiration Pneumonia in Patients With Dysphagia.

Am J Gastroenterol. 2017 Jul;112(7):1074-1083

Authors: Park CH, Lee YT, Yi Y, Lee JS, Park JH, Yoon KJ

Abstract
OBJECTIVES: The introduction of high-resolution manometry (HRM) offered an improved method to objectively analyze the status of pharynx and esophagus. At present, HRM for patients with oropharyngeal dysphagia has been poorly studied. We aimed to determine feeding method and predict the development of aspiration pneumonia in patients with oropharyngeal dysphagia using HRM.
METHODS: We recruited 120 patients with dysphagia who underwent both HRM and videofluoroscopic swallow study. HRM was used to estimate pressure events from velopharynx (VP) to upper esophageal sphincter (UES). Feeding methods were determined to non-oral or oral feeding according to dysphagia severity. We prospectively followed patients to assess the development of aspiration pneumonia.
RESULTS: VP maximal pressure and UES relaxation duration were independently associated with non-oral feeding. Non-oral feeding was determined based on optimal cutoff value of 105.0 mm Hg for VP maximal pressure (95.0% sensitivity and 70.0% specificity) and 0.45 s for UES relaxation duration (76.3% sensitivity and 57.5% specificity), respectively. During a mean follow-up of 18.8 months, 15.8% of patients developed aspiration pneumonia. On multivariate Cox regression analysis, VP maximal pressure (P<0.01) and UES relaxation duration (P<0.05) independently predicted the development of aspiration pneumonia. Cumulative incidence of aspiration pneumonia was significantly increased in patients with readings below optimal cutoff values for VP maximal pressure (P<0.01) and UES relaxation duration (P<0.01), individually.
CONCLUSIONS: We first established the optimal thresholds for HRM parameters to determine feeding method and predict the development of aspiration pneumonia in patients with oropharyngeal dysphagia.

PMID: 28374817 [PubMed - indexed for MEDLINE]

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Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist—head and neck surgeons: safe and efficacious

Abstract

Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist—head and neck (ORL-HN) surgeons—have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology—head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P < 0.005). The proportion of early PEG placements within 0–3 days increased from 3.6 to 14.6% (P < 0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.

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Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma.

Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma.

Int Forum Allergy Rhinol. 2017 Aug 31;:

Authors: Kılıç S, Kılıç SS, Kim ES, Baredes S, Mahmoud O, Gray ST, Eloy JA

Abstract
BACKGROUND: The role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) is not well understood.
METHODS: The National Cancer Database was queried for cases of SNSCC with known HPV status. Demographics, socioeconomic variables, TNM stage, histology, grade, treatment modalities, and overall survival (OS) through 5 years were compared between HPV-positive and HPV-negative tumors. Cox proportional hazard regression analyses were performed.
RESULTS: Seven hundred seventy (770) cases were identified; 526 were HPV-negative (68.3%) and 244 (31.7%) were HPV-positive. Patients with HPV-positive tumors were younger (58.0 vs 63.7 years, p < 0.0001). Nasal cavity (49.4%) tumors were more likely to be HPV-positive (p < 0.05) than maxillary (18.8%), ethmoid (18.8%), and frontal (18.2%) sinus tumors. Large cell nonkeratinizing (42.4%), papillary (42.1%), and basaloid (56.5%) tumors were more likely than keratinizing (25.2%) tumors to be HPV-positive (p < 0.05). Well-differentiated (grade I) tumors (9.0%) were less likely than higher grade tumors to be HPV-positive (p < 0.05). Gender, race, facility type, insurance type, median income, education level, Charlson-Deyo comorbidity score, overall stage, T stage, N stage, M stage, tumor size, treatment modality, surgical approach, and surgical margins did not vary by HPV status (p ≥ 0.05). HPV-positive tumors had higher OS than HPV-negative tumors (p < 0.0001). At 5 years, OS was 68.1% and 51.5% for HPV-positive and HPV-negative tumors, respectively. On multivariate analyses, HPV positivity remained a favorable prognostic factor (hazard ratio, 0.49; 95% confidence interval, 0.34-0.70).
CONCLUSION: HPV positivity is more common in nasal cavity SCC and nonkeratinizing SNSCC. It is also a favorable prognostic factor in SNSCC. Future studies on SNSCC should take HPV positivity into consideration.

PMID: 28859244 [PubMed - as supplied by publisher]

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[A Case of Foramen Magnum Meningioma Manifesting as Hypoglossal Nerve Palsy].

Related Articles

[A Case of Foramen Magnum Meningioma Manifesting as Hypoglossal Nerve Palsy].

No Shinkei Geka. 2017 Apr;45(4):345-350

Authors: Inaka Y, Otani N, Nishida S, Ueno H, Tomiyama A, Tomura S, Toyooka T, Wada K, Mori K

Abstract
We report a case of foramen magnum meningioma manifesting as hypoglossal nerve palsy. A 72-year-old woman presented with progressive hypoglossal nerve palsy and lingual atrophy on the left side. Gadolinium-enhanced T1-weighted magnetic resonance imaging revealed a heterogeneously enhanced mass lesion with dural tail sign partially extending into the hypoglossal canal. The transcondylar approach was performed to expose the hypoglossal canal and resect the tumor completely. Histological examination revealed a transitional meningioma. The postoperative course was uneventful. Hypoglossal nerve palsy improved gradually after the operation.

PMID: 28415060 [PubMed - indexed for MEDLINE]

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Assessment of sex in a modern Turkish population using cranial anthropometric parameters.

Related Articles

Assessment of sex in a modern Turkish population using cranial anthropometric parameters.

Leg Med (Tokyo). 2016 Jul;21:45-52

Authors: Ekizoglu O, Hocaoglu E, Inci E, Can IO, Solmaz D, Aksoy S, Buran CF, Sayin I

Abstract
The utilization of radiological imaging methods in anthropometric studies is being expanded by the application of modern imaging methods, leading to a decrease in costs, a decrease in the time required for analysis and the ability to create three-dimensional images. This retrospective study investigated 400 patients within the 18-45-years age group (mean age: 30.7±11.2years) using cranial computed tomography images. We measured 14 anthropometric parameters (basion-bregma height, basion-prosthion length, maximum cranial length and cranial base lengths, maximum cranial breadth, bizygomatic diameter, upper facial breadth, bimastoid diameter, orbital breadth, orbital length, biorbital breadth, interorbital breadth, foramen magnum breadth and foramen magnum length) of cranial measurements. The intra- and inter-observer repeatability and consistency were good. From the results of logistic regression analysis using morphometric measurements, the most conspicuous measurements in terms of dimorphism were maximum cranial length, bizygomatic diameter, basion-bregma height, and cranial base length. The most dimorphic structure was the bizygomatic diameter with an accuracy rate of 83% in females and 77% in males. In this study, 87.5% of females and 87.0% of males were classified accurately by this model including four parameters with a sensitivity of 91.5% and specificity of 85.0%. In conclusion, CT cranial morphometric analysis may be reliable for the assessment of sex in the Turkish population and is recommended for comparison of data of modern populations with those of former populations. Additionally, cranial morphometric data that we obtained from modern Turkish population may reveal population specific data, which may help current criminal investigations and identification of disaster victims.

PMID: 27497333 [PubMed - indexed for MEDLINE]

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Tinnitus: Still "A Ghost in the Machine" or A Darwinian Survival Phenomenon?

Tinnitus: Still "A Ghost in the Machine" or A Darwinian Survival Phenomenon?

Int J Neurosci. 2017 Aug 31;:1-21

Authors: Fernandes S

Abstract
INTRODUCTION: The causation of tinnitus continues to intrigue. Despite the plethora of publications there is no definitive path available to concentrate our efforts, in alleviating the symptom. Several mechanical theories are available in standard tinnitus literature with varying empiricism.
OBJECTIVES: To investigate a possible way forward.
MATERIALS AND METHODS: Employing a forensic methodology ("crime scene analysis" technique) and utilising available evidence from the related sciences, inductive and abstract reasoning, a pragmatic model incorporating the known features of tinnitus is available.
RESULTS: A plausible evolutionary explanation of the origins and functions for the causation of tinnitus is offered with a possible link to its evasive nature, in our search for a cause.
CONCLUSION: The functional value of tinnitus may be provided by our evolutionary history. It is possible that tinnitus was a protective adaptive phenomenon in earlier forms but in our current environment merely contributes to nuisance value.

PMID: 28858532 [PubMed - as supplied by publisher]

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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Int J Audiol. 2017 Aug 31;:1-8

Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E

Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

PMID: 28857620 [PubMed - as supplied by publisher]

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Translation and validation of the dizziness handicap inventory in Greek language.

Translation and validation of the dizziness handicap inventory in Greek language.

Int J Audiol. 2017 Aug 30;:1-6

Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A

Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.

PMID: 28854827 [PubMed - as supplied by publisher]

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Dexamethasone for chronic subdural haematoma: a systematic review and meta-analysis

Abstract

Background

Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue.

Methods

With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect.

Results

Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06).

Conclusions

We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.

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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Int J Audiol. 2017 Aug 31;:1-8

Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E

Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

PMID: 28857620 [PubMed - as supplied by publisher]

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Translation and validation of the dizziness handicap inventory in Greek language.

Translation and validation of the dizziness handicap inventory in Greek language.

Int J Audiol. 2017 Aug 30;:1-6

Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A

Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.

PMID: 28854827 [PubMed - as supplied by publisher]

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A new semi-implantable middle ear implant for sensorineural hearing loss: three-years follow-up in a pilot patient's group.

A new semi-implantable middle ear implant for sensorineural hearing loss: three-years follow-up in a pilot patient's group.

Acta Otolaryngol. 2017 Aug 30;:1-5

Authors: Barbara M, Volpini L, Filippi C, Atturo F, Monini S

Abstract
OBJECTIVE: The aim of this article is to report on the long-term follow-up of a new semi-implantable middle ear device utilized for restoration of moderate-to-severe sensorineural hearing loss in a first series of subjects.
METHODS: Three subjects, affected by sensorineural hearing loss, have undergone implantation of Maxum(®) middle ear implant, via a transcanal approach. They all underwent an auditory assessment, paying particular attention on the pre- versus post-operative hearing levels under the unaided, best-fitted hearing aided and implant-aided conditions. The audiometric evaluation has been repeated 3 years after implantation and implemented by questionnaires aiming at the evaluation of the quality of life.
RESULTS: The post-operative hearing threshold and discrimination in quiet appear to be similar or better than those provided by conventional hearing aids, with a concomitant improvement of the subjects' quality of life. The application of the present device showed to be easy and reproducible, with no severe adverse effects recorded at the 3-years follow-up. Mild issues due to the external component were also observed, such as difficulty of keeping it continuously in place due to excess canal sweating in one subject, and a temporary loss of stability due to occurring irregularities of the external coating in another subject.
CONCLUSIONS: Long-term, preliminary data reveal that the Maxum(®) device may provide equal or better functional gain and word recognition scores in quiet in patients with moderate-to-severe sensorineural hearing loss, in comparison to optimally fitted hearing aids, with a satisfactory improvement of their quality of life.

PMID: 28854835 [PubMed - as supplied by publisher]

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Bionic balance organs: progress in the development of vestibular prostheses.

Bionic balance organs: progress in the development of vestibular prostheses.

N Z Med J. 2017 Sep 01;130(1461):56-65

Authors: Smith PF

Abstract
The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.

PMID: 28859067 [PubMed - in process]

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Novel therapeutics in supportive cancer treatment

Summary

With constantly improving cancer therapies, patient's quality of life, the management of potential side effects and treatment-related symptoms have also made considerable progress. Chemotherapy-induced nausea and vomiting (CINV) still constitutes a major problem for many patients. New developments in the field allow a more comfortable administration of guideline-based antiemetic therapy and may further improve the control of nausea. Therapeutic options for the cancer anorexia–cachexia syndrome (CACS), common in advanced cancers, are still limited and hampered by numerous side effects. Among these, targeting the ghrelin-receptor pathway could be a novel approach; however, data are still immature.

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Chemotherapies and future directions in metastatic colorectal cancer

Summary

Substantial progress has been achieved in the management of metastatic colorectal cancer (mCRC) over the last two decades. The overall survival has increased from 10 months to more than 30 months. These improvements are due to the integration of multiple cytotoxic agents and targeted therapies, as well as individualized treatment strategies using molecular and clinical factors. More specific, molecular characteristics such as RAS mutation status and clinical factors such as performance status, tumor burden, tumor-related symptoms and comorbidities are crucial in selecting treatment strategies. Here I review the landscape of cytotoxic chemotherapy for mCRC, regional chemotherapy strategies to accumulate cytotoxics within the tumor and reflect on future directions for treatment of mCRC.

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Evaluation and management of cytomegalovirus-associated congenital hearing loss.

Purpose of review: The current article reviews the current literature related to congenital cytomegalovirus (CMV)-related hearing loss. The discussion will focus on the epidemiology, pathogenesis, and clinical presentation of human CMV infection as it pertains to hearing loss. Current methods of CMV diagnosis with a focus on the evolving trend toward broader neonatal screening protocols will also be explored. Discussion of medical, surgical, and audiologic management of the condition will also be addressed. Recent findings: Much of the current research on this topic is focused on improving detection of CMV through screening programs. Some advances in understanding cochlear pathogenesis have also been made. Summary: Congenital CMV infection remains an important cause of hearing loss in infants and children. Early detection of CMV infection can broaden treatment options and allow for improved hearing and language outcome for patients with CMV-associated sensorineural hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Button battery ingestion in children.

Purpose of review: As the demand for small electronics continues to grow so does the risk of oesophageal ingestion of button batteries. These small but powerful sources of energy are ubiquitous in every household and when swallowed, especially in small children, have been shown to create significant injury in a short amount of time leading to long-term morbidity and possible death. This review highlights the latest findings regarding epidemiology, pathophysiology, diagnosis and management of ingested button batteries. Recent findings: Updated epidemiology from the National Capital Poison Center, new bench research looking at injury patterns and possible mitigation strategies, updated ideas on management algorithms including the use of a trauma protocol, close-look second endoscopy and management of button batteries in the lower gastrointestinal tract are reviewed in this paper. Summary: Despite advances in the understanding of injury mechanics and innovations leading to early diagnosis and improved management of button battery ingestion, parental and provider education remain the most important tools to keep children well tolerated from the sequelae of these potentially fatal events. Collaboration between healthcare experts, public health and industry is essential to find a safe answer to this ongoing threat. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Bionic balance organs: progress in the development of vestibular prostheses.

Bionic balance organs: progress in the development of vestibular prostheses.

N Z Med J. 2017 Sep 01;130(1461):56-65

Authors: Smith PF

Abstract
The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.

PMID: 28859067 [PubMed - in process]

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Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.

Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.

Auris Nasus Larynx. 2017 Aug 27;:

Authors: Nemade SV, Shinde KJ, Sampate PB

Abstract
INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.
OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.
METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results.
RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.
CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

PMID: 28855058 [PubMed - as supplied by publisher]

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A four-domain approach of frailty explored in the Doetinchem Cohort Study.

A four-domain approach of frailty explored in the Doetinchem Cohort Study.

BMC Geriatr. 2017 Aug 30;17(1):196

Authors: van Oostrom SH, van der A DL, Rietman ML, Picavet HSJ, Lette M, Verschuren WMM, de Bruin SR, Spijkerman AMW

Abstract
BACKGROUND: Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty.
METHODS: The study sample included 4019 men and women (aged 40-81 years) examined during the fifth round (2008-2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains.
RESULTS: About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail.
CONCLUSIONS: Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty.

PMID: 28854882 [PubMed - in process]

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Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

Epilepsia. 2017 Aug 31;:

Authors: Androsova G, Krause R, Borghei M, Wassenaar M, Auce P, Avbersek A, Becker F, Berghuis B, Campbell E, Coppola A, Francis B, Wolking S, Cavalleri GL, Craig J, Delanty N, Koeleman BPC, Kunz WS, Lerche H, Marson AG, Sander JW, Sills GJ, Striano P, Zara F, Sisodiya SM, Depondt C, EpiPGX Consortium

Abstract
OBJECTIVE: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE-HS.
METHODS: Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12-month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE-HS.
RESULTS: Seven hundred sixty-seven patients with a total of 3,249 AED trials were included. The highest 12-month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve-month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia.
SIGNIFICANCE: Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE-HS.

PMID: 28857179 [PubMed - as supplied by publisher]

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Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist—head and neck surgeons: safe and efficacious

Abstract

Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist—head and neck (ORL-HN) surgeons—have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology—head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P < 0.005). The proportion of early PEG placements within 0–3 days increased from 3.6 to 14.6% (P < 0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.

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Transnasal Endoscopic Resection of a Pleomorphic Adenoma Originate From Nasal Floor.

Transnasal Endoscopic Resection of a Pleomorphic Adenoma Originate From Nasal Floor.

J Craniofac Surg. 2017 Aug 28;:

Authors: Cho Y, Kim YG, Shin E, Kim BY

Abstract
A 81-year-old female presented to our hospital frequent epistaxis. Nasal endoscopy showed a mass obstructing nasal cavity completely and occupying middle meatus. Magnetic resonance imaging was performed, an about 4.8 × 4 × 4.2 cm sized heterogeneous T2 high signal intensity and T1 enhancing mass mainly involving right nasal cavity with invasion of right hard palate with bony destruction. Therefore, the authors planned to do endoscopic mass excision, under general anesthesia for diagnosis and treatment. The authors removed the mass from lateral nasal wall, nasal roof, nasal septum, medial maxillary wall by piece-meal. Margins of mass were clear except the nasal floor. So, the authors did frozen biopsy to confirm the clear margin in nasal floor. Endoscopy enables better visualization of tumor margins, facilitating complete removal and avoiding excessive resection and following up using good visualization.

PMID: 28857999 [PubMed - as supplied by publisher]

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Unstable thyroid function in older adults is caused by alterations in both thyroid and pituitary physiology and associated with increased mortality.

Unstable thyroid function in older adults is caused by alterations in both thyroid and pituitary physiology and associated with increased mortality.

Thyroid. 2017 Aug 30;:

Authors: Mammen JS, McGready J, Ladenson PW, Simonsick EM

Abstract
BACKGROUND: Average thyrotropin (TSH) levels are known to be higher in older adults when measured in cross-sectional populations. Possible etiologies include differential survival, neutral aging changes, or increased disease prevalence at older ages. This study aimed to elucidate the mechanisms underlying changing thyroid function during aging, and to determine the association of changes with survival, by analyzing the individual thyroid axis over time.
METHODS: Individual patterns of changing TSH and free thyroxine (FT4) were determined in 640 participants in the Baltimore Longitudinal Study of Aging who had at least three measures of serum TSH and FT4, not on medications, over an average of 7 years follow up. We identified participants with changing phenotypes based on quintiles for both slopes. Those with alterations in primary thyroid gland function demonstrated intact negative feedback (rising TSH with declining FT4 or declining TSH with rising FT4). Other participants had a parallel rise or fall of TSH and FT4 levels, consistent with pituitary dysfunction. Predictors of phenotype were analyzed by logistic regression. Differential survival between thyroid aging phenotypes was analyzed using multivariate Cox regression.
RESULTS: While the majority of participants at all ages had stable thyroid function, changes were more common among older adults, with 32.3% of those over 80 but only 9.5% of those younger than 60 demonstrating thyroid function changes in the highest and lowest quintiles. Regression to the mean accounts for some of the changes, for example increased baseline TSH was associated with a falling TSH pattern OR=1.4 (95% CI 1.1-1.7) per 1 mIU/L. Importantly, changing thyroid function in either the upper or lower quintiles of slope for TSH and FT4 was associated with increased risk of death compared to stable thyroid status with HR=5.4 (95% CI: 3.1-9.5).
CONCLUSIONS: Changing thyroid hormone function is increasingly common at older ages and associated with decreased survival. Nonetheless, the tendency for abnormal thyroid function tests to resolve, along with altered pituitary responsiveness underlying some TSH elevations, suggests that an elevated TSH level should be not assumed to represent subclinical hypothyroidism in older adults. Thus, caution is appropriate when determining the need for thyroid hormone supplements in older adults.

PMID: 28854871 [PubMed - as supplied by publisher]

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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Int J Audiol. 2017 Aug 31;:1-8

Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E

Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

PMID: 28857620 [PubMed - as supplied by publisher]

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Translation and validation of the dizziness handicap inventory in Greek language.

Translation and validation of the dizziness handicap inventory in Greek language.

Int J Audiol. 2017 Aug 30;:1-6

Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A

Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.

PMID: 28854827 [PubMed - as supplied by publisher]

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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

Int J Audiol. 2017 Aug 31;:1-8

Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E

Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

PMID: 28857620 [PubMed - as supplied by publisher]

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Translation and validation of the dizziness handicap inventory in Greek language.

Translation and validation of the dizziness handicap inventory in Greek language.

Int J Audiol. 2017 Aug 30;:1-6

Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A

Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.

PMID: 28854827 [PubMed - as supplied by publisher]

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The interpretation of static positional nystagmus in a balance clinic

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Book Review

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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia

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Are the Epworth Sleepiness Scale and Stop-Bang model effective at predicting the severity of obstructive sleep apnoea (OSA); in particular OSA requiring treatment?

Are the Epworth Sleepiness Scale and Stop-Bang model effective at predicting the severity of obstructive sleep apnoea (OSA); in particular OSA requiring treatment?

Eur Arch Otorhinolaryngol. 2017 Aug 30;:

Authors: Panchasara B, Poots AJ, Davies G

Abstract
Obstructive sleep apnoea (OSA) is a condition characterised by repetitive upper airway collapse during sleep. The condition carries a range of health sequelae that can prove fatal in cases with co-existing risk factors for the condition, such as obesity and hypertension. Utilisation of a high-performance screening tool for OSA is thus important. A retrospective audit using the ESS and Stop-Bang scores, alongside Apnoea-Hypopnea Index values, for patients who underwent polysomnography over 1 year. Multinomial logistic regression was used to compare the predictive abilities of ESS, SBM, and body mass index (BMI) for the patient outcome groups, "None" (No OSA), "Notreat" (OSA not requiring treatment) and "treat" (OSA requiring treatment). The influences of age, gender and BMI on outcome group were also assessed. 126 bariatric and 66 non-bariatric patients were included. Multinomial logistic regression failed to demonstrate predictive ability of ESS. A higher Stop-Bang score significantly increases the risk being in the "treat" group. In addition, male gender, greater age and a higher BMI each individually increase the risk of OSA requiring treatment. Stop-Bang failed to demonstrate predictive significance when age and gender were controlled for. ESS is not an appropriate screening tool for OSA. Stop-Bang, however, remains a useful screening tool, with the ability to detect patient with OSA in need of treatment. Further study may benefit the development and implementation of a concise and more specific screening tool that considers high evidence-based risk factors for OSA, including male gender, greater age and raised BMI.

PMID: 28856422 [PubMed - as supplied by publisher]

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Clarification of a suspicious thyroid nodule by use of camSPECT/US fusion imaging

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Application of esophageal irradiation stents coated with 125I particles in advanced esophageal cancer.

Related Articles

Application of esophageal irradiation stents coated with 125I particles in advanced esophageal cancer.

J BUON. 2017 Jan-Feb;22(1):265-269

Authors: Zhao P, Zhang MQ, Zhang YL, Guo YC, Zhao YL, Wu QW, Zhao YA, Zhang XZ

Abstract
PURPOSE: The current study was designed to investigate the primary efficacy of esophageal irradiation stents coated with 125I particles in the treatment of elderly patients with advanced esophageal cancer.
METHODS: Forty-three elderly patients with advanced esophageal cancer were treated with esophageal stents in the First Affiliated Hospital of Xinxiang Medical University between September 2009 and December 2010. Patients were randomly divided into group A (N=18), treated with irradiation stents, and group B (N=25), treated with ordinary stents. There were no significant intergroup differences in age, lesion length, degree of stenosis, or cancer stage. The stent implantation success rate, relief of dysphagia and complication rate, and survival were assessed.
RESULTS: The stent implantation success and short-term dysphagia relief rates were 100.0% in both groups. The mean survival time was 9.8 months and 4.8 months in groups A and B, respectively (p<0.01). However, no significant difference in pain (5/18) or esophageal restenosis (7/25) was found (both p>0.05).
CONCLUSION: Dysphagia was relieved and survival was prolonged in advanced esophageal cancer cases treated with 125I particle-coated esophageal stents. This method may be superior to the traditional stents method.

PMID: 28365964 [PubMed - indexed for MEDLINE]

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Inhibited Metamorphosis and Disruption of Antioxidant Defenses and Thyroid Hormone Systems in Bufo gargarizans Tadpoles Exposed to Copper

Abstract

Copper is a common aqueous pollutant that is known to cause oxidative stress and disrupt the thyroid axis in amphibians. In the present study, tadpoles of the Chinese toad (Bufo gargarizans) were exposed to 1, 6.4, 32, and 64 μg L⁻¹ of copper from Gosner stages 26 to 42. We aimed to examine the influence of copper on thyroid hormone-responsive and stress-associated gene expression in the hind-limb, tail, and liver of B. gargarizans tadpoles. Exposure to 64 μg L⁻¹ copper decreased percent metamorphosis and increased length of both hind-limb and tail of B. gargarizans tadpoles at Gs 42. In addition, according to real-time PCR results, exposure to 64 μg L⁻¹ copper induced downregulation of Dio2, Dio3, TRα, and TRβ mRNA levels in all tissues examined. We inferred that copper might induce a considerable reduction of TH levels through downregulation of Dio2 and Dio3 mRNA levels in peripheral tissues. Decreased TH levels may then decrease the expressions of TRα and TRβ. Also, HSP, SOD, and PHGPx transcript levels were measured to assess cellular stress which might affect TH signaling and metamorphosis. We found that copper significantly downregulated the level of HSP, SOD, and PHGPx transcripts in the hind-limb and tail. This demonstrates that high concentrations of copper could disrupt the antioxidant system of B. gargarizans tadpoles and increase oxidative damage. Therefore, we conclude that copper could disrupt the antioxidant system and cause thyroid hormone disruption in B. gargarizans tadpoles.

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Simple Tips for Ear Lobule Reconstruction-“Lobuloplasty Revisited”

Abstract

Lobuloplasty is one of the most common procedures done in outpatient basis. It is performed by a wide spectrum of surgeons ranging from general surgeon to plastic surgeon. Inspite of the innumerous techniques used, the ultimate aim of the surgery is to obtain a soft supple lobule with a well-hidden cosmetic scar without the complication of recurrence. Single site local anaesthesia, scoring and undermining of the lobule flaps and the introduction of a small cartilage piece in recurrent cases can change the outcome of the patients result. This article explains how subtle changes are still possible in common procedures like lobuloplasty to change the outcome of the results.

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Dietary sugar/starches intake and Barrett’s esophagus: a pooled analysis

Abstract

Barrett's esophagus (BE) is the key precursor lesion of esophageal adenocarcinoma, a lethal cancer that has increased rapidly in westernized countries over the past four decades. Dietary sugar intake has also been increasing over time, and may be associated with these tumors by promoting hyperinsulinemia. The study goal was to examine multiple measures of sugar/starches intake in association with BE. This pooled analysis included 472 BE cases and 492 controls from two similarly conducted case–control studies in the United States. Dietary intake data, collected by study-specific food frequency questionnaires, were harmonized across studies by linking with the University of Minnesota Nutrient Database, and pooled based on study-specific quartiles. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race, total energy intake, study indicator, body mass index, frequency of gastro-esophageal reflux, and fruit/vegetable intake. In both studies, intake of sucrose (cases vs. controls, g/day: 36.07 vs. 33.51; 36.80 vs. 35.06, respectively) and added sugar (46.15 vs. 41.01; 44.18 vs. 40.68, respectively) were higher in cases than controls. BE risk was increased 79% and 71%, respectively, for associations comparing the fourth to the first quartile of intake of sucrose (OR_Q4vs.Q1 = 1.79, 95% CI = 1.07–3.02, P _trend = 0.01) and added sugar (OR_Q4vs.Q1 = 1.71, 95% CI = 1.05–2.80, P _trend = 0.15). Intake of sweetened desserts/beverages was associated with 71% increase in BE risk (OR_Q4vs.Q1 = 1.71, 95% CI = 1.07–2.73, P _trend = 0.04). Limiting dietary intake of foods and beverages that are high in added sugar, especially refined table sugar, may reduce the risk of developing BE.

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Immortal time bias in pharmacoepidemiological studies on cancer patient survival: empirical illustration for beta-blocker use in four cancers with different prognosis

Abstract

Immortal time bias (ITB) is still seen frequently in medical literature. However, not much is known about this bias in the field of cancer (pharmaco-)epidemiology. In context of a hypothetical beneficial beta-blocker use among cancer patients, we aimed to demonstrate the magnitude of ITB among 9876 prostate, colorectal, lung and pancreatic cancer patients diagnosed between 1998 and 2011, which were selected from a database linkage of the Netherlands Cancer Registry and the PHARMO Database Network. Hazard ratios (HR) and 95% confidence intervals from three ITB scenarios, defining exposure at a defined point after diagnosis (model 1), at any point after diagnosis (model 2) and as multiple exposures after diagnosis (model 3), were calculated to investigate the association between beta-blockers and cancer prognosis using Cox proportional hazards regression. Results were compared to unbiased estimates derived from the Mantel–Byar model. Ignoring ITB led to substantial smaller HRs for beta-blocker use proposing a significant protective association in all cancer types [e.g. HR 0.18 (0.07–0.43) for pancreatic cancer in model 1], whereas estimates derived from the Mantel–Byar model were mainly suggesting no association [e.g. HR 1.10 (0.84–1.44)]. The magnitude of bias was consistently larger among cancer types with worse prognosis [overall median HR differences between all scenarios in model 1 and Mantel–Byar model of 0.56 (prostate), 0.72 (colorectal), 0.77 (lung) and 0.85 (pancreas)]. In conclusion, ITB led to spurious beneficial associations of beta-blocker use among cancer patients. The magnitude of ITB depends on the duration of excluded immortal time and the prognosis of each cancer.

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Simple Tips for Ear Lobule Reconstruction-“Lobuloplasty Revisited”

Abstract

Lobuloplasty is one of the most common procedures done in outpatient basis. It is performed by a wide spectrum of surgeons ranging from general surgeon to plastic surgeon. Inspite of the innumerous techniques used, the ultimate aim of the surgery is to obtain a soft supple lobule with a well-hidden cosmetic scar without the complication of recurrence. Single site local anaesthesia, scoring and undermining of the lobule flaps and the introduction of a small cartilage piece in recurrent cases can change the outcome of the patients result. This article explains how subtle changes are still possible in common procedures like lobuloplasty to change the outcome of the results.

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Light-emitting diode aspiration: Distinct radiographic features and approach to management

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Jeffrey C. Yeung, C. Jason Smithers, David W. Roberson
Foreign body aspiration is a potentially life threatening problem. The successful removal of airway foreign bodies is dependent on positively identifying the object and developing a solution to its extraction prior to attempts at retrieval. Thus, pre-operative radiographic evaluation is essential in the diagnosis and management of foreign body aspiration. The current case report describes the unique challenges in the evaluation and management of an unusual foreign body within the airway. The distinctive radiographic appearance of this foreign body allows it to be easily identified pre-operatively, and this may decrease the likelihood of operative complications and patient morbidity.



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Dietary sugar/starches intake and Barrett’s esophagus: a pooled analysis

Abstract

Barrett's esophagus (BE) is the key precursor lesion of esophageal adenocarcinoma, a lethal cancer that has increased rapidly in westernized countries over the past four decades. Dietary sugar intake has also been increasing over time, and may be associated with these tumors by promoting hyperinsulinemia. The study goal was to examine multiple measures of sugar/starches intake in association with BE. This pooled analysis included 472 BE cases and 492 controls from two similarly conducted case–control studies in the United States. Dietary intake data, collected by study-specific food frequency questionnaires, were harmonized across studies by linking with the University of Minnesota Nutrient Database, and pooled based on study-specific quartiles. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race, total energy intake, study indicator, body mass index, frequency of gastro-esophageal reflux, and fruit/vegetable intake. In both studies, intake of sucrose (cases vs. controls, g/day: 36.07 vs. 33.51; 36.80 vs. 35.06, respectively) and added sugar (46.15 vs. 41.01; 44.18 vs. 40.68, respectively) were higher in cases than controls. BE risk was increased 79% and 71%, respectively, for associations comparing the fourth to the first quartile of intake of sucrose (OR_Q4vs.Q1 = 1.79, 95% CI = 1.07–3.02, P _trend = 0.01) and added sugar (OR_Q4vs.Q1 = 1.71, 95% CI = 1.05–2.80, P _trend = 0.15). Intake of sweetened desserts/beverages was associated with 71% increase in BE risk (OR_Q4vs.Q1 = 1.71, 95% CI = 1.07–2.73, P _trend = 0.04). Limiting dietary intake of foods and beverages that are high in added sugar, especially refined table sugar, may reduce the risk of developing BE.

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Cardiovascular disease mortality among women with endometrial cancer in the Iowa Women’s Health Study

Abstract

Purpose

Obesity is associated with endometrial cancer (EC) development and cardiovascular disease (CVD) mortality. As the number of obese EC survivors continues to increase, an examination of CVD mortality in this vulnerable population is warranted.

Methods

In the Iowa Women's Health Study (1986–2011), we examined CVD mortality among 552 women with EC compared with 2,352 age- and body mass index-matched women without EC (controls). Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were estimated using multivariable-adjusted Cox proportional hazards regression models stratified by an indicator for match set.

Results

Compared to controls, women with EC more often reported a history of diabetes, hypertension, and never smoking. Compared with controls, women with EC had lower CVD mortality (HR 0.75, 95% CI 0.56–0.99), and higher all-cause mortality (HR 1.50, 95% CI 1.30–1.74).

Conclusions

Although some CVD risk factors were more common in women with versus without EC, CVD mortality was lower among the former group. Additional well-adjusted analyses with larger study populations are needed to understand interactions between CVD risk factors with CVD mortality among EC survivors. The CVD risk factor profile of EC survivors warrants emphasis on cardiovascular health.

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Outcomes of treatment in men with prostate cancer at the cancer centre Bahamas

Abstract

Purpose

This is a first report from The Bahamas of management and long-term outcomes in men with non-metastatic prostate cancer treated with radiotherapy, with or without androgen deprivation therapy, from 2004 to 2016.

Methods

Patients were characterized by baseline factors, stratified by risk groups using tumor stage (clinical T-stage), prostate-specific antigen (PSA) test result and Gleason grade, and sorted by treatment combinations (by radiation volume and use of androgen deprivation).

Results

Overall, 205/216 men were Afro-Caribbean. Median age was 66. There were 18 low-, 77 intermediate-, and 121 high-risk patients, treated with prostate-only versus pelvis plus prostate radiotherapy, many receiving 2 years of androgen suppression. Time to commence radiation was about 6 months from initial diagnosis. In those not relapsing, global PSA nadir was reached in 4 years and was under 1.0, reduced from a mean at baseline of 31. At 10 years, disease-free experience (32 relapses) was 68% and overall survival was 87%, although only 2/12 deaths were related to prostate cancer. This experience compares favorably with recently published outcomes from other countries using very similar treatments.

Conclusions

This study establishes benchmark statistics from diagnosis to long-term follow-up. Outcomes in Bahamian men are consistent with expectations from risk-stratified guidelines followed in developed countries.

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Effects of cholesterol, C-reactive protein, and interleukin-6 on prostate cancer risk in a population of African ancestry

Abstract

Purpose

To investigate the association between serum cholesterol and prostate cancer and whether any effect may be mediated through inflammatory markers.

Methods

Data from a case–control study of 40–80 years old Jamaican male patients (229 cases; 252 controls) were used. Cases had incident histologically-confirmed prostate cancer and controls were men with normal digital rectal examination and prostate-specific antigen (PSA) < 4 μg/L or free: total PSA > 0.15 obtained from the same clinic. Total and HDL cholesterol, interleukin-6 (IL-6), and C-reactive protein (CRP) were measured from a non-fasting sample. Multivariable logistic regression models were used to evaluate the associations between these factors and prostate cancer, adjusting for age, body mass index, waist circumference, family history of prostate cancer, diabetes, hypertension, use of cholesterol-lowering drugs, and smoking.

Results

Total cholesterol [Mean (cases, 4.71 ± 1.07; controls, 4.64 ± 1.07 mmol/L)], CRP [median (cases, 2.11; controls, 2.09 µg/ml)], and IL-6: [median (cases, 3.34; controls, 3.24 pg/ml)] did not differ by PCA status. Higher total cholesterol was associated with an increased risk of low-grade disease after adjusting for potential confounders [multivariable-adjusted OR (95% CI): tertile 2: 3.32(1.66, 6.45), tertile 3: 2.14(1.07, 4.32)]. Total cholesterol was unrelated to overall prostate cancer or high-grade disease. There was no significant association between HDL cholesterol or any of the inflammatory markers with prostate cancer.

Conclusions

Increasing total cholesterol but not inflammatory markers were associated with low-grade prostate cancer in Caribbean men.

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Patients Visiting Multiple Emergency Departments: Patterns, Costs and Risk Factors

Abstract

Objective

We sought to characterize the population of patients seeking care at multiple EDs and to quantify the proportion of all ED visits and costs accounted for by these patients.

Methods

We performed a retrospective, cohort study of de-identified insurance claims for privately insured patients with ≥ 1 ED visit between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. We identified factors associated with visiting multiple EDs.

Results

8,651,716 patients made 16,390,676 ED visits over the study period, accounting for $26,102,831,740 in ED costs. A significant minority (20.5%) of patients visited more than one ED over the study period. However, these patients accounted for a disproportionate amount of all ED visits (41.4%) and all ED costs (39.2%). A small proportion (0.4%) of patients visited 5 of more EDs but accounted for 2.8% of ED visits and costs. Among patients with two ED visits within 30-days, 32% were to different EDs. Having at least one ED visit for mental health or substance abuse related diagnosis was associated with increased odds of visiting multiple EDs.

Conclusions

A substantial minority of patients visit multiple EDs, but account for a disproportionate burden of overall ED utilization and costs. Future work should evaluate the impact of visiting multiple EDs on care utilization and outcomes and explore systems for improving access to patient records across care centers.

This article is protected by copyright. All rights reserved.

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Quality analysis of population-based information on cancer stage at diagnosis across Europe, with presentation of stage-specific cancer survival estimates: A EUROCARE-5 study

Publication date: October 2017
Source:European Journal of Cancer, Volume 84
Author(s): Pamela Minicozzi, Kaire Innos, Maria-José Sánchez, Annalisa Trama, Paul M. Walsh, Rafael Marcos-Gragera, Nadya Dimitrova, Laura Botta, Otto Visser, Silvia Rossi, Andrea Tavilla, Milena Sant
BackgroundCancer registries (CRs) are fundamental for estimating cancer burden, evaluating screening and monitoring health service performance. Stage at diagnosis—an essential information item collected by CRs—has been made available, for the first time, by CRs participating in EUROCARE-5. We analysed the quality of this information and estimated stage-specific survival across Europe for CRs with good data quality.Data and methodsSixty-two CRs sent stage (as TNM, condensed TNM or extent of disease) for 15 cancers diagnosed in 2000–2007. We assessed the quality, partly by comparing stage according to the three systems. We also developed procedures to reconstruct stage (categories: local, regional, metastatic and unknown) using information from all three systems, thus minimising the amount of missing information.ResultsModerate-to-excellent stage concordance was found for practically all 24 CRs, for which it was possible to compare at least two staging systems. However, since stage was often incorrectly assigned, and information on the presence/absence of metastases was often lacking, data on only 7/15 cancers from 34/62 CRs (15 countries) were of sufficient quality for further analysis. Cases diagnosed ≥70 years had more advanced (or lacking) stage– and worse stage-specific survival than those <70 years.ConclusionsMany European CRs collect and record reasonably accurate stage information. Others have difficulties. Both the completeness of primary data and the accuracy of stage coding need to be improved in order for CRs to fulfil their expanding roles in cancer control. We propose our stage reconstruction/checking procedures as a means of fully exploiting the stage information provided by EUROCARE CRs. More advanced (or lacking) stage at diagnosis plus poorer stage-specific survival in the elderly are worrying.



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Surgical approaches, anaesthetic management and outcome in pediatric superior mediastinal tumors

Publication date: Available online 31 August 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Gehad Ahmed, Mohammed M. Hegazy, Tarek Raafat, Hanafy Hafez, Sayed Fadel, Maged Elshafiey
BackgroundPediatric superior mediastinal tumors are a heterogeneous group of tumors with marked variation in pathology and extension. We reviewed our experience with different surgical approaches to tumors originating from or extending to superior mediastinum in pediatrics.Patients and methodsThe medical records of all patients who had undergone resection for superior mediastinal tumors in Children's Cancer Hospital – Egypt, between January 2008 to December 2015, were reviewed for demographic data, clinico-pathological features, radiologic findings, operative techniques and outcome.ResultsThe study included 20 patients. Diagnosis included: germ cell tumors (n=8), neuroblastoma (n=4), soft tissue sarcoma (n=3), thymolipoma (n=2), infantile fibromatosis (n=1), calcifying fibrous tumor (n=1), and thymic carcinoma (n=1). Tumor extension was divided into tumors extending unilaterally to one hemithorax (n=9), tumors extending bilaterally to both hemithoraces (n=4), and cervico thoracic junction tumors (n=7). Extended lateral thoracotomy was used in 8 patients. Other approaches included trapdoor (n=5), clamshell (n=4), cervical approach (n=2) and double level lateral thoracotomy (n=1). There was no perioperative mortality, and postoperative morbidity was 20%. At the end of December 2016, 15 patients were alive free of disease, 5 patients developed local and/ or distant relapse.ConclusionPediatric superior mediastinal tumors could be divided into 3 groups according to tumor extension. Each group has an optimum surgical approach that achieves the best exposure for adequate resection. However, further research is needed to confirm the conclusion as this was a descriptive study and the sample size was too small for valid statistical analysis.



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Evaluation and management of cytomegalovirus-associated congenital hearing loss.

Purpose of review: The current article reviews the current literature related to congenital cytomegalovirus (CMV)-related hearing loss. The discussion will focus on the epidemiology, pathogenesis, and clinical presentation of human CMV infection as it pertains to hearing loss. Current methods of CMV diagnosis with a focus on the evolving trend toward broader neonatal screening protocols will also be explored. Discussion of medical, surgical, and audiologic management of the condition will also be addressed. Recent findings: Much of the current research on this topic is focused on improving detection of CMV through screening programs. Some advances in understanding cochlear pathogenesis have also been made. Summary: Congenital CMV infection remains an important cause of hearing loss in infants and children. Early detection of CMV infection can broaden treatment options and allow for improved hearing and language outcome for patients with CMV-associated sensorineural hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Button battery ingestion in children.

Purpose of review: As the demand for small electronics continues to grow so does the risk of oesophageal ingestion of button batteries. These small but powerful sources of energy are ubiquitous in every household and when swallowed, especially in small children, have been shown to create significant injury in a short amount of time leading to long-term morbidity and possible death. This review highlights the latest findings regarding epidemiology, pathophysiology, diagnosis and management of ingested button batteries. Recent findings: Updated epidemiology from the National Capital Poison Center, new bench research looking at injury patterns and possible mitigation strategies, updated ideas on management algorithms including the use of a trauma protocol, close-look second endoscopy and management of button batteries in the lower gastrointestinal tract are reviewed in this paper. Summary: Despite advances in the understanding of injury mechanics and innovations leading to early diagnosis and improved management of button battery ingestion, parental and provider education remain the most important tools to keep children well tolerated from the sequelae of these potentially fatal events. Collaboration between healthcare experts, public health and industry is essential to find a safe answer to this ongoing threat. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cancers, Vol. 9, Pages 115: Chimeric Antigen Receptor (CAR) T Cell Therapy for Malignant Pleural Mesothelioma (MPM)

Cancers, Vol. 9, Pages 115: Chimeric Antigen Receptor (CAR) T Cell Therapy for Malignant Pleural Mesothelioma (MPM)

Cancers doi: 10.3390/cancers9090115

Authors: Astero Klampatsa Andrew Haas Edmund Moon Steven Albelda

Cancer immunotherapy has now become a recognized approach to treating cancers. In addition to checkpoint blockade, adoptive T cell transfer (ACT) using chimeric antigen receptors (CARs) has shown impressive clinical outcomes in leukemias and is now being explored in solid tumors. CARs are engineered receptors, stably or transiently transduced into T cells, that aim to enhance T cell effector function by recognizing and binding to a specific tumor-associated antigen. In this review, we provide a summary of CAR T cell preclinical studies and clinical trials for malignant pleural mesothelioma (MPM), a rare, locally invasive pleural cancer with poor prognosis. We list other attractive potential targets for CAR T cell therapy for MPM, and discuss augmentation strategies of CAR T cell therapy with other forms of immunotherapy in this disease.

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Editorial Board

Publication date: September–October 2017
Source:Practical Radiation Oncology, Volume 7, Issue 5





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Table of Contents

Publication date: September–October 2017
Source:Practical Radiation Oncology, Volume 7, Issue 5





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Oncologist, Cancer Patient, Oncologist

Publication date: Available online 31 August 2017
Source:Practical Radiation Oncology
Author(s): Joel E. Tepper




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Masthead

Publication date: September–October 2017
Source:Practical Radiation Oncology, Volume 7, Issue 5





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Adherence to ICRU-83 Reporting Recommendations is Inadequate in Prostate Dosimetry Studies

Publication date: Available online 31 August 2017
Source:Practical Radiation Oncology
Author(s): Aishling Mohan, Elizabeth Forde
PurposeThis study aimed to investigate if the International Commission on Radiation Units and Measurements (ICRU) 83 recommendations for reporting dosimetric endpoints are followed in published prostate studies using modulated techniques.Methods and MaterialsProstate dosimetry studies using inverse planning techniques were identified through a search of PubMed and EMBASE databases. These studies were analysed to determine if the endpoints reported followed the recommendations outlined in ICRU-83. A data collection form was completed and any alternative methods of reporting were recorded. Results were analysed using frequencies, percentages and Fisher's exact tests.ResultsThe ICRU-83 recommendations were not followed in the majority of studies. For the planning target volume the dose received by 2% of the volume (D2%), the dose received by 98% of the volume (D98%) and the dose received by 50% of the volume D50% were reported in 22.9%, 18.8%, and 8.3% of studies respectively. The adherence to reporting for the clinical target volume was below 5% for all specifications. The mean dose, the dose received by a specified volume (DV) and D2% for organs at risk were reported in 47.1%, 83.3% and 16.7% respectively. The homogeneity index was used in 14.6% of studies. Conformity was discussed in 45.8% of studies. Confidence intervals were included in 37.5% of studies.ConclusionsThe reporting recommendations of ICRU-83 were not adhered to in the majority of the dosimetry studies reviewed highlighting the need for greater diligence for authors and reviewers when publishing planning outcomes for modulated techniques.



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Evaluation of near-miss and adverse events in radiation oncology using a comprehensive causal factor taxonomy

Publication date: September–October 2017
Source:Practical Radiation Oncology, Volume 7, Issue 5
Author(s): Matthew B. Spraker, Robert Fain, Olga Gopan, Jing Zeng, Matthew Nyflot, Loucille Jordan, Gabrielle Kane, Eric Ford
PurposeIncident learning systems (ILSs) are a popular strategy for improving safety in radiation oncology (RO) clinics, but few reports focus on the causes of errors in RO. The goal of this study was to test a causal factor taxonomy developed in 2012 by the American Association of Physicists in Medicine and adopted for use in the RO: Incident Learning System (RO-ILS).Methods and materialsThree hundred event reports were randomly selected from an institutional ILS database and Safety in Radiation Oncology (SAFRON), an international ILS. The reports were split into 3 groups of 100 events each: low-risk institutional, high-risk institutional, and SAFRON. Three raters retrospectively analyzed each event for contributing factors using the American Association of Physicists in Medicine taxonomy.ResultsNo events were described by a single causal factor (median, 7). The causal factor taxonomy was found to be applicable for all events, but 4 causal factors were not described in the taxonomy: linear accelerator failure (n = 3), hardware/equipment failure (n = 2), failure to follow through with a quality improvement intervention (n = 1), and workflow documentation was misleading (n = 1). The most common causal factor categories contributing to events were similar in all event types. The most common specific causal factor to contribute to events was a "slip causing physical error." Poor human factors engineering was the only causal factor found to contribute more frequently to high-risk institutional versus low-risk institutional events.ConclusionsThe taxonomy in the study was found to be applicable for all events and may be useful in root cause analyses and future studies. Communication and human behaviors were the most common errors affecting all types of events. Poor human factors engineering was found to specifically contribute to high-risk more than low-risk institutional events, and may represent a strategy for reducing errors in all types of events.



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Role of proton-coupled folate transporter in pemetrexed-resistance of mesothelioma: clinical evidence and new pharmacological tools

Abstract

Background: Thymidylate synthase (TS) has a predictive role in pemetrexed-treatment of mesothelioma, however additional chemoresistance mechanisms are poorly understood. Here we explored the role of the reduced-folate carrier (RFC/SLC19A1) and proton-coupled folate-transporter (PCFT/SLC46A1) in antifolate-resistance in mesothelioma.Patients and methods:PCFT, RFC and TS RNA and PCFT protein levels were determined by quantitative-RT-PCR of frozen tissues and immunohistochemistry of tissue-microarrays, respectively, in two cohorts of pemetrexed-treated patients. Data were analyzed by t-test, Fisher/log-rank test and Cox-proportional models. The contribution of PCFT expression and PCFT-promoter methylation on pemetrexed activity were evaluated in mesothelioma cells and spheroids, through 5-aza-2′-deoxycytidine-mediated demethylation and siRNA-knockdown.Results: Pemetrexed-treated patients with low-PCFT had significantly lower rates of disease control, and shorter overall-survival (OS), in both the test (N = 73, 11.3 vs. 20.1 months, P = 0.01) and validation (N = 51, 12.6 vs. 30.3 months, P = 0.02) cohorts. Multivariate analysis confirmed PCFT independent prognostic role. Low-PCFT protein levels were also associated with shorter OS. Patients with both low-PCFT and high-TS levels had the worst prognosis (OS, 5.5 months), whereas associations were neither found for RFC nor in pemetrexed-untreated patients. PCFT silencing reduced pemetrexed sensitivity, while 5-aza-2′-deoxycytidine overcame resistance.Conclusions: These findings identify for the first time PCFT as a novel mesothelioma prognostic biomarker, prompting prospective trials for its validation. Moreover, preclinical data suggest that targeting PCFT-promoter methylation might eradicate pemetrexed-resistant cells characterized by low-PCFT expression.

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Genomic alterations and radioresistance in breast cancer: an analysis of the ProfiLER protocol.

Abstract

Background: Breast cancer (BC) patients with comparable prognostic features have heterogeneous outcomes, party related to a possible radiotherapy resistance leading to local-regional recurrences (LRR). The objective of the present study was to identify predictive molecular biomarkers of LRR of BC.Patients and Methods: Genetic profile of 146 BC patients' tumours included in the ProfiLER clinical trial (NC01774409) between 2013 and 2016 were analysed using Next-Generation-Sequencing and Comparative-Genomic-Hybridization tests. Patients and tumour characteristics were retrospectively collected and analyzed for association with genomic rearrangements (mutations, amplification, deletions). Only gene alterations observed in > 3% of the tumours were selected.Results: 193 genomic rearrangements were identified, and 16 were observed in > 3% of tumours. One was statistically correlated to the risk of local relapse. A median loco-regional progression free survival (LRPFS) of 23·6 years was reported for PIK3CA mutation carriers (n = 31, 21·2%) versus 9·9 years for PIK3CA wild-type patients (HR 0·27, CI95% (0·12-0·65), p=0·002 in univariate analysis). PIK3CA mutation was identified as an independent protective factor on LRR using multivariate analysis (HR 0·29, CI95% (0·09-0·99), p=0·047). All other mutations, amplifications or deletions were not found associated with LRPFS.Conclusion: PIK3CA mutation was associated with a lower risk of local relapse in this population of BCs. This is consistent with recent studies suggesting PIK3CA to be part of biological pathways impacting the radio-sensitivity.

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Grafting materials for alveolar cleft reconstruction: a systematic review and best-evidence synthesis

Publication date: Available online 31 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. Wu, W. Pan, C. Feng, Z. Su, Z. Duan, Q. Zheng, C. Hua, C. Li
The purpose of this study was to compare the efficacy of alveolar bone reconstruction for alveolar cleft patients performed with the traditional iliac graft or alternative/supplementary bone grafting materials. Electronic databases, relevant journals, and reference lists of the included studies were searched to the end of June 2016. A best-evidence synthesis was performed to draw conclusions. A total of 38 studies were included, which provided 25 pieces of evidence: seven of moderate evidence and 18 of insufficient evidence. The seven pieces of moderate evidence indicated that (1) bone morphogenetic protein 2 bound to absorbable collagen sponge shares similar cleft repair efficacy to the iliac graft; (2) covering the iliac graft with an acellular dermis matrix membrane may increase bone retention for unilateral cleft patients; (3) mixing iliac graft with platelet-rich plasma may increase bone retention for skeletally mature patients, but (4) does not achieve the same result for younger patients; and compared with the iliac graft, (5) the mandible graft is more effective, whereas (6) the cranium graft and (7) rib graft are less effective for alveolar cleft reconstruction. The efficacy of the remaining grafting materials was supported by insufficient evidence. More well-designed controlled studies are needed to ascertain the long-term clinical results of alveolar cleft reconstruction.



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Venous Diverticula Causing Pulsatile Tinnitus Treated With Coil Embolization and Stent Placement With Resolution of Symptoms: Report of Two Cases and Review of the Literature.

Objective: To report two cases of pulsatile tinnitus caused by complex venous diverticula with successful treatment via coil embolization and stent placement followed by complete resolution of symptoms. We also review the literature pertaining to venous diverticula causing pulsatile tinnitus treated using endovascular techniques. Patients: Two women patients, aged 27 and 29 years, presented to our institution with 3-month histories of pulsatile tinnitus. In each case, non-invasive imaging and conventional digital subtraction angiography (DSA) confirmed the presence of a complex right transverse-sigmoid sinus junction diverticulum. Intervention: Both patients underwent stent-assisted coil embolization of the venous diverticula. Main Outcome and Results: Clinical and DSA follow-up at 6 and 12 months confirmed resolution of symptoms with obliteration of the venous diverticulum. We also performed a PubMed database search for the period January 1995 through June 2016 using the terms pulsatile tinnitus, venous aneurysm/diverticulum, stent-assisted coil embolization, and endovascular treatment and identified reports of 14 additional patients treated using endovascular techniques. Conclusions: Venous sinus diverticula causing pulsatile tinnitus can be successfully treated with stent-assisted coil embolization with complete resolution of clinical symptoms. This is in concordance with 13 case reports in the literature involving 14 patients with venous sinus diverticula treated using endovascular techniques. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Venous Diverticula Causing Pulsatile Tinnitus Treated With Coil Embolization and Stent Placement With Resolution of Symptoms: Report of Two Cases and Review of the Literature.

Objective: To report two cases of pulsatile tinnitus caused by complex venous diverticula with successful treatment via coil embolization and stent placement followed by complete resolution of symptoms. We also review the literature pertaining to venous diverticula causing pulsatile tinnitus treated using endovascular techniques. Patients: Two women patients, aged 27 and 29 years, presented to our institution with 3-month histories of pulsatile tinnitus. In each case, non-invasive imaging and conventional digital subtraction angiography (DSA) confirmed the presence of a complex right transverse-sigmoid sinus junction diverticulum. Intervention: Both patients underwent stent-assisted coil embolization of the venous diverticula. Main Outcome and Results: Clinical and DSA follow-up at 6 and 12 months confirmed resolution of symptoms with obliteration of the venous diverticulum. We also performed a PubMed database search for the period January 1995 through June 2016 using the terms pulsatile tinnitus, venous aneurysm/diverticulum, stent-assisted coil embolization, and endovascular treatment and identified reports of 14 additional patients treated using endovascular techniques. Conclusions: Venous sinus diverticula causing pulsatile tinnitus can be successfully treated with stent-assisted coil embolization with complete resolution of clinical symptoms. This is in concordance with 13 case reports in the literature involving 14 patients with venous sinus diverticula treated using endovascular techniques. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Abnormalities of T cell receptor repertoire in CD4+ regulatory and conventional T cells in patients with RAG mutations: implications for autoimmunity

Publication date: Available online 31 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jared H. Rowe, Brian D. Stadinski, Lauren A. Henderson, Lisa Ott de Bruin, Ottavia Delmonte, Yu Nee Lee, M. Teresa de la Morena, Rakesh K. Goyal, Anthony Hayward, Huang Chiung-Hui, Maria Kanariou, Alejandra King, Taco W. Kuijpers, Jian Yi Soh, Benedicte Neven, Jolan E. Walter, Eric S. Huseby, Luigi D. Notarangelo




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