P 77 Optogenetic stimulations of striatal cholinergic interneurons in an animal model of dystonia

Dystonias are movement disorders, defined by sustained or intermittent muscle contractions causing twisting movements and postures. The most prevalent inherited form of dystonia is caused by a mutation in the gene for torsin A (DYT1, ΔGAG) with incomplete penetrance. It has been hypothesized that an increased activity of cholinergic interneurons in the striatum, resulting in abnormal synaptic plasticity, plays an important role in the disease pathophysiology. However, this hypothesis is merely based on ex vivo electrophysiological recordings in brain slices of animal models which do not show a dystonic phenotype.

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A new concept for implant-borne dental rehabilitation; how to overcome the biological weak-spot of conventional dental implants?

Every endosseous dental implant is dependent on an adequate amount and quality of peri-implant hard and soft tissues and their fully functional interaction. The dental implant could fail in cases of insufficie...

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iSepsis – Death by Fluids, Part 1

A recent study demonstrating the harm from aggressive fluid resuscitation of septic shock

EMCrit by Paul Marik.

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Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases

Pain is a very common condition in patient undergoing rehabilitation for neurological disease; however the presence of primary headaches and other cranio-facial pains, particularly when they are actually or ap...

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Brain networking analysis in migraine with and without aura

To apply effective connectivity by means of nonlinear Granger Causality (GC) and brain networking analysis to basal EEG and under visual stimulation by checkerboard gratings with 0.5 and 2.0 cpd as spatial fre...

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Tidal Carbon Dioxide as a Prognostic Feature in Inoperable Chronic Thromboembolic Pulmonary Hypertension

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1603-1604, October 2017.


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Six-Month Morbidity and Mortality among Intensive Care Unit Patients Receiving Life-Sustaining Therapy. A Prospective Cohort Study

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1562-1570, October 2017.


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Subcutaneous mastectomy in female-to-male transsexuals – optimizing perioperative and operative management in 8 years clinical experience

Publication date: Available online 29 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Wolter, T. Scholz, N. Pluto, J. Diedrichson, A. Arens-Landwehr, J. Liebau
IntroductionThe incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33 %. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with recent patient cohort (2014-2016).Patients and methodsThe records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (peri- and postoperative standard procedure and implementation of a care path in our institution, C1, 01/2008 - 12/2013, 346 mastectomies) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate were obtained in both cohorts.ResultsThe mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p<0,05). The overall complication rate could be diminished from 11.8 % to 5.5 % (p<0,05), the acute hematoma revision rate from 9.2 % to 4.1 % (p<0,05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88 % to 93.5 % „very satisfied" to „satisfied" patients.ConclusionHematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an institutional care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.



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Reappraisal of Pediatric Diastatic Skull Fractures in the 3-Dimensional CT Era: Clinical Characteristics and Comparison of Diagnostic Accuracy of Simple Skull X-Ray, 2-Dimensional CT, and 3-Dimensional CT

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Sook Young Sim, Hyun Gi Kim, Soo Han Yoon, Jong Wook Choi, Sung Min Cho, Mi Sun Choi
BackgroundDiastatic skull fractures (DSFs) in children are difficult to detect in skull radiographs before they develop into growing skull fractures; therefore, little information is available on this topic. However, recent advances in 3-dimensional (3D) computed tomography (CT) imaging technology have enabled more accurate diagnoses of almost all forms of skull fracture. The present study was undertaken to document the clinical characteristics of DSFs in children and to determine whether 3D CT enhances diagnostic accuracy.MethodsTwo hundred and ninety-two children younger than 12 years with skull fractures underwent simple skull radiography, 2-dimensional (2D) CT, and 3DCT. Results were compared with respect to fracture type, location, associated lesions, and accuracy of diagnosis.ResultsDSFs were diagnosed in 44 (15.7%) of children with skull fractures. Twenty-two patients had DSFs only, and the other 22 had DSFs combined with compound or mixed skull fractures. The most common fracture locations were the occipitomastoid (25%) and lambdoid (15.9%). Accompanying lesions consisted of subgaleal hemorrhages (42/44), epidural hemorrhages (32/44), pneumocephalus (17/44), and subdural hemorrhages (3/44). A total of 17 surgical procedures were performed on 15 of the 44 patients. Fourteen and 19 patients were confirmed to have DSFs by skull radiography and 2D CT, respectively, but 3D CT detected DSFs in 43 of the 44 children (P < 0.001).Conclusion3D CT was found to be markedly superior to skull radiography or 2D CT for detecting DSFs. This finding indicates that 3D CT should be used routinely rather than 2D CT for the assessment of pediatric head trauma.



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Chronologic Evaluation of Cerebral Hemodynamics by Dynamic Susceptibility Contrast Magnetic Resonance Imaging After Indirect Bypass Surgery for Moyamoya Disease

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Yosuke Ishii, Yoji Tanaka, Toshiya Momose, Motoshige Yamashina, Akihito Sato, Shinichi Wakabayashi, Taketoshi Maehara, Tadashi Nariai
ObjectiveAlthough indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast–magnetic resonance imaging (DSC-MRI).MethodsWe retrospectively analyzed the cases of 25 patients with MMD (37 sides; mean age, 14.7 years; range, 3–36 years) who underwent indirect bypass surgery and repeated DSC-MRI measurement within 6 months after the operation. The difference in the mean transit time (MTT) between the target regions and the control region (cerebellum) was termed the MTT delay, and we measured the MTT delay's chronologic changes after surgery.ResultsThe postoperative MTT delay was 1.81 ± 1.16 seconds within 1 week after surgery, 1.57 ± 1.01 at weeks 1–2, 1.55 ± 0.68 at weeks 2–4, 1.32 ± 0.68 at months 1–2, 0.95 ± 0.32 at months 2–3, and 0.77 ± 0.33 at months 3–6. Compared with the preoperative value (2.11 ± 0.98 seconds), the MTT delay decreased significantly from 2 to 4 weeks after surgery (P < 0.05).ConclusionsThe amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.



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Asymptomatic Ischemic Risks in Microsurgical Clipping for Unruptured Intracranial Aneurysms in Anterior Circulation

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Katsuhiro Shinagawa, Toshinori Matsushige, Takahito Okazaki, Daizo Ishii, Nobuhiko Ichinose, Shigeyuki Sakamoto, Kaoru Kurisu
BackgroundThe ischemic risk in prophylactic treatments of unruptured intracranial aneurysms (UIAs) is a serious health concern.ObjectiveThe aim of this study was to elucidate the incidence and characteristics of ischemic events in microsurgical clipping of anterior circulation UIAs.MethodsIschemic events were prospectively evaluated before and after surgery between April 2011 and March 2017. The location, volume, minimum value of apparent diffusion coefficient in high-intensity spots (HIS) on 3-T magnetic resonance diffusion-weighted imaging (DWI), and radiographic outcomes were analyzed. The relationships between DWI positivity and patient demographics, surgical procedures, and intraoperative vessel features were assessed.ResultsOverall, 78 consecutive patients including 29 men and 49 women (median age, 62 years; range, 24–77 years) with 99 UIAs were analyzed. A total of 10 in 78 craniotomies (13%) detected HIS on DWI, which were all asymptomatic. Seventeen HIS were shown, 5 of which were located in the basal ganglia, 6 in the white matter, and 6 in the cortex. The volume and minimum value of apparent diffusion coefficient were 180.4 ± 31.2 mm³ and 0.56 ± 0.03 × 10⁻³ mm²/second, respectively. Radiographic outcomes at follow-up showed that 71% of HIS on DWI led to irreversible brain ischemia. The maximum diameter of aneurysms, atherosclerotic features of the aneurysm wall, and procedure-related factors were associated with DWI positivity.ConclusionsThe asymptomatic ischemic risk associated with microsurgical clipping was not low and most lesions were irreversible. Although the mechanism could be various, the use of clips for atherosclerosis of the aneurysm and/or parental vessels requires much attention.



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Radiologic Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-Center Study

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): José L. Sanmillán, Alberto Torres-Diaz, Juan José Sanchez-Fernández, Ruth Lau, Cristina Ciller, Paloma Puyalto, Andreu Gabarrós
BackgroundPreoperative radiologic evaluation of pituitary adenomas is essential. Despite the efforts made to determine the achieved resection grade after pituitary adenoma surgery, there is a high level of disagreement among all the available classifications and measurement methods used. Our study aimed to determine pituitary adenoma imaging features, easily obtained from preoperative magnetic resonance, which could be used as resection predictor variables. Second, we analyzed the usefulness of the ellipsoid method in pituitary adenoma volume determination.MethodsTwo-hundred and ninety-four pituitary adenomas, which were surgically treated in our department, were retrospectively analyzed. Age, gender, surgical approach, hormonal status, greater tumor diameter, volume, cavernous sinus invasion, and extent of resection were evaluated.ResultsOne-hundred and forty-eight surgical procedures were conducted with a microsurgical transsphenoidal approach whereas 146 were conducted with an endoscopic endonasal approach. Gross total resection was achieved in 54.08% of cases. There were no significant differences in the extent of resection regarding the approach used, age, gender, or hormonal production by the tumor. Only Knosp grade (P < 0.001) and tumor volume (P < 0.05) had a statistically and independent significant relationship with the extent of resection. Furthermore, we found a high correlation between the calculated volume, using the ellipsoid method, and the volume measurement obtained with complex planimetry methods.ConclusionsPituitary adenoma volume and cavernous sinus invasion, graded with the Knosp scale, are 2 pituitary tumor features that, when used in combination, predict the complexity of the surgery and the difficulty of achieving gross total resection in pituitary adenoma surgery.



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Removable complete digital dentures: A workflow that integrates open technologies

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Lucio Lo Russo, Angelo Salamini
Digitalization of the design and manufacture of removable complete dentures has numerous advantages. The workflow as presented integrates current open digital technologies into a functional protocol, enabling complete dentures to be designed and fabricated without system-specific trays or instruments. This is done by using a conventional technique to acquire anatomic information.



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Impact of bacterial ice nucleating particles on weather predicted by a numerical weather prediction model

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Maher Sahyoun, Ulrik S. Korsholm, Jens H. Sørensen, Tina Šantl-Temkiv, Kai Finster, Ulrich Gosewinkel, Niels W. Nielsen
Bacterial ice-nucleating particles (INP) have the ability to facilitate ice nucleation from super-cooled cloud droplets at temperatures just below the melting point. Bacterial INP have been detected in cloud water, precipitation, and dry air, hence they may have an impact on weather and climate. In modeling studies, the potential impact of bacteria on ice nucleation and precipitation formation on global scale is still uncertain due to their small concentration compared to other types of INP, i.e. dust. Those earlier studies did not account for the yet undetected high concentration of nanoscale fragments of bacterial INP, which may be found free or attached to soil dust in the atmosphere. In this study, we investigate the sensitivity of modeled cloud ice, precipitation and global solar radiation in different weather scenarios to changes in the fraction of cloud droplets containing bacterial INP, regardless of their size. For this purpose, a module that calculates the probability of ice nucleation as a function of ice nucleation rate and bacterial INP fraction was developed and implemented in a numerical weather prediction model. The threshold value for the fraction of cloud droplets containing bacterial INP needed to produce a 1% increase in cloud ice was determined at 10⁻⁵ to 10⁻⁴. We also found that increasing this fraction causes a perturbation in the forecast, leading to significant differences in cloud ice and smaller differences in convective and total precipitation and in net solar radiation reaching the surface. These effects were most pronounced in local convective events. Our results show that bacterial INP can be considered as a trigger factor for precipitation, but not an enhancement factor.



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Isoprenoid emission variation of Norway spruce across a European latitudinal transect

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Ylva van Meeningen, Min Wang, Tomas Karlsson, Ana Seifert, Guy Schurgers, Riikka Rinnan, Thomas Holst
Norway spruce (Picea abies) is one of the dominant tree species in the European boreal zone with the capacity to grow over large areas within Europe. It is an important emitter of biogenic volatile organic compounds (BVOCs), which can act as precursors of photochemical smog and ozone and contribute to the formation and growth of secondary organic aerosols (SOA) in the atmosphere.Isoprenoid emissions were measured from Norway spruce trees at seven different sites, distributed from Ljubljana in Slovenia to Piikkiö in Finland. Four of the sites were part of a network of genetically identical spruce trees and contained two separate provenances. The remaining three sites were part of other networks which have been used to conduct studies in the European boreal zone.There were minimal differences in the standardized emission rates between sites and across latitudes. The emission profile differed between provenances and sites, but there were not any distinct patterns which could be connected to a change in latitude. By using genetically identical trees and comparing the emission rates between sites and with genetically different trees, it was observed that the emission patterns were mostly influenced by genetics. But in order to confirm this possible stability of the relative emission profile based on genetics, more studies need to be performed.The effects of branch height, season and variation between years on observed emission pattern variations were also investigated. There were indications of potential influences of all three factors. However, due to different experimental setups between measurement campaigns, it is difficult to draw any robust conclusions.



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Hip movement pathomechanics of patients with hip osteoarthritis aim at reducing hip joint loading on the osteoarthritic side

Publication date: January 2018
Source:Gait & Posture, Volume 59
Author(s): A.G. Meyer Christophe, Mariska Wesseling, Kristoff Corten, Angela Nieuwenhuys, Davide Monari, Jean-Pierre Simon, Ilse Jonkers, Kaat Desloovere
This study aims at defining gait pathomechanics in patients with hip osteoarthritis (OA) and their effect on hip joint loading by combining analyses of hip kinematics, kinetics and contact forces during gait. Twenty patients with hip OA and 17 healthy volunteers matched for age and BMI performed three-dimensional gait analysis. Hip OA level was evaluated based on plane radiographs using the Tönnis classification. Hip joint kinematics, kinetics as well as hip contact forces were calculated. Waveforms were time normalized and compared between groups using statistical parametric mapping analysis. Patients walked with reduced hip adduction angle and reduced hip abduction and external rotation moments. The work generated by the hip abductors during the stance phase of gait was largely decreased. These changes resulted in a decrease and a more vertical and anterior orientation of the hip contact forces compared to healthy controls. This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining.



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Plasticity of white matter connectivity in phonetics experts.

Related Articles

Plasticity of white matter connectivity in phonetics experts.

Brain Struct Funct. 2016 Sep;221(7):3825-33

Authors: Vandermosten M, Price CJ, Golestani N

Abstract
Phonetics experts are highly trained to analyze and transcribe speech, both with respect to faster changing, phonetic features, and to more slowly changing, prosodic features. Previously we reported that, compared to non-phoneticians, phoneticians had greater local brain volume in bilateral auditory cortices and the left pars opercularis of Broca's area, with training-related differences in the grey-matter volume of the left pars opercularis in the phoneticians group (Golestani et al. 2011). In the present study, we used diffusion MRI to examine white matter microstructure, indexed by fractional anisotropy, in (1) the long segment of arcuate fasciculus (AF_long), which is a well-known language tract that connects Broca's area, including left pars opercularis, to the temporal cortex, and in (2) the fibers arising from the auditory cortices. Most of these auditory fibers belong to three validated language tracts, namely to the AF_long, the posterior segment of the arcuate fasciculus and the middle longitudinal fasciculus. We found training-related differences in phoneticians in left AF_long, as well as group differences relative to non-experts in the auditory fibers (including the auditory fibers belonging to the left AF_long). Taken together, the results of both studies suggest that grey matter structural plasticity arising from phonetic transcription training in Broca's area is accompanied by changes to the white matter fibers connecting this very region to the temporal cortex. Our findings suggest expertise-related changes in white matter fibers connecting fronto-temporal functional hubs that are important for phonetic processing. Further studies can pursue this hypothesis by examining the dynamics of these expertise related grey and white matter changes as they arise during phonetic training.

PMID: 26386692 [PubMed - indexed for MEDLINE]

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Simulation-based education to ensure provider competency within the healthcare system

Abstract

The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic: "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on ''Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes,'' held on May 16, 2017, in Orlando, FL. Although simulation-based training is a quality and safety imperative in other high-reliability professions such as aviation, nuclear power, and the military, health care professions still lag behind in applying simulation more broadly. This is likely a result of a number of factors, including cost, assessment challenges, and resistance to change. This consensus subgroup focused on identifying current gaps in knowledge and process related to the use of simulation for developing, enhancing, maintaining individual provider competency. The resulting product is a research agenda informed by expert consensus and literature review.

This article is protected by copyright. All rights reserved.

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Chairside molecular imaging of aberrant glycosylation in subjects with suspicious oral lesions using fluorescently labeled wheat germ agglutinin

Abstract

Background

Aberrant sialylation is accepted as a carcinogenic biomarker. In previous work, fluorescently labeled wheat germ agglutinin (WGA) distinguished between cancerous and normal oral biopsies. The purpose of this study was to investigate WGA-fluorescein isothiocyanate (FITC) as a point-of-care tool for detecting oral malignant and dysplastic lesions in vivo.

Methods

Subject recruitment was divided into two groups: (1) the clinically normal oral mucosa group; or (2) the presence of clinically suspicious oral lesion(s) group. A WGA-FITC solution was topically applied to observable lesions or to half the subject's mouth (sagittal plane) if lesions were absent. Fluorescent molecular imaging was used to evaluate WGA-FITC localization.

Results

Fluorescent imaging in 55 subjects demonstrated that WGA-FITC could detect histopathologically-confirmed cancerous and dysplastic lesions with high sensitivity (100% and 81%, respectively) and specificity (82%).

Conclusion

This study supports in vivo fluorescent molecular imaging of WGA-FITC to visualize aberrant sialic acid expression associated with carcinogenesis. This technique resulted in the immediate chairside detection of oral cancerous and dysplastic lesions.

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Predictors of contralateral-bilateral nodal disease in oropharyngeal cancer: A National Cancer Data Base Study

Abstract

Background

Oropharyngeal squamous cell carcinoma (SCC) frequently presents with cervical metastasis. Roles of human papillomavirus (HPV) status, among other factors, on laterality are elusive.

Methods

The National Cancer Database was reviewed for oropharyngeal SCC diagnosed from 2010-2014. Predictors of clinically evident contralateral or bilateral nodal disease were identified.

Results

A total of 15 517 patients with oropharyngeal SCC met criteria. The majority was HPV-positive. Histologically poorly differentiated tumors were more frequent in the HPV-positive group (55.7% vs 37.6%; P < .001). By incidence, there was no statistical difference in contralateral or bilateral nodal disease between HPV-positive and HPV-negative patients (14.2% vs 14.5%, respectively; P = .769). On multivariable analysis, notable predictors of contralateral or bilateral nodal disease included HPV-positivity (odds ratio [OR] 1.26; 99% confidence interval [CI] 1.10-1.44), base of tongue (BOT) location (OR 2.15; 99% CI 1.88-2.45), poorly differentiated tumor (OR 1.72; 99% CI 1.20-2.46), and T4 classification (OR 6.65; 99% CI 5.34-8.28).

Conclusion

Patients with HPV-associated oropharyngeal SCC have increased likelihood of contralateral or bilateral nodal disease. Tumor grade, tumor location, and tumor size are also independent predictors.

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Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer

Abstract

Background

The purpose of this study is to report the economic outcomes of a new synchronous telepractice service providing speech pathology intervention to patients with head and neck cancer at nonmetropolitan facilities.

Methods

A multisite randomized controlled trial comparing standard care versus a new synchronous telepractice model was conducted within a large Australian public cancer service. Data pertaining to health service costs (staff wages, equipment, and patient travel reimbursement), patient +/- carer costs (travel and wages), and patient-reported quality of life (Assessment of Quality of Life questionnaire 4D) were collected.

Results

Eighty-two referrals (39 standard care and 43 synchronous telepractice care) were managed. The new telepractice service reported average cost savings of 12% (P < .0058) for the health service and $40.05 saving per patient per referral. An equivalent positive increase in quality of life (0.04) was reported for both groups.

Conclusion

The synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.

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Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer

Abstract

Background

This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF).

Methods

The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22-28 and 18-22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively.

Results

The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor-site aesthetic results were better.

Conclusion

The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique.

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Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism

Abstract

Background

To prevent hypocalcemia, this study examined the efficiency of a calcium supplement formula guided by predicted calcium requirement in patients with renal failure after parathyroidectomy with autotransplantation.

Methods

In the first phase, a protocol was followed whereby intravenous calcium gluconate was repeatedly titrated based on serum calcium levels in 22 patients with parathyroidectomy with autotransplantation. In the second phase, the first equation protocol was applied in 74 patients with parathyroidectomy with autotransplantation and revised.

Results

There is a significant correlation between the postoperative amount of calcium requirement and preoperative serum alkaline phosphatase level (r = 0.442; P < .001) and parathyroid hormone level (PTH; r = 0.889; P < .001). For prediction of insufficient calcium supplement, the cutoff point of PTH and alkaline phosphatase level values were calculated by receiver operating characteristic (ROC) curve analysis and modified equations were developed by regression analysis.

Conclusion

The preoperative PTH and alkaline phosphatase levels can predict postoperative calcium requirements, such that equations of calcium supplement allow the management of hypocalcemia efficiently in patients on dialysis after parathyroidectomy with autotransplantation.

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Role of macrophage migration inhibitory factor in head and neck cancer and novel therapeutic targets: A systematic review

Abstract

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in systemic, autoimmune, and inflammatory diseases, such as obesity, rheumatoid arthritis, and systemic lupus erythematosus. For the 2 past decades, MIF has been reported to participate in carcinogenesis, disease prognosis, tumor cell proliferation, invasion, and tumor-induced angiogenesis in many cancers. The purpose of this article is to review published experimental and clinical data for MIF and its involvement in upper aerodigestive tract cancers. Based on the current literature, we propose a biomolecular model describing the mechanisms underlying the involvement of MIF in the initiation, progression, apoptosis, and proliferation of head and neck tumor cells. In reference to this model, potential therapeutic approaches based on the use of MIF antagonists and neutralizing antibodies are described. It is concluded that MIF is a promising target for future therapeutic strategies, both with and without chemoradiation strategies.

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Phase I study of induction chemotherapy with afatinib, ribavirin, and weekly carboplatin and paclitaxel for stage IVA/IVB human papillomavirus-associated oropharyngeal squamous cell cancer

Abstract

Background

The human papillomavirus (HPV) E6 oncoprotein enhances the oncogenic potential of ErbB proteins in HPV-related malignancies. This phase I study evaluates the addition of afatinib, an ErbB family inhibitor, and ribavirin to paclitaxel and carboplatin induction chemotherapy in HPV-associated, locally advanced oropharyngeal squamous cell carcinoma (SCC).

Methods

This dose escalation study included 2 doses of oral afatinib: 30 and 40 mg daily. Ribavirin dosing was weight based. Paclitaxel (80 mg/m²) and carboplatin (area under the curve [AUC] 1.5) were administered on days 1 and 8 of each 21-day cycle. After 3 cycles, patients were removed from protocol to receive definitive treatment.

Results

Among 10 patients, there were no dose-limiting toxicities. Six patients (67%) had unconfirmed objective partial responses. The 2-year progression-free survival rate was 75%.

Conclusion

Afatinib, ribavirin, paclitaxel, and carboplatin induction chemotherapy is safe and well tolerated. The phase II recommended dose of afatinib is 40 mg oral daily in this combination regimen.

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Modified technique for preservation of inferior alveolar nerve during mandibulectomy

Abstract

Background

The purpose of this article is to introduce the modified technique of preservation of the inferior alveolar nerve (IAN) during mandibulectomy for a benign lesion.

Methods

Five cases of osteofibrous hyperplasia and 3 cases of centricity osteomyelitis were included. During surgery, the IAN was marked using a planned cutting guide. Using an oscillating saw, the depth of the osteotomy along the IAN was controlled until the bone cortex was cut through. After splitting, the bony section was removed, leaving the neurovascular bundle intact. The sensation of the lower lip was evaluated using current perceptive threshold testing during follow-up.

Results

After follow-up for 6-27 months, no recurrence or secondary deformity was found. One patient had severe sensory disturbance.

Conclusion

With the use of a cutting guide and osteotomy tricks, mandibulectomy with preservation of the IAN can be accurately performed.

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“Airborne” suture tying technique: Simple steps to make it easy

Abstract

A multitude of microsurgical suture techniques have been described. Although accurate apposition and eversion of the vessel ends is paramount for the patency of anastomosis, rapidity is usually of secondary importance. However, in situations in which either multiple anastomoses are required or timely revascularization is crucial, speed becomes a determinant factor for eventual success. "Airborne" suture tying is aimed at decreasing operative time by streamlining the microvascular anastomosis. Over the years, several considerations have emerged as key points for achieving mastery of this helpful maneuver. Herein, we simplify the technique by breaking the maneuver into 2 components: the "charioteer" loop and the "lasso" loop. Relevant literature, indications, and benefits are discussed followed by step-by-step descriptions. Both back table and in vivo video demonstrations are presented online.

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18F-Fluoromisonidazole positron emission tomography/CT-guided volumetric-modulated arc therapy-based dose escalation for hypoxic subvolume in nasopharyngeal carcinomas: A feasibility study

Abstract

Background

The purpose of this study is to investigate the feasibility of a simultaneously integrated boost to the hypoxic subvolume of nasopharyngeal carcinomas (NCPs) under the guidance of ¹⁸F-fluoromisonidazole (FMISO) positron emission tomography (PET)/CT using volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques.

Methods

Eight patients with NPC were treated with simultaneous integrated boost-IMRT (treatment plan named IMRT70) with dose prescriptions of 70 Gy, 66 Gy, 60 Gy, and 54 Gy to the gross tumor volume (GTV), positive neck nodes, the planning target volume (PTV), and the clinically negative neck, respectively. Based on the same datasets, experimental plans with the same dose prescription plus a dose boost of 14 Gy (an escalation of 20% of the prescription dose) to the hypoxic volume target contoured on the pretreatment ¹⁸F-FMISO PET/CT imaging were generated using IMRT and VMAT techniques, respectively (represented by IMRT84 and VMAT84). Two or more arcs (approximately 2-2.5 arcs, totally rotating angle <1000 degrees) were used in VMAT plans and 9 equally separated fields in IMRT plans. Dosimetric parameters, total monitor units, and delivery time were calculated for comparative study of plan quality and delivery efficiency between IMRT84 and VMAT84.

Results

In experimental plans, hypoxic target volumes successfully received the prescribed dose of 84 Gy in compliance with other dose constraints with either the IMRT technique or the VMAT technique. In terms of the target coverage, dose homogeneity, and organs at risk (OAR) sparing, there was no statistically significant difference between the actual treatment plan of IMRT70 and experimental plans. The total monitor unit of VMAT84 (525.7 ± 39.8) was significantly less than IMRT70 (1171.5 ± 167; P = .001) and IMRT84 (1388.3 ± 151.0; P = .001) per fraction, with 55.1% and 62.1% reduction. The average machine delivery time was 3.5 minutes for VMAT plans in comparison with approximately 8 minutes for IMRT plans, resulting in a reduction factor of 56.2%. For experimental plans, the 3D gamma index average was over 98.0% with no statistical significant difference when a 3%/3 mm gamma passing rate criteria was used.

Conclusion

With the guidance of ¹⁸F-FMISO PET/CT imaging, dose escalation to hypoxic zones within NPC could be achieved and delivered efficiently with the VMAT technique in comparison with the IMRT technique.

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Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery

Abstract

Background

Venous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction.

Methods

A retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors.

Results

Of 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis (P = .002) are significant risk factors for VTE development.

Conclusion

Our flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given.

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Surrogate for oropharyngeal cancer HPV status in cancer database studies

Abstract

Background

The utility of cancer databases for oropharyngeal cancer studies is limited by lack of information on human papillomavirus (HPV) status. The purpose of this study was to develop a surrogate that can be used to adjust for the effect of HPV status on survival.

Methods

The study cohort included 6419 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, identified in the National Cancer Database (NCDB). The HPV surrogate score was developed using a logistic regression model predicting HPV-positive status.

Results

The HPV surrogate score was predictive of HPV status (area under the curve [AUC] 0.73; accuracy of 70.4%). Similar to HPV-positive tumors, HPV surrogate positive tumors were associated with improved overall survival (OS; hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.59-0.91; P = .005), after adjusting for important covariates.

Conclusion

The HPV surrogate score is useful for adjusting for the effect of HPV status on survival in studies utilizing cancer databases.

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Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis

Abstract

Background

Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer.

Methods

A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out.

Results

The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors.

Conclusion

Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.

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Correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma of the external auditory canal

Abstract

Background

The purpose of this study was to analyze the correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma (ACC) of the external auditory canal.

Methods

Twenty-nine patients with ACC of the external auditory canal who underwent surgery were retrospectively reviewed.

Results

Fifty percent of patients with solid pattern disease had recurrences, followed by those with cribriform (33%) and tubular (0%) pattern. Perineural invasion was common (55%), and occurred most frequently in the solid subtype (67%). The rate of otalgia was less in patients with perineural invasion (31% vs 46%). Most tumors (59%) involved the parotid gland, but it was not seen on preoperative MRI (35%).

Conclusion

The solid subtype presents the worst prognosis, and is prone to perineural invasion. Despite frequently occurring in ACC of the external auditory canal, perineural invasion may not be associated with otalgia. In ACC of the external auditory canal, high rates of occult parotid involvement support adjunctive superficial parotidectomy.

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Genomic profiling of intestinal-type sinonasal adenocarcinoma reveals subgroups of patients with distinct clinical outcomes

Abstract

Background

Patients with intestinal-type sinonasal adenocarcinoma (ITAC) have an unfavorable prognosis and new therapeutic approaches are needed to improve clinical management.

Methods

Genetic analysis of 96 ITACs was performed by microarray comparative genomic hybridization and immunohistochemistry and correlated to previously obtained mutation, methylation, and protein expression data, and with pathological characteristics and clinical outcome.

Results

Seven copy number alterations (CNAs) were significantly associated with unfavorable clinical outcome: gains at 1q22-23, 3q28-29, 6p22, and 13q31-33, and losses at 4p15-16, 4q32-35, and 10q24. Unsupervised cluster analysis resulted in 5 subgroups of ITAC with significantly distinct genetic signatures and clinical outcomes, independently of disease stage or histological subtype.

Conclusion

These data may guide studies to identify driver genes and signaling pathways involved in ITAC. In addition, the subclassification of genetic subgroups of patients with distinct clinical behavior can aid therapeutic decision making and may ultimately lead to personalized therapy with targeted inhibitors.

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Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma

Abstract

Background

Total laryngectomy remains the treatment of choice for recurrent/persistent laryngeal squamous cell carcinoma (SCC) after radiotherapy (RT) or chemoradiotherapy (CRT). However, despite attempts at aggressive surgical salvage, survival in this cohort remains suboptimal.

Methods

A prospectively maintained single-institution database was queried for patients undergoing total laryngectomy for recurrent/persistent laryngeal SCC after initial RT/CRT between 1998 and 2015(n = 244). Demographic, clinical, and survival data were abstracted. The Kaplan-Meier survival curves and hazard ratios (HRs) were calculated.

Results

Five-year overall survival (OS) was 49%. Five-year disease-free survival (DFS) was 58%. Independent predictors of OS included severe comorbidity (Adult Comorbidity Evaluation-27 [ACE-27] scale; HR 3.76; 95% confidence interval [CI] 1.56-9.06), and positive recurrent clinical nodes (HR 2.91; 95% CI 1.74-4.88).

Conclusion

Severe comorbidity status is the strongest predictor of OS, suggesting that increased attention to mitigating competing risks to health is critical. These data may inform a risk prediction model to allow for focused shared decision making, preoperative health optimization, and patient selection for adjuvant therapies.

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Risk of depressive disorder among patients with head and neck cancer: A nationwide population-based study

Abstract

Background

The purpose of this study was to assess the incidence and risk of depressive disorder among patients with head and neck cancer.

Methods

We identified 48 548 patients from the National Health Insurance Research Database (NHIRD) in Taiwan who were newly diagnosed with head and neck cancer between 2000 and 2010. Each patient was randomly frequency-matched with an individual without head and neck cancer, based on index year, sex, age, occupation category, urbanization level, monthly income, and comorbidities. The Cox proportional Registry of Catastrophic Illnesses Patient Database regression analysis was performed to estimate the effect of head and neck cancer on the risk of depressive disorder.

Results

Patients with head and neck cancer had a significantly higher risk of depressive disorder than the matched cohort (adjusted hazard ratio [HR] 3.32; 95% confidence interval [CI] 3.05-3.61), with the highest risk seen in the hypopharynx and oropharynx.

Conclusion

Patients with head and neck cancer had >3 times the incidence of depressive disorder, relative to the comparison group. Psychological evaluation and support are essential in head and neck cancer survivors.

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Injury mechanisms and electromyographic changes after injury of the recurrent laryngeal nerve: Experiments in a porcine model

Abstract

Background

Recurrent laryngeal nerve (RLN) injury during surgery may reveal differences in electromyographic (EMG) changes after sustained compression or traction.

Methods

In 20 pigs with the NIM-FLEX EMG-endotracheal tube, EMG was recorded at baseline, during sustained RLN compression, or traction until 70% amplitude decrease and during 30 minutes of recovery.

Results

Seventy percent amplitude decrease from baseline was reached after 110 ± 98 seconds (compression group) and 2034 ± 2108 seconds (traction group). Traction induced a pronounced latency increase, peaking at 122 ± 8% in contrast to compression with 106 ± 5% (P < .001). The EMG amplitude recovery to ≥50% of baseline failed in 7 nerves after compression and 8 nerves after traction.

Conclusion

Compression caused a fast decrease of EMG amplitude with minor effects on latency. In contrast, RLN traction showed early and significant latency increase preceding a delayed amplitude decrease. Recovery rate of the EMG signals were similar in both groups.

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Prognostic relevance of insulin resistance on disease-free survival in head and neck squamous cell carcinomas: Preliminary results

Abstract

Background

The primary purpose of this study was to investigate the significance of pretreatment glycemic parameters in the prognosis of head and neck squamous cell carcinoma (HNSCC).

Methods

Plasma samples of 71 patients with untreated HNSCC were obtained at the time of diagnosis. The prognostic value of fasting insulin, glucose, glycosylated hemoglobin levels, and the homeostatic model of risk assessment-insulin resistance (HOMA-IR) was evaluated toward disease-free survival.

Results

High HOMA-IR levels were associated with poor disease-free survival in intermediate-advanced stage tumors. Kaplan-Meier curves showed lower disease-free survival rates in patients with high HOMA-IR than in patients with low levels. In patients with intermediate-advanced stage tumors, multivariate analysis revealed that those with an HOMA-IR >2.974 presented a 2.7 times higher risk of poor outcome (95% confidence interval [CI] 1.023-7.341; P = .045).

Conclusion

The HOMA-IR is independently associated with disease-free survival in patients with HNSCC. We found an optimal HOMA-IR cutoff value for disease-free survival in patients with intermediate-advanced HNSCC.

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Associations between oral hygiene habits, diet, tobacco and alcohol and risk of oral cancer: A case–control study from India

Publication date: December 2017
Source:Cancer Epidemiology, Volume 51
Author(s): Bhawna Gupta, Freddie Bray, Narinder Kumar, Newell W Johnson
ObjectiveThis study examines the association between the incidence of oral cancer in India and oral hygiene habits, diet, chewing and smoking tobacco, and drinking alcohol. We also assessed the effects of oral hygiene habits with oral cancer risk among chewers versus never chewers.MethodsA hospital-based case–control study was conducted in Pune, India, based on face-to-face interviews, anthropometry, and intra-oral examinations conducted for 187 oral cancer cases and 240 controls.ResultsPoor oral hygiene score was associated with a significant risk of oral cancer (adjusted OR=6.98; 95%CI 3.72–13.05). When stratified by tobacco-chewing habit, the poor oral hygiene score was a significant risk factor only among ever tobacco chewers (adjusted OR=14.74; 95%CI 6.49–33.46) compared with never chewers (adjusted OR=0.71; 95%CI 0.14–3.63). Dental check-ups only at the time of pain by ever-chewers with poor oral hygiene was associated with an elevated risk (adjusted OR=4.22; 95%CI 2.44–7.29), while consumption of green, yellow, and cruciferous vegetables and citrus fruits was protective. A linear dose–response association was observed between oral cancer and chewing tobacco in terms of age at initiation, duration, and frequency of chewing per day (P<0.001). Smoking more than 10 bidis/cigarettes per day (adjusted OR=2.74; 95%CI 1.28–5.89) and for a duration >25 years (adjusted OR=2.31; 95%CI 1.14–4.71) elevated the risk of oral cancer.ConclusionGood oral hygiene habits – as characterized by healthy gums, brushing more than once daily, use of toothpaste, annual dental check-ups, and a minimal number of missing teeth – can reduce the risk of oral cancer significantly. In addition to refraining from chewing/smoking tobacco, a diet adequate in fruits and vegetables may protect against the disease.

Graphical abstract

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Editorial Board/Reviewing Committee

Publication date: November 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 11





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Cancers, Vol. 9, Pages 134: The Epithelial-to-Mesenchymal Transition in Breast Cancer: Focus on Basal-Like Carcinomas

Cancers, Vol. 9, Pages 134: The Epithelial-to-Mesenchymal Transition in Breast Cancer: Focus on Basal-Like Carcinomas

Cancers doi: 10.3390/cancers9100134

Authors: Monica Fedele Laura Cerchia Gennaro Chiappetta

Breast cancer is a heterogeneous disease that is characterized by a high grade of cell plasticity arising from the contribution of a diverse range of factors. When combined, these factors allow a cancer cell to transition from an epithelial to a mesenchymal state through a process of dedifferentiation that confers stem-like features, including chemoresistance, as well as the capacity to migrate and invade. Understanding the complex events that lead to the acquisition of a mesenchymal phenotype will therefore help to design new therapies against metastatic breast cancer. Here, we recapitulate the main endogenous molecular signals involved in this process, and their cross-talk with paracrine factors. These signals and cross-talk include the extracellular matrix; the secretome of cancer-associated fibroblasts, macrophages, cancer stem cells, and cancer cells; and exosomes with their cargo of miRNAs. Finally, we highlight some of the more promising therapeutic perspectives based on counteracting the epithelial-to-mesenchymal transition in breast cancer cells.

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War, Medicine, and Cultural Diplomacy in the Americas: Frank Wilson and Brazilian cardiology

Abstract

American cultural diplomacy played a key role in the institutionalization of Brazilian cardiology. In 1942, Frank Wilson, an internationally recognized pioneer in electrocardiography, made an extended wartime visit to Rio de Janeiro and São Paulo. The visit was sponsored by the United States Department of State as part of Roosevelt's Good Neighbor Policy and brought Wilson together with a group of physicians who would establish the specialty of cardiology in Brazil. This US cultural and diplomatic initiative strengthened an academic network that was already evolving and would eventually prove to be of benefit to both sides. Latin American physicians began in the 1920s to visit Wilson's laboratory at the University of Michigan, where they established the relationships on which Wilson would build. While affiliation with the "Wilson school" advanced the cause of Brazilian cardiologists who sought to establish themselves as specialists, cooperation with Latin American physicians benefitted Wilson in his pursuit of wider recognition for his innovations in the use of electrocardiography (ECG). Wilson's identity as a scientific ambassador to Latin America helped in legitimating his approach to the clinical application of the ECG. A close examination of Wilson's relationship to Brazilian cardiology demonstrates the role played by science and medicine as a part of wartime cultural diplomacy, as well as the dynamics of the transnational circulation of scientific knowledge and practices.

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Testing the Gräfenberg Ring in Interwar Britain: Norman Haire, Helena Wright, and the Debate over Statistical Evidence, Side Effects, and Intra-uterine Contraception

Abstract

This paper examines the introduction to Britain of the Gräfenberg ring, an early version of what later became known as an intrauterine device (IUD). The struggle during the interwar years to establish the value of the ring provides an opportunity for a case study of the evaluation and acceptance of a new medical device. With the professionalization of the birth control movement and the expansion of birth control clinics in interwar Britain, efforts to develop better scientific means for contraception grew rapidly. At the end of the nineteenth century, methods for controlling fertility ranged from coitus interruptus and abstinence, to diverse substances ingested or placed into the vagina, to barrier methods. The first decades of the twentieth century brought early work on chemical contraceptives as well as a number of new intrauterine devices, among them the Gräfenberg ring. Developing a cheap, reliable, and widely acceptable contraceptive became a pressing goal for activists in the voluntary birth control movement in Britain between the wars. Yet, tensions developed over the best form of contraception to prescribe. By situating the Gräfenberg ring within the context of the debates and competition among British medical and birth control professionals, this paper reveals broader issues of power relationships and expertise in the assessment of a new medical technology.

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Medical History’s Moment in Art Photography (1920 to 1950): How Lejaren à Hiller and Valentino Sarra Created a Fashion for Scenes of Early Surgery

Abstract

Two groups of black-and-white photographs are found in medical rare book rooms and the collections of historically minded physicians. They were created by artists Hiller and Sarra to bring medical history to life for members of the health professions and, to some extent, for a wider public. These were not didactic illustrations for a textbook, but elegant scenes of great figures from Antiquity to the nineteenth century, evocation not documentation even though they were based on research. As pieces of fine art, cherished in portfolios or framed on the wall, the quality prints were intended to stimulate curiosity about the achievements of the figures portrayed. While familiar to some archivists and librarians, these photographs have received almost no attention in the scholarship of medical history. Only one short article examined them in 1983. In recent years these photographers have been given new consideration by scholars of advertising and photography. Using those works and primary sources, this article expands both men's biographies, and it explores their working methods, their artistry, and their achievements. An appreciation of these photographs enlarges our understanding of the place of medical history in American culture during the first half of the twentieth century.

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Redefining Medical Confidentiality in the Digital Era: Healthcare Reform and the West German Debate over the Use of Personal Medical Information in the 1980s

In a book published in 2012 to great ballyhoo, the American cardiologist Eric Topol painted a shimmering, seductive picture of how the "super-convergence" of "the rapidly maturing digital, nonmedical world of mobile devices, cloud computing, and social networking with the emerging digital medical world of genomics, biosensors, and advancing imaging" was leading to the "creative destruction of medicine." The targets of his polemic—one where information and technology cast no shadows—were an "ossified" medical profession, a lengthy and prohibitively expensive drug approval policy, and population-based medicine, whose standardized, cookie-cutter approach insured that, more often than not, treatment would miss its mark. Glimmering on Topol's horizon was a "knowledge of individuals so fine-grained that we can speak of a science of individuality," and he hoped that in the wake of this super-convergence would follow a "rebooted life science industry [that] would leverage the science of individuality… [and get] the relevant digital readout from a person to fashion a therapy, instead of a mass-population—directed strategy."1¹

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Thomas W. Laqueur. The Work of the Dead: A Cultural History of Mortal Remains

LaqueurThomas W.. The Work of the Dead: A Cultural History of Mortal Remains. Princeton, Princeton University Press, 2015. xii, 711 pp., illus. $39.95.

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Audra Jennings. Out of the Horrors of War: Disability Politics in World War II America

JenningsAudra. Out of the Horrors of War: Disability Politics in World War II America. Philadelphia, University of Pennsylvania Press, 2016. 288 pp., illus. $55.00.

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Thomas A. Apel. Feverish Bodies, Enlightened Minds: Science and the Yellow Fever Controversy in the Early American Republic

ApelThomas A.. Feverish Bodies, Enlightened Minds: Science and the Yellow Fever Controversy in the Early American Republic. Stanford, California Stanford University Press, 2016. 208 pp., $60.00.

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Douglas C. Baynton. Defectives in the Land: Disability and Immigration in the Age of Eugenics

BayntonDouglas C.. Defectives in the Land: Disability and Immigration in the Age of Eugenics. Chicago, Illinois, University of Chicago Press, 2016. 177 pp., $35.00.

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Mical Raz. What’s Wrong with the Poor? Psychiatry, Race, and the War on Poverty Gabriel N. Mendes. Under the Strain of Color: Harlem’s Lafargue Clinic and the Promise of an Antiracist Psychiatry

RazMical. What's Wrong with the Poor? Psychiatry, Race, and the War on Poverty. Chapel Hill, North Carolina, University of North Carolina Press, 2013. 264 pp., illus. $39.95.

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Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography data.

Related Articles

Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography data.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jul 25;:

Authors: Yeo BR, Han JJ, Jung S, Park HJ, Oh HK, Kook MS

Abstract
OBJECTIVES: To evaluate horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography (3-D CT).
STUDY DESIGN: This study included 66 patients who underwent bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. With the use of 3-D CT data obtained preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3), horizontal changes of the proximal mandibular segment, including the intercondylar width, the intergonial width, and the frontal-ramal inclination were evaluated.
RESULTS: The value of the right frontal-ramal inclination was 11.43 ± 1.36° at T1, 11.91 ± 1.96° at T2, and 10.7 ± 1.5° at T3. The values of the left frontal-ramal inclination were 6.10 ± 1.03° at T1, 8.17 ± 1.66° at T2, and 7.66 ± 1.65° at T3. The values of the intergonial width were 99.67 ± 1.67 mm at T1, 98.24 ± 1.72 mm at T2, and 97.08 ± 1.71 mm at T3. The intergonial width was significantly decreased at T3 compared with T1 (P < .001). The values of the intercondylar width were 123.51 ± 1.66 mm at T1, 123.9 ± 1.66 mm at T2, and 122.88 ± 1.58 mm at T3.
CONCLUSIONS: Lower facial width at mandibular angle region decreased immediately after mandibular setback surgery and showed further decreases during the postoperative period.

PMID: 28958899 [PubMed - as supplied by publisher]

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Brazilian scientific production in Oral Medicine and Oral Pathology.

Related Articles

Brazilian scientific production in Oral Medicine and Oral Pathology.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 24;:

Authors: de Andrade RS, Martelli DRB, de Almeida OP, Lopes MA, Swerts MSO, Pires FR, de Abreu Alves F, Filho MRM, Machado RA, Martelli-Júnior H

PMID: 28958594 [PubMed - as supplied by publisher]

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Preclinical rationale for combination of crizotinib with mitomycin C for the treatment of advanced colorectal cancer

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MicroRNA signature in the chemoprevention of functionally-enriched stem and progenitor pools (FESPP) by Active Hexose Correlated Compound (AHCC)

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Activation of estrogen receptor α by estradiol and cisplatin induces platinum-resistance in ovarian cancer cells

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The European Journal of Neuroscience's mission to increase the visibility and recognition of women in science

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The efficacy of oral and subcutaneous antigen-specific immunotherapy in murine cow’s milk- and peanut allergy models

Antigen-specific immunotherapy (AIT) is a promising therapeutic approach for both cow's milk allergy (CMA) and peanut allergy (PNA), but needs optimization in terms of efficacy and safety.

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Audio-visual speech perception in prelingually deafened Japanese children following sequential bilateral cochlear implantation

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Ryosuke Yamamoto, Yasushi Naito, Keizo Fujiwara, Shogo Shinohara, Shinji Takebayashi, Masahiro Kikuchi, Tetsuhiko Michida, Kazuki Hayashi, Koji Saida, Keisuke Mizuno
ObjectivesAn effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs.MethodsThe study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility < 80% with the 1st CI).ResultsWe found evidence of the McGurk effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI.ConclusionOur results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural listening (with Bi-CIs). Overall, the findings of this study might be used to inform future research to identify the best strategies for speech training using AV integration effectively in prelingually deafened children.



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Intratympanic Injection of Steroid for Treatment of Tinnitus

Abstract

Tinnitus has become one of the most challenging tasks faced by the medical field. It has a moderately negative impact on patient's quality of life. Different methods had been developed in medical science for managing tinnitus but none of these offered a permanent cure. In our study we used a simple procedure of intratympanic injection of dexamethasone in managing our tinnitus patients. Total number of patients involved in this study were 40, 26 females and 14 males with age spanned from 15 to 65 years. Out of 40 patients, 22 of them complained of tinnitus only while the other 18 of them complained of tinnitus with impaired hearing which was confirmed further by pure tone audiometry. Injection was given under otologic microscopic vision through posteroinferior quadrant of tympanic membrane in weekly interval. After receiving several number of injections, 24 patients (60%) reported complete disappearance of tinnitus, 10 of them (25%) still had residual tinnitus but comparatively less severe and 6 (15%) of them reported no improvement.

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Human mesenchymal stromal cells as cellular drug-delivery vectors for glioblastoma therapy: a good deal?

Glioblastoma (GB) is the most malignant brain tumor in adults. It is characterized by angiogenesis and a high proliferative and invasive capacity. Standard therapy (surgery, radiotherapy and chemotherapy with ...

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β-catenin-mediated YAP signaling promotes human glioma growth

Hippo/YAP pathway is known to be important for development, growth and organogenesis, and dysregulation of this pathway leads to tumor progression.We and others find that YAP is up-regulated in human gliomas a...

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Long-Term Evaluation of Acidic Atmospheric Deposition on Soils and Soil Solution Chemistry in the Daniel Boone National Forest, USA

Abstract

Combustion of fossil fuels has contributed to many environmental problems including acid deposition. The Clean Air Act (CAA) was created to reduce ecological problems by cutting emissions of sulfur and nitrogen. Reduced emissions and rainfall concentrations of acidic ions have been observed since the enactment of the CAA, but soils continue to receive some acid inputs. Many soils sensitive to acid deposition are found to have low pH, a loss of base cations, and a shift in the mineral phase controlling the activity of Al³⁺ and/or SO₄²⁻. If inputs continue, soil may be depleted of base cations and saturated with Al and could cause low forest productivity. Soil samples and soil solutions from pan lysimeters were taken on ridge-tops in the Daniel Boone National Forest to evaluate potential impacts of acid deposition recently and in the future. Sample results were compared to historical data from identical locations. Physicochemical characteristics of the soils revealed that sites were very low in base saturation and pH and high in exchangeable acidity, illustrating change since previously sampled. Soil solution data indicated that sites periodically received high acid inputs leading to saturation of Al in soils and the formation of Al-hydroxy-sulfate minerals. Given these conditions, long-term changes in soil chemistry from acid deposition are acknowledged.

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Clinical and hemodynamic risk factors associated with discrepancies in lower limb length with capillary malformations – data from the national paediatric French cohort CONAPE

Summary

Background

Genetics discoveries have allowed for better understanding capillary malformations (CMs) with overgrowth syndrome. However, molecular analyses are still not easy to perform or interpret. Other analytical methods are needed.

Objective

We aimed to identify clinical and hemodynamic factors associated with leg length discrepancy (LLD) in children with CM of lower limbs.

Methods

Data were obtained from the multicentre French national cohort CONAPE (COhorte Nationale d'enfants atteints d'Angiome Plan de membrE inférieur), including children from 2 to 12 years old with CM of lower limbs. Clinical characteristics were prospectively collected. Hemodynamic factors were measured by an echographer who calculated the arterial blood flow (ABF) in both lower limbs. An ABF difference ≥50% between the two lower limbs was considered relevant. LLD ≥ 2% was determined by the same radiologist on centralized radiographs.

Results

We analyzed data at baseline for 96 children. The mean (SD) age was 5.6 (3.1) years; 49 (51%) were male; and 14 (15%) showed LLD. Thirty-two patients (33%) had venous anomalies, 13 (14%) lymphatic anomalies, and in 1 child, diagnosis of Parkes Weber syndrome was made. Only increased circumference above the knee was more frequent with than without LLD (50% vs 13%, p=0.02). In all, 10/79 patients (13%) showed a difference in ABF ≥50%: 4 had LLD. The frequency of differences in ABF ≥50% was greater with than without LLD [33.3% (n=4/12) vs 9.0% (n=6/67), p=0.04].

Conclusions

ABF measured by Duplex ultrasonography is a simple, low-cost and non-invasive complementary examination for help in detecting LLD, with a difference ≥ 50% possibly associated.

This article is protected by copyright. All rights reserved.

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Pirfenidone photosensitization in patients with idiopathic pulmonary fibrosis: a case series

Abstract

The oral antifibrotic agent, pirfenidone (PFD), 5-methyl-l-phenyl-[1H]-pyridine, is used to treat idiopathic pulmonary fibrosis (IPF), a chronic and fatal lung disease. In trials, PFD reduces disease progression and decreases mortality. The most common side events of PFD are skin manifestations (25%), described as a photosensitivity or rash, but they are not well characterised ¹.

This article is protected by copyright. All rights reserved.

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Doxycycline-loaded nanotube-modified adhesives inhibit MMP in a dose-dependent fashion

Abstract

Objectives

This article evaluated the drug loading, release kinetics, and matrix metalloproteinase (MMP) inhibition of doxycycline (DOX) released from DOX-loaded nanotube-modified adhesives. DOX was chosen as the model drug, since it is the only MMP inhibitor approved by the U.S. Food and Drug Administration.

Materials and methods

Drug loading into the nanotubes was accomplished using DOX solution at distinct concentrations. Increased concentrations of DOX significantly improved the amount of loaded DOX. The modified adhesives were fabricated by incorporating DOX-loaded nanotubes into the adhesive resin of a commercial product. The degree of conversion (DC), Knoop microhardness, DOX release kinetics, antimicrobial, cytocompatibility, and anti-MMP activity of the modified adhesives were investigated.

Results

Incorporation of DOX-loaded nanotubes did not compromise DC, Knoop microhardness, or cell compatibility. Higher concentrations of DOX led to an increase in DOX release in a concentration-dependent manner from the modified adhesives. DOX released from the modified adhesives did not inhibit the growth of caries-related bacteria, but more importantly, it did inhibit MMP-1 activity.

Conclusions

The loading of DOX into the nanotube-modified adhesives did not compromise the physicochemical properties of the adhesives and the released levels of DOX were able to inhibit MMP activity without cytotoxicity.

Clinical significance

Doxycycline released from the nanotube-modified adhesives inhibited MMP activity in a concentration-dependent fashion. Therefore, the proposed nanotube-modified adhesive may hold clinical potential as a strategy to preserve resin/dentin bond stability.

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Accuracy of multi-unit implant impression: traditional techniques versus a digital procedure

Abstract

Objectives

The objective of this study was to evaluate the accuracy of different impression techniques on multiple implants.

Material and methods

A master cast simulating a jaw with four implants was used.

Eight impression techniques were tested: open tray-polyether#1, open tray plus splint of impression copings with acrylic resin-polyether#1, closed tray-polyether#1, open tray-polyether#2, open tray-splint-polyether#2, closed tray-polyether#2, open tray-impression plaster, and digital impression (DI).

Five impressions of the master cast were taken with each traditional impression (TI) technique, pouring 35 sample casts. Three different clinicians took 5 DI each (n = 15).

A three-dimensional coordinate measurement machine (CMM) was used to measure implant angulation and inter-implant distances on TI casts. TI data and DI Standard Tessellation Language datasets were compared with the master cast.

The best and the worst impressions made with TI and DI were selected to fabricate four milled titanium frameworks. Passive fit was evaluated through Sheffield test, screwing each framework on the master cast. Gaps between framework-implant analogs were measured through a stereomicroscope (×40 magnification).

Results

Statistically significant differences in accuracy were found comparing the different impression techniques by CMM (p < 0.01). DI performed the best, while TI techniques revealed a greater variability in the results.

Sheffield test revealed a mean gap of 0.022 ± 0.023 mm (the best TI), 0.063 ± 0.059 mm (the worst TI), 0.015 ± 0.011 mm (the best DI), and 0.019 ± 0.015 mm (the worst DI).

Conclusions

Within the limits of this in vitro study, the digital impression showed better accuracy compared to conventional impressioning.

Clinical relevance

The digital impression might offer a viable alternative to traditional impressions for fabrication of full-arch implant-supported prostheses with satisfactory passive fit.

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Do melanoma patients with melanoma of unknown primary have better survival than patients with melanoma of known primary?

Abstract

Background

Several studies have compared the survival rate of melanoma of unknown primary (MUP) patients with patients with a known primary melanoma (MKP). Some studies found improved survival in MUP patients, whereas others found similar or poorer outcomes. The aim of this study was to evaluate if there was a difference in survival between patients with MUP and patients with a MKP with stage III and IV disease.

Methods

A retrospective study was conducted of 48 MUP patients and 502 MKP patients diagnosed with American Joint Committee on Cancer (AJCC) stage III and 92 MUP patients and 218 MKP patients diagnosed with AJCC stage IV melanoma at Aarhus University Hospital and Odense University Hospital, Denmark, between 2003 and 2013.

Results

Multivariate analysis of data identified no significant survival differences between MUP and MKP patients with stage III (hazard ratio [HR] = 0.84; P = 0.46) and stage IV (hazard ratio [HR] = 1.03; P = 0.84) disease.

Conclusions

This study included patients from two major university hospitals in Denmark and showed no difference in overall survival between MUP and MKP patients with stage III or IV disease.

Level of Evidence: Level IV, risk/prognostic study.

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Do melanoma patients with melanoma of unknown primary have better survival than patients with melanoma of known primary?

Abstract

Background

Several studies have compared the survival rate of melanoma of unknown primary (MUP) patients with patients with a known primary melanoma (MKP). Some studies found improved survival in MUP patients, whereas others found similar or poorer outcomes. The aim of this study was to evaluate if there was a difference in survival between patients with MUP and patients with a MKP with stage III and IV disease.

Methods

A retrospective study was conducted of 48 MUP patients and 502 MKP patients diagnosed with American Joint Committee on Cancer (AJCC) stage III and 92 MUP patients and 218 MKP patients diagnosed with AJCC stage IV melanoma at Aarhus University Hospital and Odense University Hospital, Denmark, between 2003 and 2013.

Results

Multivariate analysis of data identified no significant survival differences between MUP and MKP patients with stage III (hazard ratio [HR] = 0.84; P = 0.46) and stage IV (hazard ratio [HR] = 1.03; P = 0.84) disease.

Conclusions

This study included patients from two major university hospitals in Denmark and showed no difference in overall survival between MUP and MKP patients with stage III or IV disease.

Level of Evidence: Level IV, risk/prognostic study.

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Impact of Video Technology for Improving Success of Medial Canthus Episcleral Anesthesia in Ophthalmology.

Background and Objectives: Efficient learning of regional anesthesia in ophthalmology remains challenging because trainees are afforded limited opportunity to practice ocular anesthesia. The aim of this prospective, randomized, blinded study was to determine whether teaching with video improves regional anesthesia skills of residents in ophthalmology. Methods: From January to October 2016, 32 novice anesthesiology residents were evaluated while performing medial canthus episcleral procedures during a 5-day rotation. Residents were randomly assigned to either receive or not receive a video review of their performance at day 3. The primary outcome was a comparison of akinesia using a 12-point scale before incision assessed by the blinded surgeon. Results: A total of 288 blocks were performed by 32 residents and were assessed by 3 surgeons before the intervention (144 blocks) and after the intervention (144 blocks). Residents in the review group improved to a greater degree compared with residents in the no-review group. The median overall akinesia scores for the review and no-review groups were similarly low (6; interquartile range [IQR], 2-11; and 6 [IQR, 2-9], respectively) on day 1 of the rotation, whereas anesthesia performed by residents in the video group provided a better akinesia score (12 [IQR, 10-12] vs 8 [IQR, 6-10]; P

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The Technology of Video Laryngoscopy.

Tracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms. However, it is quite possible that many airway managers do not have a thorough comprehension of how these devices actually function, an understanding that is vital not only for their use but also for assessing the devices' limitations. This article discusses the development of video laryngoscopy, how the video laryngoscope works, and the impact of video laryngoscopy on difficult airway management. (C) 2017 International Anesthesia Research Society

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You Will Never Walk Alone: A Simulation Experience for Caregiver's Family and Friends.

No abstract available

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General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy.

BACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear. METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of [beta]-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines. RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P

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Monte Carlo Simulations Comparing Fisher Exact Test and Unequal Variances t Test for Analysis of Differences Between Groups in Brief Hospital Lengths of Stay.

BACKGROUND: We examined type I and II error rates for analysis of (1) mean hospital length of stay (LOS) versus (2) percentage of hospital LOS that are overnight. These 2 end points are suitable for when LOS is treated as a secondary economic end point. METHODS: We repeatedly resampled LOS for 5052 discharges of thoracoscopic wedge resections and lung lobectomy at 26 hospitals. RESULTS: Unequal variances t test (Welch method) and Fisher exact test both were conservative (ie, type I error rate less than nominal level). The Wilcoxon rank sum test was included as a comparator; the type I error rates did not differ from the nominal level of 0.05 or 0.01. Fisher exact test was more powerful than the unequal variances t test at detecting differences among hospitals; estimated odds ratio for obtaining P

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Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.

BACKGROUND: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria. METHODS: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39). The maternal mortality ratio for AFE was calculated. We applied the structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation to AFE-related maternal deaths identified by the national experts committee. Characteristics of women, pregnancies and deliveries; clinical and biological features of AFE; and specific laboratory tests used were described by the presence or not of all 4 diagnostic criteria. Management of obstetric hemorrhage and quality of care according to the experts were also described. RESULTS: The maternal mortality ratio from AFE was 0.95/100,000 live births (95% confidence interval, 0.67-1.3). Detailed clinical data were collected for 36 women who died from AFE: 21 (58%) had all 4 proposed diagnostic criteria and 15 (42%) had 1 or more missing criterion. Documented early disseminated intravascular coagulopathy was missing for 14 women, and 2 women exhibited more than 1 missing criterion. Ten of the 15 women with missing criteria had clinical coagulopathy, with standard hemostasis tests performed in only 3. Specific diagnostic examinations for AFE were performed in similar proportions by the presence or not of all diagnostic criteria. Opportunities to improve care included timely performance of indicated hysterectomy (n = 13) and improved transfusion practices (n = 9). In the context of maternal cardiac arrest, for 5 of 13 women, fetal extraction was performed within 5 minutes. CONCLUSIONS: The structured definition of AFE for research studies would exclude more than one-third of AFE-related maternal deaths identified by the national experts committee. Inclusion of clinical coagulopathy as a diagnostic criterion for AFE would reduce this proportion to 14%. There is still room for improvement in the management of obstetric hemorrhage and timely fetal extraction in the context of maternal cardiac arrest, frequently observed in AFE-related maternal death. (C) 2017 International Anesthesia Research Society

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70th World Health Assembly, Geneva, Switzerland.

No abstract available

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Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics.

BACKGROUND: To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. METHODS: We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. RESULTS: The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P

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Tumefactive Demyelinating Lesions(TDLs): A Case series of clinicoradiological features

Publication date: Available online 29 September 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Rajendra Singh Jain, Ibraheem Khan, Kapil Kandelwal, Tushar Desai
ObjectiveDiagnosis of tumefactive demyelination lesions(TDLs) is challenging to neurophysician, neuroradiologist or neurosurgeon. Our objective in this study was to analyze clinicoradiological features of TDLs.Patients and MethodA retrospective analysis with prospective follow-up of 11 cases of TDLs was performed. Study was conducted in the neurology department of a tertiary care centre of North-West India from August 2014 to March 2017. MRI of brain and cervical spine with contrast, visual evoked potential, oligoclonal bands, serum anti-AQP4 antibody and MRS performed in most of the patients.ResultsMean age of tumefactive demyelinating lesions was 19.63 years (10 –41) with male preponderance (M: F=1.4) and one of the patients was in a pediatric age group. Relapsing and demyelinating courses of disease, seizure and incomplete ring enhancement were found in 6 out of 11(54.5%), 4 out of 11 (36.3%) 3 out of 11(27.2) respectively. OCBs were positive in 4 out of 5 patients (80%).ConclusionRecognition of atypical presentation or clinicoradiological features would aid in diagnosis along with visual evoked potential, oligoclonal bands and responsiveness to steroids may obviate the need for invasive procedure like brain biopsy.



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Patient Adherence to Dysphagia Recommendations: A Systematic Review

Abstract

Patient adherence to treatment recommendations is an important issue for healthcare providers, in a multitude of specialties, and is critical when assessing the efficacy and effectiveness of a particular treatment approach. Patients who have swallowing impairment often require complex and specific interventions requiring altered daily patterns of behavior. Patients with dysphagia who do not follow recommendations or prescribed exercises may not receive maximum benefit of an intervention. Poor adherence also makes it more difficult to evaluate efficacy of a treatment both clinically and in experimental settings. Further, swallow safety can be compromised if certain recommendations are not followed. Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment. We systematically identified 12 studies that tracked and reported patient-specific adherence. In this review, we found that the average adherence rate from these studies ranges between 21.9 and 51.9%. Adherence to prophylactic treatment recommendations for patients with head and neck cancer was the focus in 9/12 studies. The findings of this review identify a large gap in knowledge regarding adherence to dysphagia treatment. Few studies account for adherence within their study designs. When planning dysphagia treatment studies, it is imperative that investigators include information regarding patient adherence to accurately interpret findings. Given the variable adherence rates found in this review, factors influencing patient adherence with dysphagia treatments should be identified to increase adherence in future trials.

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Feasibility of a Mobile Application to Enhance Swallowing Therapy for Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer

Abstract

Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.

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Anatomical topography of the inferior lumbar triangle for transversus abdominis block: comment on the article by Chatzioglou et al.

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Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement

Ultrasonograpic retrobulbar optic nerve sheath diameter (ONSD) measurement is considered to be an alternative noninvasive method to estimate intracranial pressure,but the further validation is urgently needed....

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Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of >=4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/1hexVwJ Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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