The biomechanical coordination during oropharyngeal swallowing: an evaluation with a non-invasive sensing system.

The biomechanical coordination during oropharyngeal swallowing: an evaluation with a non-invasive sensing system.

Sci Rep. 2017 Nov 09;7(1):15165

Authors: Li Q, Minagi Y, Ono T, Chen Y, Hori K, Fujiwara S, Maeda Y

Abstract
Swallowing is a very important and complex physiological behaviour. The dynamic of swallowing has created great interest as any procedural abnormality will result in dysphagia and even lower quality of life. However, a non-invasive evaluation of biomechanical coordination during oropharyngeal swallowing, which includes the activities of the tongue, the hyoid and swallowing-related muscles, has not yet been achieved. In the present study, we recruited fifteen subjects, and a non-invasive sensing system composed of a pressure sensor, a bend sensor, surface electrodes and a microphone was created to simultaneously monitor tongue pressure, hyoid motion, and surface EMG of swallowing-related muscles, as well as take sound recordings, when the subjects swallowed 5 ml of water. In addition to obtaining the durations of certain motor events, the considerable time (beginning, peak and ending time) of tongue pressure production, suprahyoid and infrahyoid muscle activity and hyoid motion were successfully measured. Moreover, the significant correlations between swallowing-related muscles, tongue pressure, and the hyoid were confirmed. These findings suggest that the non-invasive sensing system has potential as a good candidate for monitoring and evaluating the oropharyngeal process of swallowing, which may be useful in clinical work involving dysphagia evaluation and rehabilitation.

PMID: 29123186 [PubMed - in process]

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Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly.

Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly.

Eur Arch Otorhinolaryngol. 2017 Nov 09;:

Authors: de Lima Alvarenga EH, Dall'Oglio GP, Murano EZ, Abrahão M

Abstract
OBJECTIVES: To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES).
MATERIALS AND METHODS: One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity.
RESULTS: Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003).
CONCLUSIONS: Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.

PMID: 29124360 [PubMed - as supplied by publisher]

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Letter to the editor on the article "Saccular measurements in routine MRI can predict hydrops in Ménière's disease" by Simon F et al.

Letter to the editor on the article "Saccular measurements in routine MRI can predict hydrops in Ménière's disease" by Simon F et al.

Eur Arch Otorhinolaryngol. 2017 Nov 09;:

Authors: Dominguez P, Naganawa S

PMID: 29124359 [PubMed - as supplied by publisher]

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Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis

Abstract

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea–hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.

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The association between diabetes and olfactory function in adults.

The association between diabetes and olfactory function in adults.

Chem Senses. 2017 Nov 08;:

Authors: Chan JYK, García-Esquinas E, Ko OH, Tong MCF, Lin SY

Abstract
Diabetes is a significant chronic disease that in limited studies has been linked with olfactory dysfunction. We investigated the cross-sectional association between diabetes and olfactory dysfunction in 3,151 adults aged ≥40 years who participated in NHANES 2013-2014 with information on olfactory dysfunction and diabetes. Diabetes was defined from fasting serum glucose ≥126 mg/dl, oral glucose tolerance test ≥200 mg/dl, HbA1c levels ≥6.5%, physician-diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. Self-reported olfactory dysfunction was defined as a positive answer to any of the following questions: 1) "Have you had problem with smell in the past 12 months?"; 2) "Have you had a change in the ability to smell since age 25?", or 3) "Do you have phantom smells?". Participants were considered to have severe hyposmia or anosmia if they had <5 correct answers in the 8-item pocket smell test. Analyses were adjusted for the main confounders, including olfactory dysfunction risk factors. Compared to non-diabetics, diabetics under insulin treatment showed a higher prevalence of phantom odors (OR(95%CI): 2.42 (1.16; 5.06)) and a non- significant higher prevalence of severe hyposmia/anosmia (OR(95%CI): 1.57 (0.89; 2.78)). Amongst diabetics, there was a significant trend to severe hyposmia/anosmia for those on more aggressive treatments (OR (95%CI) including oral and insulin treatment compared to those who reported no use of drug treatment, respectively: 1.33 (0.60; 2.96) and 2.86 (1.28; 6.40); p trend 0.01. No association was observed between diabetes duration and prevalence of olfactory dysfunction.

PMID: 29126164 [PubMed - as supplied by publisher]

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Characterization of Whole Grain Pasta: Integrating Physical, Chemical, Molecular, and Instrumental Sensory Approaches.

Characterization of Whole Grain Pasta: Integrating Physical, Chemical, Molecular, and Instrumental Sensory Approaches.

J Food Sci. 2017 Nov;82(11):2583-2590

Authors: Marti A, Cattaneo S, Benedetti S, Buratti S, Abbasi Parizad P, Masotti F, Iametti S, Pagani MA

Abstract
The consumption of whole-grain food-including pasta-has been increasing steadily. In the case of whole-grain pasta, given the many different producers, it seems important to have some objective parameters to define its overall quality. In this study, commercial whole-grain pasta samples representative of the Italian market have been characterized from both molecular and electronic-senses (electronic nose and electronic tongue) standpoint in order to provide a survey of the properties of different commercial samples. Only 1 pasta product showed very low levels of heat damage markers (furosine and pyrraline), suggesting that this sample underwent to low temperature dry treatment. In all samples, the furosine content was directly correlated to protein structural indices, since protein structure compactness increased with increasing levels of heat damage markers. Electronic senses were able to discriminate among pasta samples according to the intensity of heat treatment during the drying step. Pasta sample with low furosine content was discriminated by umami taste and by sensors responding to aliphatic and inorganic compounds. Data obtained with this multidisciplinary approach are meant to provide hints for identifying useful indices for pasta quality.
PRACTICAL APPLICATION: As observed for semolina pasta, objective parameters based on heat-damage were best suited to define the overall quality of wholegrain pasta, almost independently of compositional differences among commercial samples. Drying treatments of different intensity also had an impact on instrumental sensory traits that may provide a reliable alternative to analytical determination of chemical markers of heat damage in all cases where there is a need for avoiding time-consuming procedures.

PMID: 29125640 [PubMed - in process]

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An Investigation into Spike-Based Neuromorphic Approaches for Artificial Olfactory Systems.

An Investigation into Spike-Based Neuromorphic Approaches for Artificial Olfactory Systems.

Sensors (Basel). 2017 Nov 10;17(11):

Authors: Vanarse A, Osseiran A, Rassau A

Abstract
The implementation of neuromorphic methods has delivered promising results for vision and auditory sensors. These methods focus on mimicking the neuro-biological architecture to generate and process spike-based information with minimal power consumption. With increasing interest in developing low-power and robust chemical sensors, the application of neuromorphic engineering concepts for electronic noses has provided an impetus for research focusing on improving these instruments. While conventional e-noses apply computationally expensive and power-consuming data-processing strategies, neuromorphic olfactory sensors implement the biological olfaction principles found in humans and insects to simplify the handling of multivariate sensory data by generating and processing spike-based information. Over the last decade, research on neuromorphic olfaction has established the capability of these sensors to tackle problems that plague the current e-nose implementations such as drift, response time, portability, power consumption and size. This article brings together the key contributions in neuromorphic olfaction and identifies future research directions to develop near-real-time olfactory sensors that can be implemented for a range of applications such as biosecurity and environmental monitoring. Furthermore, we aim to expose the computational parallels between neuromorphic olfaction and gustation for future research focusing on the correlation of these senses.

PMID: 29125586 [PubMed - in process]

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Chemotaxis to self-generated AI-2 promotes biofilm formation in Escherichia coli.

Chemotaxis to self-generated AI-2 promotes biofilm formation in Escherichia coli.

Microbiology. 2017 Nov 09;:

Authors: Jani S, Seely AL, Peabody V GL, Jayaraman A, Manson MD

Abstract
Responses to the interspecies quorum-sensing signal autoinducer-2 (AI-2) regulate the patterns of gene expression that promote biofilm development. Escherichia coli also senses AI-2 as a chemoattractant, a response that requires the periplasmic AI-2-binding protein LsrB and the chemoreceptor Tsr. Here, we confirm, as previously observed, that under static conditions highly motile E. coli cells self-aggregate and form surface-adherent structures more readily than cells lacking LsrB and Tsr, or than ΔluxS cells unable to produce AI-2. This difference is observed both at 37 and 30 °C. Cells deleted for the genes encoding the lsrACDBFG operon repressor (ΔlsrR), or the AI-2 kinase (ΔlsrK), or an AI-2 uptake channel protein (ΔlsrC), or an AI-2 metabolism enzyme (ΔlsrG) are also defective in biofilm formation. The Δtsr and ΔlsrB cells are totally defective in AI-2 chemotaxis, whereas the other mutants show normal or near-normal chemotaxis to external gradients of AI-2. These data demonstrate that chemotaxis to external AI-2 is necessary but not sufficient to induce the full range of density-dependent behaviours that are required for optimal biofilm formation. We also demonstrate that, compared to other binding-protein-dependent chemotaxis systems in E. coli, low levels (on the order of ~250 molecules of periplasmic LsrB per wild-type cell and as low as ~50 molecules per cell in some mutants) are adequate for a strong chemotaxis response to external gradients of AI-2.

PMID: 29125461 [PubMed - as supplied by publisher]

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Transforming growth factor-β1 decreases epithelial tight junction integrity in chronic rhinosinusitis with nasal polyps

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jian Jiao, Ming Wang, Su Duan, Yifan Meng, Na Meng, Ying Li, Erzhong Fan, Cezmi Akdis, Luo Zhang




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Autoinflammatory phenotypes in Aicardi-Goutières syndrome with interferon upregulation and serological autoimmune features

Publication date: Available online 11 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuji Sugawara, Kohsuke Imai, Ayako Kashimada, Kengo Moriyama, Shimpei Baba, Ryuta Nishikomori, Mizuho Motegi, Yasuo Takeuchi, Tomohiro Morio
In an Aicardi-Goutières syndrome patient, cimetidine successfully controlled periodic fever with improved serum autoimmune marker levels, suggesting the presence of crosstalk between autoinflammation and autoimmunity in type I interferonopathy.



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Allergy terminology: towards a common language and shared understanding

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael Levin
Terminology that is used in an inconsistent and ambiguous way by allergists includes the term "cross reactivity" and the use of the word "positive" when referring to allergy tests. This may have serious potential for miscommunication and adversely affect patient care.



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Title: Experimental Asthma Persists in IL33 Receptor Knockout Mice Due to the Emergence of a TSLP-driven IL9+ and IL13+ ILC2 subpopulations

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Mukesh Verma, Sucai Liu, Lidia Michalec, Anand Sripada, Magdalena M. Gorska, Rafeul Alam
BackgroundIL33 plays an important role in development of experimental asthma.ObjectiveTo study the role of the IL33 receptor (ST2) in persistence of asthma in a mouse model.MethodsWe studied allergen-induced experimental asthma in ST2 knockout (KO) and wild-type control mice. We measured airway hyperresponsiveness (AHR) by flexivent, inflammatory indices by ELISA, histology and real-time PCR, and ILC2s in lung single cell preparations by flow cytometry.ResultsThe AHR level was elevated in allergen-treated ST2 KO mice and was comparable to that from allergen-treated WT controls. Peribronchial and perivascular inflammation and mucus production were largely similar in both groups. Persistence of experimental asthma in ST2 KO mice was associated with an increase in the level of TSLP, IL9 and IL13 but not IL5 in bronchoalveolar lavage (BAL). ST2 deletion expectedly caused a reduction in IL13+ CD4 T cells, Foxp3+ Tregs and IL5+ ILC2s. Unexpectedly, ST2 deletion led to an overall increase in ILCs (CD45+lin-CD25+ cells), IL13+ ILC2s, the emergence of a TSLP-R+ IL9+ ILC2 population and an increase in intraepithelial mast cells in the lung. An anti-TSLP antibody abrogated AHR, inflammation and mucus production in allergen-treated ST2 KO mice. It also caused a reduction in ILCs, ILC2s, and IL9+ and IL13+ ILC2s in the lung.ConclusionsGenetic deletion of the IL33 receptor paradoxically increases TSLP production, which stimulates the emergence of IL9+ and IL13+ ILC2s and mast cells, and leads to the development of chronic experimental asthma. An anti-TSLP antibody abrogates all pathologic features of asthma in this model.



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The XTEND-CIU study: long term use of Omalizumab in Chronic Idiopathic Urticaria

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcus Maurer, Allen Kaplan, Karin Rosén, Michael Holden, Ahmar Iqbal, Benjamin L. Trzaskoma, Ming Yang, Thomas B. Casale
These data support omalizumab safety and efficacy in patients with antihistamine-resistant CIU/CSU to 48 weeks and provide evidence of omalizumab re-treatment efficacy and safety.



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Breastfeeding and risk of asthma, hay fever and eczema

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ek. Weronica E, Karlsson Torgny, Azuaje Hernandez Carlos, Rask-Andersen Mathias, Johansson Åsa




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Influenza-derived peptides cross-react with allergens and provide asthma protection

Publication date: Available online 10 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Chrysanthi Skevaki, Christoph Hudemann, Mikhail Matrosovich, Christian Möbs, Sinu Paul, Andreas Wachtendorf, Bilal Alashkar Alhamwe, Daniel P. Potaczek, Stefanie Hagner, Diethard Gemsa, Holger Garn, Alessandro Sette, Harald Renz
BackgroundThe hygiene hypothesis is the leading concept to explain the current asthma epidemic, which is built on the observation that a lack of bacterial contact early in life induces allergic Th2 immune responses.ObjectiveSince little is known about the contribution of respiratory viruses in this context, we evaluated the effect of prior influenza-infection on the development of allergic asthma.MethodsMice were infected with influenza and once recovered, subjected to an ovalbumin or house dust mite-induced experimental asthma protocol. Influenza-polarized T effector memory cells (Tem) were adoptively transferred to allergen sensitized animals prior to allergen challenge. A comprehensive in silico analysis assessed homologies between virus- and allergen- derived proteins. Influenza-polarized Tem cells were stimulated ex vivo with candidate peptides. Mice were immunized with a pool of virus-derived T-cell epitopes.ResultsWe found in two murine models a long-lasting preventive effect against experimental asthma features. Protection could be attributed about equally to CD4+ and CD8+ T-effector memory (Tem) cells from influenza-infected mice. An in silico bioinformatic analysis identified four influenza and three allergen-derived MHC-class I and –class II candidate T-cell epitopes with potential antigen-specific cross-reactivity between influenza and allergens. Lymphocytes from influenza-infected mice produced IFNγ and IL-2 but not IL-5 upon stimulation with the aforementioned peptides. Immunization with a mixture of the influenza-peptides conferred asthma protection, and peptide immunized mice transferred protection via CD4+ and CD8+ Tem cells.ConclusionOur results illustrate for the first time heterologous immunity of virus-infected animals towards allergens. This finding extends the original hygiene hypothesis.



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The Effect of Polyethylene Glycol (PEG) Modification on Fe Dispersal and the Catalytic Degradation of Phenol Wastewater

Abstract

Modification of a catalyst with polyethylene glycol (PEG) created a dramatic increase in the catalytic activity for the degradation of phenol wastewater. The Fe/PEG-modified γ-Al₂O₃ catalyst was prepared by an impregnation method. The as-prepared catalyst was characterized by X-ray photoelectron spectroscopy, wide- and small-angle X-ray diffraction, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and N₂ adsorption-desorption experiments, and the results showed that the Fe species were highly dispersed on the surface of the PEG-modified support. At the same time, the PEG modification resulted in an increase in the Brunauer-Emmett-Teller surface area and pore volume. The catalytic activity test showed that the Fe/PEG-modified γ-Al₂O₃ catalyst exhibited a superior performance for the degradation of phenol wastewater in this study, and the phenol and COD removal values reached 94.1 and 88.9%, respectively, within 60 min. The results clearly show that PEG modification is a promising methodology for the preparation of a catalyst with good dispersal of the active component on the support.

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Physical and chemical properties of model composites containing quaternary ammonium methacrylates

Publication date: Available online 10 November 2017
Source:Dental Materials
Author(s): Marina Lermenn Vidal, Guilherme Ferreira Rego, Gil Mendes Viana, Lucio Mendes Cabral, Juliana Primo Basílio Souza, Nick Silikas, Luis Felipe Schneider, Larissa Maria Cavalcante
ObjectiveInvestigate physical and chemical properties of model composites formulated with quaternary ammonium salt monomers (QAS) at different concentrations and alkyl chains lengthsMethodsQAS with 12 dimethylaminododecyl methacrylate (DMADDM) and 16 dimethylaminohexadecyl methacrylate (DMAHDM) chains lengths were synthesized and incorporated at 5 and 10% in model composites, resulting in four groups: G12.5 (DMADDM 5%), G12.10 (DMADDM 10%), G16.5 (DMAHDM 5%), G16.10 (DMAHDM 10%). One group was used as control group (CG 0%). Degree of conversion (DC); water sorption (WS) and solubility (SL); hygroscopic expansion (HE); degradation temperature (DT); glass transition temperature (Tg) and polymerization shrinkage (PS) were determined. Knoop hardness (KNH), flexural strength (FS) and elastic modulus (EM) were measured before and after storage Data were submitted to ANOVA and Tukey's test (p≤0.05).ResultsDC ranged between 76.1 (G12.10) and 70.7 (G16.5) %; CG had the lowest WS, SL and HE. There was no statistical difference for PS and FS. KHN values ranged between 30.2 (GC) and 25 (G16.10) and after storage the performance was depended on QAS concentration and chain length. For EM, CG had the highest values before and after storage and no difference was observed in the QAS groups before storage. After storage, the results were dependent on QAS concentration (3.5-4.3GPa).SignificanceIn general, the addition of QAS increased composite's degradation compared with the CG. In the tested QAS, the addition of DMADDM at 5% concentration resulted in a less degradable material.



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Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3-7 year results - A retrospective cohort study.

Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3-7 year results - A retrospective cohort study.

Int J Surg. 2017 Nov 06;:

Authors: Garg H, Aggarwal S, Misra MC, Priydarshini P, Swami A, Kashyap L, Jaiswal R

Abstract
INTRODUCTION: Few studies have addressed the mid to long term impact of Laparoscopic Sleeve Gastrectomy (LSG) on weight loss and obesity associated co-morbidities, particularly in Indian population. The aim of this study is to assess the efficacy of LSG in morbid obesity over 3-7 years follow up.
MATERIALS AND METHODS: Data of all patients who underwent LSG between January 2008 and March 2015 and completed their at least 1 year follow up till March 2016 was retrospectively reviewed using a prospectively collected database.
RESULTS: 424 patients undergoing primary LSG were included. The mean age (±2SD) was 39.8 ± 22.5 years and the mean Body Mass Index (BMI) (±2SD) was 46.67 ± 15.8 kg/m(2). 124 patients (29.2%) were super-obese (BMI >50 kg/m(2)). The percentage follow-up at 1 year, 3 years, 5 years and 7 years was 78.3%, 66.7%, 42.3% and 38.4% respectively. The mean percentage Excess weight Loss (%EWL) (±2SD) at 1year, 3years, 5years, and 7years was 71.8 (±50.5%), 64.95% (±41.8%), 61.7% (±46.2%) and 57.15% (±50.2%) respectively. The preoperative BMI significantly correlated with %EWL at 5 year (r(2) = 0.107, p = 0.018). The overall complication rate was 5.8%. Early complications included staple line leak (1.2%), bleeding (1.2%), deep venous thrombosis (0.4%) and 30-day mortality (0.21%). Late complications included stricture formation (0.21%) and new onset Gastro-esophageal Reflux Disease (GERD) (2.8%).At 5 years, 83.3% of diabetic patients showed remission while rest showed improvement in glycemic control with decrease in dosage. 69.3% patients showed improvement in hypertension, 100% patients showed improvement in Obstructive Sleep Apnea Syndrome, 75% patients showed improvement in hypothyroidism after surgery. GERD resolved in 62.8% patients while worsened in 11.4% patients.
CONCLUSIONS: LSG has durable weight loss at 5 year with %EWL of 61% and significant resolution of obesity associated co-morbidities.

PMID: 29122706 [PubMed - as supplied by publisher]

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Posturographic pattern of patients with chronic subjective dizziness before and after vestibular rehabilitation.

Posturographic pattern of patients with chronic subjective dizziness before and after vestibular rehabilitation.

J Vestib Res. 2017 Nov 10;:

Authors: Morisod B, Mermod M, Maire R

Abstract
INTRODUCTION: Chronic subjective dizziness (CSD) is frequently encountered in neurotology clinics. This diagnosis is mainly clinical, but computerized dynamic posturography (CDP) could be a helpful instrumental tool in the identification of these patients and validation of the treatment. This study was aimed to look for a specific posturographic pattern among patients diagnosed with CSD, and to eventually visualize improvement after vestibular rehabilitation.
METHODS: Single center, retrospective review from 2009 to 2014. We included patients diagnosed with CSD who underwent CDP in their neurotologic assessment. For those patients who benefited from vestibular rehabilitation, we compared their pre- and post-rehabilitation posturographies.
RESULTS: We included 114 patients, of whom 74% had known anxiety disorders and 33% a history of past vestibular disorder. 62% of the assessment posturographies were abnormal. The most affected sub-items were limit of stability, composite score of sensory organization tests and condition 5 in respectively 34%, 23% and 20% of the cases. In univariate analysis, only pathologic videonystagmography and history of unilateral vestibular dysfunction were significantly related to abnormal posturography. In the 42 patients who had vestibular rehabilitation and a post rehabilitation posturography, the proportion of abnormal posturography significantly dropped from 79% to 33% (p < 0.001). When it was assessed, 79% of the patients reported a subjective improvement.
CONCLUSION: Patients with CSD have a high rate of abnormal posturography, but without a specific pattern. Vestibular rehabilitation is an effective tool in the therapeutic armamentarium.

PMID: 29125531 [PubMed - as supplied by publisher]

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The impact of symptoms of anxiety and depression on subjective and objective outcome measures in individuals with vestibular disorders.

The impact of symptoms of anxiety and depression on subjective and objective outcome measures in individuals with vestibular disorders.

J Vestib Res. 2017 Nov 10;:

Authors: MacDowell SG, Trommelen R, Bissell A, Knecht L, Naquin C, Karpinski A

Abstract
BACKGROUND: Anxiety and depression are common in individuals with vestibular disorders and anecdotally symptoms of these disorders have been associated with poorer scores on subjective outcome measures of dizziness and balance. It is unknown if symptoms of psychological distress impact individual outcomes with vestibular rehabilitation therapy (VRT).
OBJECTIVE: To compare subjective and objective outcome measures in subjects with vestibular disorders who have symptoms of anxiety and/or depression to those who do not exhibit those symptoms.
METHODS: A retrospective chart review was performed at two outpatient vestibular rehabilitation clinics. Data recorded included demographics, scores on the Positive and Negative Affective Scale (PANAS), and subjective and objective outcome measures of balance and gait.
RESULTS: The PANAS scale was utilized to group subjects (N = 118) into two groups: Subjects with abnormal affect (SAA) (18.6%; N = 22) and subjects with normal affect (SNA) (81.4%; N = 96). Both groups demonstrated a statistically significant improvement in all outcome measures (p < 0.001) from evaluation to discharge. SAA subjects took longer than SNA subjects to achieve goals (p < 0.05). SAA subjects tended to have poorer outcome measure scores at both initial and final assessment, but this was not statistically significant (p > 0.05).
CONCLUSIONS: Results from this study indicate that VRT is effective in treating vestibular disorders in individuals with symptoms of psychological distress such as anxiety and depression. However, individuals with these symptoms may not achieve as high of outcomes as those that do not report symptoms of psychological distress.

PMID: 29125530 [PubMed - as supplied by publisher]

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PRMT1 promotes hyperglycemia in a FoxO1-dependent manner, affecting glucose metabolism, during hypobaric hypoxia exposure, in rat model

Abstract

Purpose

High-altitude (HA) environment causes changes in cellular metabolism among unacclimatized humans. Previous studies have revealed that insulin-dependent activation of protein kinase B (Akt) regulates metabolic processes via discrete transcriptional effectors. Moreover, protein arginine methyltransferase (PRMT)1-dependent arginine modification of forkhead box other (FoxO)1 protein interferes with Akt-dependent phosphorylation. The present study was undertaken to test the involvement of PRMT1 on FoxO1 activation during hypobaric hypoxia (HH) exposure in rat model.

Methods

Samples were obtained from normoxia control (NC) and HH-exposed (H) rats, subdivided according to the duration of HH exposure. To explore the specific role played by PRMT1 during HH exposure, samples from 1d pair-fed (PF) NC, 1d acute hypoxia-exposed (AH) placebo-treated, and 1d AH TC-E-5003-treated rats were investigated. Quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed to determine expressions of glycolytic, gluconeogenic enzymes, and insulin response regulating genes. Immuno-blot and enzyme linked immunosorbent assay (ELISA) were used for insulin response regulating proteins. Nuclear translocation of FoxO1 was analyzed using deoxyribonucleic acid (DNA)-binding ELISA kit.

Results

We observed HH-induced increase in glycolytic enzyme expressions in hepatic tissue unlike hypothalamic tissue. PRMT1 expression increased during HH exposure, causing insulin resistance and resulting increase in FoxO1 nuclear translocation, leading to hyperglycemia. Conversely, PRMT1 inhibitor treatment promoted inhibition of FoxO1 activity and increase in glucose uptake during HH exposure leading to reduction in blood-glucose and hepatic glycogen levels.

Conclusions

PRMT1 might have a potential importance as a therapeutic target for the treatment of HH-induced maladies.

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Acute radiology rarely confirms sinus disease in suspected recurrent acute rhinosinusitis.

Acute radiology rarely confirms sinus disease in suspected recurrent acute rhinosinusitis.

Am J Rhinol Allergy. 2017 Nov 01;31(6):420

Authors: Amedee RG

PMID: 29122089 [PubMed - in process]

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Factors that contribute to disagreement in satisfaction between surgeons and patients after corrective septorhinoplasty.

Factors that contribute to disagreement in satisfaction between surgeons and patients after corrective septorhinoplasty.

Am J Rhinol Allergy. 2017 Nov 01;31(6):416-419

Authors: Kim JY, Cha MJ, Kwon SS, Kim DK

Abstract
BACKGROUND: Corrective septorhinoplasty is one of the most common facial plastic surgeries. However, surgeons and patients sometimes disagree about postoperative-outcome satisfaction after corrective septorhinoplasty.
OBJECTIVE: We investigated the factors that influenced the disagreement in satisfaction between surgeons and patients after corrective septorhinoplasty.
METHODS: Surgeon satisfaction was assessed by other plastic surgeons by comparing patient photographs taken at the preoperative and 12-month postoperative periods. Patient satisfaction was assessed by the Rhinoplasty Outcome Evaluation Questionnaire (ROEQ) before surgery and 12 months after surgery. The dissatisfied group was defined as showing a negative change or no change in the ROEQ quartile between baseline and 12 months after surgery.
RESULTS: A total of 70 patients were included. No significant differences were observed between the satisfied and dissatisfied groups in sex, marital status, depression history, and major anesthetic problems. However, the dissatisfied group was significantly younger, more likely to be employed, and better educated than the satisfied group. In addition, a multivariate logistic regression analysis indicated that being highly educated was a predictor of disagreement in satisfaction between surgeons and patients.
CONCLUSION: Our findings indicated that highly educated patients who underwent corrective septorhinoplasty required more detailed preoperative guidance, including more complete information on the limitations of the surgery.

PMID: 29122088 [PubMed - in process]

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Comparison of two concentrations of triamcinolone injection in the prevention of supratip edema after external rhinoplasty: A randomized trial.

Comparison of two concentrations of triamcinolone injection in the prevention of supratip edema after external rhinoplasty: A randomized trial.

Am J Rhinol Allergy. 2017 Nov 01;31(6):412-415

Authors: Saedi B, Amali A, Arabpor M

Abstract
BACKGROUND: A comparison of the two methods of corticosteroid (triamcinolone) use in reducing supratip edema (pollybeak deformity) after rhinoplasty.
METHODS: Ninety patients who were candidates for rhinoplasty were randomly divided into three groups. Group A received no treatment, group B received 8 mg/mL of triamcinolone, and group C received 16 mg/mL of triamcinolone. Their effects on dorsal edema were evaluated by using the patients' and surgeons' visual analog scale scores. Also, dorsal edema was measured by using photo editing software.
RESULTS: There was no significant difference in the patients' characteristics in the study groups. The surgeons' visual analog scale scores were significantly better in those patients who received triamcinolone injection than in the control group (p = 0.02). However, none of the other assessment methods showed significant differences among the study groups. There was no significant difference between the two evaluated concentrations.
CONCLUSION: Triamcinolone injection had positive temporary effects on reducing supratip edema without any important complications.

PMID: 29122087 [PubMed - in process]

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Endonasal endoscopic management of frontal sinus cerebrospinal fluid leak.

Endonasal endoscopic management of frontal sinus cerebrospinal fluid leak.

Am J Rhinol Allergy. 2017 Nov 01;31(6):406-411

Authors: Jahanshahi J, Zeinalizadeh M, Reza Mohammadi H, Sadrehosseini SM

Abstract
BACKGROUND: A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome.
OBJECTIVE: To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach.
METHODS: Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated.
RESULTS: Among >100 cases of surgically repaired CSF rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Free autografts as two-layer inlay fat-muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients.
CONCLUSION: Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

PMID: 29122086 [PubMed - in process]

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Influence of chitosan-based dressing on prevention of synechia and wound healing after endoscopic sinus surgery: A meta-analysis.

Influence of chitosan-based dressing on prevention of synechia and wound healing after endoscopic sinus surgery: A meta-analysis.

Am J Rhinol Allergy. 2017 Nov 04;31(6):401-405

Authors: Liu J, Zeng Q, Ke X, Yang Y, Hu G, Zhang X

Abstract
INTRODUCTION: Endoscopic sinus surgery (ESS) has had many complications, e.g., synechia formation. This meta-analysis investigated the effect of a novel chitosan-based dressing on prevention of synechia and wound healing after ESS.
METHODS: We systematically searched various medical literature data bases and included the randomized controlled trials (RCT) regarding the effect of novel chitosan-based dressing on ESS. The study outcomes included synechia, granulations, hemostasis, crusting scores, and infection.
RESULTS: Six RCTs, which involved 337 patients, were included in the meta-analysis. Compared with control intervention after ESS, chitosan-based gel dressing substantially inhibited synechia (risk ratio [RR] 0.28 [95% confidence interval {CI}, 0.15-0.54]; p = 0.0001), improved granulations (RR 1.47 [95% CI, 1.07-2.03]; p = 0.02), and hemostasis (RR 1.47 [95% CI, 1.07-2.03]; p = 0.02) but demonstrated no effect on crusting scores (standard mean difference -0.41 [95% CI, -1.06 to 0.23]; p = 0.21) and infection (RR 0.88 [95% CI, 0.51-1.52]; p = 0.64).
CONCLUSION: Compared with control intervention, chitosan-based dressing was associated with significantly reduced synechia and with increased granulations and hemostasis but showed no influence on crusting and infection after ESS.

PMID: 29122085 [PubMed - in process]

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Vitamin D₃ deficiency and its association with nasal polyposis in patients with cystic fibrosis and patients with chronic rhinosinusitis.

Vitamin D₃ deficiency and its association with nasal polyposis in patients with cystic fibrosis and patients with chronic rhinosinusitis.

Am J Rhinol Allergy. 2017 Nov 01;31(6):395-400

Authors: Konstantinidis I, Fotoulaki M, Iakovou I, Chatziavramidis A, Mpalaris V, Shobat K, Markou K

Abstract
BACKGROUND: Currently vitamin D3 (VD3) or cholecalciferol is considered an immunomodulator that may be implicated in nasal polyposis (NP) pathophysiology.
OBJECTIVES: This study aimed to investigate if deficiency of VD3 is associated with the presence of NP in patients with cystic fibrosis (CF) and patients with chronic rhinosinusitis (CRS).
METHODS: In total, 152 adult participants were included in five phenotypic groups: CF with NP (CFwNP) (n = 27), CF without NP (CFsNP) (n = 31), CRS with NP (CRSwNP) (n = 32), CRS without NP (CRSsNP) (n = 30), and controls (n = 32). The serum levels of 25(OH)-VD3 < 20 ng/mL are considered as a deficiency, 21-29 ng/mL as insufficiency, and >30 ng/mL as sufficiency. Endoscopic and imaging staging of the mucosal disease performed with the Lund-Kennedy (LK) and Lund-Mackay (LM) scoring systems, respectively. The genotype of the patients with CF and the nasal microbial colonization of the patients with CF and patients with CRS were also recorded.
RESULTS: The patients with CFwNP had the lowest percentage of sufficiency in VD3 and the highest percentage in insufficiency among all the groups. The LM imaging scores were inversely correlated with the VD3 levels in both arms of the study (CF and CRS). Moreover, the LK endoscopic scores had a similar correlation in the CF groups; however, this was not the case with the CRS groups. The genotype of the patients with CF was not correlated with the VD3 serum levels. The patients with positive microbial colonization (mainly Pseudomonas and Staphylococcus aureus) had significantly lower VD3 serum levels in both the CF and CRS process.
CONCLUSION: VD3 deficiency seemed to be associated with the presence of nasal polyps in the patients with CRS and in the patients with CF in a similar manner. The lower the level of serum VD3, the more severe the mucosal disease was found in the imaging studies and the more frequent microbial colonization of the patients with CF and the patients with CRS.

PMID: 29122084 [PubMed - in process]

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Biocompatibility and pharmacokinetics of fluticasone-eluting sinus implant in a rabbit model.

Biocompatibility and pharmacokinetics of fluticasone-eluting sinus implant in a rabbit model.

Am J Rhinol Allergy. 2017 Nov 01;31(6):382-388

Authors: Patel VS, Walgama E, Psaltis A, Lavigne F, Pletcher SD, Hwang PH

Abstract
BACKGROUND: A novel, bioabsorbable, fibrinogen-based implant has been developed as a mucosal dressing after endoscopic sinus surgery (ESS). This implant can be formulated with fluticasone propionate (FP) for local elution of corticosteroid to reduce postoperative inflammation and promote mucosal healing.
OBJECTIVE: This study investigated the biocompatibility and pharmacokinetics of the implant in a rabbit model.
METHODS: Implants with and without FP were placed on both intact and demucosalized maxillary sinuses of 33 New Zealand White rabbits. Sinuses with either intact or denuded bone without implants acted as controls. Histopathologic assessments were carried out at 5, 15, and 28 days. Concentrations of FP in the maxillary sinus mucosa, nasal cavity mucosa, and plasma were measured for up to 44 days.
RESULTS: Implants placed on intact mucosa or denuded bone were grossly integrated within 15 days. Minimal foreign body reaction was seen with negligible differences for inflammation, fibrosis, or bone remodeling among controls, sinuses with the implant, or sinuses with the implant plus FP, at all time points. All samples also showed complete or near-complete percentage reepithelialization at 28 days, although the denuded bone controls demonstrated greater percentage reepithelialization at 5 days compared with denuded bone with the implant or implant plus FP (p < 0.0001). The maxillary sinus mucosa demonstrated levels of FP of >140 ng/g up to 44 days. Plasma concentrations of FP were generally very low and were undetectable after day 7.
CONCLUSIONS: The implant and the implant plus FP seemed to be biocompatible in rabbits. The implant plus FP effectively eluted steroid locally over at least 44 days, with negligible plasma concentrations. Further studies are warranted regarding potential therapeutic applications in patients undergoing ESS for chronic rhinosinusitis.

PMID: 29122083 [PubMed - in process]

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The relationship between social determinants of health and utilization of tertiary rhinology care.

The relationship between social determinants of health and utilization of tertiary rhinology care.

Am J Rhinol Allergy. 2017 Nov 01;31(6):376-381

Authors: Samuelson MB, Chandra RK, Turner JH, Russell PT, Francis DO

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care.
METHODS: All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010-2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses.
RESULTS: A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80% white, 82% with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p < 0.001). Utilization rates were higher in ZIP codes with a lower proportion of minorities, a higher median income, and higher rates of private insurance and college education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4% higher for every 1% increase in college-educated population (coefficient 0.04 [95% CI, 0.01-0.07]; p = 0.01).
CONCLUSION: Results of this study indicated that some social determinants of health (race, income, educational level, insurance status) do affect utilization of tertiary rhinology services. Higher utilization among those with higher income and educational attainment are contradictory to the data, which indicated that lower socioeconomic status was associated with a higher CRS rate. Further study is required to understand the disparities in rhinology utilization rates.

PMID: 29122082 [PubMed - in process]

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Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery.

Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery.

Am J Rhinol Allergy. 2017 Nov 01;31(6):370-375

Authors: Azar A, Rank MA, Zarka MA, Chang YH, Lal D

Abstract
BACKGROUND: We previously presented that women with chronic rhinosinusitis (CRS) who elected endoscopic sinus surgery (ESS) have a higher symptom burden than men. Causes of these gender-based differences warranted further study.
OBJECTIVES: To study gender differences in another cohort of adult patients with CRS who underwent ESS and to compare key histopathologic and serologic features Methods: Patients with CRS who underwent ESS (from 2011 to 2014) with structured histopathology reports on surgical samples were studied. The 13-item structured histopathology report detailed key metrics of inflammation and the presence of fungal elements. Clinical, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Mackay computed tomography (CT) score, serologic (immunoglobulin E [IgE] level, absolute eosinophil count) and histopathologic data were compared between male and female patients by using statistical software.
RESULTS: We studied 130 eligible subjects (mean age, 54.7 years; 49.2% women). Compared with the men, the women had significantly higher preoperative SNOT-22 scores (women, 48.7; men 38.0 [p = 0.004]) but similar CT scores. Serum IgE levels were significantly higher among women versus men (peak, 433.3 versus 190.8 kU/L [p = 0.03]; closest to surgery, 435.0 versus 190.8 kU/L [p = 0.03]). Tissue fungal elements were significantly more prevalent in women versus men (19.0 versus 5.2%; p = 0.02). Up to this point, the analysis was agnostic of clinical details of the subjects. Further analysis was conducted regarding clinical features. Allergic fungal sinusitis (AFS) was found significantly more commonly in the female versus male patients (21.9 versus 9.1%; p = 0.04). Women versus men had a higher prevalence of migraine (19.4 versus 4.6%; p = 0.01) or any primary headache disorders (23.0 versus 6.2%; p = 0.007).
CONCLUSION: Women who underwent ESS for CRS had higher SNOT-22 symptom burden. Worsened symptomatology may be secondary to a higher prevalence of primary headache disorders in women. However, surgeons should also be aware that female patients with CRS who seek ESS may have a higher prevalence of severe disease endotypes (more tissue fungal elements, elevated serum IgE levels) and phenotypes.

PMID: 29122081 [PubMed - in process]

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Role of adenosine monophosphate-activated protein kinase on cell migration, matrix contraction, and matrix metalloproteinase-1 and matrix metalloproteinase-2 production in nasal polyp-derived fibroblasts.

Role of adenosine monophosphate-activated protein kinase on cell migration, matrix contraction, and matrix metalloproteinase-1 and matrix metalloproteinase-2 production in nasal polyp-derived fibroblasts.

Am J Rhinol Allergy. 2017 Nov 01;31(6):357-363

Authors: Um JY, Lee SA, Park JH, Shin JM, Park IH, Lee HM

Abstract
PURPOSE: Activation of adenosine monophosphate-activated protein kinase (AMPK) by metformin, as a master regulator of metabolism, is involved in airway tissue remodeling. Here, we investigated the physical role of AMPK on cell migration, matrix contraction, and the production of matrix metalloproteinases (MMP) in nasal polyp-derived fibroblasts (NPDF).
METHODS: Primary NPDFs from six patients with chronic rhinosinusitis and nasal polyps were isolated and cultured. To assess the effect of AMPK on fibroblast migration, we conducted scratch and migration assays in NPDF treated with metformin and/or compound C. A collagen gel contraction assay measured activity of contractile. MMP expression was measured with reverse transcription-polymerase chain reaction, Western blot, and zymography. To evaluate for specific AMPK action, we examined by AMPK small interfering RNA.
RESULTS: Metformin, an activator of AMPK, significantly inhibited cell migration in NPDFs in a dose-dependent manner. Compound C, an inhibitor of AMPK, partially reversed the inhibitory effect of metformin. Metformin also significantly decreased contractile activity, with a concomitant reduction in the production of MMP-1 and MMP-2 but not of MMP-9. Specific silencing that targeted AMPK resulted in the enhancement of mobility and contractility and in the production of MMP-1 and MMP-2.
CONCLUSION: AMPK played an important role in regulating cell migration, matrix contraction, and MMP production in NPDFs, which provided data that AMPK activator might be a therapeutic target for the prevention of tissue remodeling in nasal polyps.

PMID: 29122080 [PubMed - in process]

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Sinonasal T-cell expression of cytotoxic mediators granzyme B and perforin is reduced in patients with chronic rhinosinusitis.

Sinonasal T-cell expression of cytotoxic mediators granzyme B and perforin is reduced in patients with chronic rhinosinusitis.

Am J Rhinol Allergy. 2017 Nov 01;31(6):352-356

Authors: Smith SE, Schlosser RJ, Yawn JR, Mattos JL, Soler ZM, Mulligan JK

Abstract
BACKGROUND: CD8+ T cells and natural killer (NK) cells are cytotoxic cells that use granzyme B (GrB) and perforin. Defective cytotoxic function is known to play a role in dysregulated immune response as seen in chronic sinusitis, also referred to as chronic rhinosinusitis (CRS). However, to our knowledge, in the United States, neither GrB or perforin expression has been reported in patients with CRS.
OBJECTIVE: The aim of this study was to investigate sinonasal cytotoxic cells, their mediators, and cell-specific distribution of these mediators in patients with CRS with nasal polyp (CRSwNP) and in patients with CRS without nasal polyp (CRSsNP).
METHODS: Blood and sinus tissue samples were taken from patients with CRSsNP (n = 8) and CRSwNP (n = 8) at the time of surgery. Control subjects (n = 8) underwent surgery for cerebrospinal fluid leak repair or to remove non-hormone-secreting pituitary tumors. The cells were analyzed via flow cytometry by using CD8 expression to identify cytotoxic T cells and CD56 expression to identify NK cells. Intracellular GrB and perforin expression were analyzed with flow cytometry.
RESULTS: We observed no significant differences in plasma or peripheral blood immune cell numbers or specific levels of GrB or perforin among the groups. In the sinonasal mucosa of the patients with CRSsNP and the patients with CRSwNP, there was a significant decrease in GrB and perforin levels (p < 0.05) despite similar or increased numbers of cytotoxic cells when compared with the controls. The overall decrease in GrB and perforin in the sinonasal mucosa of the patients with CRSsNP and the patients with CRSwNP was due to decreased T cell production. There was no difference in total NK cell count or expression of perforin or GrB among all the groups.
CONCLUSION: Total levels of sinonasal GrB and perforin were decreased in the sinonasal mucosa of both the patients with CRSwNP and the patients with CRSsNP compared with the controls, whereas sinonasal CD8+ T cells, (but not NK cells,), intracellular stores of GrB and perforin were reduced in the patients with CRSwNP compared with the controls.

PMID: 29122079 [PubMed - in process]

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The role of regulatory T cells in the regulation of upper airway inflammation.

The role of regulatory T cells in the regulation of upper airway inflammation.

Am J Rhinol Allergy. 2017 Nov 01;31(6):345-351

Authors: Palmer C, Mulligan JK, Smith SE, Atkinson C

Abstract
Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are inflammatory diseases of the upper airway, with a similar immunologic profile, characterized by aberrant and persistent type 2 inflammation. One cell population that has been identified as altered in both disease types is regulatory T cell (Treg). Tregs have the capacity to modulate T-effector function and suppress inflammatory cytokine production in a broad range of cell types. Given the ability of Tregs to control inflammation, the role of Tregs in respiratory diseases has attracted much attention. As discussed in this article, alterations in the Treg numbers and function, or both, have been identified in AR and CRSwNP, although much of the data is conflicting. Here, we explored what is known and, in many cases, unknown about the mechanisms by which Tregs differentiate and function, and how these functions can be controlled in the mucosal microenvironment. By gaining a greater understanding of these processes, it may be possible to harness the natural immunosuppressive activity of Tregs to ameliorate the chronic inflammation associated with AR and CRSwNP.

PMID: 29122078 [PubMed - in process]

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Beyond borders and sinuses: Rhinology and allergy research on a world stage.

Beyond borders and sinuses: Rhinology and allergy research on a world stage.

Am J Rhinol Allergy. 2017 Nov 01;31(6):343-344

Authors: Psaltis AJ

PMID: 29122077 [PubMed - in process]

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A systematic review of secondary cerebrospinal fluid leaks.

A systematic review of secondary cerebrospinal fluid leaks.

Am J Rhinol Allergy. 2017 Nov 01;31(6):48-56

Authors: Konuthula N, Khan MN, Del Signore A, Govindaraj S, Shrivastava R, Iloreta AM

Abstract
BACKGROUND: Secondary cerebrospinal leaks (CSF) are leaks that recur after an initial endoscopic repair of CSF leaks. Identification of characteristics that could predict secondary leaks may allow surgeons to plan repairs with the knowledge that these defects are more likely to fail.
OBJECTIVE: To identify characteristics that could predict secondary CSF leaks.
METHODS: A search of all studies that reported outcomes after endoscopic repair of CSF leaks was conducted by using medical literature data bases. Studies with the following criteria were included: written in the English language, secondary CSF leaks after primary repair, and assessment of success of fistula repair. Data extracted included the etiology of the leak, site of the leak, reconstructive materials used, and success of the repair.
RESULTS: Ninety-four studies, from 1988 to 2015, with a total of 3149 primary CSF leaks were included. Sixty-three studies (67%) had a success rate of ≥80%; 77 studies (82%) had secondary leak rates of <40%. For 88 of the 94 studies (94%), the success rate after secondary repair improved to 81.0-100%. Of 48 studies that included leaks of more than one site, the sphenoid was the most common site of leak in 26 studies (55%), the ethmoid was the most common site in 16 studies (34%), and the cribriform was the most common site in 11 studies (23%).
CONCLUSION: The rate of secondary CSF leaks was low due to advances in endoscopic repair techniques. Spontaneous and iatrogenic CSF leaks were more likely to recur, especially without adequate control of underlying factors, such as increased intracranial pressure and obesity. Further studies with consistent reporting are required for more definitive conclusions about secondary CSF leaks.

PMID: 29122076 [PubMed - in process]

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PRMT1 promotes hyperglycemia in a FoxO1-dependent manner, affecting glucose metabolism, during hypobaric hypoxia exposure, in rat model

Abstract

Purpose

High-altitude (HA) environment causes changes in cellular metabolism among unacclimatized humans. Previous studies have revealed that insulin-dependent activation of protein kinase B (Akt) regulates metabolic processes via discrete transcriptional effectors. Moreover, protein arginine methyltransferase (PRMT)1-dependent arginine modification of forkhead box other (FoxO)1 protein interferes with Akt-dependent phosphorylation. The present study was undertaken to test the involvement of PRMT1 on FoxO1 activation during hypobaric hypoxia (HH) exposure in rat model.

Methods

Samples were obtained from normoxia control (NC) and HH-exposed (H) rats, subdivided according to the duration of HH exposure. To explore the specific role played by PRMT1 during HH exposure, samples from 1d pair-fed (PF) NC, 1d acute hypoxia-exposed (AH) placebo-treated, and 1d AH TC-E-5003-treated rats were investigated. Quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed to determine expressions of glycolytic, gluconeogenic enzymes, and insulin response regulating genes. Immuno-blot and enzyme linked immunosorbent assay (ELISA) were used for insulin response regulating proteins. Nuclear translocation of FoxO1 was analyzed using deoxyribonucleic acid (DNA)-binding ELISA kit.

Results

We observed HH-induced increase in glycolytic enzyme expressions in hepatic tissue unlike hypothalamic tissue. PRMT1 expression increased during HH exposure, causing insulin resistance and resulting increase in FoxO1 nuclear translocation, leading to hyperglycemia. Conversely, PRMT1 inhibitor treatment promoted inhibition of FoxO1 activity and increase in glucose uptake during HH exposure leading to reduction in blood-glucose and hepatic glycogen levels.

Conclusions

PRMT1 might have a potential importance as a therapeutic target for the treatment of HH-induced maladies.

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Surgical approach to posterior inferior cerebellar artery aneurysms

Abstract

Background

The far-lateral is a standardised approach to clip aneurysms of the posterior inferior cerebellar artery (PICA). Different variants can be adopted to manage aneurysms that differ in morphology, topography, ruptured status, cerebellar swelling and surgeon preference.

Method

We distinguished five paradigmatic approaches aimed to manage aneurysms that are: proximal unruptured; proximal ruptured requiring posterior fossa decompression (PFD); proximal ruptured not requiring PFD; distal unruptured; distal ruptured.

Conclusions

Preoperative planning in the setting of PICA aneurysm surgery is of paramount importance to perform an effective and safe procedure, to ensure an adequate PFD and optimal proximal control before aneurysm manipulation.

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A Dramatic Case of Odynophagia

Abstract

We report the case of a 77-year-old male with a history of aortic stenosis and interstitial lung disease, who debuted 3 years ago with an outbreak of necrotic and very painful canker sores. The severity of the lesions and their refractory response to treatment led to several hospital admissions and multiple consultations to different specialists (ENT, rheumatology, dermatology, ophthalmology, cardiology, and internal medicine). During this time, the patient received central parenteral nutrition with an episode of catheter-related septicemia, and he came to require psychiatric assistance for autolytic ideation. Numerous diagnostic tests were performed with inconclusive results, including biopsy of the lesion (histological study, immunohistochemistry for CD68 + , CD4 + , CD8 + , CD20 + , MCT +, and cytomegalovirus, PAS, Grocott–Gomori and Zielh–Neelsen staining, and in situ hybridization for Epstein Barr virus). Numerous treatments were unsuccessfully tested until thalidomide was administered, thus completely remitting lesions but leaving retractable scarring sequelae. Since then, the patient has had two recurrences, coinciding with the reduction of thalidomide dosages, which were controlled by increasing the dose of the immunomodulator. Recurrent necrotizing major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis that may have a dramatic course. Unfortunately, the lack of etiopathogenetic uniformity precludes any specific treatment. In severe cases, immunomodulators, including thalidomide, may represent a valid therapeutic option.

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A Dramatic Case of Odynophagia

Abstract

We report the case of a 77-year-old male with a history of aortic stenosis and interstitial lung disease, who debuted 3 years ago with an outbreak of necrotic and very painful canker sores. The severity of the lesions and their refractory response to treatment led to several hospital admissions and multiple consultations to different specialists (ENT, rheumatology, dermatology, ophthalmology, cardiology, and internal medicine). During this time, the patient received central parenteral nutrition with an episode of catheter-related septicemia, and he came to require psychiatric assistance for autolytic ideation. Numerous diagnostic tests were performed with inconclusive results, including biopsy of the lesion (histological study, immunohistochemistry for CD68 + , CD4 + , CD8 + , CD20 + , MCT +, and cytomegalovirus, PAS, Grocott–Gomori and Zielh–Neelsen staining, and in situ hybridization for Epstein Barr virus). Numerous treatments were unsuccessfully tested until thalidomide was administered, thus completely remitting lesions but leaving retractable scarring sequelae. Since then, the patient has had two recurrences, coinciding with the reduction of thalidomide dosages, which were controlled by increasing the dose of the immunomodulator. Recurrent necrotizing major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis that may have a dramatic course. Unfortunately, the lack of etiopathogenetic uniformity precludes any specific treatment. In severe cases, immunomodulators, including thalidomide, may represent a valid therapeutic option.

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Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis

Abstract

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea–hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.

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Prevalence of oral HPV infection among healthy individuals and head and neck cancer cases in the French West Indies

Abstract

Purpose

Human papillomavirus (HPV) is known to play a role in the development of head and neck squamous cell carcinomas (HNSCC) and to date, no study has reported on the association between oral HPV infection and HNSCC in the Caribbean. The objective was to determine the prevalence of oral HPV infection in the French West Indies (FWI), overall and by HPV genotype, among HNSCC cases and healthy population controls.

Method

We used data from a population-based case–control study conducted in the FWI. The prevalence of oral HPV was estimated separately among 100 HNSCC cases (mean age 59 years) and 308 population controls (mean age 57 years). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using a logistic regression adjusting for age, sex, tobacco, and alcohol consumption, to assess the association between oral HPV infection and HNSCC.

Results

Prevalence of oral HPV infections was 26% in controls (30% in men and 14% in women) and 36% in HNSCC cases (36% in men, 33% in women). HPV52 was the most commonly detected genotype, in cases and in controls. The prevalence of HPV16, HPV33, and HPV51 was significantly higher in cases than in controls (p = 0.0340, p = 0.0472, and 0.0144, respectively). Oral infection with high-risk HPV was associated with an increase in risk of HNSCC (OR 1.99, 95% CI 0.95–4.15). HPV16 was only associated with oropharyngeal cancer (OR 16.01, 95% CI 1.67–153.64).

Conclusion

This study revealed a high prevalence of oral HPV infection in this middle-aged Afro-Caribbean population, and a specific distribution of HPV genotypes. These findings may provide insight into HNSCC etiology specific to the FWI.

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Experience with curative radiotherapy for cervix cancer in the Bahamas for 2006–2016

Abstract

Background

Cervix cancer is a significant health problem. As access to quality care in Small Island Developing States improves, and cancer centers become established, providers of care can summarize local experience to benchmark system quality and look for ways to further improve value.

Methods

This is a retrospective study of all cases of cervix cancer managed 2006–2016 at The Cancer Centre Bahamas, in conjunction with Princess Margaret Hospital, Nassau, affiliated with The University of West Indies. Seventy-two women received curative radiotherapy or chemoradiotherapy. Herein are reported presenting characteristics, treatments, waiting and overall treatment times, plus outcomes of recurrence, survival, and adverse events.

Results

For 68 newly diagnosed cases, median waiting time (diagnosis to commencing treatment) was 110 days. It was 90 days for those 47 cases who had no prior surgery or neoadjuvant chemotherapy. Overall, 99% of intended external radiotherapy fractions, 74% of brachytherapy sessions, and 79% of concurrent weekly chemotherapy were administered. For all 72 cases, median overall treatment time was 63 days; and for the 47 case sub-group, it was 78 days during 2006–2010 and 65 days during 2011–2016 (p = 0.005), so improving over calendar time. Four cases experienced grade 3–4 toxicities. Twelve had urological complications from disease or treatment. Five cases experienced local failure; eight experienced distant failure. Newly diagnosed stage 2B (26/72) had a 2-year survival of 71%.

Conclusion

This report demonstrates the impact of providing curative radiation-based treatments for cervical cancer in a small state. It suggests ways to further improve operations and justifies additional research.

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Prostate cancer clinical presentation, incidence, mortality and survival in Guadeloupe over the period 2008–2013 from a population-based cancer registry

Abstract

Purpose

The Caribbean population of Guadeloupe has one of the highest incidence rates of prostate cancer worldwide. In 2008, a population-based cancer registry was set up for the monitoring of cancer incidence in the aftermath of the environmental pollution with chlordecone, a persistent organochlorine insecticide formerly used in banana plantations. We describe the clinical presentation, incidence, mortality and survival of prostate cancer for the period 2008–2013.

Methods

The Guadeloupe cancer registry has been routinely collecting all incident cases of cancer since 2008. We compared age-specific incidence rates between different populations, and calculated incidence and mortality rates standardized to the world population. Kaplan–Meier observed survival and estimated age-standardized net survival were calculated by category for age, PSA level, and Gleason score using the Pohar-Perme method.

Results

Overall, 3,295 cases of prostate cancer were recorded. World-standardized incidence and mortality were respectively 184.1 [177.8–190.4] and 23.9 [21.9–25.7] per 100,000 person-years. At diagnosis, the mean age of patients was 68 ± 9.6 years old and 22% were aged over 75. Median PSA level was 8.9 [IQR: 6.0–16.0] and 13.6% of the patients had a Gleason ≥ 8. Five-year observed and net survivals were, respectively, 79.6% [77.9–81.2] and 90.7% [88.6–92.8].

Conclusion

The incidence of prostate cancer in Guadeloupe is among the highest in the world, along with those of the neighboring Caribbean countries and US African-Americans. We observed no decrease in incidence rates, and a decreasing but non-significant trend in mortality rates, which nonetheless remain higher than in high-income countries. Many Genome-Wide Association Studies are conducted to identify genetic markers involved in prostate cancer risk. In the Caribbean, complementary studies on both lifestyle and behavioral factors should highlight potential common risks among populations who share both genetic and environmental characteristics.

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Erratum to: Treadmill exercise alters ecstasy- induced long- term potentiation disruption in the hippocampus of male rats

Abstract

In the original publication of the article, author name Masoumeh Asadbegi was incorrectly written as Masoumeh Asadbeigi. The authors regret the oversight.

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Erratum to: Anatomical specificity of the brain in the modulation of Neuroglobin and Cytoglobin genes after chronic bisphenol a exposure

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Organosulfur compound protects against memory decline induced by scopolamine through modulation of oxidative stress and Na + /K + ATPase activity in mice

Abstract

The present study investigated the possible effect of BMMS in protecting against memory impairment in an Alzheimer's disease model induced by scopolamine in mice. Another objective was to evaluate the involvement of oxidative stress and Na⁺/K⁺ ATPase activity in cerebral cortex and hippocampus of mice. Male Swiss mice were divided into four groups: groups I and III received canola oil (10 ml/kg, intragastrically (i.g.)), while groups II and IV received BMMS (10 mg/kg, i.g.). Thirty minutes after treatments, groups III and IV received scopolamine (1 mg/kg, intraperitoneal (i.p.)), while groups I and II received saline (5 ml/kg, i.p.). Behavioral tests were performed thirty minutes after scopolamine or saline injection. Cerebral cortex and hippocampus were removed to determine the thiobarbituric acid reactive species (TBARS) levels, non-protein thiols (NPSH) content, catalase (CAT) and Na⁺/K⁺ ATPase activities. The results showed that BMMS pretreatment protected against the reduction in alternation and latency time induced by scopolamine in the Y-maze test and step-down inhibitory avoidance, respectively. In the Barnes maze, the latency to find the escape box and the number of holes visited were attenuated by BMMS. Locomotor and exploratory activities were similar in all groups. BMMS pretreatment protected against the increase in the TBARS levels, NPSH content and CAT activity, as well as the inhibition on the Na⁺/K⁺ ATPase activity caused by scopolamine in the cerebral cortex. In the hippocampus, no significant difference was observed. In conclusion, the present study revealed that BMMS protected against the impairment of retrieval of short-term and long-term memories caused by scopolamine in mice. Moreover, antioxidant effect and protection on the Na⁺/K⁺ ATPase activity are involved in the effect of compound against memory impairment in AD model induced by scopolamine.

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A homozygous PIGO mutation associated with severe infantile epileptic encephalopathy and corpus callosum hypoplasia, but normal alkaline phosphatase levels

Abstract

We describe two sisters from a consanguineous Arab family with global developmental delay, dystrophy, axial hypotonia, epileptic encephalopathy dominated by intractable complex partial seizures that were resistant to various anti-epileptic treatments. Dysmorphic features comprised low set ears, hypertelorism, upslanting palpebral fissures, a broad nasal bridge, and blue sclera with elongated eyelashes. Brain MRI in both children showed a corpus callosum hypoplasia that was evident already in utero and evolving cortical atrophy. Autozygosity mapping in combination with Whole Exome Sequencing revealed a homozygous missense mutation in the PIGO gene [c.765G > A, NM_032634.3] that affected a highly conserved methionine in the alkaline phosphatase-like core domain of the protein [p.(Met255Ile), NP_116023.2]. PIGO encodes the GPI-ethanolamine phosphate transferase 3, which is crucial for the final synthetic step of the glycosylphosphatidylinositol-anchor that attaches many enzymes to their cell surfaces, such as the alkaline phosphatase and granulocyte surface markers. Interestingly, measurement of serum alkaline phosphatase activities in both children was normal or only slightly elevated. Quantification of granulocyte surface antigens CD16/24/59 yielded reduced levels only for CD59. Phenotype analysis of our and other published patients with PIGO mutations reveals a more severe affectation and predominantly neurological presentation in individuals carrying a mutation in the alkaline phosphatase-like core domain thereby hinting towards a genotype-phenotype relation for PIGO gene mutations.

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Multidisciplinary Clinic Approach Improves Overall Survival Outcomes of Patients with Metastatic Germ Cell Tumors

Abstract

Background

To report our experience utilizing a multidisciplinary clinic (MDC) at Indiana University (IU) since the publication of the International Germ Cell Cancer Collaborative Group (IGCCCG), and to compare our overall survival to that of the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program.

Patients and Methods

We conducted a retrospective analysis of all patients with metastatic germ cell tumor (GCT) seen at IU from 1998-2014. 1,611 consecutive patients were identified, of whom 704 patients received an initial evaluation by our MDC (including medical oncology, pathology, urology and thoracic surgery) and started first-line chemotherapy at IU. These 704 patients were eligible for analysis. All patients in this cohort were treated with cisplatin-etoposide based combination chemotherapy. We compared the progression-free survival (PFS) and overall survival (OS) of patients treated at IU with that of the published IGCCCG cohort. OS of the IU testis cancer primary cohort (n = 622) was further compared to the SEER data of 1283 patients labeled with "distant" disease. The Kaplan-Meier method was used to estimate progression-free survival and overall survival.

Results

With a median follow-up of 4.4 years, patients with good, intermediate, and poor risk disease by IGCCCG criteria treated at IU had 5-year PFS of 90%, 84%, and 54% and 5-year OS of 97%, 92%, and 73% respectively. The 5-year PFS for all patients in the IU cohort was 79% (95%CI, 76% to 82%). The 5-year OS for the IU cohort was 90% (95% CI, 87% to 92%). IU testis cohort had 5-year OS 94% (95% CI, 91% to 96%) vs. 75% (95% CI, 73% to 78%) for the SEER "distant" cohort between 2000-2014, P-value <0.0001.

Conclusion

The MDC approach to GCT at high-volume cancer center associated with improved overall survival outcomes in this contemporary dataset. OS is significantly higher in the IU cohort compared to the IGCCCG and SEER "distant" cohort.

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Synchronous peritoneal metastases of small bowel adenocarcinoma: Insights into an underexposed clinical phenomenon

Publication date: December 2017
Source:European Journal of Cancer, Volume 87
Author(s): Laura M. Legué, Geert A. Simkens, Geert-Jan M. Creemers, Valery E.P.P. Lemmens, Ignace H.J.T. de Hingh
BackgroundThe aim of this population-based study was to provide insight into the incidence, risk factors and treatment-related survival of patients with peritoneal metastases (PM) of small bowel adenocarcinoma (SBA).MethodsData from the Netherlands Cancer Registry were used. All patients diagnosed with SBA between 2005 and 2014 were included. The influence of patient and tumour characteristics on the odds of developing PM was analysed. Subsequently, for all further analyses, patients without synchronous PM of SBA were excluded. The log-rank test and Kaplan-Meier analyses were conducted to estimate survival, and the Cox proportional hazards model was used to evaluate the risk of death.ResultsOf the 1428 included patients diagnosed with SBA, 181 (13%) presented with synchronous PM. Synchronous PM was found in 9% of the duodenal tumours and in 17% of the more distal tumours. Median overall survival of all patients with PM was 5.9 months, whereas survival of both 11 months was observed in patients treated with primary tumour resection or palliative chemotherapy and 32 months after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC). Poor prognostic factors for survival were age ≥70 years (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.1–2.2), systemic metastases other than PM (HR 2.0, 95% CI 1.4–2.9) and an advanced (HR 1.9, 95% CI 1.3–3.0) or unknown T-stage (HR 2.1, 95% CI 1.2–3.5).ConclusionsSynchronous PM was frequently encountered in SBA. Without treatment, prognosis was extremely poor. Survival was higher after primary tumour resection, palliative chemotherapy and CRS+HIPEC, but selection bias probably played a significant role calling for further clinical research.



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Risk of early-onset prostate cancer associated with occupation in the Nordic countries

Publication date: December 2017
Source:European Journal of Cancer, Volume 87
Author(s): Kathryn Hughes Barry, Jan Ivar Martinsen, Michael C.R. Alavanja, Gabriella Andreotti, Aaron Blair, Johnni Hansen, Kristina Kjærheim, Stella Koutros, Elsebeth Lynge, Pär Sparèn, Laufey Tryggvadottir, Elisabete Weiderpass, Sonja I. Berndt, Eero Pukkala
BackgroundEarly-onset prostate cancer is often more aggressive and may have a different aetiology than later-onset prostate cancer, but has been relatively little studied to date. We evaluated occupation in relation to early- and later-onset prostate cancer in a large pooled study.MethodsWe used occupational information from census data in five Nordic countries from 1960 to 1990. We identified prostate cancer cases diagnosed from 1961 to 2005 by linkage of census information to national cancer registries and calculated standardised incidence ratios (SIRs) separately for men aged 30–49 and those aged 50 or older. We also conducted separate analyses by period of follow-up, 1961–1985 and 1986–2005, corresponding to pre- and post-prostate-specific antigen (PSA) screening.ResultsFor early-onset prostate cancer (n = 1521), we observed the highest SIRs for public safety workers (e.g. firefighters) (SIR = 1.71, 95% confidence interval [CI]: 1.23–2.31) and military personnel (SIR = 1.97, 95% CI: 1.31–2.85). These SIRs were significantly higher than the SIRs for later-onset disease (for public safety workers, SIR = 1.10, 95% CI: 1.07–1.14 and for military personnel, SIR = 1.09, 95% CI: 1.05–1.13; pheterogeneity = 0.005 and 0.002, respectively). Administrators and technical workers also demonstrated significantly increased risks for early-onset prostate cancer, but the SIRs did not differ from those of later-onset disease (pheterogeneity >0.05). While our early-onset finding for public safety workers was restricted to the post-PSA period, that for military personnel was restricted to the pre-PSA period.ConclusionOur results suggest that occupational exposures, particularly for military personnel, may be associated with early-onset prostate cancer. Further evaluation is needed to explain these findings.



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“Multicentre study of patient-reported and clinical outcomes following immediate and delayed Autologous Breast Reconstruction And Radiotherapy (ABRAR study)”

Publication date: Available online 10 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kathryn H. Steele, R. Douglas Macmillan, Graham R. Ball, Malin Akerlund, Stephen J. McCulley
BackgroundTiming of autologous breast reconstruction in patients requiring adjuvant radiotherapy remains contentious. The primary objective of this study was to assess clinical and patient reported outcomes in immediate reconstruction with radiotherapy compared to delayed reconstruction after radiotherapy, the two relevant clinical pathways for patients who need radiotherapy.MethodsThis retrospective UK multi-centre study grouped patients into three categories: immediate reconstruction with post-operative radiotherapy (IBR); delayed reconstruction after radiotherapy (DBR); control group of immediate reconstruction without radiotherapy (noRT). Data collection utilised clinician questionnaire, patient questionnaire (BreastQ) and medical examination. Examination assessed fat necrosis, texture, symmetry and overall result.Results412 patients were recruited (IBR 104; DBR 119; noRT 189) with median follow-up time of 57 months. Post-operative complications were higher in IBR & noRT (p < 0.001). Total number of operations for completion of reconstruction was similar in all groups. Completion of reconstruction after mastectomy was three years longer in DBR versus IBR. BreastQ domain scores were lower in IBR versus DBR and noRT (p < 0.01) but all scores were within acceptable range (satisfaction with outcome: IBR 71; DBR 85; noRT 81). Examination scores were similar for IBR and DBR but lower than noRT (p < 0.01). Correlation between BreastQ and examination scores was poor.ConclusionsAcceptable results are observed with either IBR or DBR, with high rates of patient and clinician satisfaction, low rates of complications, and a similar number of operations to complete reconstruction in all groups suggesting all options should be considered for patients.



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Effluents from Anaerobic Digestion of Organic Wastes: Treatment by Chemical and Electrochemical Processes

Abstract

The treatment of effluent from anaerobic digestion of organic wastes was carried out using chemical and electrochemical processes, namely, chemical coagulation (CC) with lime, electrocoagulation (EC) with iron consumable electrodes, and electrochemical oxidation (EO) with a boron-doped diamond anode, at different experimental conditions. In the CC assays, the highest chemical oxygen demand (COD) removal, 50%, was achieved for a lime concentration of 70 g L⁻¹ after 2 h experiment. Under the experimental conditions studied, EC promoted COD removals of 80% after 5 h and EO led to COD removals of 43% after 6 h electrolysis, being this last removal increased to 60% when chloride was added to the effluent. A combined EC+EO treatment was also performed, utilizing the most favorable experimental conditions obtained in the individual processes, and global removals of 95% in COD and 44% in ammonia nitrogen were attained after 5 h of EC followed by 6 h of EO. These results proved that the combined process can be an efficient alternative in the treatment of effluents from anaerobic digestion of organic wastes with the characteristics of the studied effluent.

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Expression of Glut-1 in Malignant Melanoma and Melanocytic Nevi: an Immunohistochemical Study of 400 Cases

Abstract

The glucose transporter-1 (Glut-1) is a cell membrane glycoprotein involved in glucose uptake. An increased expression of Glut-1 is an important cell adaptation mechanism against hypoxia. An upregulation of Glut-1 can be found in several types of malignant tumors, which are able to reprogram their metabolism from oxidative phosphorylation to aerobic glycolysis (Warburg effect). However, the data regarding melanocytic lesions is equivocal. We performed comprehensive immunohistochemical analysis of the Glut-1 expression in 225 malignant melanomas (MM) and 175 benign nevi. Only the membranous expression of Glut-1 was regarded as positive. The expression of Glut-1 (the cut-off for positivity was determined as H-score 15) was found in 69/225 malignant melanomas. The number of positive cases and the H-score of Glut-1 increased where there was a higher Breslow thickness (p < 0.00001) when comparing pT1- pT4 MM groups. All benign nevi were classified as negative. In conclusion, the membranous expression of Glut-1 is a common feature of a malignant melanoma but this type of expression is very rare in benign melanocytic nevi. Our results suggest that the membranous expression of Glut-1 can be used as a surrogate marker in the assessing of the biological nature of benign and malignant melanocytic lesions. However, despite its high specificity, the sensitivity of this marker is relatively low. Moreover, due to the fact that the increased expression of Glut-1 correlates with a shorter survival period (10-year disease free survival, recurrence free survival and metastasis free survival and MFS), it can be used as a prognostically adverse factor.

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Study of Demographic Profile of Organophosphate Compound Poisoning with Special Reference to Early Versus Late Tracheostomy in Tertiary Care Hospital in Rural Area

Abstract

Tracheostomy is commonly performed life saving procedure. Organophosphorus compound poisoning is a very common emergency encountered in rural area where major population consists of agricultural workers. Ideal timing of tracheostomy is still controversial. Aim of the study is to assess the advantage of performing early (48 h–7 days) versus late tracheostomy (8–15 days) with regard to weaning from a ventilator, complications and length of hospital stay. This is a comparative retrospective interventional study in which 100 patients of organophosphorus poisoning who underwent tracheostomy during hospital stay due to prolonged intubation were analyzed. Study subjects were divided into two groups. Each group constitute of 50 patients each. Group A: Early tracheostomy (48 h–7 days) and Group B: Late tracheostomy (8–15 days). Early tracheostomy required a shorter duration of mechanical ventilator support (4–5 days) when compared to late tracheostomy (5–8 days), p < 0.05 and early tracheostomy facilitate early weaning. There was high incidence of complications in late tracheostomy group as compare to early tracheostomy group. Duration of hospital stay was also longer in Group B (mean 40 days) as compare to Group A (mean 32 days) with p < 0.05. We concluded that, early tracheostomy was associated with shorter duration of mechanical ventilator support, it helps for early weaning, shorted intensive care unit and hospital stay as compare to late tracheostomy.

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Medium-retaining Petri dish insert to grow and image cultured cells

Publication date: Available online 10 November 2017
Source:Journal of Neuroscience Methods
Author(s): Lech Kiedrowski, Alan Feinerman
BackgroundMicroscope chambers that accept glass coverslips with cultured cells are often used to monitor intracellular Ca²⁺ concentration ([Ca²⁺]i) during cell superfusion. Unfortunately, the experimental maneuvers associated with the coverslip installation in these chambers (medium removal and re-application) trigger unintended [Ca²⁺]i elevations.New MethodTo prevent these [Ca²⁺]i elevations, a Petri dish insert has been constructed. The insert features a superfusion-optimized well to grow cell cultures. After this insert is removed from the Petri dish, the well retains the medium. This feature allows the inserts to be installed in microscope chambers while keeping the cells submerged at all times.ResultsThese inserts were used to test the impact of a transient medium removal from the well (an equivalent of a coverslip removal from the medium) on [Ca²⁺]i in primary murine cortical neurons and astrocytes, and in HEK-293 cells. In all of these models, the medium removal/re-application caused a micromolar [Ca²⁺]i spike. While in neurons this spike was caused by a Ca²⁺ influx, in astrocytes and HEK-293 cells, it was caused by a Ca²⁺ release from intracellular stores. After the spike, a subpopulation of neurons failed to restore low [Ca²⁺]i; in 24% of the astrocytes, the spike triggered [Ca²⁺]i oscillations. However, prior to the spike, [Ca²⁺]i was low and uniform in all these cells.Comparison with existing method(s)The new method avoids the artificially-induced [Ca²⁺]i elevations that take place during the handling of glass coverslips with cultured cells.ConclusionsThe new method allows monitoring [Ca²⁺]i without disturbing the basal [Ca²⁺]i levels.



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MRI kinematic analysis of T1 sagittal motion between cervical flexion and extension positions in 145 patients

Abstract

Purpose

Although the T1 vertebra is considered as an important factor of cervical balance, little is known about its motion between flexion and extension. The purpose of present study was to analyze the T1 sagittal motion using kinematic magnetic resonance imaging (kMRI), and to identify factors that relate to T1 sagittal motion.

Methods

We retrospectively analyzed 145 kMR images taken in weight-bearing neutral, flexion and extension positions. Cervical balance parameters were evaluated in each position. The degree of T1 sagittal motion was defined as [(T1 slope at extension) − (T1 slope at flexion)]. All patients were divided into three groups: Positive group (T1 followed the head motion, T1 sagittal motion > 5°), Stable group (5 ≥, ≥ − 5) and Negative group (T1 moved in the opposite direction from the head motion, > − 5). The groups were compared and multivariate logistic regression analysis was calculated.

Results

There were 57 (40%) patients in the positive, 56 (39%) in the stable and 32 (22%) in the negative group. The positive group had the largest C2–7 sagittal vertical axis in flexion (p < 0.001) and the shortest in the extension (p = 0.023). Similar trends were seen in cranial tilt and cervical tilt. The value of T1 height < 27 mm was a significant independent factor for the negative group (p = 0.008, adjusted odds ratio = 5.958).

Conclusion

Based on T1 sagittal motion, 40% of the patients were classified in positive group (the T1 vertebra followed the head motion in flexion and extension), and 20% were classified in the negative group (the T1 vertebra moved in the opposite direction from the head motion). T1 height < 27 mm was a potential predictor of negative group.

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Pathomechanisms of Contact Sensitization

Abstract

Contact sensitization is the initial process involved in the development of an allergic reaction to xenobiotic environmental substances. Here, we briefly describe the differences between irritant and allergic contact dermatitis. Then, we highlight the essential steps involved in the development of an ACD reaction, i.e., the protein binding of haptens, genetic factors influencing the penetration of sensitizers into the skin, the different mechanisms driving the initial development of an inflammatory cytokine micromilieu enabling the full maturation of dendritic cells, the role of pre- and pro-haptens, antigen presentation and T cell activation via MHC and CD1 molecules, dendritic cell (DC) migration, and potential LC contribution as well as the different T cell subsets involved in ACD. In addition, we discuss the latest publications regarding factors that might influence the sensitizing potential such as repeated sensitizer application, penetration enhancers, humidity of the skin, microbiota, Tregs, and phthalates. Last but not least, we briefly touch upon novel targets for drug development that might serve as treatment options for ACD.

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The influence of immediately loaded implant treatment in the atrophic edentulous maxilla on oral health related quality of life of edentulous patients: 3-year results of a prospective study

To evaluate oral health related quality of life (OHQoL) in edentulous patients treated with immediately loaded implants in the maxilla.

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Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report

We describe the case of a 16-year-old female patient with micrognathia, temporomandibular joint (TMJ) ankylosis, and obstructive sleep apnea, who was treated with mandibular distraction osteogenesis (DO) combi...

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Study of Demographic Profile of Organophosphate Compound Poisoning with Special Reference to Early Versus Late Tracheostomy in Tertiary Care Hospital in Rural Area

Abstract

Tracheostomy is commonly performed life saving procedure. Organophosphorus compound poisoning is a very common emergency encountered in rural area where major population consists of agricultural workers. Ideal timing of tracheostomy is still controversial. Aim of the study is to assess the advantage of performing early (48 h–7 days) versus late tracheostomy (8–15 days) with regard to weaning from a ventilator, complications and length of hospital stay. This is a comparative retrospective interventional study in which 100 patients of organophosphorus poisoning who underwent tracheostomy during hospital stay due to prolonged intubation were analyzed. Study subjects were divided into two groups. Each group constitute of 50 patients each. Group A: Early tracheostomy (48 h–7 days) and Group B: Late tracheostomy (8–15 days). Early tracheostomy required a shorter duration of mechanical ventilator support (4–5 days) when compared to late tracheostomy (5–8 days), p < 0.05 and early tracheostomy facilitate early weaning. There was high incidence of complications in late tracheostomy group as compare to early tracheostomy group. Duration of hospital stay was also longer in Group B (mean 40 days) as compare to Group A (mean 32 days) with p < 0.05. We concluded that, early tracheostomy was associated with shorter duration of mechanical ventilator support, it helps for early weaning, shorted intensive care unit and hospital stay as compare to late tracheostomy.

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