OtoRhinoLaryngology News

Τετάρτη 3 Ιανουαρίου 2018

Elevated absolute NK cell counts in peripheral blood predict good prognosis in chronic lymphocytic leukemia

Abstract

Purpose

The aim of this study was to investigate the prognostic significance of the absolute natural killer (NK) cell counts in peripheral blood in patients with chronic lymphocytic leukemia (CLL).

Methods

A total of 273 previously untreated patients with CLL from April 2004 and October 2015 were enrolled into this retrospective study. We analysed the T cell subsets of all patients and figured out the number of NK cells. Comparisons of NK cell count as continuous parameter in different groups were described using Mann–Whitney U test and the Kruskal–Wallis test. Kaplan–Meier method was used to survival analysis, and the Cox proportional hazards models were used for the estimation of prognostic factors.

Results

NK cell counts were calculated in 273 therapy-naive CLL patients, and higher number of NK cell was observed in those with Binet stage A/B, ZAP-70 < 20%, normal serum albumin and β₂-microglobulin levels. Using a NK cell count cut-off of 0.40 × 10⁹/L, patients with lower NK cell count (< 0.40 × 10⁹/L) had a significantly shorter overall survival (OS) than those with higher NK cell count (≥ 0.40 × 10⁹/L) (P = 0.0014). Multivariate analysis showed that NK cell counts remained its prognostic value. However, the effect of NK cell count on time to treatment was not significant.

Conclusions

Our results suggest that NK cell count is an independent prognostic marker for OS in patients with CLL and NK cell counts ≥ 0.40 × 10⁹/L can routinely be used to identify patients with favorable survival.

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Cocoa Flavanol Supplementation and Exercise: A Systematic Review

Abstract

Background

Cocoa flavanols (CFs) have antioxidant and anti-inflammatory capacities and can improve vascular function. It has recently been suggested that CF intake may improve exercise performance and recovery. This systematic review aimed to evaluate the literature on the effects of CF intake on exercise performance and recovery and exercise-induced changes in vascular function, cognitive function, oxidative stress, inflammation, and metabolic parameters.

Methods

Two electronic databases (Pubmed and Web of Science) were searched for studies examining the combination of CF intake and exercise in humans (up to 28 March 2017). Articles were included if the exact amount of CFs was mentioned. The methodological quality and level of bias of the 13 included studies was assessed according to the checklist for randomized controlled trials from the Dutch Cochrane center.

Results

Acute, sub-chronic (2 weeks) and chronic (3 months) CF intake reduced exercise-induced oxidative stress. Evidence on the effect of CF on exercise-induced inflammation and platelet activation was scarce. Acute CF intake reduced and tempered the exercise-induced increase in blood pressure in obese participants. Acute and sub-chronic CF intake altered fat and carbohydrate metabolism during exercise. Acute and sub-chronic CF intake did not have ergogenic effects in athletes, while chronic CF intake improved mitochondrial efficiency in untrained participants. While combining sub-chronic CF intake and exercise training improved cardiovascular risk factors and vascular function, evidence on the synergistic effects of CF and exercise training on oxidative stress, inflammation, and fat and glucose metabolism was lacking.

Conclusion

CF intake may improve vascular function, reduce exercise-induced oxidative stress, and alter fat and carbohydrate utilization during exercise, but without affecting exercise performance. There is a strong need for future studies examining the synergetic effect of chronic CF intake and exercise training.

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Talent Identification and Development in Male Football: A Systematic Review

Abstract

Background

Expertise has been extensively studied in several sports over recent years. The specificities of how excellence is achieved in Association Football, a sport practiced worldwide, are being repeatedly investigated by many researchers through a variety of approaches and scientific disciplines.

Objective

The aim of this review was to identify and synthesise the most significant literature addressing talent identification and development in football. We identified the most frequently researched topics and characterised their methodologies.

Methods

A systematic review of Web of Science™ Core Collection and Scopus databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The following keywords were used: "football" and "soccer". Each word was associated with the terms "talent", "expert*", "elite", "elite athlete", "identification", "career transition" or "career progression". The selection was for the original articles in English containing relevant data about talent development/identification on male footballers.

Results

The search returned 2944 records. After screening against set criteria, a total of 70 manuscripts were fully reviewed. The quality of the evidence reviewed was generally excellent. The most common topics of analysis were (1) task constraints: (a) specificity and volume of practice; (2) performers' constraints: (a) psychological factors; (b) technical and tactical skills; (c) anthropometric and physiological factors; (3) environmental constraints: (a) relative age effect; (b) socio-cultural influences; and (4) multidimensional analysis. Results indicate that the most successful players present technical, tactical, anthropometric, physiological and psychological advantages that change non-linearly with age, maturational status and playing positions. These findings should be carefully considered by those involved in the identification and development of football players.

Conclusion

This review highlights the need for coaches and scouts to consider the players' technical and tactical skills combined with their anthropometric and physiological characteristics scaled to age. Moreover, research addressing the psychological and environmental aspects that influence talent identification and development in football is currently lacking. The limitations detected in the reviewed studies suggest that future research should include the best performers and adopt a longitudinal and multidimensional perspective.

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Wrapped Surgicel as an aid in microsurgical flap pedicle positioning and kinking prevention

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Picosecond 532-nm neodymium-doped yttrium aluminum garnet laser—a promising modality for the management of verrucous epidermal nevi

Abstract

The verrucous epidermal nevus (VEN) is the most common type of epidermal nevi. As lesions can be disfiguring, treatment is often sought. Many therapeutic approaches have been reported, with variable efficacy and safety. Picosecond (PS) lasers are novel laser devices designated to target small chromophores. A side effect of these lasers is blistering due to epidermal-dermal separation. We aimed to harness this side effect of the PS lasers to treat patients with VEN. The purpose of this study was to report our experience treating VEN using a PS 532-nm laser. We present a retrospective case series of six patients with large VEN who were treated using a PS 532-nm laser (2–6 treatments, 8–10 weeks apart). Response in clinical photographs was assessed by two independent dermatologists and graded on a scale of 0 (exacerbation) to 4 (76–100% improvement). Patient satisfaction was recorded on a scale of 1–5. All patients demonstrated significant improvement. Average improvement was 3.7 on the quartile scale of improvement. Patient satisfaction rate averaged 4.7. The PS 532-nm laser is a promising novel modality for the treatment of large VEN.

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Chernobyl: more systematic research needed!

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Chernobyl: more systematic research needed!

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Ex vivo-expanded NK cells from blood and ascites of ovarian cancer patients are cytotoxic against autologous primary ovarian cancer cells

Abstract

Ovarian cancer (OC) is the leading cause of gynecological cancer-related death in North America. Most ovarian cancer patients (OCPs) experience disease recurrence after first-line surgery and chemotherapy; thus, there is a need for novel second-line treatments to improve the prognosis of OC. Although peripheral blood-derived NK cells are known for their ability to spontaneously lyse tumour cells without prior sensitization, ascites-derived NK cells (ascites-NK cells) isolated from OCPs exhibit inhibitory phenotypes, impaired cytotoxicity and may play a pro-tumourigenic role in cancer progression. Therefore, it is of interest to improve the cytotoxic effector function of impaired OCP ascites-NK cells at the tumour environment. We investigated the efficacy of using an artificial APC-based ex vivo expansion technique to generate cytotoxic, expanded NK cells from previously impaired OCP ascites-NK cells, for use in an autologous model of NK cell immunotherapy. We are the first to obtain a log-scale expansion of OCP ascites-NK cells that upregulate the surface expression of activating receptors NKG2D, NKp30, NKp44, produce robust amounts of anti-tumour cytokines in the presence of OC cells and mediate direct tumour cytotoxicity against ascites-derived, primary OC cells obtained from autologous patients. Our findings demonstrate that it is possible to generate cytotoxic OCP ascites-NK cells from previously impaired OCP ascites-NK cells, which presents a promising immunotherapeutic target for the second-line treatment of OC. Future work should focus on evaluating the in vivo efficacy of autologous NK cell immunotherapy through the intraperitoneal delivery of NK cell expansion factors to a preclinical xenograft mouse model of human OC.

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Effect of Cochlear Implantation on Quality of Life in Adults with Unilateral Hearing Loss

Objective: Patients with moderate-to-profound sensorineural hearing loss in 1 ear and normal hearing in the contralateral ear, known as unilateral hearing loss (UHL) or single-sided deafness (SSD), may experience improved quality of life with the use of a cochlear implant (CI) in the affected ear. Quality of life assessment before and after implantation may reveal changes to aspects of hearing beyond those explicitly evaluated with behavioral measures. Methods: The present report completed 2 experiments investigating quality of life outcomes in CI recipients with UHL. The first experiment assessed quality of life during the 1st year of device use with 3 questionnaires: the Speech, Spatial, and Qualities of Hearing Scale (SSQ), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Tinnitus Handicap Inventory. Twenty subjects were evaluated preoperatively and 1, 3, 6, 9, and 12 months post-activation. Quality of life results were compared over the study period using traditional scoring methods and the SSQ pragmatic subscales. Subscales specific to localization and speech perception in noise were compared to behavioral measures at the preoperative and 12-month intervals. The 2nd experiment evaluated quality of life preoperatively and at the 12-month interval for CI recipients with UHL and CI recipients with bilateral hearing loss, including conventional CI users and those listening with electric-acoustic stimulation (EAS). The 3 cohorts differed in CI candidacy criteria, including the amount of residual hearing in the contralateral ear. Results: For subjects with moderate-to-profound UHL, receipt of a CI significantly improved quality of life, with benefits noted as early as 1 month after initial activation. The UHL cohort reported less perceived difficulty at the pre- and postoperative intervals than the conventional CI and EAS cohorts, which may be due to the presence of the normal-hearing ear. Each group experienced a significant benefit in quality of life on the APHAB with CI use. Conclusions: Cochlear implantation in cases of substantial UHL may offer significant improvements in quality of life. Quality of life measures revealed a reduction in perceived tinnitus severity and subjective improvements in speech perception in noise, spatial hearing, and listening effort. While self-report of difficulties were lower for the UHL cohort than the conventional CI and EAS cohorts, subjects in all 3 groups reported an improvement in quality of life with CI use.
Audiol Neurotol 2017;22:259-271

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Surgical morbidity in retroperitoneal sarcoma resection

Resection of retroperitoneal sarcoma (RPS) typically involves multivisceral resection. The morbidity of RPS resection has decreased over time despite widespread adoption of radical resection. Certain patterns of resection are associated with higher complication rates and elderly patients are at increased risk of morbidity. Administration of preoperative radiotherapy does not increase morbidity, but intraoperative and brachytherapy techniques are associated with heightened toxicities. Long-term functional outcomes and quality of life scores after RPS resection are acceptable.

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Prediction of neutrophil reduction using plasma paclitaxel concentration after administration in patients with uterine, ovarian, or cervical cancers in an outpatient clinic

Abstract

Purpose

Plasma paclitaxel (PTX) concentration 24 h or later after PTX administration may predict myelosuppression. Here, we explored predictive markers for neutropenia induced by intravenous administration of PTX in an outpatient clinic.

Methods

Thirty women suffering from uterine, ovarian or cervical cancer were enrolled in this study. PTX (mean dose: 167 mg/m²) was intravenously infused and followed by carboplatin. Plasma samples were obtained 4 h after PTX administration. Genotyping was carried out for CYP3A5*3, ABCB1 1236 C>T, 2677 G>T/A, and 3435 C>T.

Results

There was no significant relationship between genotype and reduced neutrophil count. Neutrophil reduction rate correlated with the patient's height, neutrophil count on the day of administration, and plasma PTX concentration. Multiple regression analysis with those three indices explained 47.7% of the interindividual variability of the neutrophil reduction rate. The model with plasma PTX concentration, patient's height, and plasma 6-α-hydroxy-paclitaxel /PTX concentration ratio also explained 30.0% of the interindividual variability for the neutrophil nadir count after PTX administration.

Conclusions

These results indicate that neutrophil reduction after PTX administration can be partially predicted by multiple regression analysis involving plasma concentration data collected at outpatient clinics.

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P2Y2R Deletion Ameliorates Sialadenitis in IL-14α-transgenic Mice

Abstract

Objective

Interleukin-14α-transgenic (IL-14αTG) mice develop an autoimmune exocrinopathy with characteristics similar to Sjögren's syndrome, including sialadenitis and hyposalivation. The P2Y₂ receptor (P2Y₂R) for extracellular ATP and UTP is upregulated during salivary gland inflammation (i.e., sialadenitis) where it regulates numerous inflammatory responses. The present study investigated the role of P2Y₂Rs in autoimmune sialadenitis in the IL-14αTG mouse model of Sjögren's syndrome.

Materials and methods

IL-14αTG mice were bred with P2Y₂R^-/- mice to generate IL-14αTG x P2Y₂R^-/- mice. P2Y₂R expression, lymphocytic focus scores, B and T cell accumulation and lymphotoxin-α expression were evaluated in the submandibular glands along with carbachol-stimulated saliva secretion in IL-14αTG, IL-14αTG x P2Y₂R^-/- and C57BL/6 control mice at 9 and 12 months of age.

Results

Genetic ablation of P2Y₂Rs in IL-14αTG mice significantly reduced B and T lymphocyte infiltration of submandibular glands. However, reduced sialadenitis did not restore saliva secretion in IL-14αTG x P2Y₂R^-/- mice. Decreased sialadenitis in IL-14αTG x P2Y₂R^-/- mice correlated with decreased lymphotoxin-α levels, a critical proinflammatory cytokine associated with autoimmune pathology in IL-14αTG mice.

Conclusions

The results of this study suggest that P2Y₂Rs contribute to the development of salivary gland inflammation in IL-14αTG mice and may also contribute to autoimmune sialadenitis in humans.

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Randomized, placebo-controlled, double-blind trial of clobetasol propionate 0.05% in the treatment of oral lichen planus

Abstract

Objective

To perform a randomized, placebo-controlled, double-blind study, with a follow-up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP).

Subjects And Methods

Thirty-two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow-up.

Results

Symptoms improved in all clobetasol treated patients during the first 2 months of therapy, while only 50% of placebo control group (P=0.005) displayed similar results; of the remaining half, 12.5% did experienced a worsening whilst 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol treated patients improved, while only 62.5% of the placebo treated patients had a positive response (P=0.229).

Conclusions

It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic erosive oral lesions.

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The role of YKL40 in the pathogenesis of CRS with nasal polyps

Abstract

Background

Many Chinese patients who experience chronic rhinosinusitis with nasal polyps (CRSwNP) have been shown to exhibit specifically enhanced TH1/TH17 responses and excessive neutrophil accumulation without demonstrating significant eosinophilia. These patients may be subject to different pathologies and therapies compared to Western patients. YKL40 can be produced by neutrophil and is associated with many inflammatory diseases, while its role in the pathogenesis of chronic rhinosinusitis (CRS) has yet to be determined.

Objective

The aim of this study was to investigate the relationship between the expression level and biologic role of YKL40 in CRS.

Methods

YKL40 expression was examined via quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), immunohistochemistry, and Western blot. Human nasal epithelia cells (HNECs) were isolated to detect YKL40 expression in response to specific inflammatory stimulation.

Results

YKL40 expression levels were significantly higher in NP patients compared to the turbinates of CRSsNP/CRSwNP and the control group and can be strongly activated by stimulation with IL-4 in vitro and suppressed by the other pro-inflammatory cytokines; lipopolysaccharide (LPS) and dexamethasone also caused significant decreases in YKL40 expression in HNECs.

Conclusions

YKL40 may play a significant role in Chinese patients with CRSwNP. The molecular mechanisms identified here may aid in the design of new therapeutic strategies for improving the clinical outcomes of Chinese patients.

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Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817742596

Authors: Cheraghlou S, Kuo P, Mehra S, Yarbrough WG, Judson BL

Abstract
Objective After radiation failure for early T-stage larynx cancer, national guidelines recommend salvage surgery. Total laryngectomy and conservation laryngeal surgery with an open or endoscopic approach are both used. Beyond single-institution studies, there is a lack of evidence concerning the outcomes of these procedures. We aim to study whether treatment with conservation laryngeal surgery is associated with poorer outcomes than treatment with total laryngectomy as salvage surgery after radiation failure for T1/T2 larynx cancers. Study Design A retrospective study was conducted of adult squamous cell larynx cancer cases in the National Cancer Database diagnosed from 2004 to 2012. Setting Commission on Cancer cancer programs in the United States. Methods Demographic, facility, tumor, and survival variables were included in the analyses. Multivariate survival regressions as well as univariate Kaplan-Meier analyses were conducted. Results Slightly more than 7% of patients receiving radiotherapy for T1/T2 larynx cancers later received salvage surgery. Salvage with partial laryngectomy was not associated with diminished survival as compared with total laryngectomy. However, positive surgical margins were associated with worse outcomes (hazard ratio, 1.782; P = .001), and a larger percentage of patients receiving partial laryngectomy had positive margins than those receiving total laryngectomy. Facility characteristics were not associated with differences in salvage surgery type or outcomes. Conclusion In recognition of the inherent selection bias, patients who experienced recurrences after radiation for T1/T2 larynx cancer and underwent conservation salvage laryngeal surgery demonstrated clinical outcomes similar to those of patients undergoing salvage total laryngectomy. Increased rates of positive surgical margins were observed among patients undergoing salvage conservation surgery.

PMID: 29292665 [PubMed - as supplied by publisher]

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Laryngomalacia with Epiglottic Prolapse Obscuring the Laryngeal Inlet.

http:--pubs.asahq.org-images-ASA_fulltex

Laryngomalacia with Epiglottic Prolapse Obscuring the Laryngeal Inlet.

Anesthesiology. 2016 Aug;125(2):398

Authors: Laschat M, Kaufmann J, Wappler F

PMID: 27433749 [PubMed - indexed for MEDLINE]

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Serotonin in the solitary tract nucleus shortens the laryngeal chemoreflex in anaesthetized neonatal rats.

Serotonin in the solitary tract nucleus shortens the laryngeal chemoreflex in anaesthetized neonatal rats.

Exp Physiol. 2016 Jul 01;101(7):946-61

Authors: Donnelly WT, Bartlett D, Leiter JC

Abstract
What is the central question of this study? Failure to terminate apnoea and arouse is likely to contribute to sudden infant death syndrome (SIDS). Serotonin is deficient in the brainstems of babies who died of SIDS. Therefore, we tested the hypothesis that serotonin in the nucleus of the solitary tract (NTS) would shorten reflex apnoea. What is the main finding and its importance? Serotonin microinjected into the NTS shortened the apnoea and respiratory inhibition associated with the laryngeal chemoreflex. Moreover, this effect was achieved through a 5-HT3 receptor. This is a new insight that is likely to be relevant to the pathogenesis of SIDS. The laryngeal chemoreflex (LCR), an airway-protective reflex that causes apnoea and bradycardia, has long been suspected as an initiating event in the sudden infant death syndrome. Serotonin (5-HT) and 5-HT receptors may be deficient in the brainstems of babies who die of sudden infant death syndrome, and 5-HT seems to be important in terminating apnoeas directly or in causing arousals or as part of the process of autoresuscitation. We hypothesized that 5-HT in the brainstem would limit the duration of the LCR. We studied anaesthetized rat pups between 7 and 21 days of age and made microinjections into the cisterna magna or into the nucleus of the solitary tract (NTS). Focal, bilateral microinjections of 5-HT into the caudal NTS significantly shortened the LCR. The 5-HT1a receptor antagonist, WAY 100635, did not affect the LCR consistently, nor did a 5-HT2 receptor antagonist, ketanserin, alter the duration of the LCR. The 5-HT3 specific agonist, 1-(3-chlorophenyl)-biguanide, microinjected bilaterally into the caudal NTS significantly shortened the LCR. Thus, endogenous 5-HT released within the NTS may curtail the respiratory depression that is part of the LCR, and serotonergic shortening of the LCR may be attributed to activation of 5-HT3 receptors within the NTS. 5-HT3 receptors are expressed presynaptically on C fibre afferents of the superior laryngeal nerve, and serotonergic shortening of the LCR may be mediated presynaptically by enhanced activation of inhibitory interneurons within the NTS.

PMID: 27121960 [PubMed - indexed for MEDLINE]

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Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma.

http:--production.springer.de-OnlineReso

Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma.

Dysphagia. 2016 Jun;31(3):462-72

Authors: Pisegna JM, Langmore SE

Abstract
The aim of this study was to compare selected parameters of two swallow evaluations: fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow (MBS) study. This was a cross-sectional, descriptive study. Fifty-five clinicians were asked to watch video recordings of swallow evaluations of 2 patients that were done using fluoroscopy and endoscopy simultaneously. In a randomized order, clinicians viewed 4 edited videos from simultaneous evaluations: the FEES and MBS videos of patient 1 and 2 each taking one swallow of 5 mL applesauce. Clinicians filled out a questionnaire that asked (1) which anatomical sites they could visualize on each video, (2) where they saw pharyngeal residue after a swallow, (3) their overall clinical impression of the pharyngeal residue, and (4) their opinions of the evaluation styles. Clinicians reported a significant difference in the visualization of anatomical sites, 11 of the 15 sites were reported as better-visualized on the FEES than on the MBS video (p < 0.05). Clinicians also rated residue to be present in more locations on the FEES than on the MBS. Clinicians' overall impressions of the severity of residue on the same exact swallow were significantly different depending on the evaluation type (FEES vs. MBS for patient 1 χ(2) = 20.05, p < 0.0001; patient 2 χ(2) = 7.52, p = 0.006), with FEES videos rated more severely. FEES advantages were: more visualization of pharyngeal and laryngeal swallowing anatomy and residue. However, as a result, clinicians provided more severe impressions of residue amount on FEES. On one hand, this suggests that FEES is a more sensitive tool than MBS studies, but on the other hand, clinicians might provide more severe interpretations on FEES.

PMID: 26987971 [PubMed - indexed for MEDLINE]

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An Oral Disease Severity Score (ODSS) validated for use in oral pemphigus vulgaris

Summary

Objectives

The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in pemphigus vulgaris (PV). A secondary aim was to compare the inter – intra- observer variability and ease of use with the Physician's Global Assessment (PGA) and the oral scoring methods used in Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI).

Methods

15 patients with mild to moderately severe oral PV were scored for disease severity by 10 oral medicine clinicians using the ODSS, PGA and the oral sections of ABSIS and PDAI. Two clinicians re-scored all patients after a minimum two-hour interval.

Results

Inter-observer reliability was assessed using an intra-class correlation coefficient (ICC). For the ODSS total score the ICC was 0.83, PDAI (oral total activity) 0.79 ABSIS (oral total) 0.71 and PGA was 0.7. Intra-observer agreement between initial scoring and re-scoring of the same subject by two clinicians demonstrated an ICC for each of 0.97 and 0.96 for ODSS total score; 0.99 and 0.82 for the PDAI oral activity; 0.86 and 0.45 for the ABSIS total and 0.99 and 0.64 for the PGA. Convergent validity was good with a correlation coefficient of greater than 0.5 (p<0.0001). The mean time (SD) (seconds) taken to complete each scoring method was: ODSS 76±37; PDAI 117±16; ABSIS 75±19.

Conclusion

This study has validated the ODSS for the assessment of oral PV. It has shown superior inter- and intra-observer reliability to PDAI, ABSIS and PGA and is quick to perform.

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Expression pattern of immunosurveillance-related antigen in adult T-cell leukemia/lymphoma

Abstract

Aims

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy with a poor prognosis. Human leukocyte antigen (HLA) and β2M serve as key molecules in tumor immunity, and their expression is frequently reduced in tumor cells. Programmed cell death (PD)-1/PD-ligand1 (PD-L1) interactions play a role in escape of tumor cells from T-cell immunity. Therefore, this study aimed to determine the clinicopathological relevance of HLA and β2M expressions in ATLL cells and PD-L1 expression in lymphoma or stromal cells and predict the overall survival of patients with ATLL.

Methods & Results

We analyzed a total of 123 biopsy samples from patients newly diagnosed with ATLL by using immunohistochemical analysis. Of the patients enrolled, 91 (74%) were positive for HLA (in cell membrane, 60 patients), 89 (72%) were positive for β2M (in cell membrane, 54 patients), and 48 (39%) were positive for both HLA and β2M in the cell membrane (HLA^m+β2M^m+). No significant clinical differences other than prognosis were found between the HLA^m+β2M^m+ group and the other groups. Immunophenotypical evaluation revealed significantly higher rates of CD30-positive lymphoma cells (P = 0.003) and PD-L1–positive stromal cells in microenvironments (miPD-L1^high) (P = 0.011) of the HLA^m+β2M^m+ group than in the other groups. The HLA^m+β2M^m+ group had significantly better prognosis that the other groups (P = 0.0096), and patients showing HLA^m+β2M^m+ with miPD-L1^high had the most-favorable prognosis among all groups.

Conclusions

The membranous expression of HLA and β2M is likely to reflect the immune response and would be useful to predict prognosis before starting ATLL therapy.

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Guidelines for sedation and anesthesia in GI endoscopy

This document is an update of guidelines for sedation and anesthesia in endoscopy prepared by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE). In preparing this guideline, a search of the medical literature was performed by using PubMed from January 1980 through August 2017 that related to the topic of "sedation and anesthesia for gastrointestinal endoscopy" by using the keyword(s) "sedation," "anesthesia," "gastrointestinal endoscopy," "endoscopy," "endoscopic procedures," and "procedures." The search was supplemented by accessing the "related articles" feature of PubMed, with articles identified on PubMed as the references.

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Apical Lymph Nodes in the Distant Metastases and Prognosis of Patients with Stage III Colorectal Cancer with Adequate Lymph Node Retrieval Following FOLFOX Adjuvant Chemotherapy

Abstract

The aim of the study was to assess apical lymph nodes (APNs) for predicting distant metastases in patients with stage III colorectal cancer (CRC) curatively treated with FOLFOX adjuvant chemotherapy and adequate lymph node retrieval. We investigated the correlation between APN metastasis and clinical outcomes. This retrospective study examined 97 patients. All patients were followed until death, loss to follow-up, or May 2017. Clinicopathological variables, including the APN status, were assessed. Multivariate logistic regression model was used to identify the independent risk factors for APN and distant metastases, and Cox proportional regression model was used to evaluate the association between APN metastasis and oncologic outcomes. Multivariate analyses revealed the N2 stage as an independent predictor of APN metastasis [P = 0.036; odds ratio (OR): 3.016; 95% confidence interval (CI): 1.076–8.499], while APN metastasis was an independent risk factor for distant metastases (P < 0.001; OR: 13.876; 95% CI: 3.815–50.475). Furthermore, APN metastasis was an independent risk factor for poorer disease-free survival (DFS) and overall survival (OS) (P < 0.001 and P = 0.005, respectively). The liver (31.6%) was the most common site of distant metastases in patients with APN metastases. APN metastasis is an important prognostic factor for node-positive CRC; it enhanced the distant metastases in patients with stage III CRC curatively treated with adequate lymph node retrieval following FOLFOX adjuvant chemotherapy. Therefore, for patients with stage III CRC involving APN metastasis, prospectively randomized trials are mandatory to investigate different therapeutic strategies in addition to conventional FOLFOX adjuvant chemotherapy.

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Cancers, Vol. 10, Pages 9: Current Advances in Aptamers for Cancer Diagnosis and Therapy

Cancers, Vol. 10, Pages 9: Current Advances in Aptamers for Cancer Diagnosis and Therapy

Cancers doi: 10.3390/cancers10010009

Authors: Shin-ichiro Hori Alberto Herrera John Rossi Jiehua Zhou

Nucleic acid aptamers are single-stranded oligonucleotides that interact with target molecules with high affinity and specificity in unique three-dimensional structures. Aptamers are generally isolated by a simple selection process called systematic evolution of ligands by exponential enrichment (SELEX) and then can be chemically synthesized and modified. Because of their high affinity and specificity, aptamers are promising agents for biomarker discovery, as well as cancer diagnosis and therapy. In this review, we present recent progress and challenges in aptamer and SELEX technology and highlight some representative applications of aptamers in cancer therapy.

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Effect of 17-allylamino-17-demethoxygeldanamycin (17-AAG) on Akt protein expression is more effective in head and neck cancer cell lineages that retain PTEN protein expression

Abstract

Objectives

The aim of this study was to evaluate the expression of Akt, PTEN, Mdm2 and p53 proteins in three different head and neck squamous cell carcinoma (HNSCC) cell lines (HN6, HN19 and HN30), all of them treated with epidermal growth factor (EGF) and 17-allylamino-17-demethoxygeldanamycin (17-AAG), an inhibitor of Hsp90 protein.

Material and Methods

Immunofluorescence and western blot were performed in order to analyze the location and quantification, respectively, of proteins under the action 17-AAG and EGF.

Results

Treatment with EGF resulted in increased levels of Akt, PTEN and p53 in all cell lineages. The expression of Mdm2 was constant in HN30 and HN6 lineages, while in HN19 showed slightly decreased expression. Under the action 17-AAG, in HN6 and HN19, the expression of PTEN and p53 proteins was suppressed, while Akt and Mdm2 expression was reduced. Finally, in the HN30 cell lineage were absolute absence of expression of Akt, Mdm2 and p53 and decreased expression of PTEN.

Conclusion

These data allow us to speculate on the particular utility of 17-AAG for HNSCC treatment through the inhibition of Akt protein expression, especially in the cases that retain the expression of PTEN protein.

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The role of YKL40 in the pathogenesis of CRS with nasal polyps

Abstract

Background

Objective

The aim of this study was to investigate the relationship between the expression level and biologic role of YKL40 in CRS.

Methods

Results

Conclusions

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Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Cancer Biol Ther. 2018 Jan 02;:1-12

Authors: Liang Y, Li Y, Song X, Zhang N, Sang Y, Zhang H, Liu Y, Chen B, Zhao W, Wang L, Guo R, Yu Z, Yang Q

Abstract
Recent studies have shown that long non-coding RNAs (lncRNAs) are involved in a number of biological processes; however, further study is still warranted to comprehensively reveal their functions. In this study, we showed that the lncRNA in non-homologous end joining (NHEJ) pathway 1 (LINP1) was related to breast cancer cell proliferation, metastasis and chemoresistance. Loss- and gain-of function studies were used to assess the role of LINP1 in promoting breast cancer progression. LINP1 knockdown mitigated breast cancer cell growth by inducing G1-phase cell cycle arrest and apoptosis. LINP1 also promoted breast cancer cell metastasis and influenced the expression of epithelial-mesenchymal transition-related markers. We identified p53 as a regulator of LINP1, and LINP1 overexpression could restore the metastatic effects of p53. Furthermore, LINP1 was upregulated in doxorubicin- and 5-fluorouracil-resistant cells and induced chemoresistance. We also observed that LINP1 enrichment played a critical functional role in chemoresistance by inhibiting chemotherapeutics-induced apoptosis. Moreover, LINP1 in tumors was associated with lower overall survival and disease-free survival. In conclusion, LINP1 may serve as a potential oncogene and chemoresistance-related regulator of breast cancer cells, suggesting that LINP1 might be a potent therapeutic target and might reduce chemoresistance in breast cancer.

PMID: 29293402 [PubMed - as supplied by publisher]

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Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Cancer Biol Ther. 2018 Jan 02;:1-4

Authors: Wahab A, Kesari K, J Smith S, Liu Y, Barta SK

Abstract
A 67-year-old male presented with anasarca and persistent non-pruritic rash of lower extremities. Physical examination was positive for subcutaneous edema with a non-blanching rash of abdomen and lower extremities. Labs showed leukocytosis, lymphocytosis, anemia and thrombocytopenia. He also had acute kidney injury and high anion gap (AG) metabolic acidosis with elevated lactic acid (11.3 mg/dL). Computerized tomography (CT) of abdomen and pelvis showed hepatosplenomegaly, ascites and abdominal lymphadenopathy. Peripheral blood (PB) smear showed blastiod appearing lymphocytes. He was started on bicarbonate infusion due to persistent lactic acidosis (LA), however showed no significant improvement. He was started on IV dexamethasone on 3rd day of hospitalization based on preliminary result of peripheral picture which led to some improvement in LA. Following the confirmation of mantle cell lymphoma (MCL) on bone marrow (BM) biopsy and immunophenotyping, the patient started receiving VR-CAP regimen (bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone) which led to significant improvement in LA and leukocytosis. After discharge, he received further chemotherapy with resolution of the LA and normalization of blood counts. Restaging tests confirmed a complete remission with resolution of the skin rash, resolution of the pathological lymphadenopathy and hepatosplenomegaly on imaging, and absence of lymphoma on a repeat BM biopsy.

PMID: 29293400 [PubMed - as supplied by publisher]

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Pigmented epithelioid melanocytoma with nodal melanosis: A rare cause of cystic cervical lymphadenopathy.

Pigmented epithelioid melanocytoma with nodal melanosis: A rare cause of cystic cervical lymphadenopathy.

Head Neck. 2018 Jan 02;:

Authors: Tan HJ, Lee LAL, Paulus F, Tan CC

Abstract
BACKGROUND: Head and neck malignancies often present as firm, solid nodal masses. However, malignancies arising from Waldeyer's Ring may give rise to cystic lymph nodes.
METHODS: A 57-year-old man was referred for left-sided neck swelling of 2 weeks' duration. A CT scan revealed an enlarged cystic cervical node at level 5A/B and he underwent excision biopsy.
RESULTS: Histology reported nodal fibrosis with melanophages. Further examination revealed a black nodule on his back where he had wide excision and the histology confirmed pigmented epithelioid melanocytoma.
CONCLUSION: Cervical lymphadenopathy can rarely be due to an upper back lesion, such as pigmented epithelioid melanocytoma. Thus, routine clinical examination of the upper back should be performed in patients with cervical lymphadenopathy.

PMID: 29292839 [PubMed - as supplied by publisher]

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Inhibition of novel GCN5-ATM axis restricts the onset of acquired drug resistance in leukemia

Abstract

Leukemia is majorly treated by topoisomerase inhibitors that induce DNA double strand breaks (DSB) resulting in cell death. Consequently, modulation of DSB repair pathway renders leukemic cells resistant to therapy. Since we do not fully understand the regulation of DSB repair acquired by resistant cells, targeting these cells has been a challenge. Here we investigated the regulation of DSB repair pathway in Early Drug Resistant Population (EDRP) and Late Drug Resistant Population (LDRP). We found that doxorubicin induced equal DSBs in parent and EDRP cells however; cell death is induced only in the parent cells. Further analysis revealed that EDRP cells acquire relaxed chromatin via upregulation of lysine acetyl transferase KAT2A (GCN5). Drug treatment induces GCN5 interaction with ATM facilitating its recruitment to DSB sites. Hyperactivated ATM maximize H2AX, NBS1, BRCA1, Chk2 and Mcl-1 activation, accelerating DNA repair and survival of EDRP cells. Consequently, inhibition of GCN5 significantly reduces ATM activation and survival of EDRP cells. Contrary to EDRP, doxorubicin failed to induce DSBs in LDRP because of reduced drug uptake and downregulation of TOP2β. Accordingly, ATM inhibition prior to doxorubicin treatment completely eliminated EDRP but not LDRP. Furthermore, baseline AML samples (n=44) showed significantly higher GCN5 at mRNA and protein levels in MRD positive compared to MRD negative samples. Additionally, meta-analysis (n=221) showed high GCN5 expression correlates with poor overall survival. Together, these results provide important insights into the molecular mechanism specific to EDRP and will have implications for the development of novel therapeutics for AML. This article is protected by copyright. All rights reserved.

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Recursive partitioning analysis is predictive of overall survival for patients undergoing spine stereotactic radiosurgery

Abstract

Spine stereotactic radiosurgery (SRS) offers excellent radiographic and pain control for patients with spine metastases. We created a prognostic index using recursive partitioning analysis (RPA) to allow better patient selection for spine SRS. Patients who underwent single-fraction spine SRS for spine metastases were included. Primary histologies were divided into favorable (breast/prostate), radioresistant (renal cell/sarcoma/melanoma) and other. Cox proportional hazards regression was done to identify factors associated with overall survival (OS). RPA was performed to identify factors to classify patients into distinct risk groups with respect to OS. A total of 444 patients were eligible. Median dose was 16 Gy (range 8–18) in 1 fraction and median follow-up was 11.7 months. At time of analysis, 103 (23.1%) patients were alive. Median OS was 12.9 months. RPA identified three distinct classes. Class 1 was defined as KPS > 70 with controlled systemic disease (n = 142); class 3 was defined as KPS ≤ 70 and age < 54 years or KPS ≤ 70 age ≥ 54 years and presence of visceral metastases (n = 95); all remaining patients comprise class 2 (n = 207). Median overall survival was 26.7 months for class 1, 13.4 months for class 2, and 4.5 months for class 3 (p < 0.01). Our analysis demonstrates that there is considerably variability in survival among patients undergoing spine SRS. We created an objective risk stratification via RPA for spine SRS. Given the safety and efficacy of spine SRS and good survival in class 1 and 2 patients, this RPA can help clinicians identify patients who may benefit from upfront spine SRS.

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A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia.

A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia.

Dysphagia. 2016 Jun;31(3):452-61

Authors: Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, Wolkin T

Abstract
The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol ("tongue-pressure profile training") emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol ("tongue-pressure strength and accuracy training") emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration-aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage transition duration (a measure of the duration of the bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the penetration-aspiration scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration-aspiration does not necessarily accompany improvements in tongue strength; however, tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

PMID: 26936446 [PubMed - indexed for MEDLINE]

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Assessment of alveolar bone marrow fat content using 15 T MRI.

Assessment of alveolar bone marrow fat content using 15 T MRI.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 21;:

Authors: Cortes ARG, Cohen O, Zhao M, Aoki EM, Ribeiro RA, Abu Nada L, Costa C, Arita ES, Tamimi F, Ackerman JL

Abstract
OBJECTIVES: Bone marrow fat is inversely correlated with bone mineral density. The aim of this study is to present a method to quantify alveolar bone marrow fat content using a 15 T magnetic resonance imaging (MRI) scanner.
STUDY DESIGN: A 15 T MRI scanner with a 13-mm inner diameter loop-gap radiofrequency coil was used to scan seven 3-mm diameter alveolar bone biopsy specimens. A 3-D gradient-echo relaxation time (T1)-weighted pulse sequence was chosen to obtain images. All images were obtained with a voxel size (58 µm3) sufficient to resolve trabecular spaces. Automated volume of the bone marrow fat content and derived bone volume fraction (BV/TV) were calculated. Results were compared with actual BV/TV obtained from micro-computed tomography (CT) scans.
RESULTS: Mean fat tissue volume was 20.1 ± 11%. There was a significantly strong inverse correlation between fat tissue volume and BV/TV (r = -0.68; P = .045). Furthermore, there was a strong agreement between BV/TV derived from MRI and obtained with micro-CT (interclass correlation coefficient = 0.92; P = .001).
CONCLUSIONS: Bone marrow fat of small alveolar bone biopsy specimens can be quantified with sufficient spatial resolution using an ultra-high-field MRI scanner and a T1-weighted pulse sequence.

PMID: 29292160 [PubMed - as supplied by publisher]

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Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Cancer Biol Ther. 2018 Jan 02;:1-12

Authors: Liang Y, Li Y, Song X, Zhang N, Sang Y, Zhang H, Liu Y, Chen B, Zhao W, Wang L, Guo R, Yu Z, Yang Q

PMID: 29293402 [PubMed - as supplied by publisher]

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Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Cancer Biol Ther. 2018 Jan 02;:1-4

Authors: Wahab A, Kesari K, J Smith S, Liu Y, Barta SK

PMID: 29293400 [PubMed - as supplied by publisher]

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The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis

Abstract

Background

Rugby union is a physically demanding, full-contact team sport that has gained worldwide popularity. The incidence of injury in rugby union has been widely reported in the literature. While comprehensive injury surveillance and prevention programmes have been implemented within the professional game, there is a need for similar strategies in the amateur game. Despite recent increases in the volume of research in rugby, there is little consensus regarding the true incidence rate of match and training injuries in senior amateur male rugby union players.

Objective

The aim of the current review was to systematically review the available evidence on the epidemiology of time-loss injuries in senior amateur male rugby union players and to subsequently conduct a meta-analysis of the findings.

Methods

A comprehensive search of the PubMed, Scopus, SportDiscus and Google Scholar electronic databases was performed using the following keywords; ('rugby' OR 'rugby union') AND ('amateur' OR 'community') AND ('injur*' OR 'pain*'). Six articles regarding the incidence of injury in senior amateur male rugby union players, in both matches and training, were retrieved and included in the meta-analysis to determine the overall incidence rate of match injury, with descriptive analyses also provided for other reported variables.

Results

The overall incidence rate of match injuries within senior amateur rugby union players was 46.8/1000 player hours [95% confidence interval (CI) 34.4–59.2]. Contact events accounted for the majority of injuries, with the tackler more at risk than the player being tackled, and with respective incidence rates of 15.9/1000 player hours (95% CI 12.4–19.5) and 12.2/1000 player hours (95% CI 9.3–15.1).

Conclusion

This meta-analysis found that the incidence rate of injury in amateur rugby union players was lower than that in professional players, but higher than the incidences reported in adolescent and youth rugby players. By understanding the true incidence and nature of injuries in rugby, injury prevention strategies can best be implemented. Future prevention strategies may best be aimed towards the tackle area, specifically to the tackler, in order to minimize injury risk.

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Internal Carotid Artery Pseudoaneurysm and Ischemic Stroke Secondary to Retropharyngeal and Parapharyngeal Abscess.

http:--journals.sagepub.com-pb-assets-sa

Internal Carotid Artery Pseudoaneurysm and Ischemic Stroke Secondary to Retropharyngeal and Parapharyngeal Abscess.

J Child Neurol. 2017 Feb;32(2):230-236

Authors: Ruff MW, Nasr DM, Klaas JP, Renaud DL

Abstract
Internal carotid artery pseudoaneurysm is an uncommon complication of retropharyngeal and parapharyngeal abscess in children. Treatment of the pseudoaneurysm has evolved in recent years from surgical ligation to endovascular techniques. Neurologic sequelae most commonly consist of Horner's syndrome with cerebral ischemia being uncommon. The clinical course of a 2-year-old boy with retropharyngeal abscess complicated by internal carotid artery pseudoaneurysm, is described and the literature is reviewed. A conventional angiogram confirmed the presence of a large pseudoaneurysm with no anterograde flow distal to the pseudoaneurysm and substantial collateral flow across the circle of Willis, with filling of the left anterior and middle cerebral arteries via the anterior and posterior communicating arteries. Endovascular occlusion resulted in nonfilling of the left internal carotid artery, pseudoaneurysm, and left internal jugular vein at the base of the skull. Following the procedure, the patient developed transient mild right hemiparesis associated with frontal lobe ischemia.

PMID: 27888269 [PubMed - indexed for MEDLINE]

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Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients.

Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817742373

Authors: Eskander A, Kang SY, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco J, Teknos TN

Abstract
Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

PMID: 29293404 [PubMed - as supplied by publisher]

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Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Salvage Surgery after Radiation Failure in T1/T2 Larynx Cancer: Outcomes following Total versus Conservation Surgery.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817742596

Authors: Cheraghlou S, Kuo P, Mehra S, Yarbrough WG, Judson BL

PMID: 29292665 [PubMed - as supplied by publisher]

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Economic Impact of Frozen Section for Thyroid Nodules with "Suspicious for Malignancy" Cytology.

Economic Impact of Frozen Section for Thyroid Nodules with "Suspicious for Malignancy" Cytology.

Otolaryngol Head Neck Surg. 2017 Dec 01;:194599817740328

Authors: Bollig CA, Gilley D, Lesko D, Jorgensen JB, Galloway TL, Zitsch RP, Dooley LM

Abstract
Objective To perform a cost analysis of the routine use of intraoperative frozen section (iFS) among patients undergoing a thyroid lobectomy with "suspicious for malignancy" (SUSP) cytology in the context of the 2015 American Thyroid Association guidelines. Study Design Case series with chart review; cost minimization analysis. Setting Academic. Subjects and Methods Records were reviewed for patients with SUSP cytology who underwent thyroid surgery between 2010 and 2015 in which iFS was utilized. The diagnostic test performance of iFS and the frequency of indicated completion/total thyroidectomies based on the 2015 guidelines were calculated. A cost minimization analysis was performed comparing lobectomy, with and without iFS, and the need for completion thyroidectomy according to costs estimated from 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results Sixty-five patients met inclusion criteria. The malignancy rate was 61.5%, 45% of which was identified intraoperatively. The specificity and positive predictive value were 100%. The negative predictive value and sensitivity were 83% and 95%, respectively. Completion/total thyroidectomy was indicated for 9% of patients; 83% of these individuals had findings on iFS that would have changed management intraoperatively. Application of the new guidelines would have resulted in a significant reduction in the frequency of conversion to a total thyroidectomy when compared with the actual management (26.1% vs 7.7%, P = .005). Performing routine iFS was the less costly scenario, resulting in a savings of $474 per case. Conclusion For patients with SUSP cytology undergoing lobectomy, routine use of iFS would result in decreased health care utilization.

PMID: 29292662 [PubMed - as supplied by publisher]

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Effects of a Straw Phonation Protocol on Acoustic and Perceptual Measures of an SATB Chorus.

Effects of a Straw Phonation Protocol on Acoustic and Perceptual Measures of an SATB Chorus.

J Voice. 2017 Dec 29;:

Authors: Manternach JN, Daugherty JF

Abstract
BACKGROUND: Recent scholarship has suggested that semi-occluded vocal tract (SOVT) exercises may increase vocal economy of individuals by reducing vocal effort while maintaining or increasing acoustic output. Choral singers, however, may use different resonance techniques or change voicing behaviors in an effort to hear their own sound in relation to others. One investigation revealed significant increases in a choir's mean spectral energy after participating in a straw phonation protocol. However, that study reported only acoustic measures and did not include choristers' perceptions of the choral sound and their own voicing efficiency.
OBJECTIVE: The purpose of this study was to measure the effect of a straw phonation protocol on acoustic (long-term average spectrum) and perceptual (self-report) measures of the choral sound of an intact soprano, alto, tenor, and bass (SATB) choir.
STUDY DESIGN: This is a quasi-experimental, one-group, pretest-posttest design.
METHODS: An SATB choir (N = 48 singers) performed a Renaissance motet, participated in a 4-minute voicing protocol with a small straw, and then sang the motet a second time. They completed the same procedure later in the rehearsal.
RESULTS: Long-term average spectrum results indicated no statistically significant mean changes in spectral energy after the SOVT protocols. Most participants, however, perceived that the choir sounded better (78.26%) and that their own vocal production was more efficient or comfortable (73.91%) following the protocol.
CONCLUSION: Choristers perceived less vocal effort while maintaining vocal output after straw phonation, which may feasibly align with extant solo research. More research may determine whether this result is due specifically to SOVTs.

PMID: 29292086 [PubMed - as supplied by publisher]

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Role of Endocannabinoids on Sweet Taste Perception, Food Preference, and Obesity-related Disorders.

Role of Endocannabinoids on Sweet Taste Perception, Food Preference, and Obesity-related Disorders.

Chem Senses. 2017 Dec 25;43(1):3-16

Authors: Tarragon E, Moreno JJ

Abstract
The prevalence of obesity and obesity-related disorders such as type 2 diabetes (T2D) and metabolic syndrome has increased significantly in the past decades, reaching epidemic levels and therefore becoming a major health issue worldwide. Chronic overeating of highly palatable foods is one of the main responsible aspects behind overweight. Food choice is driven by food preference, which is influenced by environmental and internal factors, from availability to rewarding properties of food. Consequently, the acquisition of a dietary habit that may lead to metabolic alterations is the result of a learning process in which many variables take place. From genetics to socioeconomic status, the response to food and how this food affects energy metabolism is heavily influenced, even before birth. In this work, we review how food preference is acquired and established, particularly as regards sweet taste; towards which flavors and tastes we are positively predisposed by our genetic background, our early experience, further lifestyle, and our surroundings; and, especially, the role that the endocannabinoid system (ECS) plays in all of this. Ultimately, we try to summarize why this system is relevant for health purposes and how this is linked to important aspects of eating behavior, as its function as a modulator of energy homeostasis affects, and is affected by, physiological responses directly associated with obesity.

PMID: 29293950 [PubMed - in process]

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Interactions of Lemon, Sucrose and Citric Acid in Enhancing Citrus, Sweet and Sour Flavors.

Interactions of Lemon, Sucrose and Citric Acid in Enhancing Citrus, Sweet and Sour Flavors.

Chem Senses. 2017 Dec 25;43(1):17-26

Authors: Veldhuizen MG, Siddique A, Rosenthal S, Marks LE

Abstract
Flavorants such as lemon extract that activate olfactory receptors may also evoke or enhance flavor qualities such as sour and sweet that are typically considered gustatory. Similarly, flavorants such as sucrose and citric acid that activate gustatory receptors may enhance flavors such as citrus that are typically considered olfactory. Here, we ask how lemon extract, sucrose, and citric acid, presented separately and together, affect sweet, sour, and citrus flavors. We accomplished this by testing, in the same 12 subjects, lemon extract and sucrose (Experiment 1), lemon extract and citric acid (Experiment 2), and lemon extract, sucrose, and citric acid (Experiment 3). Results showed that both lemon extract and citric acid increased the ratings of citrus and sour intensity. Lemon extract did not affect sweet, but citric acid did, mainly in Experiment 3. Sucrose systematically increased only sweet intensity and modulated the effect of lemon extract on sour. The most robust multiquality effect was the enhancement of sour by lemon extract. These outcomes suggest, first, a role played by experience with the statistical associations of gustatory and olfactory flavorants and, second, that lemon flavor is complex, having citrus and sour qualities that may not be fully separable in perception.

PMID: 29293949 [PubMed - in process]

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Sweet Emotion: The Role of Odor-induced Context in the Search Advantage for Happy Facial Expressions.

Sweet Emotion: The Role of Odor-induced Context in the Search Advantage for Happy Facial Expressions.

Chem Senses. 2017 Dec 23;:

Authors: Damjanovic L, Wilkinson H, Lloyd J

Abstract
The current study investigated the extent to which the concurrent presentation of pleasant and unpleasant odors could modulate the perceptual saliency of happy facial expressions in an emotional visual search task. Whilst a search advantage for happy faces was found in the no odor and unpleasant odor conditions, it was abolished under the pleasant odor condition. Furthermore, phasic properties of visual search performance revealed the malleable nature of this happiness advantage. Specifically, attention towards happy faces was optimized at the start of the visual search task for participants presented with pleasant odors, but diminished towards the end. This pattern was reversed for participants in the unpleasant odor condition. These patterns occur through the emotion-inducing capacities of odors and highlight the circumstances in which top-down factors can override perceptually salient facial features in emotional visual search.

PMID: 29293901 [PubMed - as supplied by publisher]

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Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer

.

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Type B lactic acidosis, an uncommon paraneoplastic syndrome

.

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Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Long noncoding RNA LINP1 acts as an oncogene and promotes chemoresistance in breast cancer.

Cancer Biol Ther. 2018 Jan 02;:1-12

Authors: Liang Y, Li Y, Song X, Zhang N, Sang Y, Zhang H, Liu Y, Chen B, Zhao W, Wang L, Guo R, Yu Z, Yang Q

PMID: 29293402 [PubMed - as supplied by publisher]

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Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Type B lactic acidosis, an uncommon paraneoplastic syndrome.

Cancer Biol Ther. 2018 Jan 02;:1-4

Authors: Wahab A, Kesari K, J Smith S, Liu Y, Barta SK

PMID: 29293400 [PubMed - as supplied by publisher]

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Correction to: Calycosin inhibits the in vitro and in vivo growth of breast cancer cells through WDR7-7-GPR30 Signaling

Correction

In the publication of this article [1], the molecule weight of GPR30 in figures was incorrectly, this should have been 55 kDa, and not 38 kDa.

This has now been included in this erratum.

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Correction to: Chest computed tomography angiography in children on extracorporeal membrane oxygenation (ECMO)

Abstract

The published version of this article incorrectly lists the authors' affiliations. The correct affiliations are given below. The Publisher regrets this mistake.

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Brain Injuries and Facial Fractures: A Prospective Study of Incidence of Head Injury Associated with Maxillofacial Trauma

Abstract

Background

Presence of head injuries in patients with maxillofacial trauma is a lifethreatening condition. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery. Hence, the need to know about the incidence of head injuries associated with maxillofacial trauma becomes an important aspect.

Materials and Methods

A total of 100 patients were included in the study. Patient with head injuries associated with maxillofacial fractures was accounted to determine the incidence and pattern of head injuries accompanying maxillofacial trauma. They were evaluated for epidemiological demographic and clinical characteristics.

Results

The present study had 91% predominance of male patients with age ranging from 1 to 75 years. 91% cases were as a result of RTA. The most frequent maxillofacial injury represented was the fractured mandible. The incidence of head injuries associated with maxillofacial trauma was 67 %. Among all the patterns of head injuries, concussion was the most common head injury associated with maxillofacial trauma.

Conclusion

In our study, the risk of head injury increased significantly as the Glasgow Coma Scale score decreased and with increase in the number of facial fractures. There was association between head injury and maxillofacial trauma.

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Can vascular risk factors influence number and size of cerebral metastases? A 3D-MRI study in patients with different tumor entities

Publication date: Available online 2 January 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Sandra Nagel, Benjamin-Andreas Berk, Rolf-Dieter Kortmann, Karl-Titus Hoffmann, Clemens Seidel
ObjectiveThere is increasing evidence that cerebral microangiopathy reduces number of brain metastases. Aim of this study was to analyse if vascular risk factors (arterial hypertension, diabetes mellitus, smoking, and hypercholesterolemia) or the presence of peripheral arterial occlusive disease (PAOD) can have an impact on number or size of brain metastases.Patients and Methods200 patients with pre-therapeutic 3D-brain MRI and available clinical data were analyzed retrospectively. Mean number of metastases (NoM) and mean diameter of metastases (mDM) were compared between patients with/without vascular risk factors (vasRF).ResultsNo general correlation of vascular risk factors with brain metastases was found in this monocentric analysis of a patient cohort with several tumor types. Arterial hypertension, diabetes mellitus, hypercholesterolemia and smoking did not show an effect in uni- and multivariate analysis. In patients with PAOD the number of BM was lower than without PAOD. This was the case independent from cerebral microangiopathy but did not persist in multivariate analysis.ConclusionFrom this first screening approach vascular risk factors do not appear to strongly influence brain metastasation. However, larger prospective multi-centric studies with better characterized severity of vascular risk are needed to more accurately detect effects of individual factors.

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Cancers, Vol. 10, Pages 8: Modification of Epigenetic Histone Acetylation in Hepatocellular Carcinoma

Cancers, Vol. 10, Pages 8: Modification of Epigenetic Histone Acetylation in Hepatocellular Carcinoma

Cancers doi: 10.3390/cancers10010008

Authors: Kwei-Yan Liu Li-Ting Wang Shih-Hsien Hsu

Cells respond to various environmental factors such as nutrients, food intake, and drugs or toxins by undergoing dynamic epigenetic changes. An imbalance in dynamic epigenetic changes is one of the major causes of disease, oncogenic activities, and immunosuppressive effects. The aryl hydrocarbon receptor (AHR) is a unique cellular chemical sensor present in most organs, and its dysregulation has been demonstrated in multiple stages of tumor progression in humans and experimental models; however, the effects of the pathogenic mechanisms of AHR on epigenetic regulation remain unclear. Apart from proto-oncogene activation, epigenetic repressions of tumor suppressor genes are involved in tumor initiation, procession, and metastasis. Reverse epigenetic repression of the tumor suppressor genes by epigenetic enzyme activity inhibition and epigenetic enzyme level manipulation is a potential path for tumor therapy. Current evidence and our recent work on deacetylation of histones on tumor-suppressive genes suggest that histone deacetylase (HDAC) is involved in tumor formation and progression, and treating hepatocellular carcinoma with HDAC inhibitors can, at least partially, repress tumor proliferation and transformation by recusing the expression of tumor-suppressive genes such as TP53 and RB1.

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Unexpected Persistent Dentocentral Synchondrosis of C2

Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Shahed Nalla, Esther Blanco-Perez, Federico Mata-Escolano, Susanna Llido, Juan A. Sanchis-Gimeno
BackgroundThe persistence of synchondrosis in adulthood can confound diagnostic decisions made during patient management.Case DescriptionA 59-year-old woman who presented neck pain, acute headache, and acute cervical myelopathy symptoms after suffering whiplash grade 3 in a car rear-end impact underwent a conventional radiologic study that revealed no fracture and no anatomic spine variations. The magnetic resonance imaging study revealed no spinal cord intensity signal changes, but it showed a persistent (remnant) dentocentral synchondrosis that was undetected in a previous conventional radiographic evaluation.ConclusionsThe localization and level of the remnant of the dentocentral synchondrosis are extremely important from the clinical viewpoint because of odontoid and C2 fractures. Neurosurgeons should thus be aware of the possible presence of a persistent (remnant) C2 dentocentral synchondrosis in adult subjects in order to avoid misdiagnosis with C2 fracture.

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An Unusual Case of Ureteral Perforation in Minimally Invasive Pedicle Screw Instrumentation: Case Report and Review of the Literature

Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Edward Fomekong, Julien Pierrard, Etienne Danse, Bertrand Tombal, Christian Raftopoulos
BackgroundInjury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, or vascular pelvic surgery or endoscopic procedures for ureteric diseases. We report a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement.Case DescriptionA 60-year-old man reported unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. A computer tomography workup showed contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. The patient underwent left nephrostomy and a double-J stent insertion and subsequently fully recovered. The ureter completely healed, enabling stent removal 5 months later.MethodsPubMed and EMBASE were screened for ureteral injury caused by posterior lumbar surgery.ResultsWe found 27 other reports with only 1 other case after minimally invasive transforaminal lumbar interbody.ConclusionsComplications of minimally invasive pedicle screw placement are often described as dural tear of neurologic impairment. This report shows that unexpected side effects are still possible and spine surgeons should be aware especially when performing minimally invasive procedures, in which, by definition, pedicles are concealed from direct visualization.

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ECCO Essential Requirements for Quality Cancer Care: Melanoma

Publication date: Available online 2 January 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Michel W. Wouters, Olivier Michielin, Ether Bastiaannet, Marc Beishon, Orlando Catalano, Veronique del Marmol, Roberto Delgado-Bolton, Rémi Dendale, Maria Die Trill, Andrea Ferrari, Ana-Marie Forsea, Hannelore Kreckel, József Lövey, Gre Luyten, Daniela Massi, Peter Mohr, Simon Oberst, Philippe Pereira, João Paulo Paiva Prata, Piotr Rutkowski, Tiina Saarto, Sapna Sheth, Gilly Spurrier-Bernard, Meri-Sisko Vuoristo, Alberto Costa, Peter Naredi
BackgroundECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care.ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe.Melanoma: essential requirements for quality care• Melanoma, the most-deadly skin cancer, is rising in incidence among fair-skinned people in Europe. Increasing complexity of care for advanced disease in clinical areas such as staging and new therapies requires attention to a number of challenges and inequalities in a diverse patient group.• Care for advanced melanoma must only be carried out in, or in collaboration with, specialist melanoma centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries.• It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis to treatment and follow-up, to improve survival and quality of life for patients.ConclusionTaken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma.

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ECCO Essential Requirements for Quality Cancer Care: Oesophageal and Gastric Cancer

Publication date: Available online 2 January 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): William Allum, Florian Lordick, Maria Alsina, Elisabeth Andritsch, Ahmed Ba-Ssalamah, Marc Beishon, Marco Braga, Carmela Caballero, Fatima Carneiro, Fernando Cassinello, Jan Willem Dekker, Roberto Delgado-Bolton, Karin Haustermans, Geoffrey Henning, Bettina Hutter, József Lövey, Irena Štenglová Netíková, Radka Obermannová, Simon Oberst, Siri Rostoft, Tiina Saarto, Thomas Seufferlein, Sapna Sheth, Venetia Wynter-Blyth, Alberto Costa, Peter Naredi
BackgroundECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe.Oesophageal and gastric: essential requirements for quality care• Oesophageal and gastric (OG) cancers are a challenging tumour group with a poor prognosis and wide variation in outcomes among European countries. Increasing numbers of older people are contracting the diseases, and treatments and care pathways are becoming more complex in both curative and palliative settings.• High-quality care can only be a carried out in specialised OG cancer units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries.• It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.ConclusionTaken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with CRC.

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Parents' experiences managing their child's complicated postoperative recovery

Publication date: Available online 2 January 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Mary Purcell, Julie Longard, Jill Chorney, Paul Hong
ObjectiveTonsillectomy is commonly performed as same-day surgery and parents are heavily relied upon for management of children's postoperative recovery. The objective of this study was to provide an in-depth description of the experiences parents face when managing their child's complicated postoperative recoveries at home.MethodsAn exploratory qualitative study at an academic pediatric hospital in Eastern Canada was performed. Participants included 12 parents of children aged 3–6 years who underwent adeno/tonsillectomy and experienced unexpected outcomes or complications during the postoperative recovery period. Parents participated in semi-structured interviews within 6 months of their child's surgery. Interviews were transcribed verbatim and thematic analysis was used to identify themes in the parents' experiences.ResultsParents described struggling to make the decision to come back to hospital, that adequate information does not prevent emotional difficulties, and feeling somewhat responsible for the unexpected outcome or complicated course of recovery. Communication with healthcare providers was considered very important in helping with the recovery process.ConclusionThis research helps to inform healthcare professionals about how they might better support families during complicated recovery processes. Areas of action may include clear communication, setting expectations, and psychosocial support.

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Difficult airway intubation simulation using Bonfils fiberscope and rigid fiberscope for surgical training

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Harish Dharmarajan, Yi-Chun Carol Liu, Helena Karlberg Hippard, Binoy Chandy
IntroductionPediatric otolaryngologists are frequently called to assist in difficult airway management in newborns with Pierre Robin Sequence (PRS) who have microretrognathia, glossoptosis, and an anterior larynx. The Bonfils fiberscope (BF) is a curved rigid scope designed to provide superior visualization in the anterior larynx.Objective(1) to assess whether BF provides an improvement in intubation success rate, time to intubation, or airway visualization as compared to rigid fiberscope (RF) in a difficult airway simulation setting and (2) to determine whether a training program for BF can improve time to intubation through practice trials.MethodsSix right-handed trainees completed five trials on each of the three following airway models using the BF and RF: normal anatomy, anterior larynx and PRS. The normal larynx model was intubated only with RF. Main outcome measures were the time needed for tracheal intubation and Cormack–Lehane classification (1–4).ResultsThe majority of the intubation trials showed a statistically significant difference between first and last completion times (p < .05) suggesting construct validity. Only the anterior larynx trials with BF did not demonstrate an improvement in time to intubation between first and last attempts (p < .3125). For the PRS retrognathia model, there was no statistically significant difference in time to intubation between using the BF and the RF (p < .44); in the anterior larynx model, the RF yielded a faster time to intubation than the BF on the final trial attempts (p < .0313). By Cormack–Lehane classification measures, laryngeal visualization by the BF was better than RF in the PRS manikin (p < .0022) while there was no significant difference in grade scores for the anterior larynx manikin (p < .45). All six trainees reported an improved visualization of the larynx with the BF compared to the RF for both the anterior larynx and PRS manikins; at the end of the trial runs, all participants noted an improvement in comfort level using the BF.ConclusionThe difficult airway simulation model is feasible for surgical training. BF adds superior visualization of the anterior larynx in PRS. Otolaryngology training programs may include BF as a supplemental tool in addition to RF as a part of the airway equipment training since there is significant improvement in time to intubation with consecutive practice trials and superior laryngeal visualization.

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Outcomes of adenoidectomy-alone in patients less than 3-years old

Publication date: Available online 2 January 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Kishan M. Thadikonda, Amber D. Shaffer, Amanda L. Stapleton
Objectives1. Determine the percentage of patients under the age of 3 undergoing adenoidectomy-alone who require subsequent management of residual sleep disordered breathing (SDB).2. Characterize complications following adenoidectomy and determine if any perioperative factors are associated with intra-operative or post-operative complications and outcomes.MethodsCase series with chart review was conducted including children seen at a tertiary care children's hospital between 2008 and 2012. Consecutive patients under the age of 3 who underwent adenoidectomy-alone were identified by billing codes. After excluding those with syndromes, partial adenoidectomies, and those without follow-up, 148 patients were included. Predictors of requiring additional surgery for SDB were evaluated using log-rank tests or Cox proportional hazards regression.ResultsMedian age at time of initial adenoidectomy was 27.5 months (range 11–36 months) and the patient population was comprised of 66.2% males (n = 98/148) and 89.2% Caucasians (n = 132/148). 56.5% (n = 74/131) of patients continued to have residual symptoms of SDB and 34.5% (n = 51/148) underwent additional surgical intervention. Multivariable survival analysis revealed GERD (HR, 6.21; CI, 1.29–29.77, p = .022) and tonsil size (HR, 4.07; CI, 1.57–10.51, p = .004) were significant predictors of additional surgery in this group of patients under the age of 3. There was no observed difference in intra- and post-operative complication rates between patients with and without additional operative intervention.ConclusionsResidual SDB symptoms following adenoidectomy in patients less than 3 years of age are common and require additional surgery at a high rate. Medical comorbidities such as GERD and large tonsil size may help predict the need for additional surgery.

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Αρχειοθήκη ιστολογίου

Τετάρτη 3 Ιανουαρίου 2018

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