Pesticides as risk factors for head and neck cancer: a review

Abstract

Humans may be exposed to pesticides such as fungicides, herbicides and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure and type of pesticide.

This article is protected by copyright. All rights reserved.

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Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty

Abstract

Purpose

To compare the clinical and radiological outcomes between skipped-level and all-level plating for cervical laminoplasty.

Methods

Patients with cervical spondylotic myelopathy (CSM) treated by open-door laminoplasty with minimum 2-year postoperative follow-up were included. All patients had opening from C3–6 or C3–7 and were divided into skipped-level or all-level plating groups. Japanese Orthopaedic Association (JOA) scores and canal measurements were obtained preoperatively, immediate (within 1 week) postoperatively, and at 2, 6 weeks, 3, 6 and 12 months postoperatively. Paired t test was used for comparative analysis. Receiver operating characteristic analysis was used to determine the canal expansion cutoff for spring-back closure.

Results

A total of 74 subjects were included with mean age of 66.1 ± 11.3 years at surgery. Of these, 32 underwent skipped-level plating and 42 underwent all-level plating. No significant differences were noted between the two groups at baseline and follow-up. Spring-back closure was observed in up to 50% of the non-plated levels within 3 months postoperatively. The cutoff for developing spring-back closure was 7 mm canal expansion for C3–6. No differences were observed in JOA scores and recovery rates between the two groups. None of the patients with spring-back required reoperation.

Conclusions

There were no significant differences between skipped-level and all-level plating in terms of JOA or recovery rate, and canal diameter differences. This has tremendous impact on saving costs in CSM management as up to two plates per patient undergoing a standard C3–6 laminoplasty may be omitted instead of four plates to every level to achieve similar clinical and radiological outcomes.

Level of evidence

III.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Pre- and postsynaptic ionotropic glutamate receptors in the auditory system of mammals

Publication date: Available online 28 February 2018
Source:Hearing Research
Author(s): Hideki Takago, Tomoko Oshima-Takago
The ionotropic glutamate receptors (iGluRs) concertedly mediate neurotransmission to convey, process, and integrate acoustic information along the auditory pathway. In order to ensure these challenging tasks, the iGluRs are variously expressed in auditory neurons in an age- and site-dependent manner. The subunit compositions of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) and N-methyl-D-aspartate receptors (NMDARs) are altered with development, underlying the acceleration in kinetics of excitatory postsynaptic responses. AMPAR desensitization partly affects short-term synaptic plasticity upon repetitive stimuli in subsets of auditory neurons at a given period of maturation. NMDAR activation is required for long-term synaptic plasticity in a cerebellum-like microcircuit within the first auditory brainstem nucleus. Along with their postsynaptic functions, AMPARs and NMDARs fulfill essential roles in presynaptic modulation of auditory neurotransmission. Despite the expression of the kainate and delta receptors, their functions remain unknown. Here this review aims to discuss the diverse distribution and functions of pre- and postsynaptic iGluRs in the peripheral and central auditory systems.



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From Hypothermia to Cephalosomatic Anastomoses: The Legacy of Robert White (1926–2010) at Case Western Reserve University of Cleveland

Publication date: May 2018
Source:World Neurosurgery, Volume 113
Author(s): Sunil Manjila, Vilakshan Alambyan, Gagandeep Singh, Priyanka Satish, Robert T. Geertman
Dr. Robert J. White (1926–2010) was an eminent neurosurgeon and bioethicist, renowned for his classic work in hypothermia and pioneering mammalian head transplant experiments. He founded the Division of Neurosurgery at the Cleveland Metropolitan General Hospital (currently MetroHealth Medical Center, a level 1 trauma county hospital) and became the youngest full professor at the Case Western Reserve University in Cleveland, Ohio. With over 500 research articles to his credit, he founded the Brain Research Laboratory at what was then the Cleveland Metropolitan General Hospital, which was also home to future leaders in neurosurgery, neurosciences, and allied specialties. He transferred a healthy monkey head onto a surgically beheaded monkey body under deep hypothermic conditions drawing both laurels and criticisms alike. Despite a largely controversial neurosurgical research career, his original contributions to deep hypothermia have found profound clinical applications in modern trauma and vascular neurosurgery. The new fusogens and myelorrhaphy methods being tried in Europe hold promise for a future of reanastomosing 2 homologous or heterologous tracts in the neuraxis.



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Prognostic Significance of Magnetic Resonance Imaging in Patients with Severe Nonpenetrating Traumatic Brain Injury Requiring Decompressive Craniectomy

Publication date: April 2018
Source:World Neurosurgery, Volume 112
Author(s): Kwok M. Ho, Stephen Honeybul, Ravi Ambati
BackgroundDiffuse axonal injury (DAI) detected on magnetic resonance imaging (MRI) may be useful to predict outcome after traumatic brain injury (TBI).MethodsThis study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI to predict the 18-month neurologic outcome in 56 patients who had required decompressive craniectomy after TBI.ResultsOf the 56 patients included in the study (19 scans occurred within 14 days; median time for all patients 24 days, interquartile range 14–42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI diffusion-weighted (DW) T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences was associated with an increased risk of unfavorable outcome at 18 months compared with patients without DAI (44% vs. 17%, difference = 27%, 95% confidence interval 2.4–46.7%; P = 0.032), particularly when the brainstem was involved. However, neither the grading (I to IV) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavorable and favorable outcomes (area under the receiver operating characteristic curve: 0.625 and 0.621 vs. 0.918, respectively; P < 0.001 for both comparisons). After adjustment for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavorable outcome.ConclusionsThe prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate the outcomes in patients with TBI requiring decompressive craniectomy.



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Health equity for displaced children with cancer in the Middle East

Armed conflicts in the Middle East during the past decade have forced people to flee in vast numbers to neighboring countries, and this has added substantial strains to existing resources. In this context, the needs of displaced children with noncommunicable diseases such as cancer can unfortunately be overlooked because of the complexities of coordinating multidisciplinary care and a lack of resources for managing the acute toxicities of therapy. Innovative transnational collaborations in countries such as Lebanon can serve as models for the delivery of equitable cancer care during times of geopolitical turmoil. See also pages 000-000.

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Displaced children with cancer in Lebanon: A sustained response to an unprecedented crisis

BACKGROUND

The unrest in Syria has resulted in an escalating refugee crisis. The postwar lack of health care infrastructure in Iraq has also resulted in Iraqis seeking health care in neighboring countries. Pediatric cancer is largely curable, although its treatment is expensive and complex. Strategies to implement pediatric cancer care with curative intent in these vulnerable populations are lacking.

METHODS

To assess the feasibility of a collaborative approach for the provision of care to displaced children with cancer, this study reviewed the experience of the authors over the past 6 years in Lebanon, the country with the highest number of refugees per capita in the world.

RESULTS

The American University of Beirut Medical Center and the Children's Cancer Center of Lebanon Foundation, in partnership with St. Jude Children's Research Hospital and the American Lebanese Syrian Associated Charities, established 3 successive funding programs to treat displaced children with cancer along with a continuous assessment of resource utilization. Between 2011 and 2017, 575 non-Lebanese children suspected to have cancer were evaluated. Of those, 311 received direct medical support, with 107 receiving full-treatment coverage and 204 receiving limited-workup/specialty services; the remaining 264 patients received medical consultations.

CONCLUSIONS

In addition to providing lifesaving humanitarian support, the coordination of care delivery, including the establishment of guidelines for prioritization, can help direct future efforts. Many patients continue to be in dire need of support, and this should be addressed via collaboration among governmental, nongovernmental, and health care organizations. Cancer 2018. © 2018 American Cancer Society.

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Risk of second malignancies among survivors of pediatric thyroid cancer

Abstract

Background

Thyroid carcinoma is a very rare tumor in the pediatric age group, accounting for only 1.5–3% of childhood carcinomas in the United States and Europe. We aimed to identify the risk of a second malignancy among pediatric thyroid cancer survivors.

Methods

The cohort analysis consisted of pediatric cancer patients aged less than 20 years, diagnosed with a primary thyroid cancer, identified by site code ICD-0-3: C739, and reported to the SEER 9 database between 1973 and 2013. They were followed up until December 31, 2013; the end of the study period, or up to death if earlier.

Results

Out of 1769 patients diagnosed primarily with thyroid carcinoma, 42 patients had a total of 45 incidences of subsequent malignancies. The mean age of patients at the initial diagnosis of thyroid cancer was 16 years. Females (90.5%) had a significantly higher incidence of second malignancies (SM) than males (9.5%). The overall Standardized Incidence Ratio (SIR) of SM in the study patients was higher than expected (SIR = 1.48). Some specific sites showed significantly higher incidences: the salivary glands (SIR = 33.95), the gum and other parts of the mouth [excluding the lips, tongue, salivary glands and floor of the mouth] (SIR = 24.53)*** and the kidneys (SIR = 5.72). The overall risk of SM in patients who had received radioactive iodine was higher than expected (SIR = 4.41). The cumulative incidence of SM after treatment of thyroid cancer in children increases steadily over 40 years (11.92%).

Conclusions

Race, gender, histological subtypes, and radioactive iodine are potentially significant prognostic factors for the development of SM among pediatric thyroid cancer survivors. Identification of underlying mechanisms that raise the risk of SM is important for both treatment and follow-up strategies.

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Réirradiation des tumeurs de la tête et du cou : volumes cibles, évolutions techniques et perspectives

Publication date: Available online 27 February 2018
Source:Cancer/Radiothérapie
Author(s): R. Kinj, K. Bénézery, C. Florescu, B. Gery, J.L. Habrand, J. Thariat




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Orthotopic transfer of vascularized groin lymph node flap in the treatment of breast cancer-related lymphedema: clinical results, lymphoscintigraphy findings and proposed mechanism

Publication date: Available online 28 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hin-Lun Liu, Suet-Ying Pang, Chung-Ching Lee, Melody Man-Kuen Wong, Hon-Ping Chung, Yu-Wai Chan
IntroductionVascularized lymph node transfer (VLNT) has become more popular in treating secondary lymphedema. However, the mechanism has not been clearly elucidated.The purpose of this study were (1) to evaluate the outcome of vascularized groin lymph node (VGLN) transfer using axilla as a recipient site in patients with breast cancer-related lymphedema (BCRL) and (2) to provide radiological evidence of lymphangiogenesis in VLNT.MethodsBetween August 2013 and June 2016, 30 consecutive patients with a mean age of 60 years underwent VGLN transfer for BCRL. A skinless VGLN flap nourished by the superficial circumflex iliac vessels was transferred to the axillary region of lymphedematous limb. The outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy.ResultsAt a mean follow-up of 22.11 ± 7.83 months, 21 (70%) patients had reduction in limb circumference. The mean circumference reduction rate of the lymphedematous limb was 47.06 ± 27.92% (range, 0 to 100%).Eleven (37%) patients showed radiological improvement in post-operative lymphoscintigraphy that included 7 cases of faster contrast transport and 4 cases of visualization of transplanted lymph node.ConclusionPatients with BCRL can benefit from orthotopic VGLN transfer. Lymphangiogenesis is supported by the visualization of transplanted lymph node in post-operative lymphoscintigraphy.



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A case of cytokeratin–negative sarcomatoid malignant pleural mesothelioma

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The international WAO/EAACI guideline for the management of hereditary angioedema – the 2017 revision and update

Hereditary Angioedema (HAE) is a rare and disabling disease. Early diagnosis and appropriate therapy are essential. This update and revision of the global guideline for HAE provides up-to-date consensus recomm...

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"Gan To Kagaku Ryoho"[jour]; +52 new citations

52 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Gan To Kagaku Ryoho"[jour]

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[Long-term changes in multimodal intensive tinnitus therapy : A 5‑year follow-up. German version].

Related Articles

[Long-term changes in multimodal intensive tinnitus therapy : A 5‑year follow-up. German version].

HNO. 2018 Feb 26;:

Authors: Brüggemann P, Otto J, Lorenz N, Schorsch S, Szczepek AJ, Böcking B, Mazurek B

Abstract
BACKGROUND: We present 5‑year follow-up data for tinnitus-specific and comorbid depressive symptoms as well as stress-related outcome variables of an intensive multimodal 7‑day tinnitus therapy.
METHOD: Tinnitus burden (Tinnitus Questionnaire), stress (Perceived Stress Questionnaire), and depressive symptomatology (General Depression Scale) were measured at the 5‑year follow-up after a multimodal intensive 7‑day intervention. In all, 94 patients participated in the study.
RESULTS: All outcome variables showed significant improvement at the end of the 7‑day intensive treatment. These effects remained significant after 5 years.
CONCLUSION: The results of the present study support the effectiveness of the 7‑day multimodal intensive therapy for tinnitus. Posttreatment improvements were related to both tinnitus burden as well as stress and depressive symptoms and were maintained at the 5‑year follow-up.

PMID: 29484461 [PubMed - as supplied by publisher]

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Full endoscopic vascular decompression in trigeminal neuralgia: Experience of 230 Patients.

Full endoscopic vascular decompression in trigeminal neuralgia: Experience of 230 Patients.

World Neurosurg. 2018 Feb 24;:

Authors: Dubey A, Yadav N, Ratre S, Parihar VS, Yadav YR

Abstract
BACKGROUND: Although most surgeons are employing endoscope as an adjunct to the microscope in microvascular decompression, a full endoscopic technique is less commonly performed. The present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression.
METHODS: A retrospective study was carried out in a tertiary care hospital. Patients with typical neuralgia, with or without preoperatively detected vascular compression, were advised to undergo vascular decompression.
RESULTS: Maxillary and mandibular division were involved in 116, and 93 patients respectively. Superior cerebellar (n=174) artery was most common vascular conflict followed by anterior inferior cerebellar artery (n=96). Tortuous basilar artery and small veins were possible causes of neuralgia in 1 and 2 patients respectively. Single and double vessels conflict was observed in 173 and 50 patients respectively. The compressing vessel was placed anterior to the trigeminal nerve in 39 patients. An arterial loop was in contact with the nerve, producing grooving, and displacing the nerve in 215, 35 and 21 patients respectively. Complete, satisfactory and no relief of pain was observed in 204 (88.7%), 11 (5.8%) and 15 (6.5%) patients respectively. Recurrence was observed in 25 patients at an average 60 months follow up. Temporary complications included trigeminal dysesthesia, vertigo, facial paresis, CSF leak, and reduced hearing in 9, 8, 8, 7, and 3 patients respectively.
CONCLUSION: Endoscopic vascular decompression is a safe and efficient alternative technique to endoscopic assisted microvascular decompression provided surgeon is experienced in endoscopic surgery. It is helpful in identification of all offending vessels including the double vessel, and anterior compression without brain and nerve retraction.

PMID: 29486313 [PubMed - as supplied by publisher]

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Skull Base Metastasis From Occult Renal Cell Carcinoma.

Skull Base Metastasis From Occult Renal Cell Carcinoma.

J Craniofac Surg. 2018 Feb 26;:

Authors: Golinelli G, Toso A, Rosa MS, Valletti PA, Pia F

Abstract
Skull base metastases are extremely rare. The authors report a case of a 65-year-old man who presented with a headache and diplopia secondary to a skull base metastasis from occult renal cell carcinoma. Since there were no other systemic metastases, radical nephrectomy and radiotherapy of the unresectable skull base location were performed. He subsequently received immunotherapy with sunitinib, everolimus, and sorafenib with local and systemic control of the disease after 53 months from surgery. When metastasis is unresectable radical nephrectomy and radiotherapy aimed at the metastasis may be of benefit improving quality of life. Immunotherapy may provide alternative treatment strategies improving the outcomes of patients affected by this rare pathology with historically poor prognosis.

PMID: 29485573 [PubMed - as supplied by publisher]

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Metastasis to the Sellar/Suprasellar Region in a Patient With Endometrial Carcinoma Detected by 18F-FDG PET/CT.

Metastasis to the Sellar/Suprasellar Region in a Patient With Endometrial Carcinoma Detected by 18F-FDG PET/CT.

Clin Nucl Med. 2018 Feb 27;:

Authors: Salvatore B, D'Amico D, Fonti R

Abstract
Metastases to pituitary gland, suprasellar region or skull base from endometrial carcinoma are an extremely rare occurrence. We report the case of a 77-year-old woman with metastasis to the sellar/suprasellar region from endometrial carcinoma revealed by F-FDG PET/CT and confirmed by subsequent CT and MRI of the brain. This case highlights the usefulness of a whole-body imaging methodology such as F-FDG PET/CT in the detection of distant and/or atypical sites of metastasis therefore being of help in guiding towards the correct diagnosis.

PMID: 29485436 [PubMed - as supplied by publisher]

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"Five-layer gasket seal" watertight closure for reconstruction of the skull base in complex bilateral traumatic intraorbital meningoencephaloceles: a case report and literature review.

"Five-layer gasket seal" watertight closure for reconstruction of the skull base in complex bilateral traumatic intraorbital meningoencephaloceles: a case report and literature review.

Brain Inj. 2018 Feb 27;:1-4

Authors: Zhao D, Tao S, Zhang D, Qin M, Bao Y, Wu A

Abstract
PURPOSE: Traumatic meningoencephalocele primarily occurs as a rare but complex complication of cranial base and orbital roof fractures. Traumatic intraorbital meningoencephalocele, which is rare and easily overlooked, can be life-threatening since cephalomeningitis occurs due to cerebrospinal fluid (CSF) leakage. It is obscure for the operative indications or standard surgical methods of traumatic meningoencephaloceles since the combined intricate craniofacial and basal fractures, brain injury, and CSF leak may exist. This case report proposes a new operative method for the repair of complex skull base fractures following traumatic intraorbital meningoencephalocele.
METHODS: A 30-year-old male with a history of complex trauma presented with symptoms of exophthalmos and traumatic CSF rhinorrhea was evaluated via 3D CT of the skull base and brain MRI and was diagnosed with bilateral intraorbital meningoencephaloceles and multiple craniofacial bone, skull base, and orbit fractures.
RESULTS: Successful resection of the meningoencephaloceles and reconstruction of the skull base defects were performed via craniotomy using a "five-layer gasket seal" technique that involved, from extracranial to intracranial, a gelatin sponge, muscular paste, vascularized periosteum, RapidSorb Orbital Floor Plate (OrbFloor), and Neuro-Patch layers.
CONCLUSIONS: The diagnosis and treatment of complex intraorbital meningoencephalocele require careful attention. Resection of herniated tissue is suggested due to potential contamination. The "five-layer gasket seal" watertight closure technique is recommended for successful repair of the skull base in cases involving traumatic meningoencephalocele with complex skull base fractures.

PMID: 29485295 [PubMed - as supplied by publisher]

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Clinicopathologic characteristics of poorly differentiated chordoma.

Related Articles

Clinicopathologic characteristics of poorly differentiated chordoma.

Mod Pathol. 2018 Feb 26;:

Authors: Shih AR, Cote GM, Chebib I, Choy E, DeLaney T, Deshpande V, Hornicek FJ, Miao R, Schwab JH, Nielsen GP, Chen YL

Abstract
Chordoma is a rare malignant tumor of bone with high morbidity and mortality. Recently, aggressive pediatric poorly differentiated chordoma with SMARCB1 loss has been described. This study summarizes the clinicopathologic features of poorly differentiated chordoma with SMARCB1 loss in the largest series to date. A search of records between 1990-2017 at MGH identified 19 patients with poorly differentiated chordoma. Immunohistochemical stains were evaluated. Kaplan-Meier survival statistics and log-rank (Mantel Cox) tests compared survival with other subtypes. The patients (n = 19) were diagnosed at a median age of 11 years (range: 1-29). Tumors arose in the skull base and clivus (n = 10/19; 53%); cervical spine (n = 6/19; 32%); and sacrum or coccyx (n = 3/19; 16%). The clinical stage of these patients (AJCC 7e) was stage 2A (n = 7/16; 44%); stage 2B (n = 6/16; 38%); stage 4A (n = 1/16; 6%); and stage 4B (n = 2/16; 13%). The tumors were composed of sheets of epithelioid cells with nuclear pleomorphism, abundant eosinophilic cytoplasm, and increased mitoses. Tumors were positive for cytokeratin (n = 18/18; 100%) and brachyury (n = 18/18; 100%). Patients were treated with a combination of excision, radiation therapy, and chemotherapy. No difference in overall survival, progression free survival, local control time, and metastasis free survival was identified between poorly differentiated chordoma of the skull base and of the spine. Compared to other chordoma subtypes, poorly differentiated chordoma has a significantly decreased mean overall survival after stratification by site (p = 0.037). Pediatric poorly differentiated chordoma has a distinct clinical and immunohistochemical profile, with characteristic SMARCB1 loss and decreased survival compared to conventional/chondroid chordoma. Recognition of this subtype is important because these malignancies should be treated aggressively with multimodality therapy.

PMID: 29483606 [PubMed - as supplied by publisher]

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Morphometric Analysis of the Posterior Cranial Fossa in Syndromic and Nonsyndromic Craniosynostosis.

Related Articles

Morphometric Analysis of the Posterior Cranial Fossa in Syndromic and Nonsyndromic Craniosynostosis.

J Craniofac Surg. 2017 Jul;28(5):e484-e488

Authors: Beez T, Koppel D, Sangra M

Abstract
Posterior cranial fossa (PCF) anatomy can be abnormal in craniosynostosis, and hindbrain herniation may occur. This study analyzed PCF anatomy in single suture and complex craniosynostosis.Children with craniosynostosis and age-matched controls were identified. Cephalic index (CI) for cranial vault and PCF as well as tentorial (TA) and occipital angles (OA) were measured on preoperative imaging.Children with syndromic (N = 6), bicoronal (N = 4), sagittal (N = 12), and metopic synostosis (N = 4) as well as controls (N = 10) were enrolled. Mean CI for cranial vault was 0.89, 0.93, 0.65, 0.74, and 0.78, respectively. Corresponding CI for PCF was 0.81, 0.93, 0.62, 0.74, and 0.78. Mean TA and OA were 45.4° and 96.6° in syndromic, 39.7° and 87.0° in bicoronal, 34.0 and 75.0° in sagittal, 39.7° and 87.0° in metopic synostosis, and 42.9° and 88.3° in controls.While CI, TA, and OA in metopic synostosis were similar to controls, abnormalities were found in syndromic, bicoronal, and sagittal synostosis. Syndromic and bicoronal craniosynostosis patients had a higher CI for both cranial vault and PFC as well as larger TA and OA, indicating a brachycephalic skull with steep tentorium and narrow PCF. In sagittal synostosis, CI for cranial vault and PCF were lower and TA and OA smaller, reflecting scaphocephalic deformity also at PCF, with a flat tentorium. This study provides basic PCF morphometry in craniofacial conditions.

PMID: 28665854 [PubMed - indexed for MEDLINE]

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Distances from vocal cords to mid-trachea for optimizing endotracheal tubes depth markers according to gestational age.

Related Articles

Distances from vocal cords to mid-trachea for optimizing endotracheal tubes depth markers according to gestational age.

Paediatr Anaesth. 2018 Feb 26;:

Authors: Rigo V, Fayoux P

Abstract
BACKGROUND: Adequate endotracheal tube positioning in preterm infants is complicated by the short length of the airway. Distal markers were designed to help with the insertion of endotracheal tubes at an appropriate depth below the vocal cords. However, those markers are not standardized between manufacturers, each tube size displays only one (sometimes 2) markers to provide information for infants of various gestational ages, and indicated distances are often too long for extremely preterm infants.
AIMS: The study aims to describe vocal cords to mid-tracheal distance for different gestational ages and determine if depth markers should be adjusted accordingly.
METHODS: Half the tracheal length added to the height of the posterior lamina of the cricoids approximates the distance between vocal cords and mid-trachea. Those dimensions were retrospectively retrieved from a database of laryngo-tracheal measurements obtained during autopsies of fetuses and newborn infants free of upper airway malformations. The equation of correlation between gestational age and distance from vocal cords to mid-trachea was used to calculate those distances for different gestational ages.
RESULTS: Data were derived from 114 patients. Vocal cords to mid-trachea distance is linearly correlated with gestational age (r = .90; distance = 2.831 + 0.6208 × gestational age). We suggest depth markers at 17.7, 19.0, 20.8, 22.7, 24.6, and 26.4 mm for gestational ages of 24, 26, 29, 32, 35, and 38 weeks, respectively, indicated by contrasting colors.
CONCLUSION: The linear relationship between laryngo-tracheal size and gestational age offers the opportunity to revise endotracheal tube depth markers for the smallest patients. Trials comparing those suggested markers with those currently in use are needed before implementation.

PMID: 29484763 [PubMed - as supplied by publisher]

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Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children.

Related Articles

Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children.

Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2871-2876

Authors: Manica D, de Souza Saleh Netto C, Schweiger C, Sekine L, Enéas LV, Pereira DR, Kuhl G, Carvalho PRA, Marostica PJC

Abstract
The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

PMID: 28439690 [PubMed - indexed for MEDLINE]

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Relationship between CO2 laser-induced artifact and glottic cancer surgical margins at variable power doses.

Related Articles

Relationship between CO2 laser-induced artifact and glottic cancer surgical margins at variable power doses.

Head Neck. 2016 04;38 Suppl 1:E712-6

Authors: Buchanan MA, Coleman HG, Daley J, Digges J, Sandler M, Riffat F, Palme CE

Abstract
BACKGROUND: The carbon dioxide laser can induce thermal cytologic artifacts at the margin of early glottic squamous cell carcinoma histologic specimens, which makes assessment of the margin difficult. This study assesses and correlates the depth of laser-induced thermal artifact with laser power rating.
METHODS: The surgical margins of 30 patients with early glottic squamous cell carcinomas who underwent laser resection were reanalyzed retrospectively.
RESULTS: Thermal damage consisted of collagen denaturation within the vocal cord lamina propria and vocalis muscle, and epithelial structural changes. There was a decrease in depth of tissue artifact with increased power rating (p > .05). The average depth of thermal damage was 380.83 ± 178.79 μm.
CONCLUSION: The laser causes less thermal damage at higher power, presumably because of the increased speed of cutting and reduced contact time with surrounding cells. Knowledge of the depth of thermal artifact is important surgically when ensuring the cancer is excised with sufficient oncologic margin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E712-E716, 2016.

PMID: 25899602 [PubMed - indexed for MEDLINE]

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Non-incisional pleurectomy–decortication for malignant pleural mesothelioma

Abstract

Pleurectomy–decortication (P/D) is lung-sparing surgery with curative intent for malignant pleural mesothelioma (MPM). Visceral pleurectomy is the most challenging step in this procedure. At the beginning of pleurectomy, a sharp pleural incision through the tumor is usually made to create the dissection plane between the visceral pleura and the lung parenchyma, which may cause the spread of tumor cells into the operation field. Here, we describe a sophisticated surgical technique of P/D without any pleural incision ("non-incisional P/D") to achieve en bloc removal of the entire pleura and tumor, which may improve postoperative survival by preventing tumor spread.

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Editorial Board

Publication date: February–March 2018
Source:Brain and Language, Volumes 177–178





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Native language status of the listener modulates the neural integration of speech and iconic gestures in clear and adverse listening conditions

Publication date: February–March 2018
Source:Brain and Language, Volumes 177–178
Author(s): Linda Drijvers, Asli Özyürek
Native listeners neurally integrate iconic gestures with speech, which can enhance degraded speech comprehension. However, it is unknown how non-native listeners neurally integrate speech and gestures, as they might process visual semantic context differently than natives. We recorded EEG while native and highly-proficient non-native listeners watched videos of an actress uttering an action verb in clear or degraded speech, accompanied by a matching ('to drive'+driving gesture) or mismatching gesture ('to drink'+mixing gesture). Degraded speech elicited an enhanced N400 amplitude compared to clear speech in both groups, revealing an increase in neural resources needed to resolve the spoken input. A larger N400 effect was found in clear speech for non-natives compared to natives, but in degraded speech only for natives. Non-native listeners might thus process gesture more strongly than natives when speech is clear, but need more auditory cues to facilitate access to gestural semantic information when speech is degraded.



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High prevalence of pineal cysts in adults who stutter

Publication date: February–March 2018
Source:Brain and Language, Volumes 177–178
Author(s): Richard M. Arenas, Jody M. Shoemaker, John Phillips




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Uses of biologics in allergic diseases: what to choose and when

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Tara Vinyette Saco, Amber Pepper, Thomas B. Casale




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The Eosinophil: for better or worse, in sickness and in health

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Bruce S. Bochner




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Epinephrine auto-injector needle lengths can both subcutaneous and periosteal/intraosseous injection be avoided?

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Sten Dreborg, Laura Kim, Gina Tsai, Harold Kim
BackgroundAdministration of epinephrine should be intramuscularly in the anterolateral aspect of the thigh. The length of the epinephrine autoinjector, EAI, needle should assure intramuscular injection.ObjectiveTo discuss suitable needle lengths of EAIs based on ultrasound measurements related to weight.MethodsThe skin to muscle distance (STMD) and skin to bone distance (STBD) was measured by ultrasound on the mid third anterolateral area of the right thigh, applying either high pressure (max)(8 lb.)(HPEAI) or low pressure (min)(LPEAI) on an ultra-sound probe. Three hundred two children and adolescents and 99 adults were included. The STMDmax and STMDmin as well as the STBDmax and STBDmin were estimated.ResultsUsing HPEAIs, the risk of periosteal/intraosseous penetration was 32% in children weighing less than 15 kg. The risk of subcutaneous injection was 12% in adolescents and 33% in adults. With LPEAIs, there was no risk of periosteal/intraosseous injection and the risk of subcutaneous injections in adolescents and adults was less, 2 and 10%, respectively. A new EAI aimed for injection in small children would have no risk of periosteal/intraosseous injection but 71% chance of subcutaneous deposit of epinephrine.ConclusionCommon HPEAIs have a high risk of periosteal/intraosseous penetration in children and subcutaneous injections in overweight and obese adults. The LPEAIs have some risk of subcutaneous injection in adults. HPEAIs 0.1 mg epinephrine and shorter needle has no risk of periosteal/intraosseous injection but a high risk of subcutaneous deposit. For use in adult, over-weight/obese patients, HPEAIs and LPEAIs should have longer needles. Future studies should focus on the triggering pressures and the variations in needle length.



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Hypereosinophilic syndrome presenting acutely with neurologic signs

Publication date: Available online 28 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Barbara A. Brunet, Rebecca M. Sugg, Patricia Stewart




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In vitro investigation on probiotic, anti-Candida, and antibiofilm properties of Lactobacillus pentosus strain LAP1

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Chirom Aarti, Ameer Khusro, Rakesh Varghese, Mariadhas Valan Arasu, Paul Agastian, Naïf Abdullah Al-Dhabi, Soundharrajan Ilavenil, Ki Choon Choi
ObjectiveTo investigate the probiotic characteristics, anti-Candida activity, and antibiofilm attributes of Hentak derived Lactobacillus pentosus strain LAP1.DesignThe probiotic properties of strain LAP1 was depicted by adapting standard protocols. The anti-Candida and antibiofilm properties of isolate were determined using agar well diffusion assay and ELISA reader test, respectively. The time-kill assay was performed using viable colony count assay. Further, the co-aggregation property of strain LAP1 was determined based on standard methodology.ResultsStrain LAP1 exhibited not only tolerance to acidic pH but also showed resistivity (P ≤ 0.05) to simulated gastric juice exposure. Similarly, the strain was able to tolerate bile salt, showed hyperproteolytic activity, and also depicted susceptibility to most of the antibiotics tested. Auto-aggregation phenomenon (37.5–60%), hydrophobicity nature (42.85%), and survival potentiality of strain LAP1 under freeze-dried condition (9.0 ± 0.01 log CFU/ml) made the isolate a promising probiotic candidate. Cell-free neutralized supernatant (CFNS) of strain LAP1 exhibited potent antifungal activities against C. albicans, C. tropicalis, and C. krusei with arbitrary unit of 150 ± 4.34, 200 ± 5.21, and 130 ± 5.13 AU/ml, respectively and depicted remarkable reduction in the biofilm formation of respective Candida sp. in a concentration dependent manner. Moreover, time-kill assay data provided the growth inhibition of all Candida sp. in a time dependent manner. Additionally, strain LAP1 revealed significant co-aggregate percentage with C. albicans, C. tropicalis, and C. krusei.ConclusionsL. pentosus strain LAP1 exhibited a good probiotic characteristics, potent anti-Candida activity, and significant antibiofilm property that could be undoubtedly recommended for its vast applications not only in food industries but also as biotherapeutic agent against Candida infections in pharmaceutical industries.



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A Case of Aluminum Casting in the Nasal Cavity and the Paranasal Sinus.

A Case of Aluminum Casting in the Nasal Cavity and the Paranasal Sinus.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818760274

Authors: Roh J, Mun SJ

PMID: 29486134 [PubMed - as supplied by publisher]

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A Novel Pathologic Variant in OTOF in an Iranian Family Segregating Hereditary Hearing Loss.

Related Articles

A Novel Pathologic Variant in OTOF in an Iranian Family Segregating Hereditary Hearing Loss.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818759007

Authors: Tabatabaiefar MA, Pourreza MR, Tahmasebi P, Saki N, Hashemzadeh Chaleshtori M, Salehi R, Mohammadi-Asl J

Abstract
Objective Hearing loss (HL) is the most common sensory-neural defect and the most heterogeneous trait in humans, with the involvement of >100 genes, which make a molecular diagnosis problematic. Next-generation sequencing (NGS) is a new strategy that can overcome this problem. Study Design Descriptive experimental study. Setting Diagnostic laboratory. Subjects and Methods A comprehensive family history was obtained, and clinical evaluations and pedigree analysis were performed in a family with multiple individuals with HL. As the first tier, GJB2 was sequenced, and genetic linkage analysis of DFNB1A/B was performed to rule out the most common cause of the disease. Targeted NGS was used to unravel the molecular etiology of the disease in the HL-associated genes in the proband. Two homozygous variants remained in OTOF after proper filtration. Cosegregation and in silico analysis were done. Preimplantation genetic diagnosis (PGD) was accomplished via linkage analysis and direct sequencing of the pathogenic variant. Results Clinical evaluations suggested autosomal recessive nonsyndromic HL. Two homozygous variants, c.367G>A (p.Gly123Ser) and c.1392+1G>A, were identified in cis status. c.1392+1G>A met the criteria for being pathogenic according to the variant interpretation guideline of the American College of Medical Genetics and Genomics. PGD was successfully performed to prevent the recurrence of the disease in the related family. Conclusion A novel OTOF mutation causing HL was identified. Here, we report the effectiveness of the combined application of targeted NGS and PGD in diagnosis and prevention of hereditary HL.

PMID: 29484972 [PubMed - as supplied by publisher]

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Comparison of Pediatric Intracapsular Tonsillectomy and Extracapsular Tonsillectomy: A Cost and Utility Decision Analysis.

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Comparison of Pediatric Intracapsular Tonsillectomy and Extracapsular Tonsillectomy: A Cost and Utility Decision Analysis.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818760513

Authors: Baik G, Brietzke SE

Abstract
Objectives To use decision analysis modeling to compare utility and cost outcomes of intracapsular tonsillectomy (ICT) and extracapsular tonsillectomy (ECT). To use sensitivity analysis to determine the most important factors influencing outcomes favoring one surgical method versus another. Study Design Decision analysis model. Setting Hypothetical cohort. Subjects and Methods A decision analysis model was created with computer software comparing the results of ICT and ECT. The model featured complications with completion tonsillectomy, such as postsurgical bleed, dehydration, and tonsillar regrowth. Outcomes were quantified with a utility scale ranging from 0.95 (1 surgical procedure without complications) to 0.55 (ICT, regrowth requiring completion ECT, post-ECT bleeding). Costs measured out-of-pocket costs for an insured patient and factored in different recovery times for ECT versus ICT. Results Based on baseline parameters, ECT had higher cumulative utility than ICT. Utility model results were highly dependent on the value of having a single uncomplicated surgery, as well as on the tonsillar regrowth rate. Utility was equal at a regrowth rate of 1.64%; rates above this value favored ECT. The base cost model showed that ICT ($4177.92) was less expensive than ECT ($4546.91), although ICT with regrowth had the highest outcome cost ($8393.91). ECT and ICT costs were equal at a tonsil regrowth rate of 17.8% and at a recovery period of 7.4 days. Conclusion Utility decision modeling based on best estimates for baseline parameters suggests that ECT may be slightly superior to ICT, but cost analysis suggests the opposite. However, the comparative results are highly dependent on subtle changes in the tonsil regrowth rate and the potential difference in recovery time.

PMID: 29484925 [PubMed - as supplied by publisher]

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A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

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A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818758993

Authors: Lind MM, Corridore M, Sheehan C, Moore-Clingenpeel M, Maa T

Abstract
Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork. Participants completed pre- and postworkshop questionnaires. Results Thirty-nine trainees participated over the 3-year study period. Compared with their precourse responses, participants' postcourse responses indicated either agreement or strong agreement that the multidisciplinary format (1) helped in the development of team communication skills and (2) was preferred over single-discipline training. Improvement in confidence in managing critical airway situations and in advanced airway management skills was significant ( P < .05). Eighty-one percent of participants had improved confidence in following the hospital's critical airway protocol, and 64% were better able to locate advanced airway management equipment. Discussion Multiple subspecialists manage pediatric respiratory failure, where successful care requires complex handoffs and teamwork. Multidisciplinary education to teach advanced airway management, teamwork, and communication skills is practical and preferred by learners and is possible to achieve despite differences in experience. Future study is required to better understand the impact of this course on patient care outcomes. Implications for Practice Implementation of a pediatric difficult airway course through simulation-based team training is feasible and preferred by learners among multiple disciplines. A multidisciplinary approach exposes previously unrecognized knowledge gaps and allows for better communication and collaboration among the fields.

PMID: 29484924 [PubMed - as supplied by publisher]

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Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology-Head and Neck Surgery: State of the Art Review.

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Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology-Head and Neck Surgery: State of the Art Review.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818756599

Authors: Cramer JD, Shuman AG, Brenner MJ

Abstract
Objective The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology-head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology-head and neck surgery in the United States. Data Sources PubMed/MEDLINE. Review Methods A comprehensive review of literature pertaining to VTE in otolaryngology-head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis. Data were then synthesized and compared with other surgical specialties. Conclusions We identified 29 articles: 1 prospective cohort study and 28 retrospective studies. The overall prevalence of VTE in otolaryngology appears lower than that of most other surgical specialties. The Caprini system allows effective individualized risk stratification for VTE prevention in otolaryngology. Mechanical and chemoprophylaxis ("dual thromboprophylaxis") is recommended for patients with a Caprini score ≥7 or patients with a Caprini score of 5 or 6 who undergo major head and neck surgery, when prolonged hospital stay is anticipated or mobility is limited. For patients with a Caprini score of 5 or 6, we recommend dual thromboprophylaxis or mechanical prophylaxis alone. Patients with a Caprini score ≤4 should receive mechanical prophylaxis alone. Implications for Practice Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.

PMID: 29484922 [PubMed - as supplied by publisher]

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Music Appreciation after Cochlear Implantation in Adult Patients: A Systematic Review.

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Music Appreciation after Cochlear Implantation in Adult Patients: A Systematic Review.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818760559

Authors: Riley PE, Ruhl DS, Camacho M, Tolisano AM

Abstract
Objective The cochlear implant (CI) improves quality of life for people who are severely and profoundly deafened, allowing implantees to perceive speech at levels similar to those of individuals with normal hearing. However, patients with CIs generally report a reduced appreciation of music after implantation. We aimed to systematically review the English-language literature for studies evaluating music enjoyment and perception among adult patients with CIs. Data Sources A systematic review of PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library. Review Methods The PRISMA statement was utilized to identify English-language studies reporting music appreciation among adults with CIs. Two independent reviewers performed searches through May 2017. Included studies investigated parameters related to music enjoyment and music perception, including (1) pitch and timbre perception, (2) noise-canceling algorithms, and (3) the presence of dissonant chords, lyrics, or visual cues. Results A total of 508 articles were screened for relevance. Forty-one full-text articles were evaluated, and 18 met final inclusion criteria. Studies used heterogeneous methods of outcome measurement for identifying music appreciation. The outcome measures suggest that rhythm and lyrics are important components of enjoyment. Patients with CIs had difficulty with pitch and timbre perception. Conclusion The heterogeneous outcome measures identified in this systematic review suggest that rhythm and lyrics are important components of enjoyment, while patients with CIs had difficulty with pitch and timbre perception. Because there is no standardized reporting metric for music appreciation among adult patients with CIs, a standardized validated outcome-measuring tool is warranted.

PMID: 29484920 [PubMed - as supplied by publisher]

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Equality Promotes Wellness.

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Equality Promotes Wellness.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818760260

Authors: Chandrasekhar SS

Abstract
Women otolaryngologists face issues that interfere with their wellness on a regular basis. Over the course of my career-in positions of leadership in academic practice and at the Academy's Board of Governors and Women in Otolaryngology Section and as past president of the AAO-HNS/F-I have had experiences and observations that I feel can help move the needle forward on these very important conversations.

PMID: 29484918 [PubMed - as supplied by publisher]

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Audiometric Testing Guideline Adherence in Children Undergoing Tympanostomy Tubes: A Population-Based Study.

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Audiometric Testing Guideline Adherence in Children Undergoing Tympanostomy Tubes: A Population-Based Study.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818760562

Authors: Beyea JA, Rosen E, Stephens T, Nguyen P, Hall SF

Abstract
Objective Tympanostomy tube (TT) insertion is the most common ambulatory surgery performed on children. American Academy of Otolaryngology-Head and Neck Surgery Founda-tion (AAO-HNSF) Clinical Practice Guidelines (CPGs) recommend hearing testing for all pediatric TT candidates. The aim of this study was to assess audiometric testing in this population. Study Design Retrospective population-based cohort study. Setting All hospitals in the Canadian province of Ontario. Subjects and Methods All patients 12 years of age and younger who underwent at least 1 TT procedure between January 1993 and June 2016. The primary outcomes were the percentage of patients who underwent a hearing test within 1 year before and/or 1 year after surgery. Results A total of 316,599 bilateral TT procedures were performed during the study period (1993 to 2016). Presurgical hearing tests increased from 55.7% to 74.9%, and postsurgical hearing tests increased from 42.2% to 68.9%. Younger surgeons demonstrated a greater adherence to the CPGs (relative risk [RR], 1.22; 95% CI, 1.08-1.38; P = .001). Remarkably, there was not a spike in preoperative hearing tests following the introduction of the CPGs in 2013 (RR, 1.12; 95% CI, 0.85-1.47; P = .432). Presurgical hearing testing ranged from 26.1% to 83.5% across health regions. Conclusion In this cohort of children who underwent TT placement, the trends of preoperative and postoperative audiometric testing are increasing but are still lower than recommended by the CPGs, despite a tripling of practicing audiologists. This study describes the current state of testing in Ontario and highlights issues of access to audiology services, possible parent preferences, and the importance of ongoing continuing medical education for all health care practitioners.

PMID: 29484916 [PubMed - as supplied by publisher]

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The Otolaryngologist's Role in Providing Gender-Affirming Care: An Opportunity for Improved Education and Training.

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The Otolaryngologist's Role in Providing Gender-Affirming Care: An Opportunity for Improved Education and Training.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818758270

Authors: Chaiet SR, Yoshikawa N, Sturm A, Flanary V, Ishman S, Streed CG

Abstract
Currently, there are limited resources and training available for otolaryngologists and otolaryngology practice personnel to provide gender-affirming care for transgender or gender nonconforming patients. This unique patient population may present to our offices for gender-specific care or with complaints of the ear, nose, and throat unrelated to gender identity. Our current practice has unintentional but direct consequences on our patients care, as transgender patients often report negative experiences in the healthcare setting related to their gender identity. The absence of resources and training is also seen in other specialties. Physicians who create an environment where patients of all gender identities feel welcome can better meet their patients' health care needs. In addition, otolaryngologists can play a role in easing the gender dysphoria experienced by transgender patients. We suggest educational content should be created for and made available to otolaryngologists and office staff to provide gender-affirming care.

PMID: 29484914 [PubMed - as supplied by publisher]

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Analyzing Clinical Phonological Data Using Phon.

Related Articles

Analyzing Clinical Phonological Data Using Phon.

Semin Speech Lang. 2016 May;37(2):85-105

Authors: Byun TM, Rose Y

Abstract
In this article, we describe how Phon, an open-source software program for the transcription and analysis of phonological data, can be applied to facilitate clinical phonological analyses. We begin with a summary of the types of analyses that are frequently used in the assessment and management of speech sound disorders. We then discuss challenges inherent to the transcription and analysis of clinical phonological data. For each challenge, we discuss solutions currently available within Phon and offer an outlook on future methodological and technical developments in the area of clinical phonology. This article includes a step-by-step introduction to Phon suitable for readers who lack previous experience with the software. We conclude with a discussion of data sharing and its vital role in advancing research and intervention practices in the area of speech development and disorders.

PMID: 27111269 [PubMed - indexed for MEDLINE]

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Cancers, Vol. 10, Pages 62: Tumor Resistance against ALK Targeted Therapy-Where It Comes From and Where It Goes

Cancers, Vol. 10, Pages 62: Tumor Resistance against ALK Targeted Therapy-Where It Comes From and Where It Goes

Cancers doi: 10.3390/cancers10030062

Authors: Geeta Sharma Ines Mota Luca Mologni Enrico Patrucco Carlo Gambacorti-Passerini Roberto Chiarle

Anaplastic lymphoma kinase (ALK) is a validated molecular target in several ALK-rearranged malignancies, particularly in non-small-cell lung cancer (NSCLC), which has generated considerable interest and effort in developing ALK tyrosine kinase inhibitors (TKI). Crizotinib was the first ALK inhibitor to receive FDA approval for ALK-positive NSCLC patients treatment. However, the clinical benefit observed in targeting ALK in NSCLC is almost universally limited by the emergence of drug resistance with a median of occurrence of approximately 10 months after the initiation of therapy. Thus, to overcome crizotinib resistance, second/third-generation ALK inhibitors have been developed and received, or are close to receiving, FDA approval. However, even when treated with these new inhibitors tumors became resistant, both in vitro and in clinical settings. The elucidation of the diverse mechanisms through which resistance to ALK TKI emerges, has informed the design of novel therapeutic strategies to improve patients disease outcome. This review summarizes the currently available knowledge regarding ALK physiologic function/structure and neoplastic transforming role, as well as an update on ALK inhibitors and resistance mechanisms along with possible therapeutic strategies that may overcome the development of resistance.

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Efficacy of Tympanoplasty Without Mastoidectomy for Treating Chronic Otitis Media in Patients With Mastoid Cavity Opacification in Temporal Bone Computed Tomography Findings.

Efficacy of Tympanoplasty Without Mastoidectomy for Treating Chronic Otitis Media in Patients With Mastoid Cavity Opacification in Temporal Bone Computed Tomography Findings.

Clin Exp Otorhinolaryngol. 2018 Mar;11(1):30-34

Authors: Kim H, Bae HY, Choo OS, Choung YH

Abstract
OBJECTIVES: Combined mastoidectomy is generally preferred to tympanoplasty alone when treating patients with chronic otitis media (COM), particularly when temporal bone computed tomography (TBCT) shows that the mastoid cavity contains opacification of soft tissue density. However, in cases with Eustachian tube dysfunction, a mastoid cavity volume may be a burden to its function. We hypothesized that tympanoplasty alone might be better than tympanoplasty combined with mastoidectomy because soft tissue in the mastoid cavity is a sequel to a protective physiological response. Thus, we explored the efficacy of tympanoplasty without mastoidectomy in COM patients exhibiting mastoid air cell opacification on TBCT.
METHODS: Between 2010 and 2014, a total of 33 patients, diagnosed with COM and with evidence of mastoid cavity opacification on TBCT, underwent tympanoplasty without mastoidectomy. All ears had been dry for ≥3 months before surgery. All procedures were performed by the same surgeon. We retrospectively analyzed the preoperative otoscopic findings, pre- and postoperative pure tone averages (PTAs; the mean of the values at 0.5, 1, 2, and 4 kHz), surgical procedures, and complications or recurrence.
RESULTS: Of the 33 patients, 28 (84.8%) exhibited hearing improvement after surgery. The mean pre- and postoperative PTAs were 46.9±21.2 dB and 29.4±17.0 dB, respectively (P<0.001). The air-bone gap decreased from 25.7±10.7 dB to 10.3±8.7 dB (P<0.001). Thirty-two patients (97.0%) did not develop any COM recurrence or cholesteatoma; one patient developed attic retraction of the tympanic membrane. Other minor complications were transient otorrhea caused by myringitis (two cases) and a pinpoint perforation (one case).
CONCLUSION: Tympanoplasty alone, i.e., without mastoidectomy, may adequately control COM, if it shows dry-up status for at least 3 months even though mastoid cavity opacification is detected in TBCT.

PMID: 29486541 [PubMed]

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Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis.

Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis.

Clin Exp Otorhinolaryngol. 2018 Mar;11(1):1-8

Authors: Kim BH, Park SJ, Jeong WJ, Ahn SH

Abstract
OBJECTIVES: This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses.
METHODS: Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone.
RESULTS: The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone.
CONCLUSION: Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.

PMID: 29486540 [PubMed]

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FOXP2 promotes tumor proliferation and metastasis by targeting GRP78 in triple-negative breast cancer.

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FOXP2 promotes tumor proliferation and metastasis by targeting GRP78 in triple-negative breast cancer.

Curr Cancer Drug Targets. 2018 Jan 30;:

Authors: Wu J, Liu P, Tang H, Shuang Z, Qiu Q, Song C, Liu L, Xie X, Xiao X

Abstract
The forkhead box (FOX) proteins constitute a superfamily of evolutionarily conserved transcriptional regulators with critical roles in various biological processes, including tumor development and progression. FOXP2, a member of the forkhead box P (FOXP) family, has been reported to be important in breast cancer pathogenesis and the regulation of breast cancer metastasis. However, its exact mechanisms and pathways remain unclear. This study therefore investigated the regulatory effects of FOXP2 on tumor proliferation and metastasis in triple-negative breast cancer (TNBC) and its underlying molecular mechanisms. FOXP2 was found to be highly expressed in TNBC cell lines and tissues. FOXP2 knockdown attenuated the growth and inva-siveness of TNBC cells in vitro as well as tumor progression and metastasis in vivo. Moreover, inhibition of FOXP2 downregulated the expression of glu-cose-regulated protein of molecular mass 78 (GRP78) in TNBC cells and mouse xenograft models. Correlation analysis showed that GRP78 expres-sion was positively associated with FOXP2 expression in TNBC cells. These results indicate that FOXP2 plays a crucial role in TNBC, partly via modulat-ing GRP78, and could act as a potential target for TNBC treatment.

PMID: 29484998 [PubMed - as supplied by publisher]

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Hereditary association between testicular cancer and familial ovarian cancer: A Familial Ovarian Cancer Registry study

Publication date: April 2018
Source:Cancer Epidemiology, Volume 53
Author(s): John Lewis Etter, Kevin Eng, Rikki Cannioto, Jasmine Kaur, Hani Almohanna, Emad Alqassim, J. Brian Szender, Janine M. Joseph, Shashikant Lele, Kunle Odunsi, Kirsten B. Moysich
BackgroundAlthough family history of testicular cancer is well-established as a risk factor for testicular cancer, it is unknown whether family history of ovarian cancer is associated with risk of testicular cancer.Materials and methodsUsing data from the Familial Ovarian Cancer Registry on 2636 families with multiple cases of ovarian cancer, we systematically compared relative frequencies of ovarian cancer among relatives of men with testicular and non-testicular cancers.ResultsThirty-one families with cases of both ovarian and testicular cancer were identified. We observed that, among men with cancer, those with testicular cancer were more likely to have a mother with ovarian cancer than those with non-testicular cancers (OR = 3.32, p = 0.004). Zero paternal grandmothers of men with testicular cancer had ovarian cancer.ConclusionThese observations provide compelling preliminary evidence for a familial association between ovarian and testicular cancers Future studies should be designed to further investigate this association and evaluate X-linkage.



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Improve dosimetric outcome in stage III non-small-cell lung cancer treatment using spot-scanning proton arc (SPArc) therapy

To evaluate spot-scanning proton arc therapy (SPArc) and multi-field robust optimized intensity modulated proton therapy (RO-IMPT) in treating stage III non-small-cell lung cancer (NSCLC) patients.

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Response criteria in solid tumors (PERCIST/RECIST) and SUVmax in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy

The purpose of this study was to evaluate the prognostic impact of Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) and Response Evaluation Criteria in Solid Tumors (RECIST) and of pre-...

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Neural predictors of gait stability when walking freely in the real-world

Gait impairments during real-world locomotion are common in neurological diseases. However, very little is currently known about the neural correlates of walking in the real world and on which regions of the b...

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Rise Up, Get Tested, and Live: an Arts-Based Colorectal Cancer Educational Program in a Faith-Based Setting

Abstract

Engaging community members in efforts to reduce cancer-related health disparities through community mini-grant programs has been shown to have meaningful impact. A predominantly African-American church in South Carolina was awarded a community mini-grant to increase awareness about colorectal cancer (CRC) screening among disproportionally high-risk African-American communities through culturally appropriate arts-based cancer education. The church's pastor, health and wellness ministry, and drama ministry created a theatrical production called Rise Up, Get Tested, and Live. Over 100 attendees viewed the play. A pre/post-test evaluation design assessed the effectiveness of the production in increasing participants' knowledge about CRC and examined their intentions to be screened. Results showed increased knowledge about CRC, increased awareness and understanding about the importance of CRC screening, and favorable intentions about CRC screening. Findings suggest that arts-based cancer education may be an effective tool for the dissemination of information about CRC screening.

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Impact of Previous Biologic Use on Efficacy and Safety of Brodalumab and Ustekinumab in Patients with Moderate-to-Severe Plaque Psoriasis: Integrated Analysis of AMAGINE-2 and AMAGINE-3

Abstract

Background

Biologics used increasingly used for treating moderate-to-severe psoriasis. Efficacy may differ in patients with previous biologics exposure.

Objective

To investigate the impact of previous biologic exposure on efficacy and safety of brodalumab and ustekinumab in moderate-to-severe plaque psoriasis.

Methods

Two placebo- and ustekinumab-controlled phase 3 clinical trials. Initial 12-week induction phase where patients were treated with brodalumab (210mg Q2W or 140mg Q2W), ustekinumab or placebo. Efficacy endpoints included: Psoriasis Area and Severity Index (PASI 75) and Physician's Global Assessment (sPGA 0/1) versus placebo, PASI 100 versus ustekinumab, Dermatology Life Quality Index (DLQI) and Psoriasis Symptom Inventory (PSI). Adverse events were monitored throughout.

Results

493 patients (334 [27%] brodalumab 210 mg Q2W and 159 [26%] ustekinumab) received prior biologics exposure; 150 (12%) and 62 (10%) reporting previously failed biologic. Brodalumab efficacy in patients with or without previous biologics exposure was statistically equivalent; 40.9% and 39.5% of bio-naïve and -experienced patients achieved PASI 100 at Week 12, compared with 21.1% and 17.0% with ustekinumab (both P<0.001). In patients where prior biologics had been successful or failed, 41.7% and 32.0% achieved PASI 100, compared with 21.1% and 11.3% with ustekinumab. Tolerability was similar, and did not appear to be influenced by previous biologic treatment.

Conclusions

Efficacy of brodalumab 210 mg Q2W was similar regardless of prior biologic therapy (P=0.31, 0.32 and 0.64 for PASI 75, 90, and 100 respectively). Almost twice as many patients achieved PASI 100 or complete clearance at Week 12 compared with ustekinumab; differences most noticeable where previous biologics had failed. Both treatments were well tolerated.

This article is protected by copyright. All rights reserved.

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The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities

Abstract

Purpose

The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources.

Methods

We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation-II criteria. Low risk of bias clinical practice guidelines was used to develop recommendations. In accordance with the mandate of the Global Spinal Care Initiative (GSCI), recommendations were selected that could be applied to medically underserved areas and low- and middle-income countries by considering the limited access and costs of diagnostic technologies.

Results

We screened 3069 citations; 20 guidelines were eligible for critical appraisal. We used 13 that had a low risk of bias that targeted neck and back pain.

Conclusions

When assessing patients with spine-related complaints in medically underserved areas and low- and middle-income countries, we recommend that clinicians should: (1) take a clinical history to determine signs or symptoms suggesting serious pathology (red flags) and psychological factors (yellow flags); (2) perform a physical examination (musculoskeletal and neurological); (3) do not routinely obtain diagnostic imaging; (4) obtain diagnostic imaging and/or laboratory tests when serious pathologies are suspected, and/or presence of progressive neurologic deficits, and/or disabling persistent pain; (5) do not perform electromyography or nerve conduction studies for diagnosis of intervertebral disc disease with radiculopathy; and (6) do not perform discography for the assessment of spinal disorders. This information can be used to inform the GSCI care pathway and model of care.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Corrigendum

Roy Y. Kim, Darian Mangu, Alexandria S. Hoffman, Rojan Kavosh, Eunice Jung, Noriko Itoh, Rhonda Voskuhl. Oestrogen receptor β ligand acts on CD11c⁺ cells to mediate protection in experimental autoimmune encephalomyelitis. Brain 2018; 141: 132–147; 10.1093/brain/awx315.

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Corrigendum

Justin Torok, Pedro D. Maia, Fon Powell, Sneha Pandya and Ashish Raj for the Alzheimer's Disease Neuroimaging Initiative. A method for inferring regional origins of neurodegeneration. Brain 2018; 141: 863–876; doi:10.1093/brain/awx371.

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Electro-acupuncture at ST37 and ST25 induce different effects on colonic motility via the enteric nervous system by affecting excitatory and inhibitory neurons

Abstract

Background

On the basis of the importance of the enteric nervous system (ENS) in gastrointestinal motility, we hypothesized that the ENS may mediate the therapeutic efficacy of electro-acupuncture (EA) in constipation by regulating the mechanisms underlying the effects of EA on gastrointestinal function.

Methods

Model mice with constipation were generated by gastric instillation of 0-4°C normal saline. Defecation time and stool (form and wet and dry weight) were assessed. The effect of EA at ST37 or ST25 on colorectal motility and proximal colonic motility was assessed using a water-filled balloon. The expression of protein gene product 9.5 (PGP9.5), the cholinergic neuron marker acetyltransferase (ChAT) and the anticholinergic neuron marker nitric oxide synthase (nNOS) was detected by immunohistochemistry, real-time quantitative polymerase chain reaction (qPCR) and western blot analysis.

Key Results

ST37 and ST25 improved colorectal pressure; however, ST37 but not ST25 improved proximal colonic pressure. In the proximal colon, the expression of PGP9.5 returned to normal after EA at ST 37, while EA at ST25 did not have this effect. In addition, qPCR and western blot analysis showed that ST37 could downregulate the expression of nNOS and upregulate the expression of ChAT to normal levels, while ST25 could only downregulate the expression of nNOS to normal levels.

Conclusions and Inferences

Electro-acupuncture at specific acupoints can improve intestinal motility in constipation by altering the ENS and differentially affecting excitatory and inhibitory neurons, restoring the coordination between contraction and relaxation muscles, and working in concert with the central nervous system and peripheral neural pathways.

EA stimulation at either ST 37 or ST 25 relieves the symptoms of constipation, but has different effects in the proximal colon. ST 37 alters both excitatory and inhibitory enteric neurons, while ST 25 only influences inhibitory neurons.

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Risk of intraocular and other extracutaneous involvement in patients with cutaneous juvenile xanthogranuloma

Abstract

Background/Objectives

Cutaneous juvenile xanthogranuloma is an uncommon, usually benign disease affecting infants and young children. Ocular and other systemic involvement have been reported, but their incidence is unclear, and the utility of routine screening is not well established. Our aim was to characterize the risk of ocular and systemic complications in children with cutaneous juvenile xanthogranuloma.

Methods

In this retrospective study, we reviewed the medical charts of children with cutaneous juvenile xanthogranuloma seen at Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, between January 2000 and December 2015. A comprehensive literature review was also performed.

Results

Of 338 children with cutaneous juvenile xanthogranuloma, 76 (median age 6 months, 51% female) met inclusion criteria. The most frequently involved site was the head and neck region (40%). In 39 patients (51%), there was a single lesion. Multiple lesions (>5) were evident in 20 patients (26%). Most cutaneous juvenile xanthogranulomas were micronodular (77%). None of the patients had ocular involvement. One patient had multiple asymptomatic hepatic nodules on imaging that regressed spontaneously within several months. Literature review of pediatric cutaneous juvenile xanthogranuloma series, including our cohort, revealed that the incidence of ocular manifestations is 0.24% (7/2949) and of systemic manifestations is 0.75% (22/2949).

Conclusion

Cutaneous juvenile xanthogranulomas are generally limited to the skin. Because eye involvement is rare, a routine eye examination is of low yield and probably not warranted in children with no ocular or visual symptoms. New recommendations for systemic screening could not be drawn from this study.

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Familial papular epidermal nevus with “skyline” basal cell layer and multiple pilomatricomas: A new association?

Abstract

Papular epidermal nevus with "skyline" basal cell layer is a newly described keratinocytic nevus. Recently, papular epidermal nevus with "skyline" basal cell layer has been reported in association with extracutaneous involvement, and the term papular epidermal nevus with "skyline" basal cell layer syndrome is used to indicate a neurocutaneous syndrome characterized by the presence of papular epidermal nevus with "skyline" basal cell layer and different neurologic symptoms that seem to improve during infancy and adolescence. Multiple pilomatricomas have been reported in association with various syndromes. We report herein papular epidermal nevus with "skyline" basal cell layer associated with multiple pilomatricomas in two members of a family with the aim of drawing attention to this peculiar epidermal nevus to improve our knowledge of the syndrome.

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Color Atlas of Oral Diseases, Diagnosis and Treatment Edited by G. Laskaris Fourth edition Stuttgart, Germany: Thieme, 2017. ISBN 9783137170044

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Potentialities of Six Plant Species on Phytoremediation Attempts of Fuel Oil-Contaminated Soils

Abstract

A field experiment investigating the phytoremediation potential of six plant species—Goosegrass (Eleusine indica), Bermuda grass (Cynodon dactylon), Sessile joyweed (Alternanthera sessilis), Benghal dayflower (Commelina benghalensis), Lovanga (Cleome ciliata), and Chinese violet (Asystasia gangetica)—on soil contaminated with fuel oil (82.5 ml/kg of soil) have been conducted from March to August 2016. The experiments consider three modalities—Tn: unpolluted planted soils, To: unplanted polluted soils, and Tp: polluted planted soil—randomized arranged. Only three (E. indica, C. dactylon, and A. sessilis) of the six species survived while the others died 1 month after the beginning of experimentations. The relative growth indexes showed a strong similarity between the growth parameters of E. indica and C. dactylon, each on polluted and control soils, unlike A. sessilis. Total petroleum hydrocarbons (TPHs) removal efficiency were 82.56, 80.69, and 77% on soil planted with E. indica, C. dactylon, and A. sessilis, respectively; and 57.25% on non-planted soil. According to the bioconcentration and translocation factors, E. indica and A. sessilis are involved on rhizodegradation and phytoextraction of hydrocarbons whereas C. dactylon is only involved into rhizodegradation. Overall, E. indica and C. dactylon out-yielded A. sessilis in the phytoremediation capacity of fuel oil-contaminated soils.

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Legacy Arsenic Pollution of Lakes Near Cobalt, Ontario, Canada: Arsenic in Lake Water and Sediment Remains Elevated Nearly a Century After Mining Activity Has Ceased

Abstract

Century old mine tailings in the Cobalt and Silver Center areas are widely dispersed throughout the terrestrial and aquatic environments and contain high concentrations of arsenic. Arsenic concentrations were found to be as high as 972 μg/L in surface waters and 10,800 mg/kg in lake sediment. The mean values for arsenic in surface waters and sediment from 9 lakes directly influenced by mining activity were 431 μg/L and 1704 mg/kg, respectively, whereas in the 12 control lakes with no mining activity in their catchment had mean values of 2.2 μg/L and 11 mg/kg in their water and sediment, respectively. Lakes impacted by downstream tailing migration (n = 4) were also assessed and had intermediate concentrations of arsenic. Principal component analysis identified contaminated lakes as having different geochemical signatures than control lakes but lake sediment that was sampled below tailings in contaminated lakes, deposited pre-mining, can resemble the geochemistry of those found in control lakes. Arsenic concentrations in these samples ranged from 4.4 to 185 mg/kg, which can be considered reasonable background as these areas contained abundant mineral deposits that could naturally elevate background concentrations. Even though background concentrations are naturally elevated, the presence of arsenic-rich tailings in these lakes has prevented any natural recovery from occurring. Fe-Mn oxides at the water-sediment interface perpetually scavenge arsenic from buried tailings below and from contaminated surface waters that cause arsenic concentrations to remain enriched in the upper sediments even after tailings have been buried by lake sediment. This process has prevented recovery of the lake ecosystems even after nearly a century without mining.

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Use of Hyaluronic Acid-Based Biological Bilaminar Matrix in Wound Bed Preparation: A Case Series

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The inhibition of invasion of human melanoma cells through N-cadherin knock-down

Abstract

N-cadherin seems to promote cell migration and invasion in many types of cancers. The object of this study is recognition of the possible role of N-cadherin and selected downstream protein kinases: PI3K, ERK1/2, and mTOR in cell invasion in malignant melanoma. Melanoma cells were transfected with the small interfering RNA (siRNA) that targets human N–cadherin gene (CDH2). Inhibitors LY294002 (PI3K), U0126 (ERK1/2), and everolimus (mTOR) were used to inhibit selected kinases of signalling pathways. In vitro cell invasion was studied using Matrigel and an analysis of matrix metalloproteinases MMP-2 and MMP-9 activity by gelatinase zymogram assay. Treatment of melanoma cell with either siRNA against N-cadherin or protein kinase inhibitors led to significantly decreased MMPs expression and activity, as well as diminished invasion. Both the current and the former results suggest that activation of PI3/AKT, mTOR, and ERK kinase, following N-cadherin expression, contributes not only to increased proliferation but also invasive potential of melanoma cells. The results also indicate that N-cadherin, as well as the studied kinases, should be considered as a potential target in melanoma therapy.

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Inhibition of ZERO-BK by PKC is involved in carbachol-induced enhancement of rat colon smooth muscle motility

Abstract

Background

Muscarinic acetylcholine receptor (mAChR) activation is an important factor to enhance the motility of gastrointestinal (GI) smooth muscle. Large conductance Ca²⁺-activated potassium (BK) channels are widely expressed in GI smooth muscle. Roles of BK in carbachol (a mAChR agonist) induced enhancement of GI motility and the molecular mechanisms remains unknown and were investigated in this study.

Methods

Colonic smooth muscle (CSM) strip was perfused to record motility in vitro. The patch-clamp technique was used to record BK currents. RT-PCR was used to detect the expression of BK channels in rat CSM tissues. Two different types BK channels were constructed in HEK293 cells to investigate the regulation mechanism. Paired t tests were set with a P < .05 regarded as significant.

Key Results

Carbachol enhanced CSM contraction through M₃ receptor (M₃R) were attenuated by IbTX, an inhibitor of BK. Carbachol inhibited BK currents in CSM cells and Go6983, an inhibitor of protein kinase C (PKC), reversed the effect. PKC activator, phorbol 12-myristate 13-acetate (PMA), inhibited BK currents. Two types of BK channels (ZERO-BK and STREX-BK) were detected in CSM. ZERO- but not STREX-BK channels expressed in HEK293 cells were inhibited by PMA.

Conclusion

Our results provide strong evidence that inhibition of ZERO-BK but not STREX-BK channels via PKC pathway is involved in the enhancement of CSM motility by mAChR activation. Besides the activation of BK by an increase in intracellular calcium, inhibition of BK played an important role in GI motility regulation during mAChR activation.

BK channels were involved in basic and carbachol-induced contraction regulation of GI strips. Only ZERO-BK channels were inhibited by PKC which took part in carbachol-induced motility enhancement in rat CSM.

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Electroacupuncture for patients with refractory functional dyspepsia: A randomized controlled trial

Abstract

Background

To test the efficacy of electroacupuncture for patients with refractory functional dyspepsia (FD).

Methods

A 24-week, 2-arm, single-blind, randomized controlled trial was conducted at three hospitals in China. Patients with refractory FD were randomly assigned to receive 20 sessions of authentic or sham electroacupuncture in a treatment duration of 4 weeks. The primary outcome was complete absence of dyspeptic symptoms at 16 weeks after initiation of acupuncture (week 16). The secondary outcomes included adequate relief of dyspeptic symptoms, Leeds Dyspepsia Questionnaire (LDQ), Nepean Dyspepsia Index (NDI), and adverse events. Intention-to-treat analysis was performed.

Key Results

Two hundred patients were included, of which 196 (98%) completed follow-up data at week 24. At week 16, 17 (17%) patients in the authentic electroacupuncture group vs 6 (6%) patients in the sham group achieved the primary outcome (P = .014). Sixty-two (62%) patients had adequate relief in the authentic electroacupuncture group, as compared to 22 (22%) in the sham group (P = .001). The scores of LDQ and NDI were significantly improved in both groups at week 16, and patients in the authentic electroacupuncture group have more improvements (LDQ, mean difference, −2.2, 95% confidence interval, −2.3 to −2.1, P < .001; NDI, −7.3, −10.5 to −4.2, P < .001). Results were similar for all the outcomes assessed at week 24. No serious adverse events were reported in both groups.

Conclusion

Acupuncture efficaciously improves dyspeptic symptoms in patients with refractory FD.

The efficacy of acupuncture in treating refractory functional dyspepsia is unknown. We found that electroacupuncture is efficacious and safe for this population.

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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Osteochondrolipoma of the Mandible

In this report, a very rare example of osteochondrolipoma of the mandible is described. How was this case successfully diagnosed and treated?
ePlasty, Open Access Journal of Plastic Surgery

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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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