Speech Understanding and Sound Source Localization by Cochlear Implant Listeners Using a Pinna-Effect Imitating Microphone and an Adaptive Beamformer.

Speech Understanding and Sound Source Localization by Cochlear Implant Listeners Using a Pinna-Effect Imitating Microphone and an Adaptive Beamformer.

J Am Acad Audiol. 2018 Mar;29(3):197-205

Authors: Dorman MF, Natale S, Loiselle L

Abstract
BACKGROUND: Sentence understanding scores for patients with cochlear implants (CIs) when tested in quiet are relatively high. However, sentence understanding scores for patients with CIs plummet with the addition of noise.
PURPOSE: To assess, for patients with CIs (MED-EL), (1) the value to speech understanding of two new, noise-reducing microphone settings and (2) the effect of the microphone settings on sound source localization.
RESEARCH DESIGN: Single-subject, repeated measures design. For tests of speech understanding, repeated measures on (1) number of CIs (one, two), (2) microphone type (omni, natural, adaptive beamformer), and (3) type of noise (restaurant, cocktail party). For sound source localization, repeated measures on type of signal (low-pass [LP], high-pass [HP], broadband noise).
STUDY SAMPLE: Ten listeners, ranging in age from 48 to 83 yr (mean = 57 yr), participated in this prospective study.
INTERVENTION: Speech understanding was assessed in two noise environments using monaural and bilateral CIs fit with three microphone types. Sound source localization was assessed using three microphone types.
DATA COLLECTION AND ANALYSIS: In Experiment 1, sentence understanding scores (in terms of percent words correct) were obtained in quiet and in noise. For each patient, noise was first added to the signal to drive performance off of the ceiling in the bilateral CI-omni microphone condition. The other conditions were then administered at that signal-to-noise ratio in quasi-random order. In Experiment 2, sound source localization accuracy was assessed for three signal types using a 13-loudspeaker array over a 180° arc. The dependent measure was root-mean-score error.
RESULTS: Both the natural and adaptive microphone settings significantly improved speech understanding in the two noise environments. The magnitude of the improvement varied between 16 and 19 percentage points for tests conducted in the restaurant environment and between 19 and 36 percentage points for tests conducted in the cocktail party environment. In the restaurant and cocktail party environments, both the natural and adaptive settings, when implemented on a single CI, allowed scores that were as good as, or better, than scores in the bilateral omni test condition. Sound source localization accuracy was unaltered by either the natural or adaptive settings for LP, HP, or wideband noise stimuli.
CONCLUSION: The data support the use of the natural microphone setting as a default setting. The natural setting (1) provides better speech understanding in noise than the omni setting, (2) does not impair sound source localization, and (3) retains low-frequency sensitivity to signals from the rear. Moreover, bilateral CIs equipped with adaptive beamforming technology can engender speech understanding scores in noise that fall only a little short of scores for a single CI in quiet.

PMID: 29488870 [PubMed - in process]

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Tinnitus and Self-Harm Revisited.

Tinnitus and Self-Harm Revisited.

J Am Acad Audiol. 2018 Mar;29(3):196

Authors: Jacobson GP

PMID: 29488869 [PubMed - in process]

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Bisphosphonate-induced osteonecrosis of the ear canal: our experience and a review of the literature.

Bisphosphonate-induced osteonecrosis of the ear canal: our experience and a review of the literature.

J Laryngol Otol. 2018 Feb 28;:1-3

Authors: McCadden L, Leonard CG, Primrose WJ

Abstract
BACKGROUND: Oesophageal disorders and osteonecrosis of the jaw are recognised complications of the commonly prescribed medication bisphosphonate. Despite these diagnoses being seen comparatively frequently within the ENT clinic, osteonecrosis of the external ear is a less well reported complication.
METHODS: The current literature is reviewed and our experience with six cases of bisphosphonate-related ear canal osteonecrosis is presented.
RESULTS: Six cases were identified as suffering from ear canal osteonecrosis as a result of bisphosphonate treatment. One of our cases suffered bilateral ear canal osteonecrosis after only 20 months of oral alendronic acid treatment. Management ranged from bisphosphonate cessation and topical treatment, to surgical debridement in the operating theatre.
CONCLUSION: Bisphosphonate-related ear canal osteonecrosis is undoubtedly under-diagnosed. For such a commonly prescribed medication, the risks and side effects of bisphosphonate should be better known and long-term treatment should be avoided if possible.

PMID: 29486808 [PubMed - as supplied by publisher]

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Modulation of Jaw Muscle Motor Response and Wake-Time Parafunctional Tooth Clenching With Music.

Modulation of Jaw Muscle Motor Response and Wake-Time Parafunctional Tooth Clenching With Music.

J Oral Facial Pain Headache. 2018 Feb 28;:

Authors: Cioffi I, Sobhani M, Tenenbaum HC, Howard A, Freeman BV, Thaut M

Abstract
AIMS: To evaluate the effects of Guided Music Listening (GML) on masticatory muscles and on the amplitude of wake-time tooth clenching in individuals with higher vs lower frequency of clenching episodes.
METHODS: The electromyographic (EMG) activity of the right masseter was recorded during three 20-minute music (relaxing, stress/tension, and favorite) tasks and a control no-music task in 10 (mean age ± standard deviation [SD] = 21.4 ± 3.0 years) and 11 (22.6 ± 2.9 years) healthy volunteers with higher (HP) vs lower (LP) frequency of tooth-clenching episodes, respectively. EMG episodes greater than 10% of the maximum voluntary contraction (EMG activity of the masseter during tooth clenching) and below 10% (EMG activity during rest) were analyzed. Nonparametric tests were used to assess between-group and within-group (between-task) differences in primary outcome measures.
RESULTS: In both groups, EMG activity during rest was the greatest during the stress/tension task, and it was the lowest during the favorite task in the LP group and the relaxing task in the HP group (all P < .001). In the HP group, the amplitude of clenching episodes was significantly lower during the favorite and stress/tension tasks than during the relaxing task (all P < .05), while in the LP group, it was significantly lower during the stress/tension task than during the control task (P = .001). The experiment did not affect the frequency or duration of clenching episodes.
CONCLUSION: GML modulates masticatory muscle activity. The response to GML depends on the frequency of clenching and the type of music.

PMID: 29488979 [PubMed - as supplied by publisher]

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Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer.

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer.

Rev Assoc Med Bras (1992). 2017 Dec;63(12):1082-1089

Authors: Calvas OIJ, Ramos DM, Matos LL, Kulcsar MAV, Dedivitis RA, Brandão LG, Cernea CR

Abstract
INTRODUCTION: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular.
OBJECTIVE: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence.
METHOD: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group.
RESULTS: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039).
CONCLUSION: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

PMID: 29489975 [PubMed - in process]

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[The clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis].

[The clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis].

Vestn Otorinolaringol. 2018;83(1):56-58

Authors: Kryukov AI, Romanenko SG, Pavlikhin OG, Lesogorova EV

Abstract
This article was designed to report the results of the evaluation of the clinical and functional condition of the larynx in the patients of the elder age group presenting with chronic oedematous polypoidal laryngitis before and after their surgical treatment. A total of 60 patients at the age from 60 to 72 years were available for the examination; all of them had a concomitant somatic or ENT pathology. The clinical and functional conditions of the larynx in the patients of the elder age group were studied, with special reference to those suffering from chronic oedematous polypoidal laryngitis before the surgical intervention, that determined the overall clinical picture of the disease characterized in the first place by the predominance of the severe polypoid process with the combination of the organic and functional laryngeal pathology. The specific clinical and functional features of the larynx were identified after the surgical treatment that exerted the appreciable influence on the postoperative course of the disease and the duration of dysphonia. The peculiarities of postoperative laryngitis are described. Its catarrhal form was diagnosed in 42% of the patients. The strong inflammatory reaction with exudation and formation of fibrin films was documented in 58% of the patients while 83% of them exhibited formation of the functional component of dysphonia that required the application of the additional therapeutic measures for the complete restoration of the vocal function taking into consideration the age-related alteration of the larynx together with the long-term postoperative observation of the patients.

PMID: 29488499 [PubMed - in process]

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[The modern approach to the treatment of subglottic laryngeal stenosis].

[The modern approach to the treatment of subglottic laryngeal stenosis].

Vestn Otorinolaringol. 2018;83(1):52-55

Authors: Krukov AI, Kirasirova EA, Piminidi OK, Rezakov RA, Lafutkina NV, Mamedov RF

Abstract
The objective of the present study was to optimize the treatment of patients with subglottic laryngeal stenosis.
MATERIAL AND METHODS: We have examined a total of 14 patients presenting with subglottic laryngeal stenosis. The etiological factors and underlying conditions of laryngeal stenosis were the prolonged intubation in 4 patients, Wegener granulomatosis in 6 patients, and idiopathic stenosis of the larynx in 4 patients. All the patients underwent balloon dilatation with the application of the video endoscopic technique.
RESULTS: The surgical treatment of all the patients made it possible to achieve the persistent expansion of the lumen of the subglottic part of the larynx, to shorten the periods of the in-patient treatment and rehabilitation of the patients. Restenosis of laryngeal lining stenting was observed in one patient presenting with Wegener's granulomatosis which was associated with the relapse of the underlying disease.

PMID: 29488498 [PubMed - in process]

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Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration.

Related Articles

Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration.

Spinal Cord. 2017 Nov;55(11):979-984

Authors: Ihalainen T, Rinta-Kiikka I, Luoto TM, Koskinen EA, Korpijaakko-Huuhka AM, Ronkainen A

Abstract
STUDY DESIGN: Prospective cohort study.
OBJECTIVES: Dysphagia is a relatively common secondary complication in patients with traumatic cervical spinal cord injuries (TCSCI). The purpose of this study was to determine the incidence of aspiration and penetration in patients with acute TCSCI.
SETTING: Tampere University Hospital, Tampere, Finland.
METHODS: A total of 46 patients with TCSCI were evaluated with a videofluoroscopic swallowing study (VFSS). Rosenbek's penetration-aspiration scale (PAS) was used to classify the degree of penetration or aspiration. The medical records of each patient were systematically reviewed.
RESULTS: Of the 46 patients, 85% were male. The mean age at the time of the injury was 62.1 years. Most patients had an incomplete injury (78%), and most of them due to a fall (78%). In the VFSS 19 (41%) patients penetrated and 15 (33%) aspirated. Only 12 (26%) of the patients had a PAS score of 1 indicating that swallowed material did not enter the airway. Of the patients who aspirated, 73% had silent aspiration.
CONCLUSION: The incidence of penetration or aspiration according to VFSS is high in this cohort of patients with TCSCI. Therefore, the swallowing function of patients with acute TCSCI should be routinely evaluated before initiating oral feeding. VFSS is highly recommended, particularly to rule out the possibility of silent aspiration and to achieve information on safe nutrition consistency.

PMID: 28631744 [PubMed - indexed for MEDLINE]

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Utility approach to decision-making in extended T1 and limited T2 glottic carcinoma.

Related Articles

Utility approach to decision-making in extended T1 and limited T2 glottic carcinoma.

Head Neck. 2017 Apr;39(4):779-785

Authors: van Loon Y, Stiggelbout AM, Hakkesteegt MM, Langeveld TP, de Jong RJ, Sjögren EV

Abstract
BACKGROUND: It is still undecided if endoscopic laser surgery or radiotherapy is the preferable treatment in extended T1 and limited T2 glottic tumors. Health utilities assessed from patients can aid in decision-making.
METHODS: Patients treated for extended T1 or limited T2 glottic carcinoma by laser surgery (n = 12) or radiotherapy (n = 14) assigned health utilities using a visual analog scale (VAS), time tradeoff (TTO) technique and scored their voice handicap using the Voice Handicap Index (VHI).
RESULTS: VAS and TTO scores were slightly lower for the laser group compared to the radiotherapy group, however, not significantly so. The VHI showed a correlation with the VAS score, which was very low in both groups and can be considered (near) normal.
CONCLUSION: Patients show no clear preference for the outcomes of laser surgery or radiotherapy from a quality of life (QOL) or voice handicap point of view. These data can now be incorporated into decision-making models. © 2017 Wiley Periodicals, Inc. Head Neck, 2017 © 2016 Wiley Periodicals, Inc. Head Neck 39: 779-785, 2017.

PMID: 28199035 [PubMed - indexed for MEDLINE]

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Mucosal melanoma of the upper airways tract mucosal melanoma: A systematic review with meta-analyses of treatment.

Related Articles

Mucosal melanoma of the upper airways tract mucosal melanoma: A systematic review with meta-analyses of treatment.

Head Neck. 2017 Apr;39(4):819-825

Authors: Jarrom D, Paleri V, Kerawala C, Roques T, Bhide S, Newman L, Winter SC

Abstract
BACKGROUND: Mucosal melanoma of the upper aerodigestive tract (MM-UADT) occurs in a complex anatomic region. It represents a small number of tumors of the head and neck and a small number of melanoma cases.
METHODS: Search strategies initially identified 600, 11 of which were included in this study.
RESULTS: All studies involved surgery and radiotherapy. None were randomized, and all were assessed as having a high risk of selection and performance bias. No studies reported quality of life, treatment-related mortality, or morbidity. The results indicate that the addition of radiotherapy to surgery reduces the rate of locoregional recurrence (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.42-0.87). There was no statistically significant difference in overall survival (HR, 1.16; 95% CI, 0.98-1.37).
CONCLUSION: Surgical resection with postoperative radiotherapy remains the optimal treatment strategy for locoregional control. More robust studies and the use of molecular targeted therapies need to be undertaken to improve overall survival. © 2016 Wiley Periodicals, Inc. Head Neck 39: 819-825, 2017.

PMID: 27898196 [PubMed - indexed for MEDLINE]

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Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function.

Related Articles

Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function.

Head Neck. 2016 Apr;38 Suppl 1:E1144-51

Authors: Schneider R, Sekulla C, Machens A, Lorenz K, Thanh PN, Dralle H

Abstract
BACKGROUND: The characteristics of segmental type 1 and global type 2 injuries to the recurrent laryngeal nerve (RLN) and the extent and dynamics of nerve recovery are poorly understood.
METHODS: This investigation of 785 patients who underwent thyroidectomy under continuous intraoperative nerve monitoring aimed at exploring the dynamics of loss and recovery of the nerve monitoring signal and its relationship to early postoperative vocal fold palsy.
RESULTS: Persistent complete loss of signal and signal recovery <50% identified all (based on 12 and 4 patients with type 1 injuries) or most (based on 9 of 12 and 4 of 6 patients with global type 2 injuries) early unilateral vocal fold palsies. Signal recovery ≥50% (based on 7 patients) always signified normal vocal fold function.
CONCLUSION: These data, including the observation that global type 2 injuries may entail less severe nerve injury, require validation in independent series before being adopted more widely. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1144-E1151, 2016.

PMID: 26331940 [PubMed - indexed for MEDLINE]

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Complications after CO2 laser surgery for early glottic cancer: An institutional experience.

Related Articles

Complications after CO2 laser surgery for early glottic cancer: An institutional experience.

Head Neck. 2016 Apr;38 Suppl 1:E987-90

Authors: Lee M, Buchanan MA, Riffat F, Palme CE

Abstract
BACKGROUND: Transoral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates.
METHODS: A retrospective chart review of prospectively gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas (SCCs) was analyzed to examine the complications experienced.
RESULTS: Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (n = 1), surgical emphysema (n = 1), pharyngeal bruising (n = 1), endotracheal tube cuff perforation (n = 1), anterior glottic web (n = 14), vocal cord granuloma (n = 14), laryngocele (n = 1), and none of airway fire or intraoperative or postoperative hemorrhage.
CONCLUSION: Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E987-E990, 2016.

PMID: 26040665 [PubMed - indexed for MEDLINE]

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Impact of 68Ga-PSMA-PET imaging on target volume definition and guidelines in radiation oncology - a patterns of failure analysis in patients with primary diagnosis of prostate cancer

68Ga-PSMA-PET-imaging has proven to be a highly sensitive and specific diagnostic element for patients with prostate cancer (PC). Does the standard clinical target volume (CTV) cover the majority of 68Ga-PSMA-PET...

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[Homeopathy in cancer patients: What does the "best" evidence tell us?]

[Homeopathy in cancer patients: What does the "best" evidence tell us?]

Bull Cancer. 2018 Feb 24;:

Authors: de Nonneville A, Gonçalves A

Abstract
Homeopathic medicines are used by many patients with cancer, usually alongside conventional treatment. A recent report by the European Academies' Science Advisory Council concluded that "that there are no robust and reproducible evidence that homeopathy is effective". This literature review aims to make the analysis of published controlled randomized trials involving homeopathic treatment in the field of oncology.

PMID: 29486922 [PubMed - as supplied by publisher]

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[What are the expectations of coordination and accompaniment of French patients with cancer towards their community pharmacist?]

[What are the expectations of coordination and accompaniment of French patients with cancer towards their community pharmacist?]

Bull Cancer. 2018 Feb 24;:

Authors: Hébert G, Minvielle E, Di Palma M, Lemare F

Abstract
PURPOSES: Analyze the relationship and expectations of cancer patients towards the community pharmacist in a pharmaceutical care coordination project.
METHODS: In November 2014, a questionnaire was distributed to ambulatory patients of a university hospital specialized in oncology. Thirteen questions explored the consumption habits and the usage of the pharmacy (typology of consumers, use of goods and benefits consumed), and collected their expectations for pharmaceutical benefits in the context of the management of their cancer.
RESULTS: One thousand two hundred and seventy two patients were included for a final response rate of 78%. Characteristics of the respondents: 64% were women, 63% lived in Île-de-France and 49% took cancer-related treatments (anticancer drugs, supportive care medications). More than 84% of respondents went to pharmacies at least once a month and 95% reported resorting to a single pharmacy. 36% to be ready to share their hospital discharge report with their pharmacist and 61% to have their hospitalization order sent to their "referral" pharmacy to anticipate treatments. Discussion Community pharmacists were perceived positively by the respondents. Patients were willing to share information and be accompanied by this health professional in their cancer care. Their expectations were first and foremost the management of drug-related iatrogenic effects with a report of adverse effects to the hospital, and validated solutions for their management.

PMID: 29486920 [PubMed - as supplied by publisher]

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Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

Rev Assoc Med Bras (1992). 2017 Dec;63(12):1076-1081

Authors: Wei H, Sun D, Liu M

Abstract
OBJECTIVE: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia.
METHOD: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention.
RESULTS: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01).
CONCLUSION: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

PMID: 29489982 [PubMed - in process]

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Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.

Related Articles

Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.

Head Neck. 2016 Apr;38 Suppl 1:E1221-31

Authors: Langmore SE, McCulloch TM, Krisciunas GP, Lazarus CL, Van Daele DJ, Pauloski BR, Rybin D, Doros G

Abstract
BACKGROUND: Neuromuscular electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. This study investigated the efficacy of NMES in this patient population.
METHODS: In this double-blinded, randomized controlled trial, 170 patients with head and neck cancer experiencing posttreatment dysphagia were randomized into active NMES + swallow exercise versus sham NMES + swallow exercise groups. Outcomes after a 12-week program included changes in fluoroscopy measures, diet, and quality of life.
RESULTS: After the 12-week program, the active NMES group had significantly worse Penetration Aspiration Scale scores than the sham group. Both groups reported significantly better diet and quality of life. No other measures were significant.
CONCLUSION: NMES did not add benefit to traditional swallow exercises. Unfortunately, swallow exercises were not effective by themselves either. For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia. © 2015 Wiley Periodicals, Head Neck 38: E1221-E1231, 2016.

PMID: 26469360 [PubMed - indexed for MEDLINE]

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Intravenous iron: Safe and underutilized in children

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The challenge of the management of adolescents and young adults with soft tissue sarcomas

Abstract

Soft tissue sarcomas are relatively frequent in adolescents and young adults and their clinical management may be complex, partly due to tumor associated factors, but also because different approaches have been adopted by pediatric and adult medical oncologists dealing with the same disease. However, times are changing and in the last few years, management has tended to converge towards a common strategy. Continued and increased international collaboration between pediatric and adult sarcoma groups is of critical importance to improve the quality of treatment as well as research programs dedicated to young patients with soft tissue sarcomas.

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Nontuberculous mycobacteria-associated hemophagocytic lymphohistiocytosis in MonoMAC syndrome

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Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

Rev Assoc Med Bras (1992). 2017 Dec;63(12):1076-1081

Authors: Wei H, Sun D, Liu M

Abstract
OBJECTIVE: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia.
METHOD: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention.
RESULTS: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01).
CONCLUSION: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

PMID: 29489982 [PubMed - in process]

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Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.

Related Articles

Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.

Head Neck. 2016 Apr;38 Suppl 1:E1221-31

Authors: Langmore SE, McCulloch TM, Krisciunas GP, Lazarus CL, Van Daele DJ, Pauloski BR, Rybin D, Doros G

Abstract
BACKGROUND: Neuromuscular electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. This study investigated the efficacy of NMES in this patient population.
METHODS: In this double-blinded, randomized controlled trial, 170 patients with head and neck cancer experiencing posttreatment dysphagia were randomized into active NMES + swallow exercise versus sham NMES + swallow exercise groups. Outcomes after a 12-week program included changes in fluoroscopy measures, diet, and quality of life.
RESULTS: After the 12-week program, the active NMES group had significantly worse Penetration Aspiration Scale scores than the sham group. Both groups reported significantly better diet and quality of life. No other measures were significant.
CONCLUSION: NMES did not add benefit to traditional swallow exercises. Unfortunately, swallow exercises were not effective by themselves either. For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia. © 2015 Wiley Periodicals, Head Neck 38: E1221-E1231, 2016.

PMID: 26469360 [PubMed - indexed for MEDLINE]

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Authors’ Reply to Buckner et al.: ‘Comment on: “The General Adaptation Syndrome: A Foundation for the Concept of Periodization”

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Comment on: “The General Adaptation Syndrome: A Foundation for the Concept of Periodization”

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Trading Health Risks for Glory: A Reformulation of the Goldman Dilemma

Abstract

Background

The Goldman dilemma presented athletes with a Faustian bargain that guaranteed winning an Olympic gold medal in their sport but resulted in certain death 5 years later. Athletes' responses to Goldman's bargain were reported from 1982 to 1995. Several studies subsequently evaluated people's willingness to accept the bargain proposed in the Goldman question. Our study updates Goldman's question using contingent-behavior questions, a preference-elicitation method widely applied in economics, marketing and psychology to understand people's choice behavior. Contingent-behavior questions ask people to evaluate hypothetical tradeoffs between outcomes when real-world decisions are unobservable, nonexistent, or unreliable.

Methods

A web-enabled survey was conducted with athletes in 50 sports between June, 2012 and April, 2013. Athletes were invited by their sport governing bodies in the United States to complete the online survey. Responses from 2888 athletes were collected. Our reformulation elicited athletes' willingness to accept a performance-enhancing drug (PED) associated with the risk of a realistic fatal event, not certain death. A double-bounded dichotomous-choice question format was used to elicit athletes' maximum acceptable mortality risk (MAMR) for winning an Olympic gold medal. Data were analyzed using an interval regression model to estimate the implicit probability of accepting a continuous risk level. MAMR was defined as the mortality risk level with a 0.50 probability of acceptance.

Results

Estimated mean MAMRs varied between 7 and 14% across athletes in different ranks and sports. Elite athletes were generally the most willing to accept a fatal cardiovascular risk to win a gold medal in the Olympics. This range was similar to the levels of risk that patients accept for life-changing interventions.

Conclusions

Results suggest that very few athletes would be expected to accept a PED in the bargain postulated by the Goldman dilemma. Risk tolerance among elite athletes suggest they may be more aware of the potential financial and nonfinancial benefits of such a win, and/or less optimistic about their potential to move up in the level of competition without the use of PEDs.

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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences

Abstract

Purpose

To review the incidence of perioperative and late complications of surgery for spinal deformity (ASD).

Methods

Review of the literature. We reviewed recent literature in English to investigate the incidence of complications in ASD surgery in the perioperative (≤ 3 months post-operative) and late (> 3 months post-operative) periods. Randomized-controlled trials, non-randomized trials, cohort studies, case–control studies, and case series published in 2005 or later were included. We divided articles according to surgical technique: open procedures (OP), minimally invasive surgery (MIS), and hybrid procedures (HP). Complications were recorded, grouped by surgical technique, and then classified according to a proposed Grading of Incidence of Complications (IOC).

Results

Ninety-six publications reporting on 12,168 patients were included; 68 were level IV of evidence studies, 24 were level III, and 4 level II. Perioperative IOC was 26.5% in OP, 36.4% in HP, and 24.2% in MIS. Late IOC was 11.1% in OP, 15.4% in HP, and 14.0% in MIS. IOC was significantly higher for hybrid procedures compared to both open and MIS procedures.

Conclusions

Reported complications of surgery for ASD in the recent literature are frequent (24–36% perioperative plus 11–15% late). Open procedures were the most extensively reported in the literature. Complication rates are similar for OP and MIS. HP presented higher IOC likely due to the combination of OP and MIS respective complications. Small number of studies and heterogeneity in reporting could result in risk of bias in these results. Large-scale registry-based studies can fill this gap in the future.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Interstitial Keratitis in Cogan’s Syndrome

A 24-year-old woman who had a 10-year history of intermittent episodes of redness and photophobia in both eyes presented to the ophthalmology clinic with visual changes. On examination, the visual acuity was 20/30 in the right eye and 20/25 in the left eye. Slit-lamp examination revealed…

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Dynamic changes in plasma Epstein–Barr virus DNA load during treatment have prognostic value in nasopharyngeal carcinoma: a retrospective study

Abstract

Circulating plasma Epstein–Barr virus DNA (EBV DNA) is related to tumor recurrence and metastasis and has potential as a dynamic, sensitive, and specific marker in nasopharyngeal carcinoma (NPC). We investigated the clinical significance of assessing plasma EBV DNA load at various time points during treatment. Patients with NPC (n = 949) for whom plasma EBV DNA load was measured by real-time quantitative polymerase chain reaction (RT-qPCR) before treatment (pre-EBV) and at midtreatment (mid-EBV), end of treatment (end-EBV), and 3 months after completing treatment (3 m-EBV) were retrospectively assessed. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal EBV DNA cutoff point for each time point. Overall survival (OS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) were compared using Kaplan–Meier estimates. High pre-EBV, high mid-EBV, high end-EBV, and high 3 m-EBV were all associated with significantly poorer OS, DMFS, and PFS in the entire cohort. Detectable end-EBV and 3 m-EBV was associated with significantly poorer OS, DMFS, and PFS. Among patients with detectable end-EBV, adjuvant therapy significantly improved OS (HR 2.419; 95% CI 1.297–4.51, P = 0.03) and DMFS (HR 2.45; 95% CI 1.243–4.828, P = 0.04), but not PFS (P = 0.17). EBV DNA represents a dynamic biomarker for monitoring treatment and predicting survival in NPC. Assessing plasma EBV DNA before, during, and after chemoradiotherapy could be clinically valuable and enable selection of patients most likely to benefit from additional therapy and improve assessment of treatment response and disease surveillance. Further multicenter prospective investigations are warranted.

EBV DNA represents a dynamic biomarker for monitoring treatment and predicting survival in NPC. Assessing plasma EBV DNA before, during, and after chemoradiotherapy could be clinically valuable and enable selection of patients most likely to benefit from additional therapy and improve assessment of treatment response and disease surveillance.

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The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis

Abstract

The number of elderly patients with cancer is increasing. Medical comorbidities are more common in this population. Little is known regarding the prognostic relevance of comorbidities in elderly patients with nasopharyngeal carcinoma (NPC). Using the National Cancer Data Base (NCDB), we queried patients age >65 years diagnosed with NPC and treated with definitive radiation between 2004 and 2012 to examine the association between comorbidity and survival outcomes. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). The influence of comorbidity on overall survival (OS) was evaluated. Cox proportional hazards model was used to study the impact of comorbidity on OS. A total of 1137 patients met the specified criteria. Median follow-up was 61.2 months. Five-year OS was 50.4%. Comorbidities were present in 22.4% of patients, with 17.6% of patients having a CCI score of 1% and 4.8% having a CCI score of ≥2. Patients with a CCI score of 0 had significantly higher 5-year OS than patients with a CCI score of 1 or ≥2 (53.1% vs. 42.2% vs. 32.9%, P < 0.001). In multivariate analysis, CCI was a statistically significant independent prognostic factor for the risk of death of all causes for patients with a CCI score of 1 (hazard ratio [HR]: 1.242; 95% confidence interval [CI]: 1.002–1.539) or CCI score of ≥2 (HR: 1.625; 95% CI: 1.157–2.283) when compared to patients with a CCI score of 0. Comorbidity as measured by CCI is a strong independent prognostic factor for OS in elderly patients with NPC and lends support to the inclusion of comorbidity assessment due to its prognostic value when treating elderly patients with NPC.

Elderly nasopharyngeal carcinoma patients with Charlson Comorbidity Index (CCI) score of 0 had significantly higher 5-year overall survival (OS) than patients with a CCI score of 1 or >2 (53.1% vs. 42.2% vs. 32.9%, P < 0.0001). In multivariate analysis, comorbidity was a statistically significant independent prognostic factor for OS in the elderly NPC patients.

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Prostate cancer surveillance by occupation and industry: the Canadian Census Health and Environment Cohort (CanCHEC)

Abstract

As there are no well-established modifiable risk factors for prostate cancer, further evidence is needed on possible factors such as occupation. Our study uses one of the largest Canadian worker cohorts to examine occupation, industry, and prostate cancer and to assess patterns of prostate cancer rates. The Canadian Census Health and Environment Cohort (CanCHEC) was established by linking the 1991 Canadian Census Cohort to the Canadian Cancer Database (1969–2010), Canadian Mortality Database (1991–2011), and Tax Summary Files (1981–2011). A total of 37,695 prostate cancer cases were identified in men aged 25–74 based on age at diagnosis. Cox proportional hazards models were used to estimate hazards ratios and 95% confidence intervals. In men aged 25–74 years, elevated risks were observed in the following occupations: senior management (HR = 1.12, 95% CI: 1.04–1.20); office and administration (HR = 1.19, 95% CI: 1.11–1.27); finance services (HR = 1.09, 95% CI: 1.04–1.14); education (HR = 1.05, 95% CI: 1.00–1.11); agriculture and farm management (HR = 1.12, 95% CI: 1.06–1.17); farm work (HR = 1.11, 95% CI: 1.01–1.21); construction managers (HR = 1.07, 95% CI: 1.01–1.14); firefighting (HR = 1.17, 95% CI: 1.01–1.36); and police work (HR = 1.22, 95% CI: 1.09–1.36). Decreased risks were observed across other construction and transportation occupations. Results by industry were consistent with occupation results. Associations were identified for white-collar, agriculture, protective services, construction, and transportation occupations. These findings emphasize the need for further study of job-related exposures and the potential influence of nonoccupational factors such as screening practices.

We examined occupation, industry, prostate cancer, and patterns of prostate cancer rates using a large Canadian worker cohort. Increased risks were observed in white-collar, agriculture, and protective services occupations, and decreased risks were observed in construction and transportation occupations across men aged 25–74 years. These findings emphasize the need for further study of job-related exposures and the potential influence of non-occupational factors such as screening behaviours.

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Increased expression of miR-641 contributes to erlotinib resistance in non-small-cell lung cancer cells by targeting NF1

Abstract

Epidermal growth receptor (EGFR)-targeted tyrosine kinase inhibitors (TKIs) have emerged as first-line drugs for advanced non-small-cell lung cancer (NSCLC) patients with EFGR mutations. However, most patients with NSCLC show acquired resistance to EGFR-TKIs, and low expression of NF1 is a mechanism of EGFR-TKI resistance in lung cancer. However, the mechanism by which NF1 is downregulated in EGFR-TKI-resistant NSCLC is unclear. Here, we found the increased expression of miR-641 in NSCLC cells and human NSCLC samples with resistance to TKI compared to those with sensitive to TKI. In addition, our in vitro experiments show that overexpression of miR-641 induces TKI resistance in NSCLC cells. Furthermore, we identified that miR-641 activates ERK signaling by direct targeting of neurofibromatosis 1 (NF1) in NSCLC cells. Our data show that overexpression of NF1 or silencing of ERK can block miR-641-induced resistance of NSCLC cells to erlotinib treatment. Importantly, our animal experiments show that combination of miR-641 inhibition and erlotinib treatment can significantly inhibit erlotinib-resistant NSCLC growth, inhibit proliferation and induce apoptosis compared to single-drug treatment. Our findings suggest that increased expression of miR-641 significantly contributes to erlotinib resistance development in NSCLC cells through activating ERK signaling by targeting NF1 and that inhibition of miR-641 may reverse acquired resistance of NSCLC cells to erlotinib treatment.

We first time determined the role of miR-641 on the erlotinib resistance development in NSCLC cells. Our findings suggest that upregulated expression of miR-641 was significantly associated with erlotinib resistance development in NSCLC cells. Our findings may also aid in the development of potential therapeutics for the treatment of erlotinib-resistant NSCLC.

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Systematic review of ototoxic pre-surgical antiseptic preparations – what is the evidence?

There is uncertainty regarding the safety of surgical antiseptic preparations in the ear. A systematic review of the literature was conducted to assess the evidence regarding ototoxicity of surgical antiseptic...

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Inflammatory Markers in Serum and Cerebrospinal Fluid for Early Detection of External Ventricular Drain–associated Ventriculitis in Patients With Subarachnoid Hemorrhage

Background: External ventricular drain (EVD)-associated ventriculitis is a serious complication. Early diagnosis can be difficult particularly in critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH). We examined the diagnostic potential of standard serum and cerebrospinal fluid (CSF) biomarkers to differentiate between EVD-associated infections and aseptic courses in patients with aSAH. Materials and Methods: We retrospectively evaluated the levels of inflammatory markers in serum (white blood cell count, percentage of neutrophils [sN%], and procalcitonin) and CSF (total leukocyte count [CSFTLC], CSFglucose, CSF/serumglucose ratio, CSF total protein [CSFTP]) of 63 consecutive patients with aSAH. Receiver operating characteristic curves and the area-under-the-curve (AUC) were calculated to detect the diagnostic potential, optimized threshold, sensitivity (SE), specificity (SP), + likelihood ratio (LR), and −LR of each biomarker. Results: Of all patients, 17 (27%) developed an EVD-associated ventriculitis within a mean of 7.8±2.3 days after implantation. sN% had a very good diagnostic potential (AUC=0.900, SE=70.0%, SP=100%), followed by the CSFTLC with good diagnostic potential (AUC=0.841, SE=75.0%, SP=88.5%), and the CSFTP with moderate diagnostic potential (AUC=0.772, SE=73.3%, SP=76.0%). sN% higher than 70% and a CSFTLC higher than 635/µL were highly associated with the diagnosis of ventriculitis (+LR=∞ and 6.5), sN%

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Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection

Abstract

Early identification of dysphagia by screening is recommended best practice for patients admitted to hospital with acute stroke. Screening can reduce the risk of pneumonia and promote stroke recovery, yet some institutions do not utilize a formal screening protocol. This study assessed the accuracy of informal dysphagia detection prior to implementation of a formal screening protocol. We conducted a secondary analysis of data captured between 2003 and 2008 from a sample of 250 adult stroke survivors admitted to a tertiary care centre. Using a priori criteria, patient medical records were reviewed for notation about dysphagia; if present, the date/time of notation, writer's profession, and suggestion of dysphagia presence. To assess accuracy of notations indicating dysphagia presence, we used speech language pathology (SLP) assessments as the criterion reference. There were 221 patient medical records available for review. Patients were male (56%), averaged 68 years (SD = 15.0), with a mean Canadian Neurological Scale score of 8.1 (SD = 3.0). First notations of swallowing by SLP were excluded. Of the remaining 170 patients, 147 (87%) had first notations (104 by nurses; 40 by physicians) within a median of 24.3 h from admission. Accuracy of detecting dysphagia from informal notations was low, with a sensitivity of 36.7% [95% CI, 24.9, 50.1], but specificity was high (94.2% [95% CI, 86.5, 97.9]). Informal identification methods, although timely, are suboptimal in their accuracy to detect dysphagia and leave patients with stroke at risk for poor health outcomes. Given these findings, we encourage the use of psychometrically validated formal screening protocols to identify dysphagia.

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Factors Contributing to Hydration, Fluid Intake and Health Status of Inpatients With and Without Dysphagia Post Stroke

Abstract

Dysphagia has been strongly associated with poor hydration in acute stroke settings. However, in sub-acute settings, the contribution to dehydration of dysphagia in combination with other common stroke comorbidities has not been explored. The aim of this study was to investigate which demographic and stroke comorbidities, including dysphagia, contribute most significantly to oral fluid intake, hydration status and specific adverse health outcomes for patients in sub-acute rehabilitation following stroke. Data from 100 inpatients from three Australian rehabilitation facilities (14 with confirmed dysphagia and 86 without dysphagia) were analysed. Hierarchical multiple regressions were conducted to determine which demographic or stroke comorbidities were most predictive of each outcome: average daily fluid intake; Blood urea nitrogen/creatinine (BUN/Cr) ratio as an index of hydration and medically diagnosed adverse events of pneumonia, dehydration, urinary tract infection or constipation. Average daily beverage intake (M = 1448 ml, SD 369 ml) was significantly and independently predicted by Functional Independence Measure (FIM) at admission (F change = 9.212, p = 0.004). BUN/Cr ratio (M = 20, SD 5.16) was predicted only by age (F change = 4.026, p = 0.049). Adverse health events, diagnosed for 20% of participants, were significantly predicted by Admission FIM (OR 1.040, 95% CI 1.001, 1.081, p = 0.047). Dysphagia was not a significant predictor of any of the outcomes measured. Rather, overall functional dependency was the most significant predictor of poor oral fluid intake and fluid-related adverse health outcomes in sub-acute stroke. Clinical Trial number: Data for the post hoc analysis presented in this article came from the registered trial ACTRN12610000752066.

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Sanjad-Sakati syndrome with macrocytic anemia and failure to thrive: a case from South Jordan

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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The relationship between diet quality and insulin resistance in obese children: adaptation of the Healthy Lifestyle-Diet Index in Turkey

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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HbA1c levels in children with type 1 diabetes and correlation to diabetic retinopathy

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Safety of long-term anticoagulation in patients with brain metastases

Abstract

Anticoagulation is thought to be associated with the risk of intracranial hemorrhage (ICH) in patients with brain metastases; however, the data on this topic are limited. This study was conducted to determine the incidence of ICH associated with anticoagulant use in adult patients with brain metastases. Consecutive patients with brain metastases occurring from 2006 to 2014 were identified from a single-institution database. Long-term anticoagulant therapy was defined as outpatient anticoagulation therapy of > 1 month. Chi-square tests and Fisher's exact test were used to compare rates of ICH by groups. This cohort included 125 patients with brain metastases. Of these, 64 had primary of non-small cell lung cancer (51.2%). Of these patients, 12/125 (9.6%) patients developed ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. ICH incidence was not associated with the use of anticoagulant therapy, with 8/67 (11.94%) patients on outpatient anticoagulation and 4/58 (6.9%) not on anticoagulation experiencing ICH (p = 0.33). The type of treatment did not significantly influence ICH, although those having combined WBRT and SRS were numerically more likely to experience ICH (4/15; 26.67%) of this cohort. In patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice-daily dosing (p = 1.0). Long-term anticoagulant use is not associated with an increased incidence of ICH in patients with intracranial metastases.

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Mitochondrial Acetyl-CoA Synthetase 3 is Biosignature of Gastric Cancer Progression

Abstract

Cholesterol affects cancer progression, and acetyl-CoA is the primary cholesterogenesis substrate. The previous work has defined cholesterol bioflux via lipoprotein/receptor route is the gastric cancer (GCa) prognosis biosignature. The prognosis importance of acetyl-CoA to cholesterogenesis (mevalonate pathway) in GCa is yet to be defined. Using Kaplan–Meier Plotter web-based gene survival analyzer and The Cancer Genome Atlas (TCGA)-database analyzed with DBdriver.v2 platform, we revealed acetyl-CoA production and the mevalonate pathway are associated with GCa prognosis. We found mitochondrial-derived acetyl-CoA contributing enzymes (acyl-coA synthetase super-family 3; ACSS3) is the GCa progression confounder. Interestingly, it is not HMGCR (the committee enzyme of mevalonate pathway), but lower mevalonate pathway enzymes (e.g., MVK, LSS, DHCR14A1, SC4MOL, HSD17B7, SC5D) promote GCa patients 5-years overall survival in a differential level. Advanced analyses found ACSS3 is prognosis biosignatures for multiple GCa disease conditions. This report uncovered a higher expression of ACSS3 in tumor comparing to normal parental lesions, which implicates a targeting value for GCa therapy. While knockdown ACSS3 could suppress growth and invasion of GCa cells, of which even more impactful under starvation condition. This is the first report, surprisingly, revealed ACSS3 as important cancer prognosis biomarker. Targeting ACSS3 could be a novel therapeutic strategy for cancer, in this case, GCa.

The cholesterogenic committing step enzyme (HMGCR) is not important in GCa patients, which explain the failure of statins in GCa clinical trials. However, the mitochondrial acetyl-CoA producer (ACSS3), and lower-mevalonate lipidomes are biosignatures for GCa progression. Interfering ACSS3 expression could almost abolished GCa cell growth under starvation stress. This study suggesting a targeting value of ACSS3 for GCa therapy.

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Chondroitin sulfate proteoglycans as novel drivers of leucocyte infiltration in multiple sclerosis

Abstract

Multiple sclerosis presents with profound changes in the network of molecules involved in maintaining central nervous system architecture, the extracellular matrix. The extracellular matrix components, particularly the chondroitin sulfate proteoglycans, have functions beyond structural support including their potential interaction with, and regulation of, inflammatory molecules. To investigate the roles of chondroitin sulfate proteoglycans in multiple sclerosis, we used the experimental autoimmune encephalomyelitis model in a time course study. We found that the 4-sulfated glycosaminoglycan side chains of chondroitin sulfate proteoglycans, and the core protein of a particular family member, versican V1, were upregulated in the spinal cord of mice at peak clinical severity, correspondent with areas of inflammation. Versican V1 expression in the spinal cord rose progressively over the course of experimental autoimmune encephalomyelitis. A particular structure in the spinal cord and cerebellum that presented with intense upregulation of chondroitin sulfate proteoglycans is the leucocyte-containing perivascular cuff, an important portal of entry of immune cells into the central nervous system parenchyma. In these inflammatory perivascular cuffs, versican V1 and the glycosaminoglycan side chains of chondroitin sulfate proteoglycans were observed by immunohistochemistry within and in proximity to lymphocytes and macrophages as they migrated across the basement membrane into the central nervous system. Expression of versican V1 transcript was also documented in infiltrating CD45+ leucocytes and F4/80+ macrophages by in situ hybridization. To test the hypothesis that the chondroitin sulfate proteoglycans regulate leucocyte mobility, we used macrophages in tissue culture studies. Chondroitin sulfate proteoglycans significantly upregulated pro-inflammatory cytokines and chemokines in macrophages. Strikingly, and more potently than the toll-like receptor-4 ligand lipopolysaccharide, chondroitin sulfate proteoglycans increased the levels of several members of the matrix metalloproteinase family, which are implicated in the capacity of leucocytes to cross barriers. In support, the migratory capacity of macrophages in vitro in a Boyden chamber transwell assay was enhanced by chondroitin sulfate proteoglycans. Finally, using brain specimens from four subjects with multiple sclerosis with active lesions, we found chondroitin sulfate proteoglycans to be associated with leucocytes in inflammatory perivascular cuffs in all four patients. We conclude that the accumulation of chondroitin sulfate proteoglycans in the perivascular cuff in multiple sclerosis and experimental autoimmune encephalomyelitis boosts the activity and migration of leucocytes across the glia limitans into the central nervous system parenchyma. Thus, chondroitin sulfate proteoglycans represent a new class of molecules to overcome in order to reduce the inflammatory cascades and clinical severity of multiple sclerosis.

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Atlas of the normal intracranial electroencephalogram: neurophysiological awake activity in different cortical areas

Abstract

In contrast to scalp EEG, our knowledge of the normal physiological intracranial EEG activity is scarce. This multicentre study provides an atlas of normal intracranial EEG of the human brain during wakefulness. Here we present the results of power spectra analysis during wakefulness. Intracranial electrodes are placed in or on the brain of epilepsy patients when candidates for surgical treatment and non-invasive approaches failed to sufficiently localize the epileptic focus. Electrode contacts are usually in cortical regions showing epileptic activity, but some are placed in normal regions, at distance from the epileptogenic zone or lesion. Intracranial EEG channels defined using strict criteria as very likely to be in healthy brain regions were selected from three tertiary epilepsy centres. All contacts were localized in a common stereotactic space allowing the accumulation and superposition of results from many subjects. Sixty-second artefact-free sections during wakefulness were selected. Power spectra were calculated for 38 brain regions, and compared to a set of channels with no spectral peaks in order to identify significant peaks in the different regions. A total of 1785 channels with normal brain activity from 106 patients were identified. There were on average 2.7 channels per cm³ of cortical grey matter. The number of contacts per brain region averaged 47 (range 6–178). We found significant differences in the spectral density distributions across the different brain lobes, with beta activity in the frontal lobe (20–24 Hz), a clear alpha peak in the occipital lobe (9.25–10.25 Hz), intermediate alpha (8.25–9.25 Hz) and beta (17–20 Hz) frequencies in the parietal lobe, and lower alpha (7.75–8.25 Hz) and delta (0.75–2.25 Hz) peaks in the temporal lobe. Some cortical regions showed a specific electrophysiological signature: peaks present in >60% of channels were found in the precentral gyrus (lateral: peak frequency range, 20–24 Hz; mesial: 24–30 Hz), opercular part of the inferior frontal gyrus (20–24 Hz), cuneus (7.75–8.75 Hz), and hippocampus (0.75–1.25 Hz). Eight per cent of all analysed channels had more than one spectral peak; these channels were mostly recording from sensory and motor regions. Alpha activity was not present throughout the occipital lobe, and some cortical regions showed peaks in delta activity during wakefulness. This is the first atlas of normal intracranial EEG activity; it includes dense coverage of all cortical regions in a common stereotactic space, enabling direct comparisons of EEG across subjects. This atlas provides a normative baseline against which clinical EEGs and experimental results can be compared. It is provided as an open web resource (https://mni-open-ieegatlas.research.mcgill.ca).

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Cognition and dementia in older patients with epilepsy

Abstract

With advances in healthcare and an ageing population, the number of older adults with epilepsy is set to rise substantially across the world. In developed countries the highest incidence of epilepsy is already in people over 65 and, as life expectancy increases, individuals who developed epilepsy at a young age are also living longer. Recent findings show that older persons with epilepsy are more likely to suffer from cognitive dysfunction and that there might be an important bidirectional relationship between epilepsy and dementia. Thus some people with epilepsy may be at a higher risk of developing dementia, while individuals with some forms of dementia, particularly Alzheimer's disease and vascular dementia, are at significantly higher risk of developing epilepsy. Consistent with this emerging view, epidemiological findings reveal that people with epilepsy and individuals with Alzheimer's disease share common risk factors. Recent studies in Alzheimer's disease and late-onset epilepsy also suggest common pathological links mediated by underlying vascular changes and/or tau pathology. Meanwhile electrophysiological and neuroimaging investigations in epilepsy, Alzheimer's disease, and vascular dementia have focused interest on network level dysfunction, which might be important in mediating cognitive dysfunction across all three of these conditions. In this review we consider whether seizures promote dementia, whether dementia causes seizures, or if common underlying pathophysiological mechanisms cause both. We examine the evidence that cognitive impairment is associated with epilepsy in older people (aged over 65) and the prognosis for patients with epilepsy developing dementia, with a specific emphasis on common mechanisms that might underlie the cognitive deficits observed in epilepsy and Alzheimer's disease. Our analyses suggest that there is considerable intersection between epilepsy, Alzheimer's disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.

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Use of topical therapies for pediatric psoriasis: A systematic review

Abstract

Psoriasis is one of the most common chronic skin diseases, affecting 1%-3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%-100% mean improvement in severity, and calcipotriol to 52%-64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.

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Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-related overgrowth spectrum: A brief report

Abstract

A patient with extensive multisystem overgrowth caused by a somatic gain of function PIK3CA-mutation is described. This case is an example of the clinical diversity of the PIK3CA-Related Overgrowth Spectrum (PROS) as the patient had overlapping features of Congenital Lipomatous Overgrowth Vascular malformations Epidermal nevi and Skeletal abnormalities (CLOVES) syndrome and Megalencephaly-Capillary malformation Polymicrogyria (MCAP) syndrome and underlines the utility of this umbrella term.

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Married, unmarried, divorced, and widowed and the risk of stroke

Objectives

Most studies report that marriage carries a lower risk of stroke than single living. Whether the marriage advantage is applicable with respect to all other marital status categories (unmarried, divorced, widow) remains unclear. We studied marital status and its association with incident stroke.

Material and Methods

We included all patients > 40 years of age admitted to hospital for stroke in Denmark during 2003-2012 and compared marital status to the general Danish population (5.5 millions). Relative risks (RR) for stroke were estimated in log-linear Poisson regression models adjusting for age, sex, calendar year, income, and length of education.

Results

A total of 58 847 patients with incident stroke were included. Crude incidence rates of stroke (per 1000 per year) among the four marital status categories were as follows: 1.96 (married), 1.52 (unmarried), 2.36 (divorced), and 5.43 (widowed). Compared to married persons, adjusted risk of stroke was significantly increased for divorced (RR 1.23; CI 1.19-1.27) and unmarried men (RR 1.07; CI 1.03-1.11) but not for widowed men (RR 1.02; CI 0.98-1.06); risk was slightly increased for divorced women (RR 1.10; CI 1.06-1.15) while not for widowed (RR 1.0; CI 0.97-1.03) and unmarried women (RR 0.97; CI 0.97-1.03).

Conclusions

Divorce was associated with higher risk of stroke, especially in men. Living in marriage or as unmarried or widower had only little or no impact on the risk of stroke.

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Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection

Abstract

Early identification of dysphagia by screening is recommended best practice for patients admitted to hospital with acute stroke. Screening can reduce the risk of pneumonia and promote stroke recovery, yet some institutions do not utilize a formal screening protocol. This study assessed the accuracy of informal dysphagia detection prior to implementation of a formal screening protocol. We conducted a secondary analysis of data captured between 2003 and 2008 from a sample of 250 adult stroke survivors admitted to a tertiary care centre. Using a priori criteria, patient medical records were reviewed for notation about dysphagia; if present, the date/time of notation, writer's profession, and suggestion of dysphagia presence. To assess accuracy of notations indicating dysphagia presence, we used speech language pathology (SLP) assessments as the criterion reference. There were 221 patient medical records available for review. Patients were male (56%), averaged 68 years (SD = 15.0), with a mean Canadian Neurological Scale score of 8.1 (SD = 3.0). First notations of swallowing by SLP were excluded. Of the remaining 170 patients, 147 (87%) had first notations (104 by nurses; 40 by physicians) within a median of 24.3 h from admission. Accuracy of detecting dysphagia from informal notations was low, with a sensitivity of 36.7% [95% CI, 24.9, 50.1], but specificity was high (94.2% [95% CI, 86.5, 97.9]). Informal identification methods, although timely, are suboptimal in their accuracy to detect dysphagia and leave patients with stroke at risk for poor health outcomes. Given these findings, we encourage the use of psychometrically validated formal screening protocols to identify dysphagia.

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Factors Contributing to Hydration, Fluid Intake and Health Status of Inpatients With and Without Dysphagia Post Stroke

Abstract

Dysphagia has been strongly associated with poor hydration in acute stroke settings. However, in sub-acute settings, the contribution to dehydration of dysphagia in combination with other common stroke comorbidities has not been explored. The aim of this study was to investigate which demographic and stroke comorbidities, including dysphagia, contribute most significantly to oral fluid intake, hydration status and specific adverse health outcomes for patients in sub-acute rehabilitation following stroke. Data from 100 inpatients from three Australian rehabilitation facilities (14 with confirmed dysphagia and 86 without dysphagia) were analysed. Hierarchical multiple regressions were conducted to determine which demographic or stroke comorbidities were most predictive of each outcome: average daily fluid intake; Blood urea nitrogen/creatinine (BUN/Cr) ratio as an index of hydration and medically diagnosed adverse events of pneumonia, dehydration, urinary tract infection or constipation. Average daily beverage intake (M = 1448 ml, SD 369 ml) was significantly and independently predicted by Functional Independence Measure (FIM) at admission (F change = 9.212, p = 0.004). BUN/Cr ratio (M = 20, SD 5.16) was predicted only by age (F change = 4.026, p = 0.049). Adverse health events, diagnosed for 20% of participants, were significantly predicted by Admission FIM (OR 1.040, 95% CI 1.001, 1.081, p = 0.047). Dysphagia was not a significant predictor of any of the outcomes measured. Rather, overall functional dependency was the most significant predictor of poor oral fluid intake and fluid-related adverse health outcomes in sub-acute stroke. Clinical Trial number: Data for the post hoc analysis presented in this article came from the registered trial ACTRN12610000752066.

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National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy

Summary

Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.

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The Effectiveness of Standing on a Balance Board for Increasing Energy Expenditure

ABSTRACTPURPOSETo investigate differences in energy expenditure (EE), heart rate (HR), productivity, fatigue, and pain while performing desk work while sitting (SIT), standing (STAND), and standing on a balance board (BOARD).METHODSThirty healthy adults (60% female; age 39.7 ± 11.8 y; BMI 26.7 ± 5.0 kg·m−2) employed in sedentary-based jobs volunteered for this randomized crossover trial. Participants performed typing work in three different positions: SIT, STAND, and BOARD; each condition lasting 30 min. Oxygen consumption (VO2) was measured via indirect calorimetry and EE was calculated using respiratory quotient and corresponding caloric equivalent values. Productivity was quantified by measuring words typed per min, accuracy, and typing mistakes. Overall feelings of fatigue and pain were self-reported three times during each position using validated 10-cm visual analog scales. Repeated measures ANOVA were used to assess differences in outcome variables across conditions.RESULTSVO2 was significantly different among all conditions regardless of current standing desk use (SIT 3.35 ± 0.53; STAND 3.77 ± 0.48; BOARD 3.92 ± 0.54 mL·kg−1·min−1, p0.05). Fatigue progressively increased over each 30 min condition whereas pain in SIT and BOARD increased from min 10 to 20, then leveled off between min 20 to 30. For STAND, pain continued to increase over time.CONCLUSIONCompared with sitting, a balance board may be effective for increasing EE without interfering with productivity in an occupational setting. PURPOSE To investigate differences in energy expenditure (EE), heart rate (HR), productivity, fatigue, and pain while performing desk work while sitting (SIT), standing (STAND), and standing on a balance board (BOARD). METHODS Thirty healthy adults (60% female; age 39.7 ± 11.8 y; BMI 26.7 ± 5.0 kg·m−2) employed in sedentary-based jobs volunteered for this randomized crossover trial. Participants performed typing work in three different positions: SIT, STAND, and BOARD; each condition lasting 30 min. Oxygen consumption (VO2) was measured via indirect calorimetry and EE was calculated using respiratory quotient and corresponding caloric equivalent values. Productivity was quantified by measuring words typed per min, accuracy, and typing mistakes. Overall feelings of fatigue and pain were self-reported three times during each position using validated 10-cm visual analog scales. Repeated measures ANOVA were used to assess differences in outcome variables across conditions. RESULTS VO2 was significantly different among all conditions regardless of current standing desk use (SIT 3.35 ± 0.53; STAND 3.77 ± 0.48; BOARD 3.92 ± 0.54 mL·kg−1·min−1, p0.05). Fatigue progressively increased over each 30 min condition whereas pain in SIT and BOARD increased from min 10 to 20, then leveled off between min 20 to 30. For STAND, pain continued to increase over time. CONCLUSION Compared with sitting, a balance board may be effective for increasing EE without interfering with productivity in an occupational setting. Corresponding author: Chantal A. Vella, PhD, Address: 875 Perimeter Drive MS 2401, Moscow, ID 83844–2401. Phone: 208-885-2189. Email: cvella@uidaho.edu There was no financial support in relation to the current project. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare that there are no conflicts of interest and that the results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. © 2018 American College of Sports Medicine

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Intra-operative high-resolution mapping of slow wave propagation in the human jejunum: Feasibility and initial results

Abstract

Background

Bioelectrical slow waves are a coordinating mechanism of small intestine motility, but extracellular human studies have been restricted to a limited number of sparse electrode recordings. High-resolution (HR) mapping has offered substantial insights into spatiotemporal intestinal slow wave dynamics, but has been limited to animal studies to date. This study aimed to translate intra-operative HR mapping to define pacemaking and conduction profiles in the human small intestine.

Methods

Immediately following laparotomy, flexible-printed-circuit arrays were applied around the serosa of the proximal jejunum (128-256 electrodes; 4-5.2 mm spacing; 28-59 cm²). Slow wave propagation patterns were mapped, and frequencies, amplitudes, downstroke widths, and velocities were calculated. Pacemaking and propagation patterns were defined.

Key Results

Analysis comprised nine patients with mean recording duration of 7.6 ± 2.8 minutes. Slow waves occurred at a frequency of 9.8 ± 0.4 cpm, amplitude 0.3 ± 0.04 mV, downstroke width 0.5 ± 0.1 seconds, and with faster circumferential velocity than longitudinal (10.1 ± 0.8 vs 9.0 ± 0.7 mm/s; P = .001). Focal pacemakers were identified and mapped (n = 4; mean frequency 9.9 ± 0.2 cpm). Disordered slow wave propagation was observed, including wavefront collisions, conduction blocks, and breakout and entrainment of pacemakers.

Conclusions & Inferences

This study introduces HR mapping of human intestinal slow waves, and provides first descriptions of intestinal pacemaker sites and velocity anisotropy. Future translation to other intestinal regions, disease states, and postsurgical dysmotility holds potential for improving the basic and clinical understanding of small intestine pathophysiology.

This study evaluated the feasibility of high-resolution (HR) slow wave mapping in the human small intestine, including defining spatiotemporal propagation patterns. Slow wave frequency, amplitude, downstroke width, and anisotropic velocity profile were quantitatively defined, and focal pacemakers and disordered propagation events were mapped. This study presents the first account of human HR intestinal mapping, offering a technique for quantitative assessment of intestinal bioelectrical activity and enabling future investigation of potential slow wave abnormalities in human diseases and/or postsurgical dysmotility.

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Resolution of traumatic bilateral vertebral artery injury

Abstract

Purpose

Cerebrovascular ischaemia is a rare but serious complication of damage to the carotid or vertebral arteries in the neck caused by blunt injury to the neck. Screening for blunt cerebrovascular injury should be performed in patients with certain signs or symptoms and risk factors. We described a case of traumatic bilateral vertebral artery injury (VAI) including unilateral vertebral arterial occlusion that resolved 3 months post-injury with antiplatelet and direct oral anticoagulant therapy. This resolution of traumatic bilateral VAI is very rare. Vertebral artery injury should be suspected in patients with displaced fracture dislocation of the cervical spine, particularly in the elder and those with ankylosing spondylitis, and therefore imaging of these patients should include a modality to look at the patency of the vertebral arteries.

Case description

A 70-year-old man who was diagnosed with ankylosing spondylitis collapsed and presented with tetraplegia. Computed tomography showed C3 fracture dislocation, and magnetic resonance imaging showed a high-signal intensity and intense compression of the spinal cord from C2 to C3. Cerebral angiogram showed left vertebral artery occlusion and right vertebral artery stenosis. Heparin was administered to prevent posterior circulation stroke and he underwent posterior fixation. Three months post-injury, a cerebral angiogram showed the resolution of the bilateral VAI.

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Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading

Abstract

Purpose

Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws.

Methods

In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm³ ± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm³ ± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from − 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion ("screw toggling") within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles.

Results

The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard titanium screws (3701 ± 1228 vs. 3751 ± 1614 load cycles, p = 0.89). PMMA cement augmentation of CF/PEEK pedicle screws furthermore significantly increased the mean number of load cycles until loosening by 1.63-fold (5100 ± 1933 in augmented vs. 3130 ± 2132 in nonaugmented CF/PEEK screws, p = 0.015). In addition, angular screw motion assessed by stress fluoroscopy was significantly smaller in augmented than in nonaugmented CF/PEEK screws before as well as after failure.

Conclusions

Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Etiology of hormone receptor positive breast cancer differs by levels of histologic grade and proliferation

Abstract

Limited epidemiological evidence suggests that the etiology of hormone receptor positive (HR+) breast cancer may differ by levels of histologic grade and proliferation. We pooled risk factor and pathology data on 5,905 HR+ breast cancer cases and 26,281 controls from 11 epidemiological studies. Proliferation was determined by centralized automated measures of KI67 in tissue microarrays. Odds ratios (OR), 95% confidence intervals (CI) and p-values for case-case and case-control comparisons for risk factors in relation to levels of grade and quartiles (Q1-Q4) of KI67 were estimated using polytomous logistic regression models. Case-case comparisons showed associations between nulliparity and high KI67 [OR (95% CI) for Q4 vs Q1 = 1.54 (1.22, 1.95)]; obesity and high grade [grade 3 vs 1 = 1.68 (1.31, 2.16)]; and current use of combined hormone therapy (HT) and low grade [grade 3 vs 1 = 0.27 (0.16, 0.44)] tumors. In case-control comparisons, nulliparity was associated with elevated risk of tumors with high but not low levels of proliferation [1.43 (1.14, 1.81) for KI67 Q4 vs 0.83 (0.60, 1.14) for KI67 Q1]; obesity among women ≥50 years with high but not low grade tumors [1.55 (1.17, 2.06) for grade 3 vs 0.88 (0.66, 1.16) for grade 1]; and HT with low but not high grade tumors [3.07 (2.22, 4.23) for grade 1 vs 0.85 (0.55, 1.30) for grade 3]. Menarcheal age and family history were similarly associated with HR+ tumors of different grade or KI67 levels. These findings provide insights into the etiologic heterogeneity of HR+ tumors. This article is protected by copyright. All rights reserved.

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Interaction analysis between germline susceptibility loci and somatic alterations in lung cancer

Abstract

Emerging evidence indicates that germline variations may interact with somatic events in carcinogenesis. However, the germline-somatic interaction in lung cancer remains largely unknown. We investigated whether lung cancer driver genes (CDGs) were more likely to locate within cancer susceptibility regions. Pathway analysis was performed to identify common pathways underlying CDGs and cancer susceptibility genes (CSGs). Next, we analyzed the associations between lung cancer risk SNPs and somatic alterations, including mutations and copy number alterations, in the level of genes, pathways, and overall burden of alterations. Enrichment analysis showed that lung CDGs are more likely to locate within cancer susceptibility regions (P = 8.40 × 10⁻³). Both of lung CSGs and CDGs showed significant enrichment in pathways such as cell cycle and p53 signaling pathway. Gene-based analysis showed that rs36600 (22q12.2) was associated with somatic mutations within ARID1A (OR = 2.45, 95%CI: 1.47-4.08, P = 5.78 × 10⁻⁴). Pathway-based analysis of somatic truncation mutations identified rs2395185 and rs3817963 at 6p22.1 were associated with cell cycle pathway (OR = 1.56, P = 3.61 × 10⁻⁴ for rs2395185; OR = 1.58, P = 4.15 × 10⁻⁴ for rs3817963), and rs3817963 was also associated with MAPK signaling pathway (OR = 1.54, P = 8.58 × 10⁻⁴). Further analysis associated rs2395185 at 6p22.1 (HLA class II genes) with increased APOBEC3A expression (P = 9.50 × 10⁻³) and elevated APOBEC mutagenesis (P = 3.58 × 10⁻³). These results indicate germline-somatic interactions in lung tumorigenesis, and help to uncover the molecular mechanisms underlying lung cancer risk SNPs. This article is protected by copyright. All rights reserved.

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A clinicopathological study and prognostic factor analysis of 177 salivary duct carcinoma patients from The Netherlands

Abstract

Salivary duct carcinoma (SDC) is a subtype of salivary gland cancer with a dismal prognosis and a need for better prognostication and novel treatments. The aim of this national cohort study was to investigate clinical outcome, prognostic factors, Androgen Receptor (AR) and Human Epidermal Growth Factor Receptor 2 (HER2) expression.

SDC patients diagnosed between 1990 – 2014 were identified by the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA). Subsequently, medical records were evaluated and pathological diagnoses reviewed. Data were analyzed for overall survival (OS), disease free survival (DFS), distant metastasis free survival (DMFS), and prognostic factors. AR was evaluated by immunohistochemistry (IHC), HER2 by IHC and fluorescent-in-situ-hybridization.

A total of 177 patients were included. The median age was 65 years, 75% were male. At diagnosis, 68% presented with lymph node metastases and 6% with distant metastases. Median OS, DFS and DMFS were 51, 23 and 26 months, respectively. In patients presenting without distant metastases, the absolute number of positive lymph nodes was associated with poor OS and DMFS in a multivariable analysis. AR and HER2 were positive in 161/168 (96%) and 44/153 (29%) tumors, respectively, and were not prognostic factors.

SDC has a dismal prognosis with primary lymph node involvement in the majority of patients. The absolute number of lymph node metastases was found to be the only prognostic factor for DMFS and OS. AR expression and, to a lesser extent, HER2 expression hold promise for systemic treatment in the metastatic and eventually adjuvant setting. This article is protected by copyright. All rights reserved.

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Editorial Board

Publication date: 15 March 2018
Source:Journal of Neuroscience Methods, Volume 298





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Comparison of propofol and desflurane for postanaesthetic morbidity in patients undergoing surgery for aneurysmal SAH: a randomized clinical trial

Abstract

Purpose

Surgery for aneurysmal clipping after subarachnoid haemorrhage (SAH) poses a unique anaesthetic challenge. However, data on the influence of anaesthetic agents in these patients are lacking. The study aims to evaluate the superiority of propofol over desflurane for postanaesthetic morbidity in patients undergoing surgery following aneurysmal SAH.

Methods

Seventy World Federation of Neurosurgeons Grade I and II patients were randomized into propofol (n = 35) and desflurane groups (n = 35). Anaesthesia was maintained with propofol/fentanyl in propofol group and desflurane/fentanyl in the desflurane group. Jugular venous oxygen saturation (SjVO₂) and brain relaxation were assessed intraoperatively. Time to eye opening, response to verbal commands, and extubation were noted from the time of discontinuing the anaesthetic agent. Duration of postoperative hospital stay and modified Rankin score (MRS) at discharge were subsequently compared.

Results

Median postoperative hospital stay was 9 (6, 14) days with use of propofol and 9 (7, 12) days in desflurane group (P = 0.671). 18 patients in the propofol group and 14 patients in the desflurane group had good outcome (modified Rankin score 0–1; P = 0.453). Both the anaesthetics were similar in terms of intraoperative haemodynamics, brain relaxation, time to eye opening, response to verbal commands, and extubation time (P > 0.05). Emergence hypertension was more in the desflurane group (P = 0.007). The intraoperative SjVO₂ values were significantly higher in the desflurane group (P < 0.05).

Conclusion

Propofol and desflurane are comparable in terms of postoperative morbidity in patients undergoing aneurysm neck clipping following SAH.

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Issue Information - Ed Board

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Predicting an adrenal crisis: can we do it?

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Copeptin in hyponatremia: is there a role for this biomarker in the diagnostic workup?

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Comprehensive Effect of P-Nitrophenol Degradation in the Iron Oxide/Oxalate Suspension

Abstract

The degradation and transformation of p-nitrophenol (PNP) was evaluated with as-prepared iron oxides (γ-FeOOH, Fe₃O₄, and α-Fe₂O₃) as catalyst. Results showed that α-Fe₂O₃ exhibited higher catalytic activity than the other two samples for reduction transformation and oxidative degradation of PNP. α-Fe₂O₃ showed higher surface-bound Fe(II) contents in the presence of oxalic acid and stronger affinity to PNP, leading to an increase in PNP reductive transformation. And α-Fe₂O₃ could effectively adsorb visible light and hinder the recombination of charge carriers, resulting in higher oxidative degradation activity. p-Aminophenol (PAP), as the main reduction transformation product of PNP, could be removed further by oxidative degradation in the reaction system itself. A possible mechanism was suggested for the comprehensive effect of PNP degradation during the reaction process.

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