Disruption of de novo fatty acid synthesis via acetyl-CoA carboxylase 1 inhibition prevents acute graft-versus-host disease

Abstract

Upon antigen-specific or allogeneic activation, T cells sharply increase their metabolic activity to cope with augmented needs for proliferation and effector functions. Therefore, enzymes involved in energy metabolism constitute attractive targets to modulate the activity of pathogenic effector T cells in the setting of graft-versus-host-disease (GVHD). Here we show that T cells deficient for acetyl-CoA carboxylase 1 (TACC1) are dramatically less pathogenic than wild type T cells in a lethal C57BL/6 into BALB/c model of acute GVHD and permitted sustained survival of recipient mice. In line with this clinical observation, higher frequencies of GVHD-suppressing Foxp3⁺ regulatory T (Treg) cells were detected in the colon of TACC T-cell recipients. In vitro, T-cell stimulation with allogeneic DCs induced higher proportions of Treg cells but also led to diminished proliferation of TACC1 T cells compared to wild type T cells. Furthermore, TACC1 T cells activated by allogeneic DCs showed impaired glycolysis and lipid synthesis. Thus, targeting de novo fatty acid synthesis via acetyl-CoA carboxylase inhibition may be a promising new strategy to prevent GVHD.

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Selective depletion of CD11c+CD11b+ dendritic cells partially abrogates tolerogenic effects of intravenous MOG in murine EAE

Intravenous (i.v.) injection of a soluble myelin antigen can induce tolerance, which effectively ameliorates experimental autoimmune encephalomyelitis (EAE). We have previously shown that i.v. MOG induces tolerance in EAE and expands a subpopulation of tolerogenic CD11c⁺CD11b⁺ dendritic cells (DCs) with an immature phenotype having low expression of IA and co-stimulatory molecules CD40, CD86, and CD80. Here we further investigate the role of tolerogenic DCs in i.v. tolerance by injecting clodronate-loaded liposomes, which selectively deplete CD11c⁺CD11b⁺ and immature DCs, but not CD11c⁺CD8⁺ DCs and mature DCs. I.v. MOG-induced suppression of EAE was partially, yet significantly, blocked by CD11c⁺CD11b⁺ DC depletion. While i.v. MOG inhibited IA, CD40, CD80, CD86 expression and induced TGF-β, IL-27, IL-10 production in CD11c⁺CD11b⁺ DCs, these effects were abrogated after injection of clodronate-loaded liposomes. Depletion of CD11c⁺CD11b⁺ DCs also precluded i.v. autoantigen-induced T-cell tolerance, such as decreased production of IL-2, IFN-γ, IL-17 and numbers of IL-2⁺, IFN-γ⁺, and IL-17⁺ CD4⁺ T cells, as well as an increased proportion of CD4⁺CD25⁺Foxp3⁺ regulatory T cells and CD4⁺IL-10⁺Foxp3⁻ Tr1 cells. CD11c⁺CD11b⁺ DCs, through low expression of IA and co-stimulatory molecules as well as high expression of TGF-β, IL-27 and IL-10, play an important role in i.v. tolerance-induced EAE suppression.

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Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Dysphagia. 2016 Jun 23;

Authors: Okuno K, Nohara K, Takai E, Sakai T, Fleetham JA, Ayas NT, Lowe AA, Almeida FR

Abstract
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.

PMID: 27338262 [PubMed - as supplied by publisher]

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Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Chin J Integr Med. 2016 Jul;22(7):525-31

Authors: Mao LY, Li LL, Mao ZN, Han YP, Zhang XL, Yao JX, Li M

Abstract
OBJECTIVE: To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.
METHODS: A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.
RESULTS: A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.
CONCLUSIONS: Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.

PMID: 27339160 [PubMed - in process]

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Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma.

Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma.

Case Rep Urol. 2016;2016:7050981

Authors: Yoshie H, Nakazawa R, Usuba W, Kudo H, Sato Y, Sasaki H, Chikaraishi T

Abstract
We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.

PMID: 27340589 [PubMed]

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Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.

Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.

Surg Endosc. 2016 Jun 23;

Authors: Docimo S, Mathew A, Shope AJ, Winder JS, Haluck RS, Pauli EM

Abstract
INTRODUCTION: Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
METHODS: A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student's t test and Chi-square test.
RESULTS: Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years, p = 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m(2), p = 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71, p = 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418, p = 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063, p = 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980, p = 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157, p = 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg, p < 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (p < 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %, p < 0.0001).
CONCLUSION: POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.

PMID: 27338580 [PubMed - as supplied by publisher]

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Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

Related Articles

Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

J Gastrointest Surg. 2015 Jul;19(7):1355-62

Authors: Fisichella PM, DeMeester SR, Hungness E, Perretta S, Soper NJ, Rosemurgy A, Torquati A, Sachdeva AK, Patti MG

Abstract
New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.

PMID: 25678255 [PubMed - indexed for MEDLINE]

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Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Related Articles

Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Eur J Pediatr Surg. 2015 Oct;25(5):397-404

Authors: Olbers J, Gatzinsky V, Jönsson L, Friberg LG, Abrahamsson K, Sillén U, Gustafsson P

Abstract
OBJECTIVE: For many years, esophageal atresia (EA) has been curable by surgery. However, severe respiratory morbidity and gastroesophageal reflux (GER) symptoms remain a problem in many patients. The purpose of this study was to describe respiratory and esophageal morbidity, esophageal function, and lung function, including the small airways, in patients with the most common type of the malformation (EA with a distal fistula).
METHODS: The study comprised 26 children undergoing surgery for EA, who had performed respiratory and esophageal function studies at the age of 7 years in a follow-up program. The study design was retrospective analysis of both these 7-year functional investigations and esophageal and respiratory morbidity from birth to the age of 7 years, as documented in medical records. Pulmonary function was evaluated mainly by spirometry and multiple breath washout (MBW), whereas esophageal function was evaluated by 24-hour pH studies.
RESULTS: We found a high prevalence of both respiratory (69%) and esophageal (62%) morbidity between birth and 7 years among the EA children. Examination with MBW (peripheral airway function) revealed few abnormal results, whereas spirometry revealed high airway obstruction in half the children, which also correlated well with overall respiratory symptoms (p = 0.047), as well as recurrent pneumonias (p = 0.035). However, no association with GER symptoms was found. In addition, 46% of the children had GER according to pH measurements, which were correlated to clinical GER symptoms but not to respiratory symptoms.
CONCLUSION: This study confirms a high prevalence of respiratory and esophageal morbidity. In terms of respiratory function, the high proportion with a spirometric abnormality indicated an associated developmental delay/dysfunction in the central airways, whereas the peripheral airways appeared to have normal function at this age. Tracheomalacia may explain the spirometric abnormalities, but this need to be studied in more detail.

PMID: 25302538 [PubMed - indexed for MEDLINE]

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Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

Related Articles

Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

J Gastrointest Surg. 2015 Jul;19(7):1355-62

Authors: Fisichella PM, DeMeester SR, Hungness E, Perretta S, Soper NJ, Rosemurgy A, Torquati A, Sachdeva AK, Patti MG

Abstract
New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.

PMID: 25678255 [PubMed - indexed for MEDLINE]

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Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Dysphagia. 2016 Jun 23;

Authors: Okuno K, Nohara K, Takai E, Sakai T, Fleetham JA, Ayas NT, Lowe AA, Almeida FR

Abstract
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.

PMID: 27338262 [PubMed - as supplied by publisher]

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Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Dysphagia. 2016 Jun 23;

Authors: Okuno K, Nohara K, Takai E, Sakai T, Fleetham JA, Ayas NT, Lowe AA, Almeida FR

Abstract
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.

PMID: 27338262 [PubMed - as supplied by publisher]

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Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Chin J Integr Med. 2016 Jul;22(7):525-31

Authors: Mao LY, Li LL, Mao ZN, Han YP, Zhang XL, Yao JX, Li M

Abstract
OBJECTIVE: To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.
METHODS: A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.
RESULTS: A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.
CONCLUSIONS: Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.

PMID: 27339160 [PubMed - in process]

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Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma.

Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma.

Case Rep Urol. 2016;2016:7050981

Authors: Yoshie H, Nakazawa R, Usuba W, Kudo H, Sato Y, Sasaki H, Chikaraishi T

Abstract
We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.

PMID: 27340589 [PubMed]

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Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.

Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.

Surg Endosc. 2016 Jun 23;

Authors: Docimo S, Mathew A, Shope AJ, Winder JS, Haluck RS, Pauli EM

Abstract
INTRODUCTION: Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
METHODS: A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student's t test and Chi-square test.
RESULTS: Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years, p = 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m(2), p = 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71, p = 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418, p = 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063, p = 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980, p = 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157, p = 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg, p < 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (p < 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %, p < 0.0001).
CONCLUSION: POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.

PMID: 27338580 [PubMed - as supplied by publisher]

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Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

Related Articles

Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

J Gastrointest Surg. 2015 Jul;19(7):1355-62

Authors: Fisichella PM, DeMeester SR, Hungness E, Perretta S, Soper NJ, Rosemurgy A, Torquati A, Sachdeva AK, Patti MG

Abstract
New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.

PMID: 25678255 [PubMed - indexed for MEDLINE]

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Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Related Articles

Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Eur J Pediatr Surg. 2015 Oct;25(5):397-404

Authors: Olbers J, Gatzinsky V, Jönsson L, Friberg LG, Abrahamsson K, Sillén U, Gustafsson P

Abstract
OBJECTIVE: For many years, esophageal atresia (EA) has been curable by surgery. However, severe respiratory morbidity and gastroesophageal reflux (GER) symptoms remain a problem in many patients. The purpose of this study was to describe respiratory and esophageal morbidity, esophageal function, and lung function, including the small airways, in patients with the most common type of the malformation (EA with a distal fistula).
METHODS: The study comprised 26 children undergoing surgery for EA, who had performed respiratory and esophageal function studies at the age of 7 years in a follow-up program. The study design was retrospective analysis of both these 7-year functional investigations and esophageal and respiratory morbidity from birth to the age of 7 years, as documented in medical records. Pulmonary function was evaluated mainly by spirometry and multiple breath washout (MBW), whereas esophageal function was evaluated by 24-hour pH studies.
RESULTS: We found a high prevalence of both respiratory (69%) and esophageal (62%) morbidity between birth and 7 years among the EA children. Examination with MBW (peripheral airway function) revealed few abnormal results, whereas spirometry revealed high airway obstruction in half the children, which also correlated well with overall respiratory symptoms (p = 0.047), as well as recurrent pneumonias (p = 0.035). However, no association with GER symptoms was found. In addition, 46% of the children had GER according to pH measurements, which were correlated to clinical GER symptoms but not to respiratory symptoms.
CONCLUSION: This study confirms a high prevalence of respiratory and esophageal morbidity. In terms of respiratory function, the high proportion with a spirometric abnormality indicated an associated developmental delay/dysfunction in the central airways, whereas the peripheral airways appeared to have normal function at this age. Tracheomalacia may explain the spirometric abnormalities, but this need to be studied in more detail.

PMID: 25302538 [PubMed - indexed for MEDLINE]

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Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

Related Articles

Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

J Gastrointest Surg. 2015 Jul;19(7):1355-62

Authors: Fisichella PM, DeMeester SR, Hungness E, Perretta S, Soper NJ, Rosemurgy A, Torquati A, Sachdeva AK, Patti MG

Abstract
New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training.

PMID: 25678255 [PubMed - indexed for MEDLINE]

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Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study.

Dysphagia. 2016 Jun 23;

Authors: Okuno K, Nohara K, Takai E, Sakai T, Fleetham JA, Ayas NT, Lowe AA, Almeida FR

Abstract
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.

PMID: 27338262 [PubMed - as supplied by publisher]

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Structure of a New Palatal Plate and the Artificial Tongue for Articulation Disorder in a Patient with Subtotal Glossectomy.

Structure of a New Palatal Plate and the Artificial Tongue for Articulation Disorder in a Patient with Subtotal Glossectomy.

Acta Med Okayama. 2016 Jun;70(3):205-211

Authors: Kozaki KI, Kawakami S, Konishi T, Ohta K, Yano J, Onoda T, Matsumoto H, Mizukawa N, Kimata Y, Nishizaki K, Iida S, Gofuku A, Abe M, Minagi S, Okayama Dream Speech Project

Abstract
A palatal augmentation prosthesis (PAP) is used to facilitate improvement in the speech and swallowing functions of patients with tongue resection or tongue movement disorders. However, a PAP's effect is limited in cases where articulation disorder is severe due to wide glossectomy and/or segmental mandibulectomy. In this paper, we describe speech outcomes of a patient with an articulation disorder following glossectomy and segmental mandibulectomy. We used a palatal plate (PP) based on a PAP, along with an artificial tongue (KAT). Speech improvement was evaluated by a standardized speech intelligibility test consisting of 100 syllables. The speech intelligibility score was significantly higher when the patient wore both the PP and KAT than when he wore neither (p＝0.013). The conversational intelligibility score was significantly improved with the PP and KAT than without PP and KAT (p＝0.024). These results suggest that speech function can be improved in patients with hard tissue defects with segmental mandibulectomy using both a PP and a KAT. The nature of the design of the PP and that of the KAT will allow these prostheses to address a wide range of tissue defects.

PMID: 27339210 [PubMed - as supplied by publisher]

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Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: A randomized, double-blind clinical trial.

Related Articles

Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: A randomized, double-blind clinical trial.

Clin Neurophysiol. 2016 Mar;127(3):1907-13

Authors: Du J, Yang F, Liu L, Hu J, Cai B, Liu W, Xu G, Liu X

Abstract
OBJECTIVE: This randomized, sham-controlled, double-blind study was conducted to investigate the effects of high-frequency versus low-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with poststroke dysphagia during early rehabilitation.
METHODS: Forty patients with poststroke dysphagia were randomized to receive five daily sessions of sham, 3-Hz ipsilesional, or 1-Hz contralesional rTMS. Swallowing function, the severity of stroke and functional disability, and cortical excitability were examined before, immediately after five daily sessions, as well as the first, second, and third month after the last session.
RESULTS: At baseline, no significant differences between groups were observed in terms of demographic and clinical rating scales. However, a significantly greater improvement in swallowing function as well as functional disability was observed after real rTMS when compared with sham rTMS, which remained 3 months after the end of the treatment sessions. In addition, 1-Hz rTMS increased cortical excitability of the affected hemisphere and decreased that of the non-affected hemisphere; however, 3-Hz rTMS only increased cortical excitability of the affected hemisphere.
CONCLUSION: rTMS (both high and low frequency) improved swallowing recovery in patients with poststroke dysphagia, and the effects lasted for at least 3 months.
SIGNIFICANCE: rTMS appears to be a beneficial therapeutic modality for patients with dysphagia during the early phase of stroke.

PMID: 26778719 [PubMed - indexed for MEDLINE]

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Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Related Articles

Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.

Eur J Pediatr Surg. 2015 Oct;25(5):397-404

Authors: Olbers J, Gatzinsky V, Jönsson L, Friberg LG, Abrahamsson K, Sillén U, Gustafsson P

Abstract
OBJECTIVE: For many years, esophageal atresia (EA) has been curable by surgery. However, severe respiratory morbidity and gastroesophageal reflux (GER) symptoms remain a problem in many patients. The purpose of this study was to describe respiratory and esophageal morbidity, esophageal function, and lung function, including the small airways, in patients with the most common type of the malformation (EA with a distal fistula).
METHODS: The study comprised 26 children undergoing surgery for EA, who had performed respiratory and esophageal function studies at the age of 7 years in a follow-up program. The study design was retrospective analysis of both these 7-year functional investigations and esophageal and respiratory morbidity from birth to the age of 7 years, as documented in medical records. Pulmonary function was evaluated mainly by spirometry and multiple breath washout (MBW), whereas esophageal function was evaluated by 24-hour pH studies.
RESULTS: We found a high prevalence of both respiratory (69%) and esophageal (62%) morbidity between birth and 7 years among the EA children. Examination with MBW (peripheral airway function) revealed few abnormal results, whereas spirometry revealed high airway obstruction in half the children, which also correlated well with overall respiratory symptoms (p = 0.047), as well as recurrent pneumonias (p = 0.035). However, no association with GER symptoms was found. In addition, 46% of the children had GER according to pH measurements, which were correlated to clinical GER symptoms but not to respiratory symptoms.
CONCLUSION: This study confirms a high prevalence of respiratory and esophageal morbidity. In terms of respiratory function, the high proportion with a spirometric abnormality indicated an associated developmental delay/dysfunction in the central airways, whereas the peripheral airways appeared to have normal function at this age. Tracheomalacia may explain the spirometric abnormalities, but this need to be studied in more detail.

PMID: 25302538 [PubMed - indexed for MEDLINE]

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Transmesenteric hernia presenting as acute abdomen in a pediatric patient

2016-06-25T06-46-12Z
Source: Case Study and Case Report
Debabrata Das, Dhrubajyoti Maulik, Subuddha Chatterjee, Dev Vrat Singh, Arghya Choudhuri.
A 10 years old male presented with acute onset progressive abdominal pain and bilious vomiting for 2 days, abdominal distension and absolute constipation for last 1 day. Pain started at periumbilical region and then became diffuse. At first pain was intermittent and colicky, later became dull aching and constant. Patient had associated 10-12 episodes of projectile bilious vomiting for last 2 days. There was no past H/O any surgery or chronic illness. On general survey patient was dehydrated and had tachycardia and tachypnoea. On abdominal examination there was abdominal distension, less abdominal movement with respiration, visible peristalsis at epigastric and umbilical region. Hernial orifices were normal. Guarding, generalised tenderness and rebound tenderness was present, hyperperistaltic sound was present. Investigations revealed leucocytosis, straight X-ray abdomen showed multiple air fluid level in central part of abdomen. Patient was resuscitated with IV fluids and exploratory laparotomy was performed. On exploration strangulated jejunum(of 15cm length) was seen 50cm distal to DJ flexure which was seen herniated through a round mesenteric defect (approximated 5cm diameter) adjacent to the strangulated segment. Portion of the gut was gangrenous and non viable.Resection of the affected part of jejunum with end to end jejunojejunal anastomosis done in interrupted single layer extramucosal technique with polyglycolic 3-0.Mesenteric defect was closed. Post - operative recovery was uneventful.


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Testicular morphometry, Sperm Characteristics and Viscera Organ Weights of Rabbits following the Administration of Aqueous Extract of Gmelina arborea Leaves

2016-06-25T05-13-12Z
Source: International Journal of Livestock Research
Adakole Hyacinth Abu, Terzungwe Ahemen, Haaga E..
An experiment was conducted to investigate the effect of aqueous Gmelina arborea leaf extract on testicular morphometry, cauda epididymal sperm characteristics and organ weights of male rabbits. Thirty two (32) rabbit bucks, aged 9-11 weeks with an average weight of 1300g, were randomly allocated to four treatments comprising of varying concentrations (0, 200, 400 and 600ml of extract per liter of water) of Gmelina arborea leaf. Each treatment consisting of 8 animals per group was replicated 8 times with one animal per replicate. Animals were fed aqueous Gmelina arborea leaf extracts for a period of fourteen (14) weeks. At the end of the experimental trial, the bucks were sacrificed and testicular morphometry; caudal epididymal sperm characteristics and viscera organ weights were evaluated. The results showed significant (P


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Minimal vascular flows cause strong heat sink effects in hepatic radiofrequency ablation ex vivo.

Minimal vascular flows cause strong heat sink effects in hepatic radiofrequency ablation ex vivo.

J Hepatobiliary Pancreat Sci. 2016 Jun 23;

Authors: Lehmann KS, Poch FG, Rieder C, Schenk A, Stroux A, Frericks BB, Gemeinhardt O, Holmer C, Kreis ME, Ritz JP, Zurbuchen U

Abstract
PURPOSE: To assess the lower threshold of vascular flow rate on the heat sink effect in bipolar radiofrequency ablation (RFA) ex vivo.
METHODS: Glass tubes (vessels) of 3.4 mm inner diameter were introduced in parallel to bipolar RFA applicators into porcine liver ex vivo. Vessels were perfused with flow rates of 0 to 1,500 ml/min. RFA (30 W power, 15 kJ energy input) was carried out at room temperature and 37 °C. Heat sink effects were assessed in RFA cross sections by the decrease in ablation radius, area and by a high-resolution sector planimetry.
RESULTS: Flow rates of 1 ml/min already caused a significant cooling effect (p ≤ 0.001). The heat sink effect reached a maximum at 10 ml/min (18.4 mm/s) and remained stable for flow rates up to 1,500 ml/min.
CONCLUSIONS: Minimal vascular flows of ≥ 1 ml/min cause a significant heat sink effect in hepatic RFA ex vivo. A lower limit for volumetric flow rate was not found. The maximum of the heat sink effect was reached at a flow rate of 10 ml/min and remained stable for flow rates up to 1,500 ml/min. Hepatic inflow occlusion should be considered in RFA close to hepatic vessels.

PMID: 27338856 [PubMed - as supplied by publisher]

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Computed Tomography-guided Radiofrequency Ablation for Sub-diaphragm Hepatocellular Carcinoma: Safety and Efficacy of Inducing an Artificial Pneumothorax.

Computed Tomography-guided Radiofrequency Ablation for Sub-diaphragm Hepatocellular Carcinoma: Safety and Efficacy of Inducing an Artificial Pneumothorax.

Acta Med Okayama. 2016 Jun;70(3):189-95

Authors: Fujiwara H, Arai Y, Ishii H, Kanazawa S

Abstract
We retrospectively evaluated the safety and efficacy of artificial pneumothorax induction to perform computed tomography (CT)-guided radiofrequency ablation (RFA) for sub-diaphragm hepatocellular carcinomas (HCCs). From June 2008 to October 2010 at our institution, 19 HCCs (16 patients) were treated using CT-guided RFA after artificial pneumothorax induction. A 23-G needle was inserted into the liver surface at a site of 2 connected pleurae without lung tissue. After a small amount of air was injected, the pleural space widened, creating a small pneumothorax. Additional air was insufflated via a newly inserted 18-G cannula to raise the lung away from the planned puncture line for RFA. The electrode was then advanced transthoracically. Ablation was performed using a cool-tip electrode with manual impedance control mode. The injected air was then aspirated as much as possible. Artificial pneumothorax was successfully induced in all cases. The average total volume of injected air in each case was 238ml. No artificial pneumothorax-related complication occurred; lung injury occurred in one case during RF electrode insertion. No local progression occurred during follow-up. Recurring HCCs were observed in eight patients. Artificial pneumothorax induction is safe and effective for CT-guided RFA of sub-diaphragm HCCs, which are difficult to locate on US.

PMID: 27339208 [PubMed - in process]

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Impaction of surgical margin status on the survival outcome after surgical resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.

Impaction of surgical margin status on the survival outcome after surgical resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.

J Surg Res. 2016 Jun 1;203(1):163-73

Authors: Li MX, Bi XY, Li ZY, Huang Z, Han Y, Zhao JJ, Zhao H, Cai JQ

Abstract
BACKGROUND: Conflicting results about the prognostic value of surgical margin status in patients with intrahepatic cholangiocarcinoma (ICC) have been reported. We aimed to assess the association between surgical margin status and prognosis in ICC through a meta-analysis.
MATERIALS AND METHODS: We conducted a literature search of the articles evaluating the prognostic value of surgical margin status in patients with ICC. The pooled estimation of the hazard ratio (HR) with the 95% confidence interval (CI) was performed to determine the influence of surgical margin status on the survival outcome.
RESULTS: A total of 21 studies involving 3201 patients were finally included into the meta-analysis. The percentage of patients with positive surgical margin ranged from 7.2% to 75.9% in the enrolled studies. The pooled estimates showed that patients with positive surgical margin had inferior overall survival (HR: 1.864; 95% CI: 1.542-2.252; P < 0.001) and progression-free survival (HR: 2.033; 95% CI: 1.030-4.011; P = 0.041) than patients with negative ones. The subgroup analyses and sensitivity analyses were consistent with the overall results.
CONCLUSIONS: Patients with negative surgical margin had significantly favorable overall survival and progression-free survival after surgical resection for ICC. The notion of achieving the R0 resection should be emphasized.

PMID: 27338547 [PubMed - in process]

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Urotensin-II receptor: a double identity receptor involved in vasoconstriction and in the development of digestive tract cancers and other tumors.

Urotensin-II receptor: a double identity receptor involved in vasoconstriction and in the development of digestive tract cancers and other tumors.:

Urotensin-II receptor: a double identity receptor involved in vasoconstriction and in the development of digestive tract cancers and other tumors.

Curr Cancer Drug Targets. 2016 Jun 20;

Authors: Federico A, Zappavigna S, Dallio M, Misso G, Merlino F, Loguercio C, Novellino E, Paolo Grieco PX, Caraglia M

Abstract
Urotensin II and Urotensin-II receptor are important molecular factors that regulate vasoconstriction and all the diseases that are linked to abnormalities in blood pressure regulation (i.e.: hypertension, kidney diseases, cirrhosis etc.). Recently Urotensin II and its receptor have also been involved in metabolic syndrome, diabetes and schizophrenia. Recent strong findings suggest thatUrotensin II and its receptor are involved in the onset and development of different epithelial cancers. Indeed, it was reported that cell growth, motility and invasion in human breast, bladder, prostate, colorectal and glioblastoma cancer cells were regulated by Urotensin II and Urotensin-II receptor axis. This axis also regulated focal adhesion kinase and small Guanosine-5'-triphosphate binding proteins that likely had a role in motility and invasion mediated by Urotensin-II receptor. Additionally, its expression on tumour tissues is variably associated to the prediction of the clinical outcome of the patients and it can be considered an alternative molecular marker to be used as prognostic factor in human cancers. In conclusion, a new weapon in the treatment of human cancers is highlighting a new scenario for the future.

PMID: 27338741 [PubMed - as supplied by publisher]

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Urotensin-II receptor: a double identity receptor involved in vasoconstriction and in the development of digestive tract cancers and other tumors.

Urotensin-II receptor: a double identity receptor involved in vasoconstriction and in the development of digestive tract cancers and other tumors.

Curr Cancer Drug Targets. 2016 Jun 20;

Authors: Federico A, Zappavigna S, Dallio M, Misso G, Merlino F, Loguercio C, Novellino E, Paolo Grieco PX, Caraglia M

Abstract
Urotensin II and Urotensin-II receptor are important molecular factors that regulate vasoconstriction and all the diseases that are linked to abnormalities in blood pressure regulation (i.e.: hypertension, kidney diseases, cirrhosis etc.). Recently Urotensin II and its receptor have also been involved in metabolic syndrome, diabetes and schizophrenia. Recent strong findings suggest thatUrotensin II and its receptor are involved in the onset and development of different epithelial cancers. Indeed, it was reported that cell growth, motility and invasion in human breast, bladder, prostate, colorectal and glioblastoma cancer cells were regulated by Urotensin II and Urotensin-II receptor axis. This axis also regulated focal adhesion kinase and small Guanosine-5'-triphosphate binding proteins that likely had a role in motility and invasion mediated by Urotensin-II receptor. Additionally, its expression on tumour tissues is variably associated to the prediction of the clinical outcome of the patients and it can be considered an alternative molecular marker to be used as prognostic factor in human cancers. In conclusion, a new weapon in the treatment of human cancers is highlighting a new scenario for the future.

PMID: 27338741 [PubMed - as supplied by publisher]

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EDITORIAL

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Masthead - Editorial Board And Table of Contents

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Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Table of Contents -  1. Original Research The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale Max N Brondfield, Stanley Sciortino, Catherine Juillard, Paula Fleisher, Laura A Schmidt, Rochelle Dicker 1-10 Full Text PDF | Abstract | Abstract Spanish | 10.5005/jp-journals-10030-1136 |FREE 2. Original Research Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal Helena Facundo, Juan Manuel Troncoso 11-17 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1137 |FREE 3. Original Research Rol de la Simulación para la Conformación del Criterio y la Decisión en el Trauma Paulo Raul Paglilla, Ruben Daniel Algieri, Maria Soledad Ferrante, Juan Pablo Fernandez, Juan Sebastián Ugartemendía, Ernesto Donnelly 18-25 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1138 |FREE 4. Original Research At the Razor's Edge: Surgeons have Lower Stress Levels than the General Population Phillipe Abreu-Reis, Adonis Nasr, Flavio Saavedra Tomasich, Iwan Augusto Collaco, Tayron Bassani, Gustavo Moreira Clivatti, Alana Padilha Fontanella, Juliana Midori Ito, Marília França Madeira Manfrinato, Ivilin Hammerschmidt 26-30 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1139 |FREE 5. Original Research Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma Silvia Ines Guerrero, Juan Paulo Serrano, Laura Juliana Delgado, Dairon Gelvez 31-37 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1140 |FREE 6. Original Research Trauma en ancianos – Experiencia de dos hospitales de referencia en Cali, Colombia Juan S Calle Toro, Alvaro I Sanchez, Monica Morales, Alberto F Garcia 38-42 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1141 |FREE 7. Original Research Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region Álvaro I Sánchez, Alberto F García, Mauricio Velsquez, Juan Carlos Puyana 43-51 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1142 |FREE 8. Review Article Fundamentos para la Elaboración de Manuscritos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 1): Cómo Elaborar y Cómo Presentar un Resúmen para Una Reunión Científica Andres M Rubiano, Raúl A Echeverri, Juan C Puyana 52-57 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1143 |FREE 9. Case Report Fístula Aortoentérica Secundaria A Prótesis De Dacron Alejandro J Pérez-Alonso, Carlos del Olmo-Rivas, Ignacio Machado-Romero, Patrizio Petrone 58-60 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1144 |FREE 10. Case Report Small Bowel Obstruction in a Young Female following an Unsafe Abortion: An Unusual Cause Apoorv Goel, Roli Bansal, Sarita Goel, Ayush Agarwal 61-63 Full Text PDF | Abstract | Abstract Spanish</ a> | 10.5005/jp-journals-10030-1145 |FREE

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Ειδοποίηση Μελετητή - [ Head and Neck's Diseases ]

Ειδοποίηση Μελετητή:[ Head and Neck's Diseases ]

Stem Cell Transplantation for Refractory Crohn Disease

RK Burt, MA Ruiz, RL Kaiser - JAMA, 2016

... 200 mg/kg) of cyclophosphamide. Mobilization of stem cells in patients with
autoimmune diseases is, depending on the disease, more safely performed with
either 2 g/m 2 cyclophosphamide and G-CSF or with G-CSF alone. ...

The non-coding landscape of head and neck squamous cell carcinoma.

AE Zou, H Zheng, MA Saad, M Rahimy, J Ku, SZ Kuo… - Oncotarget, 2016

... (6)Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
Head and neck squamous cell carcinoma (HNSCC) is an aggressive disease marked
by frequent recurrence and metastasis and stagnant survival rates. ...

Expression of the CXCL12/CXCR4 chemokine axis predicts regional control in head and neck squamous cell carcinoma

X León, S Diez, J García, J Lop, A Sumarroca, M Quer… - European Archives of Oto- …, 2016

... Nodal metastatic disease is one of the most important prognostic factors in head and neck
squamous cell carci- nomas (HNSCC) [1]. Depending on the extent of the nodal disease, treatment
consists of surgery, radiotherapy, chemoradiotherapy, or a combination of these. ...

Outcomes of cutaneous squamous cell carcinoma of the head and neck with parotid metastases

LJ McDowell, TJ Tan, M Bressel, V Estall, S Kleid… - Journal of Medical Imaging …, 2016

... The most recent edition of the AJCC staging system adopted the well-recognised head and neck
mucosal nodal staging system and combines parotid and cervical disease into a single regional
group, irrespective of the location of the metastases.[18] Other staging systems ...

Stem Cell Transplantation for Refractory Crohn Disease—Reply

CJ Hawkey, J Lindsay, J Gribben - JAMA, 2016

... Ann NY Acad Sci. 1995;770:1-7. PubMed | Link to Article. 3 +. Snowden JA, Saccardi
R, Allez M, et al; EBMT Autoimmune Disease Working Party (ADWP); Paediatric
Diseases Working Party (PDWP). Haematopoietic SCT in ...

Using Aptamer-Based Technology to Probe the Plasma Proteome for Cardiovascular Disease Prediction

MS Sabatine - JAMA, 2016

Opinion from JAMA — Using Aptamer-Based Technology to Probe the
Plasma Proteome for Cardiovascular Disease Prediction.

[HTML] Intensity‐modulated radiotherapy in the treatment of locoregionally advanced head and neck cancer: implementation and outcomes in a New Zealand community …

CN Rumley, N Nedev, K Sharples, J Lee, DS Lamb - Journal of Medical Radiation …, 2016

... Actuarial estimates of 3-year LRC, disease-free survival and OS were 87.3%, 74.4% and 73.7%
respectively. Conclusion. Definitive treatment of stage III and IV cancer of the head and neck
with IMRT and concurrent chemotherapy was achievable in the community setting. ...

Radiation Therapy for Head and Neck Cancer and Angioneogenesis

I NEOVASCULARIZATION - JACC: CARDIOVASCULAR IMAGING, 2016

... (1) described 9 patients with atherosclerotic carotid artery disease associated with RT for head
and neck cancer (HNC). ... From the aCenter for Inherited Cardiovascular Diseases, IRCCS
Foundation Policlinico San Matteo, Pavia, Italy; and the bCardiovascular Center ...

… treatment-related severe neutropenia and neutropenic fever in induction chemotherapy with docetaxel for locally advanced head and neck cancer patients with …

TY Wang, WM Chen, LY Yang, CY Chen, WC Chou… - Supportive Care in Cancer, 2016

... Overall response rate and disease control rate also had no significant difference (59.4 vs 40.0 %,
p = 0.215; 68.8 vs 53.3 %, p = 0.305, respectively). ... Table 1 Characters of advanced head and neck
cancer patient underwent induction TPF Score <7 Score ≥7 p value ...

Quality Indicators for Head and Neck Oncologic Surgery Academic versus Nonacademic Outcomes

SV Puram, N Bhattacharyya - Otolaryngology--Head and Neck Surgery, 2016

... To capture these factors, an analysis is required of 5-year survival or quality of life in patients
with similar diseases, need for adjuvant chemotherapy or radiation, or requirement ... In addition,
the NIS is not a clinical database, and so detailed head and neck–specific outcomes ...

[HTML] Effects of definitive chemoradiation on circulating immunologic angiogenic cytokines in head and neck cancer patients

V Sridharan, DN Margalit, SA Lynch, M Severgnini… - Journal for ImmunoTherapy …, 2016

... We extend these findings to patients with head and neck cancer treated with radiation, providing
potential mechanistic insights to the changes we observe. Elevated PLGF levels are associated
with disease progression and higher risk of lymph node or distant metastases in ...

Haemoglobin and creatinine values as prognostic factors for outcome of concurrent radiochemotherapy in locally advanced head and neck cancers

P Ghadjar, C Pöttgen, D Joos, S Hayoz, M Baumann… - Strahlentherapie und …, 2016

... with concurrent platinum-based chemotherapy is one recom- mended type of treatment for patients
with locoregionally advanced squamous cell head and neck cancer (HNSCC) who desire organ
preservation, and for those who have surgically unresectable disease [1, 2 ...

Squamous cell carcinoma of the tongue during pregnancy: A case report and review of the literature

J Murphy, DR Berman, SP Edwards, J Prisciandaro… - Journal of Oral and …, 2016

... Pregnancy is not an absolute contraindication to computerized tomography of the head and neck
with appropriate shielding. ... Cheung 17, 2009, 22, 25, T4aN3M0, Continued C/S wk 32, Chemo
during pregnancy ChemoRT post delivery, Persistent neck disease – salvage surgery ...

Placebo-Controlled, Double-Blind, Randomized Study of a Dry Guarana Extract in Patients with Head and Neck Tumors Undergoing Chemoradiotherapy: Effects on …

SPS Martins, CL Ferreira, A del Giglio - Journal of Dietary Supplements, 2016

... this randomized, double-blind, placebo-controlled phase II study on patients with localized or
locally advanced head and neck cancer with ... We excluded patients with chronic diseases that
could induce fatigue, such as chronic renal failure, fibromyalgia, chronic anemia, and ...

ACR Appropriateness Criteria® Locoregional therapy for resectable oropharyngeal squamous cell carcinomas

JJ Beitler, H Quon, CU Jones, JK Salama, PM Busse… - Head & Neck, 2016

... chemoradiation or transoral surgery with neck dissection and appropriate adjuvant
therapy. Concurrent chemoradiation is preferred for T3 to T4 disease. © 2016 American
College of Radiology. Head Neck, 2016. INTRODUCTION. ...

A novel missense variant in PRKCB segregates low-frequency hearing loss in an autosomal dominant family with Meniere's disease

C Martín-Sierra, T Requena, L Frejo, SD Price… - Human Molecular Genetics, 2016

... 5 Dept. of Otolaryngology-Head and Neck Surgery, Univ. of Illinois at Chicago, Chicago IL,
60612, USA. ... Abstract. Meniere's Disease (MD) is a complex disorder associated with an
accumulation of endolymph in the membranous labyrinth in the inner ear. ...

Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy

JG Eriksen, P Lassen - Molecular Radio-Oncology, 2016

... J Natl Cancer Inst 100:407–420CrossRefPubMed. Gillison ML, Snijders PJ, Chaturvedi AK,
Steinberg BM, Schwartz S, Castellsague X (2012a) Human papillomavirus and diseases of
the upper airway: head and neck cancer and respiratory papillomatosis. ...

Near-Infrared Optical Imaging for Diagnosis of Maxillary Sinusitis

CA Coughlan, AE Cerussi, J Kim, S Ison… - … --Head and Neck Surgery, 2016

... NIR illumination produced unique patterns reflecting different disease states: normal sinus
anatomy, mild sinus disease and/or mucosal thickening, and complete ... 1 Guidelines are published
by the American Academy of Otolaryngology—Head and Neck Surgery Foundation ...

Desmosomes in disease: a guide for clinicians

A Celentano, N Cirillo - Oral Diseases, 2016

... This is the case of renal cell carcinoma, prostate cancer, endometrial carcinoma, head and
neck cancer, lung ... diagnosis of desmosome-related conditions, especially blistering diseases,
and to outline the rationale for the diagnostic investigations required. ...

[HTML] The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

S Grønlund, K Mey, E Andersen, ER Rasmussen - Laryngoscope Investigative …, 2016

... Cystic metastasis from head and neck squamous cell cancer: a distinct disease variant? Head
Neck 2006;28:633–638. doi: 10.1002/hed.20381. ... Cystic metastasis from head and neck squamous
cell cancer: a distinct disease variant? Head Neck 2006;28:633–638. ...

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Ειδοποίηση Μελετητή - [ Foreign Body Aspiration ]

Ειδοποίηση Μελετητή:[ Foreign Body Aspiration ]

[PDF] A Retrospective Review of Pattern of Inhalational Foreign Body from A North Indian Centre

MA Latoo, Z Beigh, AS Jallu - PARIPEX-Indian Journal of Research, 2016

... Introduction Foreign body (FB) aspiration remains a common but largely preventable problem. ...
Clin Otolaryngol 2006;31:347-349. | 6. Hasdiraz L, Bicer C, Bilgin M, Oguzakaya FTurban pin
aspiration: non-asphyxiating tracheobronchial foreign body in young Islamic women. ...

Infections in the Breast–Common Imaging Presentations and Mimics

MD Agarwal, S Venkataraman, PJ Slanetz - Seminars in Roentgenology, 2016

... on antibiotics tailored to microbial growth and sensitivity, follow-up imaging with ultrasound should
be performed promptly, with re-aspiration as needed. ... 12 Rarely, postoperative infection may be
due to a retained foreign body, which can be radiodense on mammography (Fig. ...

Pelvic Limb Amputation for the Treatment of a Soft-tissue Sarcoma of the Tibiotarso-tarsometatarsal Joint in a Blue-and-gold Macaw (Ara ararauna)

N Summa, S Boston, D Eshar, B Lee-Chow, E Harrison… - Journal of Avian Medicine …, 2016

... no overt evidence of bone or joint involvement (Fig 1). Fine-needle aspiration of the ... described
as pseudoencapsulated tumors that can arise from any part of the body and have ... 2,18 The
development of canine STS has been related to radiation, trauma, foreign bodies including ...

MATERI ABSES PARU

I ALAM, I BIOLOGI, I KEDOKTERAN, I KESEHATAN…

... 1. Condition Contoh Infeksi berat Immunodeficiency atau immunosuppression disorder Conditiopn
leading to repeated aspiration Yang lain ... Riley-Day syndrome Cystic fibrosis Misplaced central
nervouse catheter Alpha-antitrypsin deficicency Foreign body in respiration tract ...

A Feminist Reclamation of Sexiness

S Lintott, S Irvin - Body Aesthetics, 2016

... to appreciate foods and forms of art that were previously distasteful or foreign to them ... in their
particularity (in the sense discussed earlier), and that I recognize his body as infused ... sexy seems
to involve looking at and contemplating actual people with an aspiration to appreciate ...

Malignant Melanoma of the Syrinx and Liver in an African Grey Parrot (Psittacus erithacus erithacus)

TC Shrader, JW Carpenter, AG Cino-Ozuna… - Journal of Avian Medicine …, 2016

... for a complete blood cell count (CBC) and biochemical profile, whole-body radiographs were ...
Other differentials for syrinx dysfunction in birds include mycoses, inhaled foreign bodies,
parasitism ... Fine-needle aspiration of a liver nodule, however, may have yielded a diagnosis ...

13 Constitutional interpretation in an age of globalisation

VV Ramraj - Constitutional Interpretation in Singapore: Theory and …, 2016

1 From here to modernity

CW Mills - The Subcultural Imagination: Theory, Research and …, 2016

... the collapse or hollowing out of narratives that connected collective and individual aspiration
to each ... depart their real or imagined stylistic ghettoes to engage with the wider body politic, that ...
that sought to overthrow the 'ancien regime'of Feudal absolutism or foreign despotism. ...

The test of time

ES O'Connor - The Routledge Companion to Reinventing …, 2016

Crafting Community: George Nakashima and Modern Design in India

CME Guth - Journal of Design History, 2016

... being into the terms of God-existence' required a synthesis of all yogas, a combination of body,
mind, intellect ... It would help the country in earning valuable foreign exchange for ... the same process
that nature uses in the creation of a tree—with one addition, the aspiration of man ...

2 The walls come tumbling down

M Margetts - Contemporary Clay and Museum Culture, 2016

4 Principled pragmatism and the hthird wavei of communitarian judicial review in Singapore

T Li-ann - Constitutional Interpretation in Singapore: Theory and …, 2016

Asian Regionality and Post-2015 Consultation: Donors' Self-Images and the Discourse

S Yamada - Post-Education-Forall and Sustainable Development …, 2016

... hosted the G20 summit in 2010, co-hosted the Fourth High-Level Forum for Aid Effectiveness
(HLF-4) with OECD in 2011, and co-hosted the World Education Forum with UNESCO in 2015
indicates this aspiration for leadership. An official in the Ministry of Foreign Affairs and ...

Rethinking Feminism in Early Modern Studies: Gender, Race, and Sexuality

A Loomba, ME Sanchez - 2016

The Interplay of Social and Ethnic Classroom Composition, Tracking, and Gender on Students' School Satisfaction

K Scharenberg - Journal of Cognitive Education and Psychology, 2016

... effects comprise institutional effects because of tracking, and compo- sitional effects because
of the composition of the student body. ... comes to explaining how compositional and institutional
effects influ- ence student outcomes such as achievement, self-evaluation, or aspiration. ...

Laying Claim: African American Cultural Memory and Southern Identity

PG Davis - 2016

... As the Bureau's report notes for 2010, that year the region's share of the African American
population was the highest it had been since 1960.3 Most interestingly, this return has been
motivated not only by the aspiration to exploit greater economic opportunities but also by the ...

Spiders of the Market: Ghanaian Trickster Performance in a Web of Neoliberalism

DA Donkor - 2016

A Home for All Jews: Citizenship, Rights, and National Identity in the New Israeli State

O Rozin - 2016

... Itamar Rabinovich and Jehuda Reinharz, editors, Israel in the Middle East: Documents and
Readings on Society, Politics, and Foreign Relations, Pre ... They offer a portrait of contemporary
Israeli citizenship.6 The Jewish people's Zionist revival produced an aspiration to form a ...

Republic of Taste: Art, Politics, and Everyday Life in Early America

CE Kelly - 2016

... years later, Anti-Federalists repurposed Adams's metaphor to attack the proposed Constitution,
which failed to provide a legislative body that could ... If taste accommodated social aspiration and
encouraged political debate, it also suggested the possibility of affinity grounded in a ...

Nation Building in Kurdistan: Memory, Genocide and Human Rights

M Ihsan - 2016

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