High salivary testosterone to androstenedione (T/A4) ratio and adverse metabolic phenotypes in women with PCOS

Abstract

Background

Polycystic ovary syndrome (PCOS) is characterized by a combination of hormonal and metabolic disturbances, such as insulin resistance, glucose intolerance, anovulation and hyperandrogenism. Clinical phenotypes of PCOS show different patterns of steroid hormones that have been investigated to some extent. This study aimed to establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of salivary testosterone and androstenedione, and to describe the salivary testosterone to androstenedione (T/A4) ratio as a new tool for the assessment of hyperandrogenism and metabolic health.

Material and Methods

Saliva and serum samples of 274 PCOS patients and 51 healthy women were used for the quantification of steroid hormones. A comprehensive clinical and metabolic assessment was performed. Salivary testosterone and androstenedione were measured via LC-MS/MS. The salivary T/A4 ratio was calculated and correlated with hormones and metabolic parameters.

Results

Salivary testosterone (p<0.001), androstenedione (p<0.001) and the salivary T/A4 ratio (p<0.001) were significantly higher in PCOS patients compared to healthy women. In PCOS patients, a high salivary T/A4 ratio was associated with an adverse metabolic phenotype, i.e. glucose intolerance (p=0.019), insulin resistance (p<0.001), metabolic syndrome (p<0.001), obesity (p<0.001) and oligo-/anovulation (p=0.001). Significant correlations of the salivary T/A4 ratio with adverse metabolic parameters were found.

Conclusion

Quantification of salivary androgens provides an attractive alternative to serum analysis and helps in characterising metabolic health in women with PCOS. Our data show a strong link between a high salivary T/A4 ratio and an adverse metabolic phenotype in PCOS patients.

This article is protected by copyright. All rights reserved.

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First trimester isolated maternal hypothyroxinemia: adverse maternal metabolic profile and impact on the obstetrical outcome

Abstract

Background

Isolated maternal hypothyroxinemia (IH) is defined as low maternal FT4 (<5^th percentile) and normal TSH. There is concern on its potential negative effects on the mother and offspring.

Objective

We aimed to evaluate the prevalence of IH and to assess the consequences of hypothyroxinemia on the maternal and foetal outcomes.

Subjects and methods

From a total of 1300 consecutive pregnant women recruited during the prenatal screen (mean gestational age, 11.8 weeks), thyroid function parameters were assessed in 879 women. After exclusion of women with T4 supplements, with twin pregnancies and with diabetes, data from 783 women were included. Maternal and neonatal outcomes in 55 selected women with IH and negative thyroid auto antibodies, without thyroid disorders or pregnancy achieved through assisted reproductive techniques were compared with a selected euthyroid control group (N=165).

Results

Among the 783 non - diabetic singleton pregnant women, 68 women (8.7%) were identified with IH. When compared to the selected euthyroid controls, selected women with hypothyroxinemia had significantly increased BMI in preconception (p=0.003), in the first trimester (p=0.004) and at the time of delivery (p=0.001). At term, foetal breech presentation and caesarian section rate were significantly higher (p=0.006 and p=0.026, respectively) than in the euthyroid controls. A significantly increase in macrosomia was also noted (p=0.026).

Conclusion

The prevalence of hypothyroxinemia in early pregnancy was of 8.7%. IH is associated with an increased maternal BMI and is related with a risk of breech presentation, a significant increase in macrosomia and caesarian sections. Screening should consider overweight as risk factor for hypothyroxinaemia.

This article is protected by copyright. All rights reserved.

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Patient-performed pinnaplasty using industrial nail glue

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Priyanka Chadha, Florian Bast
Malformations of the pinna occur in around 2–5% of all newborns. Prominent ears in childhood can be a source of psychological distress and lead to bullying and social exclusion. We present the case of a 14-year-old girl who inflicted chronic, non-healing wounds in the post auricular area bilaterally after attempting to glue back her ears with industrial strength glue. To our knowledge, this is the first case of its kind to be published.



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Basic discriminative and semantic processing in patients in the vegetative and minimally conscious state

Publication date: Available online 30 December 2016
Source:International Journal of Psychophysiology
Author(s): Helena Erlbeck, Ruben G.L. Real, Boris Kotchoubey, Donatella Mattia, Jakob Bargak, Andrea Kübler
Patients who survive injuries to the brain following accidents or diseases often acquire a disorder of consciousness (DOC). Assessment of the state of consciousness in these patients is difficult since they are usually incapable of reproducible motor movements. The application of event-related potentials (ERP) recorded via EEG constitutes one promising approach to complement the assessment of cognitive functions in DOC patients. For these assessments, a hierarchical approach was suggested which means that paradigms aiming at higher order ERPs are only presented if early responses were found. In this study, 19 behaviorally unresponsive or low-responsive DOC patients were presented with three auditory paradigms using passive instructions. The paradigms aimed at eliciting the Mismatch Negativity (MMN) and N400 and were applied at two time points. One oddball paradigm (MMN) and two semantic paradigms (word-pairs: N400 Words; sentences: N400 Sentences) were included. The majority of patients (n=15) did not show any response to the stimulation. In the MMN paradigm, an MMN was identified in two patients, in the N400 Words paradigm, only an N1 was identified in one patient, and in the N400 Sentences paradigm, a late positive complex (LPC) was identified in two patients. These data contradict the hierarchical approach since the LPC was identified in patients who did not exhibit an MMN. They further support the notion that even higher information processing as addressed with the N400 paradigms is preserved in a minority of DOC patients. Thus, in this sample, around 10% of the DOC patients exhibited indicators of preserved consciousness.



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Improving the competency of dental hygiene students in detecting dental restorations using quantitative light-induced fluorescence technology

Publication date: Available online 30 December 2016
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Hye-Young Oh, Hoi-In Jung, Jeong-Woo Lee, Baek-Il Kim
ObjectivesThe purpose of this study was to determine the usefulness of a quantitative light-induced fluorescence (QLF) technology in detecting dental restorations by comparing the detection ability of dental hygiene students between using conventional visual inspections alone and visual inspections combined with QLF technology.MethodsThe subjects of this study comprised 92 dental hygiene students. The students assigned to the control group only used white-light images to visually assess the mouth environment, while those in the experimental group additionally used fluorescence images. Using the test results of an experienced inspector as a reference value, the agreement between the reference value and the evaluation results of the students in the experimental and control groups was evaluated using Cohen's kappa and the percentage agreement. The subjects were then classified into groups covering three percentage ranges according to the score distribution and agreement values of the three groups were compared. The percentage agreement was calculated according to the type of dental restorationsResultsThe mean kappa value was significantly higher in the experimental group than the control group (0.70 vs 0.60, p<0.01), as was the percentage agreement (80.06% vs 72.64%, p<0.01). The agreement rate when using QLF technology increased by 8% more in the middle and bottom percentage groups than in the top percentage group (p<0.01). The agreement rate also varied with the type of restoration, being significantly higher for a sound tooth or tooth-colored restoration in the experimental group (p<0.01).ConclusionsCombining QLF technology with conventional visual inspections could improve the ability to detect dental restorations and distinguish sound teeth from aesthetic restorations.



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Table of Contents

Publication date: January 2017
Source:Pediatric Neurology, Volume 66





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Editorial Board and Masthead

Publication date: January 2017
Source:Pediatric Neurology, Volume 66





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Meetings of Interest

Publication date: January 2017
Source:Pediatric Neurology, Volume 66





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Editorial Board

Publication date: January–February 2017
Source:Aggression and Violent Behavior, Volume 32





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Age-related alterations in human neocortical plasticity

Publication date: Available online 30 December 2016
Source:Brain Research Bulletin
Author(s): M.J. Spriggs, C.J. Cadwallader, J.P. Hamm, L.J. Tippett, I.J. Kirk
Age-related changes in neuroplasticity may be central to the cognitive decline associated with even healthy ageing. Modulated Long-Term Potentiation (LTP) and Long-Term Depression (LTD) have been repeatedly demonstrated in aged rodents, however the translation to human research has been limited by a scarcity of non-invasive methods for doing so. We have previously demonstrated that, following a block of high frequency presentations of a visual stimulus (referred to as a "visual tetanus"), there is a LTP-like enhancement of the N1b component of the visually evoked potential (VEP) to subsequent low frequency presentations of the same stimulus. The aims of the current study were, firstly, to use this electroencephalography (EEG) paradigm to assess age group differences in neocortical plasticity in humans, and secondly, to expand on the visual LTP paradigm by examining plasticity in another component of the VEP; the P2a. While a young participant group (N=29, age range=19–35) demonstrated the expected LTP-like enhancement of the N1b immediately following the visual tetanus, an older participant group (N=19, age range=68–91) did not. However, both age groups demonstrated a positive shift of the P2a component after repeated presentations of low frequency baseline blocks, which is hypothesized to be an LTD-like shift in the VEP. These results support the rodent literature indicating an age-related shift in threshold for LTP, but a relative preservation of the threshold for LTD. This study not only provides valuable insight into healthy age-related alterations in neocortical plasticity, but is also the first to identify an LTD-like modulation of the VEP in humans.



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Neuronal expression of a thyroid hormone receptor α mutation alters mouse behaviour

Publication date: 15 March 2017
Source:Behavioural Brain Research, Volume 321
Author(s): S. Richard, N. Aguilera, M. Thévenet, O. Dkhissi-Benyahya, F. Flamant
In humans, alterations in thyroid hormone signalling are associated with mood and anxiety disorders, but the neural mechanisms underlying such association are poorly understood. The present study investigates the involvement of neuronal thyroid hormone receptor α (TRα) in anxiety, using mouse genetics and Cre/loxP technology to specifically alter TRα signalling in neurons. We evaluated the behaviour of mice expressing a dominant negative, neuron-specific mutation of TRα (TRα^AMI/Cre3 mice), using the elevated-plus maze, light-dark box and open-field tests. In a first experiment, mice were housed individually, and the behaviour of TRα^AMI/Cre3 mice differed significantly from that of control littermates in these 3 tests, suggesting heightened anxiety. In a second experiment, designed to evaluate the robustness of the results with the same 3 tests, mice were housed in groups. In these conditions, the behaviour of TRα^AMI/Cre3 mice differed from that of control littermates only in the light-dark box. Thus, TRα^AMI/Cre3 mice appear to be more likely to develop anxiety under stressful housing conditions than control mice. These results suggest that in adult mice, thyroid hormone signalling in neurons, via TRα, is involved in the control of anxiety behaviour.



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Characteristics and processing of Pol IV transcripts in Arabidopsis

Publication date: Available online 30 December 2016
Source:Journal of Genetics and Genomics
Author(s): Hsuan Yu Kuo, Elise L. Jacobsen, Yanping Long, Xinyuan Chen, Jixian Zhai




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Adaptive responses of heart and skeletal muscle to spermine oxidase overexpression: Evaluation of a new transgenic mouse model

Publication date: Available online 30 December 2016
Source:Free Radical Biology and Medicine
Author(s): Roberta Ceci, Guglielmo Duranti, Alessia Leonetti, Stefano Pietropaoli, Federico Spinozzi, Lucia Marcocci, Roberto Amendola, Francesco Cecconi, Stefania Sabatini, Paolo Mariottini, Manuela Cervelli
Spermine oxidase oxidizes spermine to produce H2O2, spermidine, and 3-aminopropanal. It is involved in cell drug response, apoptosis, and in the etiology of several pathologies, including cancer. Spermine oxidase is an important positive regulator of muscle gene expression and fiber size and, when repressed, leads to muscle atrophy. We have generated a transgenic mouse line overexpressing Smox gene in all organs, named Total-Smox. The spermine oxidase overexpression was revealed by β-Gal staining and reverse-transcriptase/PCR analysis, in all tissues analysed. Spermine oxidase activity resulted higher in Total-Smox than controls. Considering the important role of this enzyme in muscle physiology, we have focused our study on skeletal muscle and heart of Total-Smox mice by measuring redox status and oxidative damage. We assessed the redox homeostasis through the analysis of the reduced/oxidized glutathione ratio. Chronic H2O2 production induced by spermine oxidase overexpression leads to a cellular redox state imbalance in both tissues, although they show different redox adaptation. In skeletal muscle, catalase and glutathione S-transferase activities were significantly increased in Total-Smox mice compared to controls. In the heart, no differences were found in CAT activity level, while GST activity decreased compared to controls. The skeletal muscle showed a lower oxidative damage than in the heart, evaluated by lipid peroxidation and protein carbonylation. Altogether, our findings illustrate that skeletal muscle adapts more efficiently than heart to oxidative stress H2O2-induced. The Total-Smox line is a new genetic model useful to deepen our knowledge on the role of spermine oxidase in muscle atrophy and muscular pathological conditions like dystrophy.

Graphical abstract

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Human papillomavirus status and the relative biological effectiveness of proton radiotherapy in head and neck cancer cells

Abstract

Background

Human papillomavirus (HPV)-positive oropharyngeal carcinomas response better to X-ray therapy (XRT) than HPV-negative disease. Whether HPV status influences the sensitivity of head and neck cancer cells to proton therapy or the relative biological effectiveness (RBE) of protons versus XRT is unknown.

Methods

Clonogenic survival was used to calculate the RBE; immunocytochemical analysis and neutral comet assay were used to evaluate unrepaired DNA double-strand breaks.

Results

HPV-positive cells were more sensitive to protons and the unrepaired double-strand breaks were more numerous in HPV-positive cells than in HPV-negative cells (p < .001). Protons killed more cells than did XRT at all fraction sizes (all RBEs > 1.06). Cell line type and radiation fraction size influenced the RBE.

Conclusion

HPV-positive cells were more sensitive to protons than HPV-negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Orbital Imaging Manifestations of Neurocutaneous Syndromes Revisited

Publication date: Available online 30 December 2016
Source:Current Problems in Diagnostic Radiology
Author(s): Abanti Das, Sanjay Sharma
Neurocutaneous syndromes or phakomatosis represent a heterogeneous group of multi-systemic disorders involving structures of ectodermal origin. Characteristic ocular manifestations are described for individual entities which are often the first clues to the underlying diagnosis. However, opaque ocular media or involvement of retrobulbar orbit limits adequate clinical evaluation. This underlines the role of imaging, especially cross-sectional imaging modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), which offer a comprehensive evaluation of orbit and its contents. This review aims to summarize the cross-sectional imaging features of orbital manifestations of common neurocutaneous syndromes encountered in clinical practice.



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Human papillomavirus status and the relative biological effectiveness of proton radiotherapy in head and neck cancer cells

Abstract

Background

Human papillomavirus (HPV)-positive oropharyngeal carcinomas response better to X-ray therapy (XRT) than HPV-negative disease. Whether HPV status influences the sensitivity of head and neck cancer cells to proton therapy or the relative biological effectiveness (RBE) of protons versus XRT is unknown.

Methods

Clonogenic survival was used to calculate the RBE; immunocytochemical analysis and neutral comet assay were used to evaluate unrepaired DNA double-strand breaks.

Results

HPV-positive cells were more sensitive to protons and the unrepaired double-strand breaks were more numerous in HPV-positive cells than in HPV-negative cells (p < .001). Protons killed more cells than did XRT at all fraction sizes (all RBEs > 1.06). Cell line type and radiation fraction size influenced the RBE.

Conclusion

HPV-positive cells were more sensitive to protons than HPV-negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Complication and surgical site infection for salvage surgery in head and neck cancer after chemoradiotherapy and bioradiotherapy

Publication date: Available online 30 December 2016
Source:Auris Nasus Larynx
Author(s): Hidenori Suzuki, Nobuhiro Hanai, Daisuke Nishikawa, Yujiro Fukuda, Yasuhisa Hasegawa
ObjectiveWe aimed to investigate the complications, surgical site infection (SSI), and survival in salvage surgery without free-flap reconstruction for patients with head and neck squamous cell carcinoma who were treated by platinum-based chemoradiotherapy (Plat-CRT) or cetuximab-based bioradiotherapy (Cet-BRT).MethodsThirty-three patients treated by Plat-CRT and six treated by Cet-BRT had salvage surgery. We categorized postoperative complications according to the Clavien–Dindo classification and SSI according to the wound grading scale. Overall survival calculated by Kaplan–Meier method.ResultsPatients with Cet-BRT were significantly associated with the presence of SSI (P<0.01) and grades IIIb–V of the Clavien–Dindo classification (P<0.01) compared with those with Plat-CRT. Patients with Cet-BRT had a significantly lower overall survival than those with Plat-CRT (P<0.05).ConclusionWe demonstrated that patients with Cet-BRT were significantly more associated with the presence of SSI and grades IIIb–V in the Clavien–Dindo classification than those with CRT.



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Effect of ambient temperature on species lumping for total organic gases in gasoline exhaust emissions

Publication date: March 2017
Source:Atmospheric Environment, Volume 152
Author(s): Anirban Roy, Yunsoo Choi
Volatile organic compound (VOCs) emissions from sources often need to be compressed or "lumped" into species classes for use in emissions inventories intended for air quality modeling. This needs to be done to ensure computational efficiency. The lumped profiles are usually reported for one value of ambient temperature. However, temperature-specific detailed profiles have been constructed in the recent past - the current study investigates how the lumping of species from those profiles into different atmospheric chemistry mechanisms is affected by temperature, considering three temperatures (−18 °C, −7 °C and 24 °C). The mechanisms considered differed on the assumptions used for lumping: CB05 (carbon bond type), SAPRC (ozone formation potential) and RACM2 (molecular surrogate and reactivity weighting). In this space, four sub-mechanisms for SAPRC were considered. Scaling factors were developed for each lumped model species and mechanism in terms of moles of lumped species per unit mass. Species which showed a direct one-to-one mapping (SAPRC/RACM2) reported scaling factors that were unchanged across mechanisms. However, CB05 showed different trends since one compound often is mapped onto multiple model species, out of which the paraffinic double bond (PAR) is predominant. Temperature-dependent parameterizations for emission factors pertaining to each lumped species class and mechanism were developed as part of the study. Here, the same kind of model species showed varying lumping parameters across the different mechanisms. These differences could be attributed to differing approaches in lumping. The scaling factors and temperature-dependent parameterizations could be used to update emissions inventories such as MOVES or SMOKE for use in chemical transport modeling.



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25 years of Current Opinion in Otolaryngology & Head and Neck Surgery

No abstract available

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Avoiding complications in endoscopic skull base surgery

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.

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What is the evidence for genetics in chronic rhinosinusitis?

Purpose of review: To perform analysis of evidence in current literature on the topic of genetics and chronic rhinosinusitis (CRS), with a particular focus on recent findings in the cystic fibrosis transmembrane regulator (CFTR), genes associated with primary ciliary dyskinesia, and taste receptor T2R38. Other genes that have been found to have association with CRS are also presented and discussed. Recent findings: Recent studies in CFTR and CRS research have investigated possible CFTR-potentiators for treatment of refractory CRS. The T2R38 gene has been shown to be applicable in the clinical setting with a testable phenotype and may have a role in the prognosis and influencing management strategies of CRS patients. Many genes of the immune system have been studied, with genome-wide association studies and candidate-gene approaches identifying new associations that will need replication and further elucidation. Summary: CRS is a multifactorial disease, with strong evidence of a genetic component in its pathophysiology for some cases. Currently, there are over 70 genes that have been genetically associated with CRS in the past 15 years. Future investigations into genetic causes and predispositions of CRS may allow for improved prognostication and development of disease-prevention strategies as well as novel therapeutic targets.

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Caudal septum surgery techniques reviewed

Purpose of review: The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing. Recent findings: Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome. Summary: Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.

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Polyps, asthma, and allergy: what's new

Purpose of review: Although chronic rhinosinusitis with nasal polyps, asthma, and allergy share common inflammatory mechanisms, there is no evidence of cause-and-effect relationship. In this review, we present new studies investigating the complex immunology that links these diseases. Advances in new therapies as well as evidence regarding indication and timing of surgery, especially of more complex cases, are highlighted. Recent findings: New studies have endotyped patients in an effort to describe the exact inflammatory profile of each phenotype, whereas described cytokines seem to play a significant role in amplification of T2 inflammation, directly or via innate lymphoid cells. New mAbs that block specific cytokines of these pathways have been developed and seem to show reduced asthma severity as well as improved sinonasal outcomes. Moreover, it has been shown that operating early in the course of disease leads not only to bigger improvements in SNOT-22 outcomes but also to reduced asthma incidence postoperatively in refractory cases. Summary: Applying data from current studies in clinical practice, we could better manage refractory cases with asthma and polyps, both medically and surgically. Treatment has to be patient-centered, and this demands a multidisciplinary-team approach of the airway diseases.

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The state of sinus care in 2017

No abstract available

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The evidence for olfactory training in treating patients with olfactory loss

Purpose of review: The purpose of this review is to go over the only therapy for olfactory loss supported by level 1a evidence that is currently available, which is olfactory training. This therapy is widely underutilized and has the potential to help many patients with olfactory dysfunction who are otherwise offered no management options. Recent findings: We will review the rationale, clinical studies, and quality of the evidence regarding olfactory training, specifically the olfactory system's inherent ability to regenerate, the plasticity of the system, and the multiple protocols and modifications of protocols present in the literature. Summary: Olfactory training is an effective therapy for some patients suffering from olfactory loss, and, while we do not yet know the optimal duration or number of odorants or exact patient population it may be most beneficial for, as an extremely easy, self-driven therapy with no significant side-effects, it should be consistently offered to this patient population.

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Update on nonmalignant lesions of the inferior turbinate

Purpose of review: The inferior turbinates are routinely examined by otolaryngologists on anterior rhinoscopy and nasal endoscopy. Most lesions of the inferior turbinate are benign but can often be confused with malignancy. This review highlights the broad differential of nonmalignant lesions of the inferior turbinates and their management. Recent findings: A variety of infectious, inflammatory, neoplastic, and vascular lesions may affect the inferior turbinates. The most common nonmalignant lesions of the sinonasal region are nasal polyps, inverted papillomas, hemangiomas, and angiofibromas. Early lesions are often asymptomatic and discovered incidentally on routine examination. As these lesions grow they present with nonspecific signs that can be seen in benign, malignant, and infectious etiologies. The most common signs and symptoms are nasal obstruction, rhinorrhea, epistaxis, sinusitis, and hyposmia. Most nonmalignant lesions have characteristic appearances but definitive diagnosis is achieved with biopsy or culture. If the lesions are small the biopsy itself is often curative. Summary: Lesions of the inferior turbinates are rarely isolated to these structures alone. Careful examination can noninvasively assist in early diagnosis of extensive lesions. Once malignancy and processes such as invasive fungal sinusitis or inverted papillomas have been ruled out, treatment of these lesions is ordinarily noncomplicated and definitive.

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Editorial introductions

No abstract available

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Anesthesia for functional endoscopic sinus surgery

Purpose of review: The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed. Recent findings: There are mixed data as to whether traditional inhalation anesthesia or total intravenous anesthesia is superior with respect to better surgical fields and decreased blood loss. A review of the literature tends to favor total intravenous anesthesia. Cerebral oximetry and transcranial Doppler ultrasound are emerging techniques to monitor cerebral perfusion during deliberate hypotension. Summary: Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.

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Sinonasal methicillin-resistant Staphylococcus aureus: updates on treatment

Purpose of review: Over the past two decades, the management of methicillin-resistant Staphylococcus aureus (MRSA) in chronic rhinosinusitis has posed significant challenges. This document reviews current management techniques and novel treatment modalities for sinonasal MRSA infections. Recent findings: Topical antibiotic therapy, that is, drops (ofloxacin) and ointments (mupirocin) as off-label use for the management of MRSA chronic sinusitis, has shown beneficial results. Other more recently trialed nonantibiotic modalities such as antimicrobial photodynamic therapy and colloidal silver irrigation are also showing promise. Summary: Sinonasal MRSA is considered to be associated with recalcitrant chronic sinusitis. Advancements in systemic and local antibiotics in its management have been slow and unsatisfactory. Attention is shifting to the use of nonantibiotic antibacterial treatments. Knowledge of these options is critical to improve the overall management of these chronic patients.

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The role of sinus surgery in sleep outcomes

Purpose of review: Poor sleep is associated with reduced health, increased morbidity, and increased mortality. Recent findings: Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases in the United States, affecting up to 16% of the U.S. population. It has been linked to poor sleep with up to 75% of patients with CRS reporting reduced sleep. Yet there has been little examining the improvement in sleep following surgical treatment of patients with CRS. Summary: In this review, we examine the current knowledge on the association between sleep and CRS as well as review the current data examining the role of sinus surgery. After a structured literature search, we conclude that an evolving body of research demonstrates that sleep is compromised in the majority of patients with CRS. Following surgical treatment of CRS, there is a significant improvement in reported sleep quality that is correlated with subsequent improvement in disease-specific quality of life. Furthermore, we acknowledge that additional research characterizing both objective and subjective measures of sleep following surgical treatment is still needed. Additional investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

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Comprehensive management of hereditary hemorrhagic telangiectasia

Purpose of review: Hereditary hemorrhagic telangiectasia (HHT), or Osler Weber-Rendu disease, is a rare inherited disorder of fibrovascular tissue affecting various organs. Epistaxis is the most common symptom of HHT but as the disease affects multiple organs, a multisystem and multidisciplinary approach to management is required. The purpose of this article is to provide an overview of the multidisciplinary approach to HHT for the otolaryngologist and to discuss the current pharmacologic and procedural treatment options available for HHT-related epistaxis. Recent findings: Multidisciplinary expert guidelines have better defined what screening tests are advised for the multisystem evaluation of the HHT patient. New pharmacologic therapies including bevacizumab (Avastin) used submucosally or topically have shown promise as in-office treatment modalities. Sclerotherapy of telangiectasia, including in-office applications, has recently proven safe and effective. Summary: HHT remains a difficult disease to treat. Being aware of the common organ systems involved by the disease will help the practicing otolaryngologist to ensure the patient receives appropriate multidisciplinary care. For HHT-related epistaxis, new medical and surgical options allow for a wider range of treatments than were previously available.

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The role of aspirin desensitization in the management of aspirin-exacerbated respiratory disease

Purpose of review: Aspirin-exacerbated respiratory disease (AERD) is a progressive inflammatory disease of the upper and lower airways characterized by marked eosinophilic nasal polyposis, asthma, and respiratory reactions to medications that inhibit the cyclooxygenase pathway. Aspirin desensitization has proven to be an effective tool in the management of this disease when used in a multidisciplinary setting. The purpose of this article is to review the current literature regarding AERD, aspirin desensitization, and share our opinion regarding the most optimal multidisciplinary approach to these complex patients. Recent findings: Numerous studies, including randomized, double-blind, placebo-controlled trials, have demonstrated the therapeutic effectiveness of aspirin desensitization with significant improvement in number of sinus infections per year, olfactory scores, nasal symptom scores, asthma symptom scores, sinus operations, hospitalizations, emergency room visits, and oral steroid use. Furthermore, the role of surgery is becoming increasingly important for recalcitrant sinus disease with recent studies showing comprehensive surgery as more beneficial to disease management. Summary: Aspirin desensitization is an effective therapeutic tool in the management of AERD. A multidisciplinary approach is critical between the otorhinolaryngologist and allergist to provide the most optimal care for this complex patient population.

http://ift.tt/2hBEUrF

An update on endoscopic orbital decompression

Purpose of review: Endoscopic orbital decompression is an ever-evolving surgical procedure with modifications as well as new indications for the procedure. The purpose of this review is to update the reader on optimizing patient selection, surgical timing, highlight the latest modifications to surgical technique and to evaluate surgical outcomes that can be achieved. Recent findings: Patient selection, disease pathology, and optimization of technology can lead to improved outcomes. Changes in technology continue to modify surgical techniques and surgical training, working towards decreased surgical complications with improved outcomes. Historically multiple approaches have been used for orbital decompression and this highlights that a balanced orbital decompression usually leads to the best outcome. Summary: Orbital decompression has evolved significantly since its inception over 100 years ago. Identifying the right patient, the ideal timing, and the indication for the procedure with utilization of technology can lead to improved outcomes and decreased complications.

http://ift.tt/2hBwhgT

Postoperative care in endoscopic sinus surgery: a critical review

Purpose of review: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard treatment for medically refractive disease. Postoperative care is recommended by international leaders as an important part of the patient's management. This article is a critical review and discussion focusing on postoperative care, which is based on expert opinion, clinical studies, randomized controlled trials and meta-analysis studies. Recent findings: Postoperative care including nasal rinsing, topical corticosteroids, antibiotics and avoidance of nasal packing are unanimously considered to be the cornerstone of best practice following FESS. However, the effectiveness of in-office nasal debridement is still under debate. Summary: There is a lack of consensus regarding the necessity of performing in-office nasal debridement and the majority of clinicians carry out their postoperative care according to experience and their own preference. This is often determined by the extent of surgery performed, the severity of the postoperative inflammation, as well as being dependent on the patient's discomfort, the time constraints associated with postoperative care and the costs associated with additional appointments. Ideally, nasal debridement should be performed by the operating surgeon under endoscopic control both gently and atraumatically.

http://ift.tt/2hBwxN3

Posttreatment surveillance for sinonasal malignancy

Purpose of review: Sinonasal neoplasms have a high rate of recurrence following treatment, and clinicians utilize a variety of surveillance techniques. Generally, surveillance modality and frequency of follow-up are determined by the guidelines for head and neck cancer as a broad category. However, recent studies have demonstrated that a more tailored approach to follow-up may be necessary. Recent findings: Endoscopy has low sensitivity in recurrence detection, especially in the asymptomatic patient. However, it is able to identify superficial recurrences that may be more amenable to repeat resection. Conversely, imaging [computed tomography (CT), MRI, and 18F-fluorodeoxyglucose-PET/CT] is useful in ruling out disease, but the inflammatory environment of the posttreatment sinonasal cavity leads to a high number of false positives. This is especially notable in PET/CT, which has worse specificity and positive predictive value in sinonasal malignancy than in head and neck malignancy overall, especially in the early posttreatment period. Little data are available on optimal timing and duration of follow-up, but tumor histology and aggressiveness should be considered when choosing a surveillance approach. Summary: Sinonasal malignancy surveillance strategies may warrant modifications of current protocols used for head and neck malignancy. This is due to a number of factors, including a greater diversity of sinonasal disorder and increased duration of posttreatment sinonasal inflammation. Clinicians should be aware of the performance parameters of commonly used surveillance techniques and adjust follow-up regimens based on this information.

http://ift.tt/2hBqmZ2

Avoiding complications in endoscopic skull base surgery

Purpose of review: Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. Recent findings: Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. Summary: Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.

http://ift.tt/2hBpfIW

25 years of Current Opinion in Otolaryngology & Head and Neck Surgery

No abstract available

http://ift.tt/2iyQ7bb

What is the evidence for genetics in chronic rhinosinusitis?

Purpose of review: To perform analysis of evidence in current literature on the topic of genetics and chronic rhinosinusitis (CRS), with a particular focus on recent findings in the cystic fibrosis transmembrane regulator (CFTR), genes associated with primary ciliary dyskinesia, and taste receptor T2R38. Other genes that have been found to have association with CRS are also presented and discussed. Recent findings: Recent studies in CFTR and CRS research have investigated possible CFTR-potentiators for treatment of refractory CRS. The T2R38 gene has been shown to be applicable in the clinical setting with a testable phenotype and may have a role in the prognosis and influencing management strategies of CRS patients. Many genes of the immune system have been studied, with genome-wide association studies and candidate-gene approaches identifying new associations that will need replication and further elucidation. Summary: CRS is a multifactorial disease, with strong evidence of a genetic component in its pathophysiology for some cases. Currently, there are over 70 genes that have been genetically associated with CRS in the past 15 years. Future investigations into genetic causes and predispositions of CRS may allow for improved prognostication and development of disease-prevention strategies as well as novel therapeutic targets.

http://ift.tt/2iyULFT

The state of sinus care in 2017

No abstract available

http://ift.tt/2hBrR9W

The evidence for olfactory training in treating patients with olfactory loss

Purpose of review: The purpose of this review is to go over the only therapy for olfactory loss supported by level 1a evidence that is currently available, which is olfactory training. This therapy is widely underutilized and has the potential to help many patients with olfactory dysfunction who are otherwise offered no management options. Recent findings: We will review the rationale, clinical studies, and quality of the evidence regarding olfactory training, specifically the olfactory system's inherent ability to regenerate, the plasticity of the system, and the multiple protocols and modifications of protocols present in the literature. Summary: Olfactory training is an effective therapy for some patients suffering from olfactory loss, and, while we do not yet know the optimal duration or number of odorants or exact patient population it may be most beneficial for, as an extremely easy, self-driven therapy with no significant side-effects, it should be consistently offered to this patient population.

http://ift.tt/2hBmG9I

Caudal septum surgery techniques reviewed

Purpose of review: The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing. Recent findings: Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome. Summary: Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.

http://ift.tt/2hBrE6y

Update on nonmalignant lesions of the inferior turbinate

Purpose of review: The inferior turbinates are routinely examined by otolaryngologists on anterior rhinoscopy and nasal endoscopy. Most lesions of the inferior turbinate are benign but can often be confused with malignancy. This review highlights the broad differential of nonmalignant lesions of the inferior turbinates and their management. Recent findings: A variety of infectious, inflammatory, neoplastic, and vascular lesions may affect the inferior turbinates. The most common nonmalignant lesions of the sinonasal region are nasal polyps, inverted papillomas, hemangiomas, and angiofibromas. Early lesions are often asymptomatic and discovered incidentally on routine examination. As these lesions grow they present with nonspecific signs that can be seen in benign, malignant, and infectious etiologies. The most common signs and symptoms are nasal obstruction, rhinorrhea, epistaxis, sinusitis, and hyposmia. Most nonmalignant lesions have characteristic appearances but definitive diagnosis is achieved with biopsy or culture. If the lesions are small the biopsy itself is often curative. Summary: Lesions of the inferior turbinates are rarely isolated to these structures alone. Careful examination can noninvasively assist in early diagnosis of extensive lesions. Once malignancy and processes such as invasive fungal sinusitis or inverted papillomas have been ruled out, treatment of these lesions is ordinarily noncomplicated and definitive.

http://ift.tt/2hBlmnr

Polyps, asthma, and allergy: what's new

Purpose of review: Although chronic rhinosinusitis with nasal polyps, asthma, and allergy share common inflammatory mechanisms, there is no evidence of cause-and-effect relationship. In this review, we present new studies investigating the complex immunology that links these diseases. Advances in new therapies as well as evidence regarding indication and timing of surgery, especially of more complex cases, are highlighted. Recent findings: New studies have endotyped patients in an effort to describe the exact inflammatory profile of each phenotype, whereas described cytokines seem to play a significant role in amplification of T2 inflammation, directly or via innate lymphoid cells. New mAbs that block specific cytokines of these pathways have been developed and seem to show reduced asthma severity as well as improved sinonasal outcomes. Moreover, it has been shown that operating early in the course of disease leads not only to bigger improvements in SNOT-22 outcomes but also to reduced asthma incidence postoperatively in refractory cases. Summary: Applying data from current studies in clinical practice, we could better manage refractory cases with asthma and polyps, both medically and surgically. Treatment has to be patient-centered, and this demands a multidisciplinary-team approach of the airway diseases.

http://ift.tt/2hBm9Vi

Editorial introductions

No abstract available

http://ift.tt/2hBEUIb

Sinonasal methicillin-resistant Staphylococcus aureus: updates on treatment

Purpose of review: Over the past two decades, the management of methicillin-resistant Staphylococcus aureus (MRSA) in chronic rhinosinusitis has posed significant challenges. This document reviews current management techniques and novel treatment modalities for sinonasal MRSA infections. Recent findings: Topical antibiotic therapy, that is, drops (ofloxacin) and ointments (mupirocin) as off-label use for the management of MRSA chronic sinusitis, has shown beneficial results. Other more recently trialed nonantibiotic modalities such as antimicrobial photodynamic therapy and colloidal silver irrigation are also showing promise. Summary: Sinonasal MRSA is considered to be associated with recalcitrant chronic sinusitis. Advancements in systemic and local antibiotics in its management have been slow and unsatisfactory. Attention is shifting to the use of nonantibiotic antibacterial treatments. Knowledge of these options is critical to improve the overall management of these chronic patients.

http://ift.tt/2hBlDqw

The role of sinus surgery in sleep outcomes

Purpose of review: Poor sleep is associated with reduced health, increased morbidity, and increased mortality. Recent findings: Chronic rhinosinusitis (CRS) is one of the most prevalent chronic diseases in the United States, affecting up to 16% of the U.S. population. It has been linked to poor sleep with up to 75% of patients with CRS reporting reduced sleep. Yet there has been little examining the improvement in sleep following surgical treatment of patients with CRS. Summary: In this review, we examine the current knowledge on the association between sleep and CRS as well as review the current data examining the role of sinus surgery. After a structured literature search, we conclude that an evolving body of research demonstrates that sleep is compromised in the majority of patients with CRS. Following surgical treatment of CRS, there is a significant improvement in reported sleep quality that is correlated with subsequent improvement in disease-specific quality of life. Furthermore, we acknowledge that additional research characterizing both objective and subjective measures of sleep following surgical treatment is still needed. Additional investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

http://ift.tt/2hBsnEY

Anesthesia for functional endoscopic sinus surgery

Purpose of review: The present article summarizes anesthetic techniques used during functional endoscopic sinus surgery to decrease bleeding and aid in creating a clear surgical field. The applicable physiology behind these anesthetic techniques is reviewed with emphasis on the effect on bleeding and the surgical field. Deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring are discussed. Recent findings: There are mixed data as to whether traditional inhalation anesthesia or total intravenous anesthesia is superior with respect to better surgical fields and decreased blood loss. A review of the literature tends to favor total intravenous anesthesia. Cerebral oximetry and transcranial Doppler ultrasound are emerging techniques to monitor cerebral perfusion during deliberate hypotension. Summary: Total intravenous anesthesia using propofol and remifentanil is the current favored technique for producing deliberate hypotension during endoscopic sinus surgery due to its hemodynamic stability and smooth rapid emergence.

http://ift.tt/2hBtTXs

Comprehensive management of hereditary hemorrhagic telangiectasia

Purpose of review: Hereditary hemorrhagic telangiectasia (HHT), or Osler Weber-Rendu disease, is a rare inherited disorder of fibrovascular tissue affecting various organs. Epistaxis is the most common symptom of HHT but as the disease affects multiple organs, a multisystem and multidisciplinary approach to management is required. The purpose of this article is to provide an overview of the multidisciplinary approach to HHT for the otolaryngologist and to discuss the current pharmacologic and procedural treatment options available for HHT-related epistaxis. Recent findings: Multidisciplinary expert guidelines have better defined what screening tests are advised for the multisystem evaluation of the HHT patient. New pharmacologic therapies including bevacizumab (Avastin) used submucosally or topically have shown promise as in-office treatment modalities. Sclerotherapy of telangiectasia, including in-office applications, has recently proven safe and effective. Summary: HHT remains a difficult disease to treat. Being aware of the common organ systems involved by the disease will help the practicing otolaryngologist to ensure the patient receives appropriate multidisciplinary care. For HHT-related epistaxis, new medical and surgical options allow for a wider range of treatments than were previously available.

http://ift.tt/2hBm9EM

The role of aspirin desensitization in the management of aspirin-exacerbated respiratory disease

Purpose of review: Aspirin-exacerbated respiratory disease (AERD) is a progressive inflammatory disease of the upper and lower airways characterized by marked eosinophilic nasal polyposis, asthma, and respiratory reactions to medications that inhibit the cyclooxygenase pathway. Aspirin desensitization has proven to be an effective tool in the management of this disease when used in a multidisciplinary setting. The purpose of this article is to review the current literature regarding AERD, aspirin desensitization, and share our opinion regarding the most optimal multidisciplinary approach to these complex patients. Recent findings: Numerous studies, including randomized, double-blind, placebo-controlled trials, have demonstrated the therapeutic effectiveness of aspirin desensitization with significant improvement in number of sinus infections per year, olfactory scores, nasal symptom scores, asthma symptom scores, sinus operations, hospitalizations, emergency room visits, and oral steroid use. Furthermore, the role of surgery is becoming increasingly important for recalcitrant sinus disease with recent studies showing comprehensive surgery as more beneficial to disease management. Summary: Aspirin desensitization is an effective therapeutic tool in the management of AERD. A multidisciplinary approach is critical between the otorhinolaryngologist and allergist to provide the most optimal care for this complex patient population.

http://ift.tt/2hBEUrF

An update on endoscopic orbital decompression

Purpose of review: Endoscopic orbital decompression is an ever-evolving surgical procedure with modifications as well as new indications for the procedure. The purpose of this review is to update the reader on optimizing patient selection, surgical timing, highlight the latest modifications to surgical technique and to evaluate surgical outcomes that can be achieved. Recent findings: Patient selection, disease pathology, and optimization of technology can lead to improved outcomes. Changes in technology continue to modify surgical techniques and surgical training, working towards decreased surgical complications with improved outcomes. Historically multiple approaches have been used for orbital decompression and this highlights that a balanced orbital decompression usually leads to the best outcome. Summary: Orbital decompression has evolved significantly since its inception over 100 years ago. Identifying the right patient, the ideal timing, and the indication for the procedure with utilization of technology can lead to improved outcomes and decreased complications.

http://ift.tt/2hBwhgT

Postoperative care in endoscopic sinus surgery: a critical review

Purpose of review: Chronic rhinosinusitis with and without nasal polyps is a common disease affecting people all over the world. Functional endoscopic sinus surgery (FESS) has become the gold standard treatment for medically refractive disease. Postoperative care is recommended by international leaders as an important part of the patient's management. This article is a critical review and discussion focusing on postoperative care, which is based on expert opinion, clinical studies, randomized controlled trials and meta-analysis studies. Recent findings: Postoperative care including nasal rinsing, topical corticosteroids, antibiotics and avoidance of nasal packing are unanimously considered to be the cornerstone of best practice following FESS. However, the effectiveness of in-office nasal debridement is still under debate. Summary: There is a lack of consensus regarding the necessity of performing in-office nasal debridement and the majority of clinicians carry out their postoperative care according to experience and their own preference. This is often determined by the extent of surgery performed, the severity of the postoperative inflammation, as well as being dependent on the patient's discomfort, the time constraints associated with postoperative care and the costs associated with additional appointments. Ideally, nasal debridement should be performed by the operating surgeon under endoscopic control both gently and atraumatically.

http://ift.tt/2hBwxN3

Posttreatment surveillance for sinonasal malignancy

Purpose of review: Sinonasal neoplasms have a high rate of recurrence following treatment, and clinicians utilize a variety of surveillance techniques. Generally, surveillance modality and frequency of follow-up are determined by the guidelines for head and neck cancer as a broad category. However, recent studies have demonstrated that a more tailored approach to follow-up may be necessary. Recent findings: Endoscopy has low sensitivity in recurrence detection, especially in the asymptomatic patient. However, it is able to identify superficial recurrences that may be more amenable to repeat resection. Conversely, imaging [computed tomography (CT), MRI, and 18F-fluorodeoxyglucose-PET/CT] is useful in ruling out disease, but the inflammatory environment of the posttreatment sinonasal cavity leads to a high number of false positives. This is especially notable in PET/CT, which has worse specificity and positive predictive value in sinonasal malignancy than in head and neck malignancy overall, especially in the early posttreatment period. Little data are available on optimal timing and duration of follow-up, but tumor histology and aggressiveness should be considered when choosing a surveillance approach. Summary: Sinonasal malignancy surveillance strategies may warrant modifications of current protocols used for head and neck malignancy. This is due to a number of factors, including a greater diversity of sinonasal disorder and increased duration of posttreatment sinonasal inflammation. Clinicians should be aware of the performance parameters of commonly used surveillance techniques and adjust follow-up regimens based on this information.

http://ift.tt/2hBqmZ2

External validation of a published nomogram for prediction of brain metastasis in patients with extra-cerebral metastatic breast cancer and risk regression analysis

Publication date: February 2017
Source:European Journal of Cancer, Volume 72
Author(s): Ludivine Genre, Henri Roché, Léonel Varela, Dorra Kanoun, Monia Ouali, Thomas Filleron, Florence Dalenc
BackgroundSurvival of patients with metastatic breast cancer (MBC) suffering from brain metastasis (BM) is limited and this event is usually fatal. In 2010, the Graesslin's nomogram was published in order to predict subsequent BM in patients with breast cancer (BC) with extra-cerebral metastatic disease. This model aims to select a patient population at high risk for BM and thus will facilitate the design of prevention strategies and/or the impact of early treatment of BM in prospective clinical studies.Patients and methodsNomogram external validation was retrospectively applied to patients with BC and later BM between January 2005 and December 2012, treated in our institution. Moreover, risk factors of BM appearance were studied by Fine and Gray's competing risk analysis.ResultsAmong 492 patients with MBC, 116 developed subsequent BM. Seventy of them were included for the nomogram validation. The discrimination is good (area under curve = 0.695 [95% confidence interval, 0.61–0.77]). Risk factors of BM appearance are: human epidermal growth factor receptor 2 (HER2) overexpression/amplification, triple-negative BC and number of extra-cerebral metastatic sites (>1). With a competing risk model, we highlight the nomogram interest for HER2+ tumour subgroup exclusively.ConclusionGraesslin's nomogram external validation demonstrates exportability and reproducibility. Importantly, the competing risk model analysis provides additional information for the design of prospective trials concerning the early diagnosis of BM and/or preventive treatment on high risk patients with extra-cerebral metastatic BC.



http://ift.tt/2hUQQm3

Are rapidly growing cancers more lethal?

Publication date: February 2017
Source:European Journal of Cancer, Volume 72
Author(s): Hans-Olov Adami, Peter Csermely, Daniel V. Veres, Louise Emilsson, Magnus Løberg, Michael Bretthauer, Mette Kalager
The view, that rapidly growing tumours are more likely than slow-growing tumours to metastasize and become lethal, has remained almost axiomatic for decades. Unaware of any solid evidence supporting this view, we undertook an exhaustive system-level analysis of intra- and intercellular signalling networks. This analysis indicated that rapid growth and metastasis are often different outcomes of complex integrated molecular events. Evidence from humans can be derived chiefly from screening interventions because interval cancers that surface clinically shortly after a negative screening test are, on average, more rapidly growing than cancers not detected by screening. We reviewed all available data limited to cancers of the breast, cervix and large bowel. The evidence from humans provides no support for the theory that rapidly growing cancers are more prone to metastasize. These findings indicate that the prevailing view should be reconsidered, as should the impact of length-biased sampling in cancer screening, and the findings provide no support for treating interval cancers more aggressively than non-interval cancers.



http://ift.tt/2hUPA2q

Use of Interactive iBooks for Patient Education in Otology

Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.

http://ift.tt/2iyGKIh

Use of Interactive iBooks for Patient Education in Otology

Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter.

http://ift.tt/2iyGKIh

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

There are approximately 436,000 head and neck cancer survivors in the United States currently [1], with 5-year survival rates reported at 63.2% for oral cavity and pharynx and 60.6% for larynx [2]. Virtually all head and neck cancer (HNC) patients present with one or more oral or dental complications [3], which can be mild and include discomfort and pain, or more serious, with morbidities such as dysphagia, mucositis, xerostomia or osteoradionecrosis [4–6]. Further, these complications impact quality of life (QOL) long after treatment [5].

http://ift.tt/2hBggYh

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

There are approximately 436,000 head and neck cancer survivors in the United States currently [1], with 5-year survival rates reported at 63.2% for oral cavity and pharynx and 60.6% for larynx [2]. Virtually all head and neck cancer (HNC) patients present with one or more oral or dental complications [3], which can be mild and include discomfort and pain, or more serious, with morbidities such as dysphagia, mucositis, xerostomia or osteoradionecrosis [4–6]. Further, these complications impact quality of life (QOL) long after treatment [5].

http://ift.tt/2hBggYh

Eosinophilic airway inflammation in asthma is associated with an altered airway microbiome

Subjects with asthma have higher microbiome diversity, and an altered composition with more Proteobacteria and less Bacteroidetes compared to healthy controls. Studies comparing airway inflammation and airway microbiome are sparse, especially in subjects not on anti-inflammatory treatment.

http://ift.tt/2iOs7nA

Central Sleep Apnea: The problem of diagnosis

Central sleep-related breathing disturbances (SRBD) in heart failure patients are highly relevant in the practice of sleep medicine due to their prevalence and prognostic impact [1]. Repeated episodes of hypoxia and reoxygenation, as well as sympathetic activation associated with arousals from sleep promote the progression of heart failure [2]. As a consequence, both central and obstructive SRBD impair longterm survival of heart failure (HF) patients [3]. The results of the SERVE-HF trial are being intensively discussed intensively and have caused controversy [4, 5]; however, they only refer to patients with substantially reduced left ventricular ejection fraction (LVEF) [4, 6].

http://ift.tt/2igNXze

Unusual bifid crista galli in a patient with cleft lip and palate

Abstract

One of the most common craniofacial malformations observed in newborn babies is cleft lip and palate (CLP). This syndrome presents with some anatomic variations. The aim of this study was to understand an anatomic variation of the crista galli that had not been reported previously in patients with CLP. A 17-year-old boy with CLP was referred to an orthodontic clinic for cone-beam computed tomography (CBCT) imaging before treatment. Axial and coronal sections and three-dimensional images showed that the crista galli had bifid heads that were attached to each other. Incomplete ossification had resulted in a bifid crista galli and the appearance of a suture in the anterior coronal section of the CBCT images. This anatomic variation could allow penetration of the anterior fossa during endoscopic surgery, which could be dangerous for the patient.

http://ift.tt/2iyBBjr

Diagnostic value of computed tomography, magnetic resonance imaging, and scintigraphy in diagnosing actinomycosis of the mandible

Abstract

Mandibular actinomycosis is an uncommon disease caused by Actinomyces israelii. Actinomycosis infection typically manifests as a chronic disease resulting in multiple abscesses, firm soft tissue mass, and presence of sulfur granules in exudates or tissues. A few reports have provided imaging findings of actinomycosis in the head and neck, but computed tomography (CT), magnetic resonance imaging (MRI), and scintigraphy of mandibular actinomycosis have not been fully described. Here, we report a case of mandibular actinomycosis with CT, MRI, and scintigraphy. The purpose of this article is to characterize the CT, MRI, and scintigraphy findings in cases of actinomycosis. Contrast-enhanced CT of the masticator space showed heterogeneous enhancement and a nonenhancing portion, suggestive of necrotic foci. Bone tissue algorithm CT showed an osteolytic lesion in the ramus of the left mandible only. On post-contrast T1-weighted images, the masticator space showed heterogeneous enhancement and nonenhancing portion, suggestive of necrotic foci. Bone scintigraphy revealed monostatic involvement of the mandible with a homogeneous intense uptake pattern. Gallium scintigraphy revealed significantly increased uptake in the left side of the face. These findings can be helpful for differentiating actinomycosis from other tumors of the mandible.

http://ift.tt/2hBa1Uw

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying an Adequate Intensity and Variation in Treatment Response

Purpose

This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response.

Method

An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures.

Results

Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment.

Conclusion

The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

http://ift.tt/2igQeKB

Attic cholesteatoma with closure of the entrance to pars flaccida retraction pocket

We report three patients with pars flaccida-type cholesteatoma (attic cholesteatoma) with closure of the entrance to the cholesteatoma at the time of surgery. These patients were diagnosed with attic cholesteatoma requiring surgery on the basis of abnormal findings of the pars flaccida, audiometry, and temporal bone computed tomography during the clinical course. Intraoperatively, cholesteatoma matrix and granulation tissue were observed behind the intact pars flaccida epithelium, which suggested that the entrance had apparently closed and the continuity with the cholesteatoma matrix disappeared after resolution of inflammation at the pars flaccida.

http://ift.tt/2iNqhj4

Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Atopy is one of the most common causes of eosinophilia in the developed world.1,2 Antihistamines have been successfully used in the treatment of atopy and associated eosinophilia.3,4 However, it is unclear whether antihistaminic therapy is effective in controlling eosinophilia in patients without associated atopy.1–4 We present a case of a nonatopic child who presented with idiopathic eosinophilia responding to antihistaminic therapy.

http://ift.tt/2hUHIhA

Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

The association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.

http://ift.tt/2hD29na

Attic cholesteatoma with closure of the entrance to pars flaccida retraction pocket

We report three patients with pars flaccida-type cholesteatoma (attic cholesteatoma) with closure of the entrance to the cholesteatoma at the time of surgery. These patients were diagnosed with attic cholesteatoma requiring surgery on the basis of abnormal findings of the pars flaccida, audiometry, and temporal bone computed tomography during the clinical course. Intraoperatively, cholesteatoma matrix and granulation tissue were observed behind the intact pars flaccida epithelium, which suggested that the entrance had apparently closed and the continuity with the cholesteatoma matrix disappeared after resolution of inflammation at the pars flaccida.

http://ift.tt/2iNqhj4

A Comparative Study of the VHI-10 and the V-RQOL for Quality of Life Among Chinese Teachers With and Without Voice Disorders

To investigate the differences and correlation between the Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) in teachers in China with and without voice disorders.

http://ift.tt/2im5XGw

Cetirizine-responsive, persistent idiopathic eosinophilia in a nonatopic child

Atopy is one of the most common causes of eosinophilia in the developed world.1,2 Antihistamines have been successfully used in the treatment of atopy and associated eosinophilia.3,4 However, it is unclear whether antihistaminic therapy is effective in controlling eosinophilia in patients without associated atopy.1–4 We present a case of a nonatopic child who presented with idiopathic eosinophilia responding to antihistaminic therapy.

http://ift.tt/2hUHIhA

Autonomic function in adults with allergic rhinitis and its association with disease severity and duration

The association between allergic rhinitis (AR) and the autonomic nervous system (ANS) has recently received substantial attention. However, no studies have assessed how the heart rate variability (HRV) parameters are associated with duration and disease severity in AR.

http://ift.tt/2hD29na

A veil in the oral cavity: report of two cases of oral synechiae

An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.

http://ift.tt/2hxzDyh

Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella–nasion–A-point angle (SNA) of 80–84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip–chin–throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared.

http://ift.tt/2iOiUf6

Utility of polysomnography in determination of laryngomalacia severity

To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients.

http://ift.tt/2hD4FcJ

Otorhinolaryngology/Head and Neck Surgery in a Low Income Country: The Haitian Experience

Little is known regarding the diagnosis and management of pediatric surgical conditions of the head and neck in low-income countries. Haiti, the western hemisphere's poorest country, recently developed its first Otorhinolaryngology (ORL) department at the Hopital de L'Universite d'Etat d'Haiti (HUEH).1 This manuscript assesses the caseload at HUEH with a special emphasis on pediatric cases, with the aim of characterizing ORL related conditions and their treatments in low-income countries.

http://ift.tt/2hUQ3l4

A Population Based Analysis of the Implementation of Pediatric Facemasks in Girls Youth Lacrosse

To determine the incidence, relative risk reduction, odds ratio and absolute risk reduction of head and ear injuries associated with the implementation of pediatric facial eye guards in lacrosse events.

http://ift.tt/2hD37zL

Prevalence of and outcomes from Staphylococcus aureus pneumonia among hospitalized patients in the United States, 2009-2012

Publication date: Available online 30 December 2016
Source:American Journal of Infection Control
Author(s): David M. Jacobs, Amy Shaver
BackgroundThe burden of Staphylococcus aureus pneumonia is unknown despite being a major cause of mortality. We investigated national estimates of methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA) pneumonias and predictors of in-hospital mortality and hospital length of stay (LOS).MethodsThis was a retrospective analysis of the National Inpatient Sample from 2009-2012. Adult patients with an ICD-9-CM primary diagnosis code for MRSA or MSSA pneumonia were included. Data weights were used to derive national estimates. Prevalence rates were reported per 100,000 hospital discharges, with trends presented descriptively.ResultsThere were 104,562 patients who had a primary diagnosis of S aureus pneumonia, with 81,275 from MRSA. MRSA pneumonia prevalence decreased steadily from 2009 (75.6 cases per 100,000 discharges) to 2012 (56.6 cases per 100,000 discharges), with MSSA pneumonia experiencing a slight decrease. Mortality rates decreased between 2009 and 2012 for MRSA pneumonia (7.9% to 6.4%) and MSSA pneumonia (6.9% to 4.7%; P = .008). LOS was higher for MRSA (6.9-7.8 days) compared with MSSA (6.1-6.4 days).ConclusionsThe prevalence of MRSA pneumonia has decreased among hospitalized adults in the United States in recent years accompanied by improvements in mortality and LOS. Although the prevalence of MRSA pneumonia is declining, national vigilance is still warranted.



http://ift.tt/2imcdOd

Tofacitinib relieves symptoms of stimulator of interferon genes (STING)–associated vasculopathy with onset in infancy caused by 2 de novo variants in TMEM173

Stimulator of interferon genes (STING), which is encoded by transmembrane protein 173 (TMEM173), is an important mediator in initiating innate immune responses by detecting aberrant DNA species or cyclic di-GMP-AMP (cGAMP) in the cytosol and driving synthesis of type I interferon.1-3 cGAMP molecules, which are produced by cyclic GMP-AMP synthase, bind to STING homodimers embedded in the endoplasmic reticulum membrane and eventually cause phosphorylation of interferon regulatory factor 3 by activating Tank-binding kinase 1 (TBK1).

http://ift.tt/2igG9gV

The Acceptable Noise Level and the Pure-Tone Audiogram

Purpose

The vast majority of previous studies suggest that there is no relationship between the acceptable noise level (ANL) and pure-tone hearing thresholds reported as the average pure-tone hearing thresholds (pure-tone average). This study aims to explore (a) the relationship between hearing thresholds at individual frequencies and the ANL and (b) a measure of the slope of the audiogram and ANL.

Method

Sixty-three Danish adult hearing aid users participated. Assessments were pure-tone audiogram and 3 different versions of the ANL test made monaurally at 2 different sessions.

Results

The findings show that low-frequency hearing thresholds and the slope of the audiogram are significantly related to all versions of the ANL.

Conclusion

It is possible that previous studies have failed to discover a relationship between ANL and hearing thresholds due to the use of the broad 4-frequency pure-tone average. This has implications for our understanding of the ANL test.

http://ift.tt/2imfEo2

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)-17.

http://ift.tt/2iqfaje

Management of hidradenitis suppurativa in pregnancy

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women.

http://ift.tt/2imgd1r

Human polyomavirus 6 and 7 are associated with pruritic and dyskeratotic dermatoses

Human polyomavirus (HPyV)6 and HPyV7 are shed chronically from human skin. HPyV7, but not HPyV6, has been linked to a pruritic skin eruption of immunosuppression.

http://ift.tt/2iqpk3y

Versatility of buccinator flaps for the treatment of palatal defects: a series of cases

The buccinator flap is currently one of the best techniques for the reconstruction of defects in the oral cavity and other sites. Reconstruction of the palate is a major challenge because of the functional consequences of the excision of lesions in this area. The main goal is to maintain separation between the mouth and the nose. We have done a cross-sectional retrospective descriptive study of a series of cases reconstruction of palatal defects with buccinator flap at the University Hospital Miguel Servet in Zaragoza during a six-year period and compared our results, morbidity, and mortality with those of published series.

http://ift.tt/2igvzqh

Trial of Lenvatinib Plus Pembrolizumab in Subjects With Selected Solid Tumors

Condition:   Solid Tumors
Interventions:   Drug: lenvatinib;   Drug: pembrolizumab
Sponsor:   Eisai Co., Ltd.
Not yet recruiting - verified December 2016

http://ift.tt/2iynFGf

EUS-FNA for Retropharyngeal Lymph Node (RPLN) in Recurrent Nasopharyngeal Carcinoma (NPC) Patients

Condition:   Nasopharyngeal Carcinoma
Intervention:   Procedure: EUS-FNA for RPLN in NPC patients
Sponsor:   Sun Yat-sen University
Recruiting - verified December 2016

http://ift.tt/2hB2mFt

Relationship of Metabolic Syndrome and Its Components With Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2iymBCr

Influence of the SPInal MANipulation on Muscle Spasticity and Manual Dexterity in Cerebral Palsy.

Condition:   Cerebral Palsy, Spastic
Interventions:   Procedure: Spinal manipulation;   Procedure: Imitation of the spinal manipulation
Sponsor:   International Clinic of Rehabilitation, Ukraine
Recruiting - verified December 2016

http://ift.tt/2hAJcQ4

Exercise Program Based on Motor Learning and Forward Head Posture Correction

Conditions:   Musculoskeletal Abnormalities;   Deformity
Intervention:   Other: Exercise program based on motor learning principles
Sponsor:   Eleni Kapreli
Not yet recruiting - verified December 2016

http://ift.tt/2iykWww

Trial of Lenvatinib Plus Pembrolizumab in Subjects With Selected Solid Tumors

Condition:   Solid Tumors
Interventions:   Drug: lenvatinib;   Drug: pembrolizumab
Sponsor:   Eisai Co., Ltd.
Not yet recruiting - verified December 2016

http://ift.tt/2iynFGf

EUS-FNA for Retropharyngeal Lymph Node (RPLN) in Recurrent Nasopharyngeal Carcinoma (NPC) Patients

Condition:   Nasopharyngeal Carcinoma
Intervention:   Procedure: EUS-FNA for RPLN in NPC patients
Sponsor:   Sun Yat-sen University
Recruiting - verified December 2016

http://ift.tt/2hB2mFt

Relationship of Metabolic Syndrome and Its Components With Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Lin Liao
Not yet recruiting - verified December 2016

http://ift.tt/2iymBCr

Influence of the SPInal MANipulation on Muscle Spasticity and Manual Dexterity in Cerebral Palsy.

Condition:   Cerebral Palsy, Spastic
Interventions:   Procedure: Spinal manipulation;   Procedure: Imitation of the spinal manipulation
Sponsor:   International Clinic of Rehabilitation, Ukraine
Recruiting - verified December 2016

http://ift.tt/2hAJcQ4

Exercise Program Based on Motor Learning and Forward Head Posture Correction

Conditions:   Musculoskeletal Abnormalities;   Deformity
Intervention:   Other: Exercise program based on motor learning principles
Sponsor:   Eleni Kapreli
Not yet recruiting - verified December 2016

http://ift.tt/2iykWww

Enhancement of Chlorella vulgaris harvesting via the electro-coagulation-flotation (ECF) method

Abstract

This article explores the potential of using an electro-coagulation-flotation (ECF) harvester to allow flotation of microalgae cells for surface harvesting. A response surface methodology (RSM) model was used to optimize ECF harvesting by adjusting electrode plate material, electrode plate number, charge of the electrodes, electrolyte concentration, and pH value of the culture solution. The result revealed that three aluminum electrode plates (one anode and two cathodes), brine solution (8 g/L), and acidity (pH = 4) of culture solution (optimized ECF harvester) The highest flocculant concentration was measured at 2966 mg/L after 60 min and showed a 79.8 % increase of flocculation concentration. Such results can provide a basis for designing a large-scale microalgae harvester for commercial use in the future.

http://ift.tt/2hUrt46

Elemental content of mosses and lichens from Livingston Island (Antarctica) as determined by instrumental neutron activation analysis (INAA)

Abstract

The total content of 8 major and 32 trace elements in four species of mosses and two of lichens as well as neighboring soil and rocks collected from different places of the Livingston Island Antarctica was determined by instrumental neutron activation analysis. The main goals of the project consisted of evidencing the possible trace of anthropogenic contamination as well as the influence of altitude on the distribution of considered elements. In the absence of a unanimously accepted descriptor, enrichment factor, geo-accumulation, and pollution load indices with respect to soil and rocks were used. The data, interpreted within the model of a reference plant, were compared with previous studies regarding the same organisms in similar geographic and climatological areas. The experimental results evidenced different capacity of mosses and lichens to retain the considered elements, but within experimental uncertainties, no traces of anthropogenic pollution were found. At the same time, it was found that the content of most of the elements decreased with the altitude.

http://ift.tt/2hCNqbO

Forecasting residential electricity demand in provincial China

Abstract

In China, more than 80% electricity comes from coal which dominates the CO2 emissions. Residential electricity demand forecasting plays a significant role in electricity infrastructure planning and energy policy designing, but it is challenging to make an accurate forecast for developing countries. This paper forecasts the provincial residential electricity consumption of China in the 13th Five-Year-Plan (2016–2020) period using panel data. To overcome the limitations of widely used predication models with unreliably prior knowledge on function forms, a robust piecewise linear model in reduced form is utilized to capture the non-deterministic relationship between income and residential electricity consumption. The forecast results suggest that the growth rates of developed provinces will slow down, while the less developed will be still in fast growing. The national residential electricity demand will increase at 6.6% annually during 2016–2020, and populous provinces such as Guangdong will be the main contributors to the increments.

http://ift.tt/2hCXkdg

Carbon and water footprints of irrigated corn and non-irrigated wheat in Northeast Spain

Abstract

Irrigation increases yields and allows several crops to be produced in regions where it would be naturally impossible due to limited rainfall. However, irrigation can cause several negative environmental impacts, and it is important to understand these in depth for the correct application of mitigation measures. The life cycle assessment methodology was applied herein to compare the main irrigated and non-irrigated crops in Northeast Spain (corn and wheat, respectively), identifying those processes with greater contribution to environmental impacts (carbon and water footprint categories) and providing scientifically-sound information to facilitate government decisions. Due to concerns about climate change and water availability, the methods selected for evaluation of environmental impacts were IPCC 2013 GWP (carbon footprint) and water scarcity indicator (water footprint). The area studied, a 7.38-km² basin, was monitored for 12 years, including the period before, during, and after the implementation of irrigation. The functional unit, to which all material and energy flows were associated with, was the cultivation of 1 ha, throughout 1 year. The overall carbon footprint for irrigated corn was higher, but when considering the higher productivity achieved with irrigation, the emissions per kilogram of corn decrease and finally favor this irrigated crop. When considering the water footprint, the volumes of irrigation water applied were so high that productivity could not compensate for the negative impacts associated with water use in the case of corn. Nevertheless, consideration of productivities and gross incomes brings the results closer. Fertilizer use (carbon footprint) and irrigation water (water footprint) were the main contributors to the negative impacts detected.

http://ift.tt/2hUxOfV

The influence of maternal exposure history to virus and medicine during pregnancy on congenital heart defects of fetus

Abstract

Congenital heart disease (CHD) is the most common birth defect. It is due to dysfunction of the heart and great vessels during embryo development stage, or the channel was not closed after birth. This study focuses on investigating the influence of virus infection and medicine history during pregnancy on the incidence rate of CHD of fetus. We conducted a retrospective birth cohort study of infant born in the maternal and child health hospital of Fanyu district in Guangzhou. Five thousand three hundred eighty one cases with complete medical records, including mothers, fathers, and infants, were enrolled. The exposure history of mothers to virus and medicine from 6 months before pregnancy to prenatal examination was investigated, including mflu, mumps, measles, rubella, chickenpox, and hepatitis and antibiotics, tocolytic agent, anticonvulsants, antipyretic and analgesic, antitumor drug, folic acid supplement, and contraceptive. The relationship between virus infection and medicine history during pregnancy and CHD was analyzed. There was statistical difference between a normal group and a defected group in influenza infection and tocolytic agent and contraceptive pill. The exposure history to influenza and medicines, such as tocolytic agent and contraceptive pill, during pregnancy influenced the incidence rate of CHD of fetus.

http://ift.tt/2hCM00Q

Estimation of students’ exposure to metal concentrations from river-dust episodes during 1994–2012

Abstract

Two elementary schools (Shiuguang and Fongrong) from Yulin County in Taiwan, near a main area of potential exposure to Aeolian river-dust, were selected to collect outdoor and indoor PM₁₀ aerosols and to measure five metals in PM₁₀ (As, Ni, Cr, Cd, and Mn). Significant relationships (p < 0.01) were found between outdoor PM₁₀ concentrations at Lunbei's air quality monitoring station and the two elementary schools. The outdoor PM₁₀ concentrations at the monitoring station and the schools' indoor PM₁₀ concentrations also showed significant correlations. This study also established a relationship between the outdoor and indoor concentrations of PM₁₀ and metals in the schools. Estimations were made regarding students' 8 h of exposure to metal concentrations from river-dust episodes during 1994–2012, based on correlation equations that were shown to be statistically significant.

http://ift.tt/2hUq90S

Bacterial community profile of contaminated soils in a typical antimony mining site

Abstract

The soils around the world's largest antimony mine have been contaminated by high concentrations of Sb and As, which might influence microbial diversity in the surrounding soils. The ecological effects of bioavailable Sb and As on the composition and diversity of microbial community in soils remain unknown. In this study, the relative abundance, taxonomic diversity and composition of bacterial community in soils from a typical Sb mine area, and the relationship between the bacterial community and bioavailable concentrations as well as environmental factors have been investigated comprehensively using high-throughput sequencing (HTS) and diffusive gradients in thin films (DGT). The results indicated that Proteobacteria, Acidobacteria, Chloroflexi, Bacteroidetes, Actinobacteria, Gemmatimonadetes, and Cyanobacteria were the dominant bacterial populations at phylum level in all soil samples, accounting for more than 80% of the bacteria sequenced. The abundance and diversity of bacterial community vary along a metal contamination gradient. Redundancy discriminate analysis (RDA) revealed that 74.74% of bacterial community variation in the contaminated soils was explained by six environmental factors (pH, Sb_DGT, As_DGT, potential ecological risk index (RI), TC, TN), among which pH, Sb_DGT, and As_DGT were dominant factors influencing the composition and diversity of bacteria. This study contributes to our understanding of microbial diversity in a local ecosystem and introduces the option of studying bioavailable Sb and As using DGT.

http://ift.tt/2hCNGrf

Sublethal effect assessment of a low-power and dual-frequency anti-cyanobacterial ultrasound device on the common carp ( Cyprinus carpio ): a field study

Abstract

The use of ultrasonication for cyanobacterial control in freshwater bodies has become increasingly popular during the last decades despite controversial efficiency on large scale application. Apart from that, little information is currently available regarding ultrasound toxicity potential towards non-target species. This work was designed to address this issue in the common carp using a low-power (7–9 W output) and dual-frequency (23 and 46 kHz) anti-cyanobacterial ultrasound device. Results showed that carps were unaffected by ultrasound exposure when exposed in floating cages in fish ponds over a 30-day period. The experiment duration was the main factor influencing all measured biological parameters in exposed and non-exposed organisms. Indeed, it was positively associated with an increase in fish condition factor. Cortisol level also tended to slightly increase over the number of days of experiment but its variation did not enable to sort out any ultrasound exposure-related stress. Moreover, an overall diminution along the experimental period of the expression level of a set of biomarkers could be reported, encompassing cellular antioxidant enzyme activities such as superoxide dismutase (SOD), glutathione peroxydase (GPx), catalase and glutathione S-transferase (GST), and lactate dehydrogenase activity. Subtle changes in these biomarkers were dependent of the type of enzyme activity and especially of the origin of fish (i.e., sampled pond) regardless of the presence of ultrasound equipment, reflecting thereby fish adaptation to local environmental conditions in each pond. In conclusion, this study does not provide indication that ultrasonication in the aforementioned conditions affects the welfare and physiological homeostasis of carps.

http://ift.tt/2hUpaOi

Alkyl amine and vegetable oil mixture—a viable candidate for CO 2 capture and utilization

Abstract

In this present work, the absorption of CO₂ in alkyl amines and vegetable oil mixture has been evaluated. The results showed that the absorption is higher in alkyl amines and vegetable oil mixture compared with the aqueous alkyl amines. In addition to that, by employing the greener and non-toxic vegetable oil media, the CO₂ gas has been captured as well as converted into value-added products, such as carbamates of ethylenediamine, diethylenetriamine, and triethylenetetramine. The carbamates have been isolated and characterized by Fourier transform infrared and ¹H and ¹³C nuclear magnetic resonance spectroscopic techniques. The formation of these products in precipitate form has not been observed in the case of aqueous medium. Among the various alkyl amine and vegetable oil combinations, triethylenetetramine in coconut oil medium showed the maximum CO₂ capture capacity of 72%. The coconut oil used for the process has been recovered, recycled, and reused for 3 cycles. Thus, this novel scheme seems to be a better alternative to conquer the drawback of aqueous amine-based CO₂ capture as well as for the capture and utilization of the CO₂ gas to gain the value-added products.

http://ift.tt/2hCQcO9

Development of a PCR-free DNA-based assay for the specific detection of Vibrio species in environmental samples by targeting the 16S rRNA

Abstract

A novel PCR-free DNA-based assay was developed for the detection of Vibrio spp. A sandwich hybridization format using an immobilized capture probe and a labeled signal probe was selected and combined with chemiluminescent method for the detection of the RNA target. In a first step, probes were validated using positive controls (PCs). A linearity was observed between 0.1 and 2.5 nM of PC, and detection limit was determined as 0.1 nM. In a second step, specificity was checked by using RNA extracted from a panel of 31 environmental bacterial strains. Detection limit of 5 ng μL⁻¹ of total fragmented RNA was obtained, and the assay allowed a good discrimination between the 21 Vibrio and the 10 non-Vibrio strains tested. Finally, the DNA-based assay was successfully applied to analysis of spiked and natural environmental samples. Stability and analysis time of the DNA-based assay were also investigated to optimize working conditions. We demonstrated that microplates can be coated beforehand with capture probe and stored at 4 °C without any buffer in wells for at least 30 days. The use of the pre-made plates enables the assay to be completed in 2 h. The developed assay appeared as an interesting tool to determine the presence of bacteria in environmental samples.

http://ift.tt/2hUl9tq