Head and Neck Diseases by Alexandros G.Sfakianakis: 03/05/17

Κυριακή 5 Μαρτίου 2017

Autism genetics: opportunities and challenges for clinical translation

Various large studies have provided unprecedented insights into the genetics of autism spectrum disorders (ASDs). This Review discusses the challenges and opportunities of translating genetic and biological insights into clinical progress for ASDs, in areas including genetic testing, ASD classification, genetic counselling, comorbidities and therapeutics.

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Diagnostic Utility of Testosterone Priming Prior to Dynamic Tests to Differentiate Constitutional Delay in Puberty from Isolated Hypogonadotropic Hypogonadism

Abstract

Context

Differentiation between constitutional delay in puberty (CDP) and isolated hypogonadotropic hypogonadism (IHH) during adolescence is a great clinical challenge and the available diagnostic tests are of limited value.

Objective

To study the effect of withdrawal of short term, low dose testosterone therapy (testosterone priming) on the discriminatory power of dynamic tests for hypothalamo-pituitary-testicular axis to differentiate CDP from IHH.

Design

A prospective study (n=30) consisting of 20 boys with delayed puberty (Group A) and 10 patients with IHH (Group B).

Intervention

Patients in groups A and B underwent Triptorelin and hCG stimulation tests, prior to and 2 months after withdrawal of 'testosterone priming' (100 mg intramuscularly 4 weekly for 3 months) and were followed up until onset of puberty or 18 years of age, whichever was earlier.

Results

At baseline, Triptorelin-stimulated 4h LH, with a cut-off of 2.8 IU/l, and hCG-stimulated day 7 testosterone with a cut-off of 3.8 nmol/L had sensitivities of 80% each, and specificities of 93% and 87%, respectively, to diagnose CDP. After withdrawal of testosterone,a 4h LH cut-off of 14.7IU/l and day 7 testosterone cut-off of 10.3nmol/L had sensitivities of 93% and 88% respectively, and specificity and positive predictive value of 100% each. A basal inhibin B >94.7ng/l was discriminatory for diagnosing CDP after withdrawal of testosterone priming.

Conclusions

Inhibin B levels or 4 h LH after Triptorelin stimulation are the best discriminatory tests to differentiate CDP from IHH, when performed after withdrawal of 'testosterone priming'.

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Apolipoprotein B: a possible new biomarker for anaphylaxis

There are few published studies describing biochemical markers that correlate with the severity of anaphylactic reactions during oral food challenges or accidental reactions to foods. Identifying patients with increased risk of severe reactions is a priority within the field of anaphylaxis. Previous studies have examined laboratory markers such as specific immunoglobulin E (IgE; to allergenic foods or components thereof), parameters of the basophil activation test, and platelet-activating factor (PAF).

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The PD20 but not the PC20 in a methacholine challenge test is device independent

Methacholine challenge tests aid in the diagnosis or exclusion of asthma based on the dose (PD20) or concentration (PC20) of inhaled methacholine that provokes a 20% decrease in the forced expiratory volume in 1 second (FEV1). However, since the American Thoracic Society (ATS) standards were published in 2000,1 the English Wright nebulizer (EW) recommended for the 2-minute tidal breathing method has become difficult to find; hence, many laboratories substitute other nebulizers with little standardization of the amount expected to deposit within the lungs.

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Apolipoprotein B: a possible new biomarker for anaphylaxis

The PD20 but not the PC20 in a methacholine challenge test is device independent

VideoEndocrinology™ High-Impact Videos

FREE ACCESS through March 14, 2017.

Transoral Endoscopic Total Parathyroidectomy in Renal Hyperparathyroidism Patient
Thanyawat Sasanakietkul, Wirada Wandee, Pornpeera Jitpratoom, Angkoon Anuwong

Transoral Endoscopic Thyroidectomy Vestibular Approach
Thanyawat Sasanakietkul, Tobias Carling

Robotic Bilateral Cortical-Preserving Adrenalectomy in an MEN2A Patient with Steroid Allergy
Nisar Zaidi, Zanati Ahmed, Jesse Gutnick, Eren Berber

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

http://ift.tt/2m9lScM

VideoEndocrinology™ High-Impact Videos

FREE ACCESS through March 14, 2017.

Transoral Endoscopic Total Parathyroidectomy in Renal Hyperparathyroidism Patient
Thanyawat Sasanakietkul, Wirada Wandee, Pornpeera Jitpratoom, Angkoon Anuwong

Transoral Endoscopic Thyroidectomy Vestibular Approach
Thanyawat Sasanakietkul, Tobias Carling

Robotic Bilateral Cortical-Preserving Adrenalectomy in an MEN2A Patient with Steroid Allergy
Nisar Zaidi, Zanati Ahmed, Jesse Gutnick, Eren Berber

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

http://ift.tt/2m9lScM

Reply

We thank Tam and Grayson1 for their correspondence and for raising the interesting possibility that rhinovirus-specific IgE might play a role in mediating the severity of rhinovirus-triggered asthma exacerbation. Although our data do not exclude this possibility, we point out several lines of evidence that support the key role that allergic sensitization (mainly to house dust mite) plays in influencing the clinical phenotype of rhinovirus infection: (1) There is a robust interaction between early life sensitization to dust mite and early life rhinovirus infection that amplifies the risk of asthma inception later in life.

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IgE and antiviral immune response in asthma

We read with interest the article by Kantor et al,1 in which they showed that rhinovirus-triggered asthma exacerbation was associated with higher asthma exacerbation severity and drove a higher antigen-specific IgE response. Looking specifically at mouse and dust mite sensitization, they found that the magnitude of the rise in specific IgE level was associated with the severity of the rhinovirus-triggered asthma exacerbation. On the basis of this, they concluded that interactions between rhinovirus infection and allergen-specific IgE levels may help to explain interindividual variation in disease manifestation.

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Subepithelial rectal gastrointestinal stromal tumor – the use of endoscopic ultrasound-guided fine needle aspiration to establish a definitive cytological diagnosis: a case report

Gastrointestinal stromal tumors are the most common mesenchymal neoplasms affecting the gastrointestinal tract. The stomach is the most common location to be affected, and the rectum one of the rarest, but the...

http://ift.tt/2mqZApt

Plasticity of hippocampal memories in humans

Publication date: April 2017
Source:Current Opinion in Neurobiology, Volume 43
Author(s): Aidan J Horner, Christian F Doeller
The human hippocampus is a brain region that supports episodic and spatial memory. Recent experiments have drawn on animal research and computational modelling to reveal how the unique computations and representations of the hippocampus support episodic and spatial memory. Invasive electrophysiological recordings and non-invasive functional brain imaging have provided evidence for the rapid formation of hippocampal representations, as well as the ability of the hippocampus to both pattern-separate and pattern-complete input from the neocortex. Further, recent evidence has shown that hippocampal representations are in constant flux, undergoing a continual process of strengthening, weakening and altering. This research offers a glimpse into the highly plastic and flexible nature of the human hippocampal system in relation to episodic memory.

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The Association Between Disruptive Mood Dysregulation Disorder Symptoms and Sleep Problems in Children with and without ADHD

Many youth experience persistent irritability and recurrent temper outbursts, conceptualized by DSM-5 as Disruptive Mood Dysregulation Disorder (DMDD). Sleep deprivation impairs emotion regulation which could increase rates of DMDD symptoms, especially in those with preexisting regulatory impairments, as seen with ADHD. However, there has been little examination of the relationship between chronic sleep problems and DMDD symptoms.

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Exploring the nap paradox: are mid-day sleep bouts a friend or foe?

The mid-day nap, sometimes called a siesta, is a ubiquitous occurrence across the lifespan. It is well established that in addition to reducing sleepiness, mid-day naps offer a variety of benefits: memory consolidation, preparation for subsequent learning, executive functioning enhancement, and a boost in emotional stability. These benefits are present even if a sufficient amount of sleep is obtained during the night prior. However, we present a paradox: in spite of these reported benefits of naps, frequent napping has also been associated with numerous negative outcomes (eg, cognitive decline, hypertension, diabetes), particularly in older populations.

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The SERVE-HF safety notice in clinical practice-experiences of a tertiary sleep center

In May 2015, the results of the SERVE-HF trial - addressing adaptive servoventilation (ASV) in chronic heart failure (CHF) patients with central sleep apnea (CSA) - prompted a field safety notice. It was recommended to identify CHF patients treated with ASV and to advise the discontinuation of the treatment. We aimed to analyze the identification process and effect of ASV discontinuation on affected patients.

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Autocannibalism induced by obstructive sleep apnea

A 55-year-old tetraplegic male was referred to the sleep center with symptoms of obstructive sleep apnea (OSA). He also had an unusual history of biting his fingers off, reportedly in his sleep. Polysomnography confirmed severe obstructive sleep apnea and video analysis showed that apneic arousals induced these finger biting episodes. The patient was successfully treated with continuous positive airway pressure therapy and is no longer damaging his remaining digits during sleep.

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A Comparison of Two Cadaveric Acellular Dermal Matrices for Immediate Breast Reconstruction: A Prospective Randomized Trial

AlloDerm RTU® and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients were randomized into AlloMax or AlloDerm arms (n=15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on post-operative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration.

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Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency

The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy.

http://ift.tt/2mtxCtp

Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: A multicenter study of 446 surgical cases in Japan

The Objective of this study was to assess the practicality of the cholesteatoma staging system proposed by the Japan Otological Society (JOS) for acquired middle ear cholesteatoma (the 2010 JOS staging system).

http://ift.tt/2m9hUB1

Protective effect of an astaxanthin nanoemulsion against neomycin-induced hair-cell damage in zebrafish

Degeneration of the mechanosensory hair cells of the inner ear sensory epithelia is the main cause of deafness. Hair cells are commonly lost through drug-and noise-induced trauma, as well as aging. Many recent studies have reported that the cause of damage to these hair cells is oxidative stress due to free radicals. In particular, hair cells are very susceptible to aminoglycosides [1]. Antioxidants reduce the generation of oxygen-derived free radicals, and various antioxidants have been marketed, with different dosage forms available for each agent.

http://ift.tt/2lu6Z8a

Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: A multicenter study of 446 surgical cases in Japan

Protective effect of an astaxanthin nanoemulsion against neomycin-induced hair-cell damage in zebrafish

The Analysis of Reliability and Validity of the IT-MAIS, MAIS and MUSS

The aim of this study was to investigate the reliability and validity of the Infant-toddler Meaningful Auditory Integration Scale (IT-MAIS), Meaningful Auditory Integration Scale (MAIS), and Meaningful Use of Speech Scale (MUSS).

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Theory of mind and language development in Japanese children with hearing loss

This study investigates the development of theory of mind (ToM) in Japanese children with hearing loss (HL) and its relationship with language abilities using the data of a large sample size.

http://ift.tt/2mqMQ1S

Coblation of suprastomal granulomas in tracheostomy-dependent children

Suprastomal granulomas pose a persistent challenge for tracheostomy-dependent children. They can limit phonation, cause difficulty with tracheostomy tube changes and prevent decannulation. We describe the use of the coblator for radiofrequency plasma ablation of suprastomal granulomas in five consecutive children from September 2012 to January 2016.

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Medial Olivocochlear function in children with poor speech-in-noise performance and language disorder

Contralateral masking of transient-evoked otoacoustic emissions is a phenomenon that suggests an inhibitory effect of the olivocochlear efferent auditory pathway. Many studies have been inconclusive in demonstrating a clear connection between this system and a behavioral speech-in-noise listening skill. The purpose of this study was to investigate the activation of a medial olivocochlear (MOC) efferent in children with poor speech-in-noise (PSIN) performance and children with language impairment and PSIN (SLI+PSIN).

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Using sildenafil (viagra) to treat congenital lymphatic malformations of the head and neck, our experience

This case report demonstrates the multiple challenges a paediatric otolaryngologist encounters when treating children with congenital lymphatic malformations of the head and neck. The pathophysiology of this condition, which presents as a broad spectrum of disease, is poorly understood and perhaps explains why directed medical therapy is yet to be wholly successful. Current reported approaches include observation in the outpatient setting, surgical resection, endovascular sclerotherapy and radiofrequency ablation [1].

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Primary respiratory and food allergy to mealworm

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The benzene metabolite 1,4-benzoquinone reduces Treg function – a potential mechanism for tobacco smoke-associated atopic dermatitis

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Subepithelial rectal gastrointestinal stromal tumor – the use of endoscopic ultrasound-guided fine needle aspiration to establish a definitive cytological diagnosis: a case report

Improved prediction of protein–protein interactions using novel negative samples, features, and an ensemble classifier

Publication date: Available online 4 March 2017
Source:Artificial Intelligence in Medicine
Author(s): Leyi Wei, Pengwei Xing, Jiancang Zeng, JinXiu Chen, Ran Su, Fei Guo
Computational methods are employed in bioinformatics to predict protein–protein interactions (PPIs). PPIs and protein–protein non-interactions (PPNIs) display different levels of development, and the number of PPIs is considerably greater than that of PPNIs. This significant difference in the number of PPIs and PPNIs increases the cost of constructing a balanced dataset. PPIs can be classified as either physical or genetic. However, ready-made PPNI databases were proven only to have no physical interactions and were not proven to have no genetic interactions. Hence, ready-made PPNI databases contain false negative non-interactions. In this study, two PPNI datasets were artificially generated from a PPI database. In contrast to various traditional PPI feature extraction methods based on sequential information, two types of novel feature extraction methods were proposed. One is based on secondary structure information, and the other is based on the physicochemical properties of proteins. The experimental results of the RandomPairs dataset validate the efficiency and effectiveness of the proposed prediction model. These results reveal the potential of constructing a PPI negative dataset to reduce false negatives. Related datasets, tools, and source codes are accessible at http://ift.tt/2mUCNQH.

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Pharmacological and antihyperalgesic properties of the novel α2/3 preferring GABAA receptor ligand MP-III-024

Publication date: Available online 4 March 2017
Source:Brain Research Bulletin
Author(s): Bradford D. Fischer, Raymond J. Schlitt, Bryan Z. Hamade, Sabah Rehman, Margot Ernst, Michael M. Poe, Guanguan Li, Revathi Kodali, Leggy A. Arnold, James M. Cook
γ-Aminobutyric acid type A (GABAA) receptors are located in spinal nociceptive circuits where they modulate the transmission of pain sensory signals from the periphery to higher centers. Benzodiazepine-type drugs bind GABAA, receptors containing α1, α2, α3, and α5 subunits (α1GABAA, α2GABAA, α3GABAA, and α5GABAA receptors, respectively) through which they inhibit the transmission of these signals. However, the role of these different GABAA receptor subtypes in the antihyperalgisic properties of benzodiazepine-type drugs has not been characterized fully and is limited by currently available compounds. In the present study we describe the novel benzodiazepine site positive allosteric modulator modulator methyl 8-ethynyl-6-(pyridin-2-yl)-4H-benzo[f]imidazo[1,5-a][1,4]diazepine-3-carboxylate (MP-III-024). MP-III-024 displayed preference for α2GABAA and α3GABAA receptors relative to α1GABAA and α5GABAA receptors as well as an improved metabolic profile relative to subtype-selective positive modulators that are available currently. MP-III-024 produced a dose- and time-dependent reversal of mechanical sensitivity. On locomotor activity and schedule-controlled responding, MP-III-024 was ineffective across the doses tested. These data provide further evidence that α2GABAA and α3GABAA receptors play an important role in the antihyperalgiesic effects and may not be involved in some of the off target effects of benzodiazepine-like drugs. Further, these findings suggest that MP-III-024 is an ideal research tool for investigating the role of α2GABAA and α3GABAA receptors in the behavioral properties of benzodiazepine-like drugs in mice.

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Characterizations of CD4-1, CD4-2 and CD8β T cell subpopulations in peripheral blood leucocytes, spleen and head kidney of Japanese flounder (Paralichthys olivaceus)

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Jing Xing, Junjie Ma, Xiaoqian Tang, Xiuzhen Sheng, Wenbin Zhan
In the previous study, antibodies against CD3 molecule have been produced and were used in labeling T cells in Japanese flounder (Paralichthys olivaceus). In this paper, CD4⁺ and CD8⁺ lymphocytes subpopulations in peripheral blood leucocytes (PBL), spleen and head kidney of flounder were investigated. The flounder CD4-1, CD4-2 and CD8β recombinant proteins and their antibodies (Abs) were produced, then the cross-reactivity of the Abs to CD4-1, CD4-2 and CD8β was detected by Western blotting, respectively, and the reactions of Abs to PBL were analyzed by immunofluorescence staining (IFS) and flow cytometry (FCM). CD4-1⁺/CD3⁺, CD4-2⁺/CD3⁺, and CD8β⁺/CD3⁺ lymphocytes in PBL, spleen and head kidney were observed by double IFS, then their proportions were analyzed using two-color FCM, respectively. Further, CD4-1/CD8β, CD4-2/CD8β, or CD4-1/CD4-2 lymphocytes were analyzed using double-IFS and two-color FCM. Finally, CD4-1⁺, CD4-2⁺, and CD8β⁺ lymphocytes in spleen and head kidney were observed by immunohistochemistry. The results showed that the Abs were specific for CD4-1, CD4-2 and CD8β molecules, respectively. The proportions of CD4-1⁺/CD3⁺, CD4-2⁺/CD3⁺, and CD8β⁺/CD3⁺ lymphocytes were 6.7±2.0%, 8.6±2.8%, 2.1±1.3% in PBL; 13.6±3.6%, 15.6±5.2%, 2.8±1.4% in spleen; 20.0±4.6%, 20.5±4.6%, 3.2±1.5% in head kidney, respectively. Most CD4⁺ and CD8⁺ cell subpopulations belonged to CD3⁺ cells; there were no cross-reactivity between CD4⁺ and CD8⁺ cells. CD4-1⁺/CD4-2⁻, CD4-1⁻/CD4-2⁺, and CD4-1⁺/CD4-2⁺ cells presented different proportions in PBL, spleen and head kidney, among them, CD4-1⁺/CD4-2⁺ cell is the majority of CD4T cell subpopulation.

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Characterizations of CD4-1, CD4-2 and CD8β T cell subpopulations in peripheral blood leucocytes, spleen and head kidney of Japanese flounder (Paralichthys olivaceus)

Inhibition of Bcl-2/xl with ABT-263 selectively kills senescent Type II pneumocytes and reverses persistent pulmonary fibrosis induced by ionizing radiation in mice

Publication date: Available online 4 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jin Pan, Deguan Li, Yanfeng Xu, Junling Zhang, Yueying Wang, Mengyi Chen, Shuai Lin, Lan Huang, Eun Joo Chung, Deborah E. Citrin, Yingying Wang, Martin Hauer-Jensen, Daohong Zhou, Aimin Meng
PurposeIonizing radiation (IR)-induced pulmonary fibrosis (PF) is an irreversible and severe late effect of thoracic radiotherapy. The goal of this study was to determine whether clearance of senescent cells with ABT-263, a senolytic drug that can selectively kill senescent cells, can reverse PF.Methods and MaterialsC57BL/6J mice were exposed to a single dose of 17 Gy on the right side of the thorax. Sixteen weeks after IR, they were treated with 2 cycles of vehicle or ABT-263 (50 mg/kg/day for 5 days per cycle) by gavage. The effects of ABT-263 on IR-induced increases in senescent cells, elevation in the expression of selective inflammatory cytokines, matrix metalloproteinases (Mmps) and tissue inhibitors of Mmps (Timps), and the severity of the tissue injury and fibrosis in the irradiated lungs were evaluated 3 weeks after the last treatment, in comparison with the changes observed in the irradiated lungs before the treatment or after vehicle treatment.ResultsThe results show that 16 weeks after exposure of C57BL/6 mice to a single dose of 17 Gy thoracic irradiation resulted in persistent pulmonary fibrosis associated with a significant increase in senescent cells. Treatment of the irradiated mice with ABT-263 after they had developed persistent pulmonary fibrosis reduced senescent cells and reversed the disease.ConclusionsTo our knowledge, this is the first study to demonstrate that PF can be reserved by a senolytic drug such as ABT-263 after it becomes a progressive disease. Therefore, ABT-263 has the potential to be developed as a new treatment for PF.

Teaser

Ionizing radiation (IR)-induced pulmonary fibrosis (PF) is an irreversible and severe late effect of thoracic radiotherapy. Our studies show that ABT-263, a specific Bcl-2/xl inhibitor and a newly identified senolytic drug that can selectively kill senescent cells, could reverse PF even when the pulmonary fibrosis had already became persistent in mice after thoracic irradiation. This finding suggests that ABT-263 has the potential to be used as an effective treatment for PF.

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Interim 18FDG PET/CT during chemo-radiotherapy in the management of head-neck cancer patients: a systematic review

Publication date: Available online 4 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Cristina Garibaldi, Sara Ronchi, Marta Cremonesi, Laura Gilardi, Laura Travaini, Mahila Ferrari, Daniela Alterio, Johannes H.A.M. Kaanders, Delia Ciardo, Roberto Orecchia, Barbara Alicja Jereczek-Fossa, Chiara Maria Grana
Positron-Emission-Tomography (PET) is an imaging modality widely applied in oncology for tumor staging, volume delineation in radiotherapy planning, and therapy response assessment. ¹⁸F-fluorodeoxyglucose PET combined with Computed Tomography (¹⁸F-FDG-PET/CT) plays a significant role in the management of locally advanced head-neck cancer patients in the pre-treatment setting to predict outcome and prognosis and after chemo-radiotherapy (CRT) to assess tumor response. This review aims to evaluate the use of FDG-PET acquired during CRT, ad interim FDG (FDGint), in order to identify tumor response at an early stage, modify the treatment plan if necessary or setup alternative strategies to enhance the therapeutic ratio. Most of the works confirmed the value of FDGint in predicting the response to CRT, while a few highlighted the poor predictive value of FDGint compared to FDG acquired two-four months after the end of CRT, which was well correlated with local and regional control and survival. Such findings deserve to be further analyzed in a more numerous and homogeneous series according to the tumor site and CRT schedules. The best time to assess tumor response during RT remains a matter of debate, although two weeks seem most favorable, still providing opportunity to adapt the treatment strategy.

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Outcomes of Routine Intensity Modulated Radiotherapy Quality Assurance in a large Head and Neck Cancer Center

Publication date: Available online 4 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Isuru Amarasena, Ieta D'Costa, Tsien Fua, Albert Tiong, Vaughan Geddes, Phillip Tran, Chen Liu, June Corry
This is a retrospective analysis of a prospective database analysing an IMRT QA programme utilised in routine clinical practice at a large HNC center. The programme resulted in significant percentage of Major changes that were implemented and the time required for the QA process was less than expected. This study can inform discussion on optimal RT QA processes in routine clinical practice.

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Long-term growth decline in Toona ciliata in a moist tropical forest in Bangladesh: Impact of global warming

Publication date: April 2017
Source:Acta Oecologica, Volume 80
Author(s): Mizanur Rahman, Rofiqul Islam, Mahmuda Islam
Tropical forests are carbon rich ecosystems and small changes in tropical forest tree growth substantially influence the global carbon cycle. Forest monitoring studies report inconsistent growth changes in tropical forest trees over the past decades. Most of the studies highlighted changes in the forest level carbon gain, neglecting the species-specific growth changes which ultimately determine community-level responses. Tree-ring analysis can provide historical data on species-specific tree growth with annual resolution. Such studies are inadequate in Bangladesh, which is one of the most climate sensitive regions in the tropics. In this study, we investigated long-term growth rates of Toona ciliata in a moist tropical forest of Bangladesh by using tree-ring analysis. We sampled 50 trees of varying size, obtained increment cores from these trees and measured tree-ring width. Analyses of growth patterns revealed size-dependent growth increments. After correcting for the effect of tree size on tree growth (ontogenetic changes) by two different methods we found declining growth rates in T. ciliata from 1960 to 2013. Standardized ring-width index (RWI) was strongly negatively correlated with annual mean and maximum temperatures suggesting that rising temperature might cause the observed growth decline in T. ciliata. Assuming that global temperatures will rise at the current rate, the observed growth decline is assumed to continue. The analysis of stable carbon and oxygen isotopes may reveal more insight on the physiological response of this species to future climatic changes.

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Non-mammalian models reveal the role of alternative ligands for thyroid hormone receptors

Publication date: Available online 4 March 2017
Source:Molecular and Cellular Endocrinology
Author(s): Aurea Orozco, Iván Lazcano, Gabriela Hernández-Puga, Aurora Olvera
Thyroid hormones, or THs, are well-known regulators of a wide range of biological processes that occur throughout the lifespan of all vertebrates. THs act through genomic mechanisms mediated by thyroid hormone receptors (TRs). The main product of the thyroid gland is thyroxine or T4, which can be further transformed by different biochemical pathways to produce at least 15 active or inactive molecules. T3, a product of T4 outer-ring deiodination, has been recognized as the main bioactive TH. However, growing evidence has shown that other TH derivatives are able to bind to, and/or activate TRs, to induce thyromimetic effects. The compiled data in this review points to at least two of these TR alternative ligands: TRIAC and T2. Taking this into account, non-mammalian models have proven to be advantageous to explore new TH derivatives with potential novel actions, prompting a re-evaluation of the role and mechanism of action of TR alternative ligands that were previously believed to be inactive. The functional implications of these ligands across different vertebrates may require us to reconsider current established notions of thyroid physiology.

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Are Future Radiation Oncologists Equipped With the Knowledge to Manage Elderly Patients With Cancer?

Are Future Radiation Oncologists Equipped With the Knowledge to Manage Elderly Patients With Cancer?

Int J Radiat Oncol Biol Phys. 2017 Jan 09;:

Authors: Morris L, Thiruthaneeswaran N, Lehman M, Hasselburg G, Turner S

Abstract
PURPOSE: To assess radiation oncology (RO) trainee knowledge, attitudes, and clinical practice relating to geriatric oncology.
METHODS AND MATERIALS: A custom online survey was anonymously administered to RO trainees across Australia, New Zealand, and Singapore. The survey assessed 3 domains: (1) trainee demographics and prior training in geriatric medicine; (2) current clinical practice and attitudes regarding elderly cancer patients and radiation therapy; and (3) opinions regarding educational opportunities around geriatric oncology. The survey was developed and reviewed by radiation oncologists with expertise in education and training.
RESULTS: A total of 61 trainees (52%) responded to the survey. More than half had not undertaken a geriatric medicine term before RO speciality training. A total of 91.8% of respondents had not received teaching during RO training specifically regarding geriatric oncology. The use of geriatric assessment (GA) tools for determining suitability for radiation therapy was uncommon, with 80.3% of respondents rarely or never using them. More than two-thirds of respondents reported not seeking or rarely seeking multidisciplinary input from a geriatrician when assessing suitability for treatment. Trainees had low confidence levels in managing complex issues commonly observed in the elderly. Only 39.3% felt they had the confidence to manage these issues, with 31.2% not confident/not at all confident. Respondents reported functional status, assessment of comorbidity, physiologic age, and cognition as the major factors applied to treatment decisions. Input from a geriatrician was lowest ranked. Of factors influencing choice of dose/fractionation schedule, physiologic age ranked highest, whereas use of GA tool ranked the lowest. The majority of trainees (85.3%) agreed or strongly agreed they would benefit from more training around RO in elderly patients, and 65.6% felt the addition of learning objectives to RO curriculum around geriatric oncology would be valuable.
CONCLUSIONS: Radiation oncology trainees report inadequate training and experience in geriatric oncology and geriatric medicine. Radiation oncology trainees rarely use and poorly understand the rationale for GA tools and geriatrician input in clinical practice. Trainees strongly support improved education in geriatric oncology.

PMID: 28258899 [PubMed - as supplied by publisher]

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Using Proton Beam Therapy in the Elderly Population: A Snapshot of Current Perception and Practice.

Using Proton Beam Therapy in the Elderly Population: A Snapshot of Current Perception and Practice.

Int J Radiat Oncol Biol Phys. 2017 Jan 06;:

Authors: Thariat J, Sio T, Blanchard P, Patel S, Demizu Y, Ampil F, Guihard S, Miller RC, Karlsson U, Krengli M, Giap H, Nguyen N

Abstract
PURPOSE: With limited proton therapy (PT) resources, several centers have designed their own decision-making systems for PT slot prioritization. The pediatric population is well recognized for deriving benefits from PT; however, elderly patients are not a focus for PT. When should PT be considered for use in the elderly population?
METHODS AND MATERIALS: We performed a pilot survey of 25 international academic radiation oncologists (ROs) who also spend significant amounts of clinical time caring for elderly patients.
RESULTS: Of the 12 respondents (48%), 58% used photons only, 17% used protons only, and 25% used photons and protons. Their definition of elderly was age ≥70 years. Geriatric evaluation was not systematic. Hypofractionation (60%) and decrease in total dose (50%) were advocated by half the ROs on the basis of age. Target volumes were similar to those in young patients for 80% of ROs. Organs at risk (OARs) associated with vulnerability and constraints to these OARs were considered different for 40% and 10% of ROs, respectively. Priorities for PT were ranked from highest to lowest as follows: survival, toxicity, quality of life, tumor coverage, locoregional control, patient's wish, dose to vulnerable OARs (oral mucosa, esophagus), quality-adjusted life-years, cost, irradiated volume, and integral dose. All ROs considered elderly patients eligible for accrual in clinical trials.
CONCLUSIONS: This snapshot survey showed the current gap between chronological age and eventual PT allocation among some PT centers worldwide. The findings suggest that elderly age may become an even weaker argument against PT in the future. They also point out a lack of a systematic geriatric approach. As PT might be regarded as a relevant therapeutic means in the elderly population to limit the toxicity burden and hospital costs, better guidance to allocate PT for this growing segment of the population is still needed.

PMID: 28258888 [PubMed - as supplied by publisher]

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Patients with negative multi-gene panel testing: a back to the future paradox?

Patients with negative multi-gene panel testing: a back to the future paradox?

Fam Cancer. 2017 Mar 03;:

Authors: Sorscher SM

PMID: 28258424 [PubMed - as supplied by publisher]

http://ift.tt/2lLratn

Facing two faces: Defense activation varies as a function of personal relevance

Publication date: Available online 4 March 2017
Source:Biological Psychology
Author(s): Florian Bublatzky, Georg W. Alpers
It can be unsettling to be watched by a group of people, and when they express anger or hostility, this can prime defensive behavior. In contrast, when others smile at us, this may be comforting. This study tested to which degree the impact of facial expressions (happy, neutral, and angry) varies with the personal relevance of a social situation. Modelling a triadic situation, two faces looked either directly at the participant, faced each other, or they were back to back. Results confirmed that this variation constitutes a gradient of personal relevance (directed frontally > towards > away), as reflected by corresponding defensive startle modulation and autonomic nervous system activity. This gradient was particularly pronounced for angry faces and it was steeper in participants with higher levels of social anxiety. Thus, sender-recipient constellations modulate the processing of facial emotions in favor of adequate behavioral responding (e.g., avoidance) in group settings.

http://ift.tt/2mThwql

Automating Cell Detection and Classification in Human Brain Fluorescent Microscopy Images Using Dictionary Learning and Sparse Coding

Publication date: Available online 4 March 2017
Source:Journal of Neuroscience Methods
Author(s): Maryana Alegro, Panagiotis Theofilas, Austin Nguy, Patricia A. Castruita, William Seeley, Helmut Heinsen, Daniela M. Ushizima, Lea T. Grinberg
BackgroundImmunofluorescence (IF) plays a major role in quantifying protein expression in situ and understanding cell function. It is widely applied in assessing disease mechanisms and in drug discovery research. Automation of IF analysis can transform studies using experimental cell models. However, IF analysis of postmortem human tissue relies mostly on manual interaction, often subjected to low-throughput and prone to error, leading to low inter and intra-observer reproducibility. Human postmortem brain samples challenges neuroscientists because of the high level of autofluorescence caused by accumulation of lipofuscin pigment during aging, hindering systematic analyses. We propose a method for automating cell counting and classification in IF microscopy of human postmortem brains. Our algorithm speeds up the quantification task while improving reproducibility.New methodDictionary learning and sparse coding allow for constructing improved cell representations using IF images. These models are input for detection and segmentation methods. Classification occurs by means of color distances between cells and a learned set.ResultsOur method successfully detected and classified cells in 49 human brain images. We evaluated our results regarding true positive, false positive, false negative, precision, recall, false positive rate and F1 score metrics. We also measured user-experience and time saved compared to manual countings.Comparison with existing methodsWe compared our results to four open-access IF-based cell-counting tools available in the literature. Our method showed improved accuracy for all data samples.ConclusionThe proposed method satisfactorily detects and classifies cells from human postmortem brain IF images, with potential to be generalized for applications in other counting tasks.

http://ift.tt/2lsQKbv

Isometric endurance test of the cervical flexor muscles – reliability and normative reference values

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Jari Ylinen, Petri Salo, Salme Järvenpää, Arja Häkkinen, Riku Nikander
ObjectiveTo obtain reference values for the isometric endurance test (IET) of the cervical flexor muscles, investigate its reproducibility, and compare the results with the maximal isometric strength test (MIST) of the cervical flexor muscles.DesignCross-sectional non-comparative study with single group repeated measurements.MethodsAltogether 219 healthy females aged 20 to 59 years volunteered to participate in the study. The IET was performed in the supine position and MIST seated. The reproducibility was evaluated by the intraclass correlation coefficient (ICC) and an analysis described by Bland and Altman. The relationship between the two measuring methods was evaluated by Pearson's correlation coefficient.ResultsThe mean (SD) IET time was 60 (33) seconds with no significant differences between the age groups of each decade. The ICC for intrarater repeatability was 0.80. However, the Bland-Altman analysis suggested moderate variation in repeated measurements. Pearson's correlation coefficient between the IET and MIST was 0.56.ConclusionNormative reference values for the IET are presented. Although the ICC showed good repeatability, one should consider that the change at follow-up visits has to be considerable to be clinically relevant. The correlation between the endurance time and maximal flexion strength was moderate. Thus IET of the cervical flexor muscles may be used in the clinic like the Biering-Sorenson test has been used to assess fatigue of the trunk extensor muscles.

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Low handgrip strength levels among adolescents in a city in Southern Brazil

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Diego Augusto Santos Silva, Andreia Pelegrini, João Antônio Chula de Castro, Tiago Rodrigues de Lima, Gabriel Renaldo de Sousa, João Marcos Ferreira de Lima Silva, Edio Luiz Petroski
ObjectiveTo estimate the prevalence of low handgrip strength (HGS) levels and sociodemographic characteristics, health behaviours and body fatness status related in adolescents. Method: Cross-sectional epidemiological study with 636 adolescents aged 14-19 years in a city in southern Brazil. HGS was measured by dynamometer. Sociodemographic and behavioural data were collected using self-report questionnaires. Body mass and height was measured by Body Mass Index. Results: Prevalence of low HGS levels was 47% (63.5% boys, 37.7% girls). Boys aged 14-16 years were more likely to have low HGS levels. Girls who were of higher socioeconomic status and who were less physically active were more likely to have low HGS levels. Overweight girls were less likely to have low HGS levels. Conclusions: High prevalence of low HGS levels was observed in adolescents. Increased HGS levels should be focused on younger boys and normal-weight girls with higher socioeconomic status and lower levels of physical activity.

http://ift.tt/2mTk0VR

The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Muhammad Nazim Farooq, Mohammad A. Mohseni-Bandpei, Syed Amir Gilani, Muhammad Ashfaq, Qamar Mahmood
ObjectiveTo determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).MethodsSixty eight patients with chronic mechanical NP were randomly allocated into two groups by using a computer generated random sequence table with 34 patients in the multi-modal mobilization group and 34 patients in the routine physiotherapy group. Baseline values for pain, disability, NME, and neck ROM were recorded using visual analogue scale (VAS), neck disability index (NDI), neck flexor muscle endurance test and universal goniometer respectively, before the treatment. Each patient received 10 treatment sessions over a period of four weeks and at the end of four weeks all the outcome measures were recorded again.ResultsA paired t-test revealed significant pre to post treatment differences for all outcome measures in both groups (p < 0.001 in all instances). An independent t-test revealed statistically significant differences for pain, disability, NME, and neck rotation in favor of the multi-modal mobilization group with a between group difference of 1.57 cm for VAS (p < 0.001), 11.74 points for NDI (p = 0.001), 18.45 seconds for NME (p < 0.001) and 6.06 to 8.24 degrees for neck ROM (p < 0.05).ConclusionThe results suggest that a combination of cervical mobilization with routine physiotherapy is more effective for reducing pain and disability and improving NME and neck ROM in patients with chronic mechanical NP compared to routine physiotherapy alone.

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The effects of clinical Pilates exercises on patients with shoulder pain: A randomized clinical trial

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Esra Atılgan, Aydan Aytar, Aslıcan Çağlar, Ayça Aytar Tığlı, Gamze Arın, Gökmen Yapalı, Pınar Kısacık, Utku Berberoğlu, Hülya Özlem Şener, Edibe Ünal
AimThe purpose of this study was to determine the effect of Clinical Pilates exercises on patients with shoulder pain.Material and MethodsThirty-three patients, experiencing shoulder pain continuously for at least four weeks were selected as study subjects. The patients were randomly divided into two groups, namely Clinical Pilates exercise (n=17) group and conventional exercise (n=16) group. The patients were treated for five days a week, the total treatment being carried out for 10 days. The assessment of pain and disability amongst the patients were done at the baseline and at the end of the treatment sessions, using Visual Analogue Scale (VAS) and Shoulder Pain and Disability Index (SPADI).ResultsThe clinical Pilates exercise group showed a significant improvement in all scores used for assessment (p<0.05), while the conventional exercise group demonstrated a significant improvement only in the SPADI total score (p<0.05). A comparison of scores for the VAS, SPADI-Pain and SPADI-Total between the two groups, revealed a significant improvement in the Clinical Pilates exercise group (p<0.05).ConclusionIt was demonstrated by the study that Clinical Pilates exercise is an efficient technique for patients experiencing shoulder pain, as it helps reduce pain and disability among them.

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Reliability of Kinematic Measures in Subjects With Anterior Cruciate Ligament Deficiency During Dual-Task Walking

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Salman Nazary-Moghadam, Mahyar Salavati, Ali Esteki, Behnam Akhbari, Sohrab Keyhani, Afsaneh Zeinalzadeh
ObjectiveTo define the throughout within- and between-day reliability of gait parameters in single - and dual-task conditions in subjects with and without anterior cruciate ligament deficiency (ACLD).MethodsFourteen subjects with ACLD and 14 healthy subjects completed a walking task on a treadmill with three levels of velocity (self-selected, high and low), with or without performing an auditory Stroop task over two sessions each 3-5 days apart. The gait kinematic parameters, including maximum and minimum hip flexion, total hip range of motion, maximum and minimum knee flexion and total knee range of motion were recorded using a motion analysis system. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the coefficient of variation (CV) were used to determine inter- and intrasession reliability of kinematic and cognitive measures.ResultsICCs for ACLD group in dual-task and single task conditions ranged between 0.50 to 0.93 and 0.53 to 0.93, respectively. ICC values for healthy groups in dual-task and single task conditions ranged between 0.36 to 0.90 and 0.39 to 0.87, respectively. When comparing relative reliability across kinematic variables in different velocities, ICC values were generally identical in all three levels of velocity.ConclusionThe findings suggest that dual-tasking could also be applied reliably for the assessment of functional activities in subjects with and without ACLD.

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Postural insoles on gait in children with cerebral palsy: Randomized controlled double-blind clinical trial

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Hugo Pasin Neto, Luanda André Collange Grecco, Luis Alfredo Braun Ferreira, Natália Almeida Carvalho Duarte, Manuela Galli, Claudia Santos Oliveira
The aim of the present study was to assess the effect of postural insoles on gait performance in children with Cerebral Palsy (CP).Twenty four children between four and 12 years of age were randomly allocated either the control group (n = 12) or experimental group (n = 12).The control group used placebo insoles and the experimental group used postural insoles. Three-dimensional gait analysis was performed under three conditions: barefoot, in shoes and in shoes with insoles. Three evaluations were carried out: 1)immediately following placement of the insoles; 2)after three months of insole use; and 3)one month after suspending insole use. Regarding the immediate effects and after three months use of insole, significant improvements in gait velocity and cadence were found in the experimental group, along with an increase in foot dorsiflexion, a reduction in knee flexion and a reduction in internal rotation. Conversely, these changes were not maintained in the third assessment, one month after withdrawal of the insoles. The use of postural insoles led to improvements in gait performance in children with CP.

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Effect of Movement Control and stabilization Exercises in People with Extension Related Non -Specific Low Back Pain- A pilot Study

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Sara Salamat, Saeed Talebian, Hosein Bagheri, Nader Maroufi, Mohammad Jafar Shaterzadeh, Gitta Kalbasi, Kieran O'Sullivan
BackgroundExercise is considered an effective treatment strategy for non-specific chronic low back pain (NSCLBP).In spite of the wide use of exercise protocols, it is not clear what type of exercise is more effective in decreasing pain, disability and normalizing muscle activation patterns in people with chronic low back pain.ObjectivesTo assess the effects of two exercise protocols (stabilization vs movement control) on pain and disability scores and the flexion relaxation ratio (FRR) of lumbar multifidus (LM) and iliocostalis lumbarum pars thoracic (ICLT) in people with extension related non-specific chronic low back pain.Study designPilot randomized control trial.Methods32 subjects with active extension pattern chronic low back pain (stabilization group=16, movement control group=16) participated in this study. Treatment groups received 4 weeks of exercise therapy. Outcomes were based on pain score (Numeric rating Scale-NRS), disability (Oswestry Disability Index- ODI) and FRR of the LM and ICLT.ResultsFour people dropped out of the study in each group for reasons unrelated to the protocols of the study. Pain and disability reduced in both groups, with no significant difference between the groups. The FRR of LM did not change in either treatment group after treatment. However, the FRR of ICLT was significantly increased after treatment in the movement control group.ConclusionBoth movement control and stabilization exercises reduced pain and disability in the short-term among people with extension pattern NSCLBP, with no difference in effectiveness between the groups. However, movement control exercises were more effective in normalizing back muscle activation patterns than stabilization exercises.

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Immediate effect of common peroneal nerve electrical stimulation on quadriceps muscle arthrogenic inhibition in patients with knee osteoarthritis

Publication date: Available online 4 March 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Hossein Rafsanjani, Khosro Khademi-Kalantari, Asghar Rezasoltani, Sedigheh Sadat Naimi, Mehri Ghasemi, Shapour Jaberzadeh
ObjectiveTo investigate the immediate effect of electrical stimulation of the common peroneal nerve on the maximum voluntary activation of the quadriceps muscle in patients with knee osteoarthritis.MethodologyFifteen subjects with knee osteoarthritis (mean age: 50.5±13 years) participated in this study. To measure the arthrogenic inhibition ratio of quadriceps, a burst of electrical stimulation was superimposed on the maximum voluntary contraction, and the percentage of change in the force production was computed. The same measurement was also performed with concurrent electrical stimulation of the common peroneal nerve.ResultsAll the patients with knee osteoarthritis showed significant arthrogenic inhibition of the quadriceps muscle. The stimulation of the common peroneal nerve was able to reduce this inhibition and increase the capacity of the muscle to produce a significantly higher knee extension force (p=0.028).ConclusionsElectrical stimulation of the common peroneal nerve concurrent with the maximum voluntary effort can remove the arthrogenic inhibition of the quadriceps muscle in patients with knee osteoarthritis. This finding could have clinical implications in the management of patients with knee disorders.

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Posterior Cord Syndrome and Trace Elements Deficiency as an Uncommon Presentation of Common Variable Immunodeficiency

Diarrhea is one of the most common symptoms in common variable immunodeficiency, but neurologic manifestations are rare. We presented a 50-year-old woman with recurrent diarrhea and severe weight loss that developed a posterior cord syndrome. Endoscopy found a duodenal villous blunting, intraepithelial lymphocytosis, and lack of plasma cells and magnetic resonance imaging of the spine was normal. Laboratory assays confirmed common variable immunodeficiency syndrome and showed low levels of trace elements (copper and zinc). Treatment was initiated with parenteral replacement of trace elements and intravenous human immunoglobulin and the patient improved clinically. In conclusion, physicians must be aware that gastrointestinal and neurologic disorders may be related to each other and remember to request trace elements laboratory assessment.

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Smartphone–based enzymatic biosensor for oral fluid L-lactate detection in one minute using confined multilayer paper reflectometry

Publication date: 15 August 2017
Source:Biosensors and Bioelectronics, Volume 94
Author(s): Donato Calabria, Cristiana Caliceti, Martina Zangheri, Mara Mirasoli, Patrizia Simoni, Aldo Roda
The development of smartphone–based biosensors for point-of-care testing (POCT) applications allows realizing "all in one" instruments, with large potential distribution among the general population. With this respect, paper color-based detection performed by reflectance measurement is the most popular, simple, inexpensive and straightforward method. Despite the large number of scientific publications related to these biosensors, they still suffer from a poor detectability and reproducibility related to inhomogeneity of color development, which leads to low assay reproducibility. To overcome these problems, we propose a smartphone paper-based biosensor, in which all the reagents necessary to complete the analysis are co-entrapped on paper in a "wafer"-like bilayer film of polyelectrolytes (Poly (allyl amine hydrochloride/poly(sodium 4-styrene sulfonate)). Using a 3D printing low-cost technology we fabricated the smartphone-based device that consists in a cover accessory attached to the smartphone and incorporating a light diffuser over the flash to improve the image quality, a mini dark box and a disposable analytical cartridge containing all the reagents necessary for the complete analysis. The biosensor was developed exploiting coupled enzyme reactions for quantifying L-lactate in oral fluid, which is considered a biomarker of poor tissue perfusion, a key element in the management of severe sepsis, septic shock and in sports performance evaluation. The developed method is sensitive, rapid, and it allows detecting L-lactate in oral fluid in the relevant physiological range, with a limit of detection of 0.1mmolL⁻¹. The extreme simplicity of assay execution (no reagents need to be added) and flexibility of fabrication of the device, together with the high assay versatility (any oxidase can be coupled with HRP-based color change reaction) make our approach suitable for the realization of smartphone-based biosensors able to non-invasively detect a large variety of analytes of clinical interest.

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Fundamental studies of adrenal retinoid-X-receptor: Protein isoform, tissue expression, subcellular distribution, and ligand availability

Publication date: Available online 4 March 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Behling Cheng, Fatema H. Al-Shammari, Isra'a A. Ghader, Fatima Sequeira, Jitendra Thakkar, Thazhumpal C. Mathew
Adrenal gland reportedly expresses many nuclear receptors that are known to heterodimerize with retinoid-X-receptor (RXR) for functions, but the information regarding the glandular RXR is not adequate. Studies of rat adrenal homogenate by Western blotting revealed three RXR proteins: RXRα (55kDa), RXRβ (47kDa) and RXR (56kDa). RXRγ was not detectable. After fractionation, RXRα was almost exclusively localized in the nuclear fraction. In comparison, substantial portions of RXRβ and RXR were found in both nuclear and post-nuclear particle fractions, suggesting genomic and non-genomic functions. Cells immunostained for RXRα were primarily localized in zona fasciculata (ZF) and medulla, although some stained cells were found in zona glomerulosa (ZG) and zona reticularis (ZR). In contrast, cells immunostained for RXRβ were concentrated principally in ZG, although some stained cells were seen in ZR, ZF, and medulla (in descending order, qualitatively). Analysis of adrenal lipid extracts by LC/MS did not detect 9-cis-retinoic acid (a potent RXR-ligand) but identified all-trans retinoic acid. Since C20 and C22 polyunsaturated fatty acids (PUFAs) can also activate RXR, subcellular availabilities of unesterified fatty acids were investigated by GC/MS. As results, arachidonic acid (C20:4), adrenic acid (C22:4), docosapentaenoic acid (C22:5), and cervonic acid (C22:6) were detected in the lipids extracted from each subcellular fraction. Thus, the RXR-agonizing PUFAs are available in all the main subcellular compartments considerably. The present findings not only shed light on the adrenal network of RXRs but also provide baseline information for further investigations of RXR heterodimers in the regulation of adrenal steroidogenesis.

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Management of respiratory tract infections in young children-A qualitative study of primary care providers' perspectives.

Management of respiratory tract infections in young children-A qualitative study of primary care providers' perspectives.

NPJ Prim Care Respir Med. 2017 Dec;27(1):15

Authors: Biezen R, Brijnath B, Grando D, Mazza D

Abstract
Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers' time constraints, parental anxiety, general practitioners' perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers' management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children.
RESPIRATORY TRACT INFECTIONS: CLINICIANS SWAYED BY PARENTAL ANXIETY AND PRESSURE: The emotions and psychology of both parents and clinicians influence how respiratory tract infections (RTIs) are managed in young children. Researchers in Australia, led by Ruby Biezen from Monash University, interviewed 30 primary care clinicians about their views on how to care for children with RTIs, such as the common cold. The interviews focused on symptomatic management, over-the-counter medications and antibiotic use. Despite the availability of best-practice guidelines, clinicians did not always follow the recommendations owing to factors such as time constraints, parental anxiety, perceived parental pressure, and fear of losing patients. These are some of the reasons why clinicians sometimes advise or prescribe unnecessary medications. The authors suggest that a team approach involving multiple healthcare professionals who deliver consistent advice could improve guideline adherence.

PMID: 28258279 [PubMed - in process]

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Systematic Analysis of Cell-Type Differences in the Epithelial Secretome Reveals Insights into the Pathogenesis of Respiratory Syncytial Virus-Induced Lower Respiratory Tract Infections.

Systematic Analysis of Cell-Type Differences in the Epithelial Secretome Reveals Insights into the Pathogenesis of Respiratory Syncytial Virus-Induced Lower Respiratory Tract Infections.

J Immunol. 2017 Mar 03;:

Authors: Zhao Y, Jamaluddin M, Zhang Y, Sun H, Ivanciuc T, Garofalo RP, Brasier AR

Abstract
Lower respiratory tract infections from respiratory syncytial virus (RSV) are due, in part, to secreted signals from lower airway cells that modify the immune response and trigger airway remodeling. To understand this process, we applied an unbiased quantitative proteomics analysis of the RSV-induced epithelial secretory response in cells representative of the trachea versus small airway bronchiolar cells. A workflow was established using telomerase-immortalized human epithelial cells that revealed highly reproducible cell type-specific differences in secreted proteins and nanoparticles (exosomes). Approximately one third of secretome proteins are exosomal; the remainder are from lysosomal and vacuolar compartments. We applied this workflow to three independently derived primary human cultures from trachea versus bronchioles. A total of 577 differentially expressed proteins from control supernatants and 966 differentially expressed proteins from RSV-infected cell supernatants were identified at a 1% false discovery rate. Fifteen proteins unique to RSV-infected primary human cultures from trachea were regulated by epithelial-specific ets homologous factor. A total of 106 proteins unique to RSV-infected human small airway epithelial cells was regulated by the transcription factor NF-κB. In this latter group, we validated the differential expression of CCL20/macrophage-inducible protein 3α, thymic stromal lymphopoietin, and CCL3-like 1 because of their roles in Th2 polarization. CCL20/macrophage-inducible protein 3α was the most active mucin-inducing factor in the RSV-infected human small airway epithelial cell secretome and was differentially expressed in smaller airways in a mouse model of RSV infection. These studies provide insights into the complexity of innate responses and regional differences in the epithelial secretome participating in RSV lower respiratory tract infection-induced airway remodeling.

PMID: 28258195 [PubMed - as supplied by publisher]

http://ift.tt/2mpowxi

Right Donor Kidneys in Living Donor Kidney Transplantation.

Right Donor Kidneys in Living Donor Kidney Transplantation.

World J Surg. 2017 Mar 03;:

Authors: Khan TT, Ahmad N

PMID: 28258462 [PubMed - as supplied by publisher]

http://ift.tt/2mT90Yq

Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis.

Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis.

World J Surg. 2017 Mar 03;:

Authors: Allaix ME, Rebecchi F, Morino M, Schlottmann F, Patti MG

Abstract
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of unknown origin that affects about 40,000 new patients every year in the USA. Albeit the disease is labelled as idiopathic, it is thought that pathologic reflux, often silent, plays a role in its pathogenesis through a process of microaspiration of gastric contents.
AIMS: The aim of this study was to review the available evidence linking reflux to IPF, and to study the effect of medical and surgical therapy on the natural history of this disease.
RESULTS: Medical therapy with acid-reducing medications controls the production of acid and has some benefit. However, reflux and aspiraion of weakly acidic or alkaline gastric contents can still occur. Better results have been reported after laparoscopic anti-reflux surgery, as this form of therapy re-establishes the competence of the lower esophageal sphincter, therefore stopping any type of reflux.
CONCLUSIONS: A phase II NIH study in currently in progress in the USA to determine the role of antireflux surgery in patients with GERD and IPF. The hope is that this simple operations might alter the natural history of IPF, avoiding progression and the need for lung transplantation.

PMID: 28258461 [PubMed - as supplied by publisher]

http://ift.tt/2mTdePZ

Evaluation of Gastroesophageal Reflux Disease.

Evaluation of Gastroesophageal Reflux Disease.

World J Surg. 2017 Mar 03;:

Authors: Fisichella PM, Andolfi C, Orthopoulos G

Abstract
INTRODUCTION: Gastroesophageal reflux disease (GERD) may present with heartburn, regurgitation, dysphagia, chronic cough, laryngitis, or even asthma. The clinical presentation of GERD is therefore varied and poses certain challenges to the physician, especially given the limitations of the diagnostic testing.
DISCUSSION: The evaluation of patients with suspected GERD might be challenging. It is based on the evaluation of clinical features, objective evidence of reflux on diagnostic testing, correlation of symptoms with episodes of reflux, evaluation of anatomical abnormalities, and excluding other causes that might account for the presence of the patient's symptoms.
CONCLUSIONS: The diagnostic evaluation should include multiple tests, in addition to a thorough clinical examination.

PMID: 28258460 [PubMed - as supplied by publisher]

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Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection.

Significance of Simultaneous Splenic Artery Resection in Left-Sided Portal Hypertension After Pancreaticoduodenectomy with Combined Portal Vein Resection.

World J Surg. 2017 Mar 03;:

Authors: Gyoten K, Mizuno S, Nagata M, Ogura T, Usui M, Isaji S

Abstract
BACKGROUND: In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH).
METHODS: The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence.
RESULTS: The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05).
CONCLUSION: In PD with resection of PV-SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.

PMID: 28258459 [PubMed - as supplied by publisher]

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Clinical Prediction Rules for Appendicitis in Adults: Which Is Best?

Clinical Prediction Rules for Appendicitis in Adults: Which Is Best?

World J Surg. 2017 Mar 03;:

Authors: Kularatna M, Lauti M, Haran C, MacFater W, Sheikh L, Huang Y, McCall J, MacCormick AD

Abstract
BACKGROUND: Clinical prediction rules (CPRs) provide an objective method of assessment in the diagnosis of acute appendicitis. There are a number of available CPRs for the diagnosis of appendicitis, but it is unknown which performs best.
AIM: The aim of this study was to identify what CPRs are available and how they perform when diagnosing appendicitis in adults.
METHOD: A systematic review was performed in accordance with the PRISMA guidelines. Studies that derived or validated a CPR were included. Their performance was assessed on sensitivity, specificity and area under curve (AUC) values.
RESULTS: Thirty-four articles were included in this review. Of these 12 derived a CPR and 22 validated these CPRs. A narrative analysis was performed as meta-analysis was precluded due to study heterogeneity and quality of included studies. The results from validation studies showed that the overall best performer in terms of sensitivity (92%), specificity (63%) and AUC values (0.84-0.97) was the AIR score but only a limited number of studies investigated at this score. Although the Alvarado and Modified Alvarado scores were the most commonly validated, results from these studies were variable. The Alvarado score outperformed the modified Alvarado score in terms of sensitivity, specificity and AUC values.
CONCLUSION: There are 12 CPRs available for diagnosis of appendicitis in adults. The AIR score appeared to be the best performer and most pragmatic CPR.

PMID: 28258458 [PubMed - as supplied by publisher]

http://ift.tt/2mTcAln

From Heartburn to Barrett's Esophagus, and Beyond.

From Heartburn to Barrett's Esophagus, and Beyond.

World J Surg. 2017 Mar 03;:

Authors: Schlottmann F, Patti MG, Shaheen NJ

Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. About 10-15% of patients with GERD will develop Barrett's esophagus (BE).
AIMS: The aims of this study were to review the available evidence of the pathophysiology of BE and the role of anti-reflux surgery in the treatment of this disease.
RESULTS: The transformation of the squamous epithelium into columnar epithelium with goblet cells is due to the chronic injury produced by repeated reflux episodes. It involves genetic mutations that in some patients may lead to high-grade dysplasia and cancer. There is no strong evidence that anti-reflux surgery is associated with resolution or improvement in BE, and its indications should be the same as for other GERD patients without BE.
CONCLUSIONS: Patients with BE without dysplasia require endoscopic surveillance, while those with low- or high-grade dysplasia should have consideration of endoscopic eradication therapy followed by surveillance. New endoscopic treatment modalities are being developed, which hold the promise to improve the management of patients with BE.

PMID: 28258457 [PubMed - as supplied by publisher]

http://ift.tt/2maVQHZ

Laparoscopic Repair of Duodenal Atresia: Systematic Review and Meta-Analysis.

Laparoscopic Repair of Duodenal Atresia: Systematic Review and Meta-Analysis.

World J Surg. 2017 Mar 03;:

Authors: Mentessidou A, Saxena AK

Abstract
PURPOSE: To investigate the outcome of laparoscopic repair of duodenal atresia (LRDA) in relation to different approaches with regard to suture material and anastomosis technique. To identify evidence for the safety and efficacy of LRDA compared with the conventional open repair.
METHODS: Systematic search was performed for all studies on LRDA, excluding case reports, and all comparative studies between LRDA and open repair. Chi-square was used to assess associations between complications or conversions rates and different LRDA approaches (suture material, suturing technique). Meta-analysis was employed to compare LRDA and open repair.
RESULTS: The complications and conversions rates of LRDA were not affected by the different suture materials (Silk, Vicryl, PDS; p = 0.51) or suturing technique (interrupted, continuous; p = 0.46). The meta-analysis did not show significant differences between LRDA and open repair in overall complications rate (p = 0.88), time to feeds (p = 0.12) and hospitalization time (p = 0.28), although it revealed longer operative time with LRDA (p < 0.0001).
CONCLUSIONS: LRDA shows comparable safety and efficacy with the open repair, although it is associated with significantly longer operative time. There is no evidence that the type of the suture material or anastomotic technique affects the outcome of LRDA.

PMID: 28258456 [PubMed - as supplied by publisher]

http://ift.tt/2mSWzf4

The Impact of Healthcare Privatization on Access to Surgical Care: Cholecystectomy as a Model.

The Impact of Healthcare Privatization on Access to Surgical Care: Cholecystectomy as a Model.

World J Surg. 2017 Mar 03;:

Authors: Alkhamis AA

PMID: 28258455 [PubMed - as supplied by publisher]

http://ift.tt/2mT8yt3

Indeterminate Pulmonary Nodules in Resected Liver Metastases from Colorectal Cancer: A Comparison of Patient Outcomes.

Indeterminate Pulmonary Nodules in Resected Liver Metastases from Colorectal Cancer: A Comparison of Patient Outcomes.

World J Surg. 2017 Mar 03;:

Authors: Robertson V, Neal CP, Jones M, Dennison AR, Garcea G

Abstract
AIMS: Hepatic metastasectomy remains the only potentially curative treatment for colorectal liver metastases (CRLM). Some of these patients develop indeterminate pulmonary nodules (IPNs). This study aimed to compare outcomes of patients with and without IPN undergoing resection of CRLM to ascertain whether their presence is clinically significant.
METHODS: Cases and controls were identified from a prospectively maintained database of CRLM resections. Patients with staging radiology demonstrating IPNs were included as cases. Controls were matched to the cases by four primary factors: age, type of resection (primary or redo), clinical risk score (CRS) and chemotherapy.
RESULTS: The median disease-free survival (DFS) and overall survival (OS) for the cases were 7.0 months (95% CI 4.8-9.2) and 28.6 months (95% CI 21.2-36.0), respectively, and 12.0 months (95% CI 10.7-13.2) and 30.5 months (95% CI 19.4-41.6) for the controls. The 1-, 3- and 5-year survival rates were 92.7, 39.7 and 0.0% for the IPN group, and 92.4, 32.9 and 21.9% for those without. In total, 60.7% of IPN patients progressed to lung metastases, of which 39.3% underwent pulmonary resections. DFS was significantly shorter in the IPN group (p = 0.022), but OS was not significantly different (p = 0.421). The presence of IPN was independently associated with a shortened DFS (p = 0.027), as was a CRS of 3 or greater (p = 0.007).
CONCLUSION: This study suggests that IPN does not significantly affect OS, but may predict earlier disease recurrence. IPN presence alone should not preclude radical resection but could be used to prompt more careful post-operative surveillance to detect lung metastases at a potentially operable stage.

PMID: 28258454 [PubMed - as supplied by publisher]

http://ift.tt/2lNlXBY

Failure of Conservative Treatment of Acute Diverticulitis with Extradigestive Air.

Failure of Conservative Treatment of Acute Diverticulitis with Extradigestive Air.

World J Surg. 2017 Mar 03;:

Authors: Colas PA, Duchalais E, Duplay Q, Serra-Maudet V, Kanane S, Ridereau-Zins C, Lermite E, Aubé C, Hamy A, Venara A

Abstract
BACKGROUND: Medical management for perforated diverticulitis without abscess or peritonitis (PDwAP) has a success rate of 40-70%. Identifying patients with a risk of medical treatment failure would improve outcomes. The aim of this study was to identify the risk factors for failure of medical treatment in patients admitted with PDwAP.
METHODS: This multicenter retrospective observational study included all consecutive patients admitted for PDwAP and not surgically treated over a 7-year period. Peritonitis classified on the Hinchey scale was excluded. Potential clinical, biological and radiological risk factors for medical treatment failure were collected and compared between the group of patient with a failure of medical treatment (F) and the group in which treatment did not fail. Data were collected at referral.
RESULTS: Ninety-one patients were included, and 29 had a failure of treatment (31.9%). The median heart rate was different between the two groups (p < 0.001), at approximately 100/min in the F group. A blood level of C-reactive protein (CRP) ≥150 mg/mL was associated with a higher rate of failure (p = 0.021), but it was not confirmed in multivariate analysis. Pneumoperitoneum ≥5 mm and intraperitoneal liquid located in the pouch of Douglas were more likely to be present in the F group (respectively, p = 0.001 and p < 0.001). A multivariate analysis showed independent risk factors as being the highest pneumoperitoneum diameter >5 mm (OR 5.193; p = 0.015) and peritoneal fluid location in the pouch of Douglas (OR 4.103; p = 0.036).
CONCLUSION: The severity of sepsis (tachycardia and CRP ≥150 mg/mL) and of imaging signs (pneumoperitoneum ≥5 mm and peritoneal fluid in the pouch of Douglas) were risk factors for medical treatment failure of PDwAP requiring special supervision so as not to lose time in undertaking surgical management.

PMID: 28258453 [PubMed - as supplied by publisher]

http://ift.tt/2mSWs3k

Pathophysiology of Gastroesophageal Reflux Disease.

Pathophysiology of Gastroesophageal Reflux Disease.

World J Surg. 2017 Mar 03;:

Authors: Menezes MA, Herbella FA

Abstract
Gastroesophageal reflux disease pathophysiology is multifactorial and linked to a misbalance between the aggressiveness of the refluxate into the esophagus or adjacent organs and the failure of protective mechanisms associate or not to a defective valvular mechanism at the level of the esophagogastric junction incapable of dealing with a transdiaphragmatic pressure gradient. Antireflux mechanisms include the lower esophageal sphincter and abdominal esophagus, the diaphragm, the angle of His, the Gubaroff valve, and the phrenoesophageal membrane. Protective mechanisms include esophageal motility, saliva production, and epithelial protection. Disruption of this balance occurs most commonly due to the presence of a hiatal hernia, esophageal dysmotility, a rise in abdominal pressure (obesity), and decrease in thoracic pressure (chronic lung diseases).

PMID: 28258452 [PubMed - as supplied by publisher]

http://ift.tt/2mT14pV

Surgical Treatment of High-Grade Dysplasia and Early Esophageal Cancer.

Surgical Treatment of High-Grade Dysplasia and Early Esophageal Cancer.

World J Surg. 2017 Mar 03;:

Authors: McLaren PJ, Dolan JP

Abstract
BACKGROUND: The treatment of early-stage esophageal cancer and high-grade dysplasia of the esophagus has changed significantly in recent years. Many early tumors that were traditionally treated with esophagectomy can now be resected with endoscopic therapy alone. These new endoscopic modalities can offer similar survival outcomes without the associated morbidity of a major operation. However, a number of these cases may still require surgical intervention as the best treatment option.
METHODS: The current scientific literature, national and international guidelines were reviewed for recommendations regarding optimal treatment of early esophageal malignancy.
RESULTS: The primary advantage of surgery over endoscopic treatment lies in the reduced risk of recurrence as well as the ability to assess harvested lymph nodes for regional disease. We recommend that esophageal tumors that have invaded into the submucosa (T1b) or beyond should be treated with an esophagectomy. In addition, dysplastic lesions and cancers that demonstrate poorly differentiated pathology or lymphovascular or perineural invasion should be surgically resected. Finally, large tumors, multifocal lesions, tumors within a long segment of Barrett's esophagus, tumors adjacent to a hiatal hernia, tumors that cannot be resected enbloc with endoscopic techniques should also be treated with an esophagectomy.
CONCLUSIONS: When performed at high-volume centers in experienced hands, esophagectomy can have consistently good outcomes for high-grade dysplasia and early esophageal cancers, and should be considered as a treatment option.

PMID: 28258451 [PubMed - as supplied by publisher]

http://ift.tt/2mazwhJ

Does Nissen Fundoplication Provide Lifelong Reflux Control? Symptomatic Outcome After 31-33 Years.

Does Nissen Fundoplication Provide Lifelong Reflux Control? Symptomatic Outcome After 31-33 Years.

World J Surg. 2017 Mar 03;:

Authors: Neuvonen P, Sand J, Matikainen M, Rantanen T

Abstract
BACKGROUND: A substantial number of people are suffering from gastroesophageal reflux disease (GERD). The indication for surgical treatment is the failure of medical treatment in patients with objectively verified GERD. The use of PPIs has been noted to increase with the length of follow-up after fundoplication, raising questions concerning the durability of surgical results. The aim of the study was to investigate the results of open Nissen fundoplication (ONF) over a follow-up of more than 31 years.
METHODS: ONF was performed for 38 consecutive patients. Questionnaires concerning long-term outcome were sent on December 14, 2015, to the 24 patients still living. Long-term symptom evaluation was carried out using the Gastrointestinal Symptom Rating Scale (GSRS), Visick grading, a Visual Analog Scale (VAS), the DeMeester-Johnson reflux scale, and the 15D tool.
RESULTS: Seventeen (70.8%) of the 24 patients still living participated in the study. The typical symptoms of GERD had resolved significantly. Dysphagia was graded as none or minimal by 13 (81.3%) patients. The mean 15D score of the patient group was clinically and statistically the same (0.896 vs. 0.899) as that of the age- and sex-standardized general population (p = 0.912). Six (15.8%) patients had used antireflux medication after the operation and 4 of them (10.6%) continuously.
CONCLUSIONS: Patients in the present study used PPIs less frequently than what has been reported in previous long-term follow-up studies. Our results indicate that successful surgery may provide lifelong relief of GERD symptoms and normalize the health-related quality of life in GERD patients.

PMID: 28258450 [PubMed - as supplied by publisher]

http://ift.tt/2lNCndR

Laparoscopic Adjustable Gastric Banding: Predictive Factors for Weight Loss and Band Removal After More than 10 Years' Follow-Up in a Single University Unit.

Laparoscopic Adjustable Gastric Banding: Predictive Factors for Weight Loss and Band Removal After More than 10 Years' Follow-Up in a Single University Unit.

World J Surg. 2017 Mar 03;:

Authors: Tammaro P, Hansel B, Police A, Kousouri M, Magnan C, Marmuse JP, Arapis K

Abstract
BACKGROUND: Weight loss and overall outcomes following laparoscopic adjustable gastric banding (LAGB) are more variable than with other bariatric procedures. Our aim was to investigate the predictive value of certain parameters in a cohort of 794 patients with 10 years' minimum follow-up after LAGB.
METHODS: We retrospectively reviewed the records of 794 patients undergoing LAGB performed by the authors between April 1996 and December 2004. We collected patients' data on weight loss and band-related complications and performed logistic regression modelling and calculated Kaplan-Meier curves for band preservation.
RESULTS: The follow-up rate at 10 years was 90.4%. The mean follow-up duration was 15.1 years (range, 120-228 months). Overall band removal with or without conversion or replacement was required in 304 (38.2%) patients. The mean survival time of the band was 148.4 months (95% confidence interval: 138.3-167.4), and there was no difference in the rate of removal by operative technique (p = 0.7). The highest rate of band removal occurred in female patients (p = 0.05), those with BMI > 50 kg/m(2) (p = 0.005) and in those <40 years of age (p = 0.04). For patients with the band in situ, the success rate was significantly lower in patients with initial BMI > 50 kg/m(2). Conversely, differences in success rate were not statistically significant for age (using 50 years as the cut-off), technique or sex.
CONCLUSIONS: Higher rates of removal occurred in women, younger patients and those with BMI > 50 kg/m(2). Regardless of these criteria, the rate of band removal for complications rose over time. Patients should be informed of the high risk of the need for band removal long-term.

PMID: 28258449 [PubMed - as supplied by publisher]

http://ift.tt/2mToImf

Surgical Treatment of Gastroesophageal Reflux Disease.

Surgical Treatment of Gastroesophageal Reflux Disease.

World J Surg. 2017 Mar 03;:

Authors: Schlottmann F, Herbella FA, Allaix ME, Rebecchi F, Patti MG

Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. Lifestyle modifications and proton pump inhibitors (PPI) therapy are effective in the majority of patients and remain the mainstay of treatment of GERD. However, some patients will need surgical intervention because they have partial control of symptoms, do not want to be on long-term medical treatment, or suffer complications related to PPI therapy.
AIMS: The aim of this study was to review the available evidence that supports laparoscopic antireflux surgery, and to study the effect of surgical therapy on the natural history of GERD.
RESULTS: The key elements for the success of antireflux surgery are proper patient selection, careful analysis of the indications for surgery, complete pre-operative work-up, and proper execution of the surgical technique.
CONCLUSIONS: When the key elements are respected, antireflux surgery is very effective in controlling GERD, and it is associated to minimal morbidity and mortality.

PMID: 28258448 [PubMed - as supplied by publisher]

http://ift.tt/2mSVlAy

Time to CT and Surgery for HPB Trauma in Scotland Prior to the Introduction of Major Trauma Centres.

Time to CT and Surgery for HPB Trauma in Scotland Prior to the Introduction of Major Trauma Centres.

World J Surg. 2017 Mar 03;:

Authors: McKechnie PS, Kerslake DA, Parks RW

Abstract
AIMS: To assess the time taken to CT and emergency surgery for trauma patients with an injury to liver, spleen or pancreas prior to the introduction of major trauma centres (MTCs) in Scotland.
METHODS: A search was performed of the Scottish Trauma Audit Group database for any patient with relevant injuries over a 2-year period. Primary outcome measures were time to CT and emergency surgery. Patient demographics were also recorded.
RESULTS: A total of 211 patients were identified of whom 23 had more than one organ affected. There were a total of 234 injuries (123 liver, 99 splenic and 12 pancreatic) in these patients. A total of 160 injuries (75.8%) suffered blunt trauma. Of 211 patients, 157 underwent emergency CT with a median time to scan of 73 min (range 4-474). Hospitals provisionally designated as MTCs were 9 min faster than non-MTCs in time to CT. There was no difference in time of day. Ninety-nine patients had surgery within 24 h at a median time of 200 min. Twenty-five patients with hypotension on presentation took a median time of 130 min. Only 44 patients (27%) had a CT or emergency surgery within the expected MTC target of 1 h. Thirty-nine patients required transfer to another centre.
CONCLUSIONS: Current management of patients with abdominal trauma and haemodynamic instability remains sub-optimal in Scotland when compared to recognized performance indicators of CT and emergency surgery within 1 h. Implementation of a major trauma network in Scotland should improve access to emergency radiology and surgery and efforts to shorten current timelines should improve patient outcomes.

PMID: 28258447 [PubMed - as supplied by publisher]

http://ift.tt/2mT90aS

Needlestick Injuries, Glove Perforation and Round-Tipped Blunt Needles.

Needlestick Injuries, Glove Perforation and Round-Tipped Blunt Needles.

World J Surg. 2017 Mar 03;:

Authors: Mingoli A, Brachini G, Sgarzini G, Binda B, Zambon M

PMID: 28258446 [PubMed - as supplied by publisher]

http://ift.tt/2mT5JIA

Olfactory and gustatory functions in patients with non-complicated type 1 diabetes mellitus.

Olfactory and gustatory functions in patients with non-complicated type 1 diabetes mellitus.

Eur Arch Otorhinolaryngol. 2017 Mar 03;:

Authors: Altundag A, Ay SA, Hira S, Salıhoglu M, Baskoy K, Denız F, Tekelı H, Kurt O, Yonem A, Hummel T

Abstract
The aim of this study was to evaluate any possible relationship between diabetic state and olfactory and gustatory functions in patients with non-complicated diabetes mellitus type 1 (T1D), and also to present evidence of the association between olfactory and gustatory scores and HbA1c values and disease durations. The study included 39 patients with non-complicated T1D and 31 healthy controls. Clinical characteristics such as age, gender, duration of disease, education levels and biochemical analyses (fasting blood glucose, urea, creatinine, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL-C), triglyceride, HbA1c, C-peptide, postprandial blood glucose) were measured. Subjective olfactory and gustatory tests were performed for all participants. There were no significant differences in olfactory tests between the two groups (odor thresholds 8.63 ± 0.91 vs. 8.55 ± 0.57, p = 0.66; odor discrimination 12.97 ± 0.80 vs. 12.74 ± 0.79, p = 0.24; odor identification 13.81 ± 0.98 vs. 13.72 ± 0.89, p = 0.69; TDI score 35.34 ± 1.94 vs. 34.97 ± 1.4, p = 0.37). There were also no significant differences in gustatory tests between the two groups (bitter 3.45 ± 0.51 vs. 3.44 ± 0.50, p = 0.90; sweet 3.32 ± 0.48 vs. 3.38 ± 0.49, p = 0.60; salty 3.13 ± 0.72 vs. 3.10 ± 0.72, p = 0.88; total score of taste 13.16 ± 1.61 vs. 13.13 ± 1.22, p = 0.92). Comparison of gustatory and olfactory scores according to disease duration of type 1 diabetes mellitus patients revealed that there were no differences between groups (all p > 0.05). T1D without complications may not be associated with olfactory and gustatory dysfunction according to subjective testing. We also found that gustatory and olfactory functions may not be related with HbA1c values and disease duration in non-complicated T1D.

PMID: 28258376 [PubMed - as supplied by publisher]

http://ift.tt/2mGNLMP

Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale.

Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale.

Eur Arch Otorhinolaryngol. 2017 Mar 03;:

Authors: van Zijl FV, Timman R, Datema FR

Abstract
The nasal obstruction symptom evaluation (NOSE) scale is a validated disease-specific, self-completed questionnaire for the assessment of quality of life related to nasal obstruction. The aim of this study was to validate the Dutch (NL-NOSE) questionnaire. A prospective instrument validation study was performed in a tertiary academic referral center. Guidelines for the cross-cultural adaptation process from the original English language scale into a Dutch language version were followed. Patients undergoing functional septoplasty or septorhinoplasty and asymptomatic controls completed the questionnaire both before and 3 months after surgery to test reliability and validity. Additionally, we explored the possibility to reduce the NOSE scale even further using graded response models. 129 patients and 50 controls were included. Internal consistency (Cronbach's alpha 0.82) and test-retest reliability (intraclass correlation coefficient 0.89) were good. The instrument showed excellent between-group discrimination (Mann-Whitney U = 85, p < 0.001) and high response sensitivity to change (Wilcoxon rank p < 0.001). The NL-NOSE correlated well with the score on a visual analog scale measuring the subjective sensation of nasal obstruction, with exception of item 4 (trouble sleeping). Item 4 provided the least information to the total scale and item 3 (trouble breathing through nose) the most, particularly in the postoperative group. The Dutch version of the NOSE (NL-NOSE) demonstrated satisfactory reliability and validity. We recommend the use of the NL-NOSE as a validated instrument to measure subjective severity of nasal obstruction in Dutch adult patients.

PMID: 28258375 [PubMed - as supplied by publisher]

http://ift.tt/2mSLkDA

Polymorphism 4G/5G of the plasminogen activator inhibitor 1 gene as a risk factor for the development of allergic rhinitis symptoms in patients with asthma.

Polymorphism 4G/5G of the plasminogen activator inhibitor 1 gene as a risk factor for the development of allergic rhinitis symptoms in patients with asthma.

Eur Arch Otorhinolaryngol. 2017 Mar 03;:

Authors: Lampalo M, Jukic I, Bingulac-Popovic J, Marunica I, Petlevski R, Pavlisa G, Popovic-Grle S

Abstract
Plasminogen activator inhibitor-1 (PAI-1) is a glycoprotein which has a role in tissue remodelling after inflammatory processes. The objective is to investigate the frequency of PAI-1 gene polymorphism (4G/5G) in patients with a lung ventilation dysfunction in asthma and allergic rhinitis. Genomic DNA was isolated and genotypes of polymorphism of PAI-1 4G/5G and ABO were determined using the methods of RT-PCR and PCR-SSP. Study group includes 145 adult patients diagnosed with chronic asthma, with all clinically relevant parameters and the laboratory markers of pO2, IgE and eosinophils in sputum and nasal swab. In the processing of data, appropriate statistical tests (Kolmogorov-Smirnov test, median, interquartile ranges, χ (2) and Mann-Whitney U tests) were used. Patients with symptoms of allergic rhinitis were significantly younger and had an almost four time higher levels of IgE (P = 0.001), higher pO2 (P = 0.002) and PEF (P = 0.036), compared to those who do not have these symptoms. Genotype PAI 4G/4G is significantly more common in patients with allergic rhinitis (28.1% vs. 16.1%; P = 0.017) compared to the genotype 5G/5G. Carriers of the genotype 4G/5G also have a borderline statistical significance. There were no statistically significant difference in the incidence of allergic rhinitis in the carriers of any ABO genotypes. The frequency of PAI genotype 4G/4G is significantly more common in patients with allergic rhinitis. The results suggest that the carriers of at least one 4G allele are at a higher risk for developing symptoms of allergic rhinitis in asthma.

PMID: 28258374 [PubMed - as supplied by publisher]

http://ift.tt/2lN8F8O

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Κυριακή 5 Μαρτίου 2017

Abstract

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Objective

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Intervention

Results

Conclusions

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