Role of Negative Vector Orbit in Orbital Blow-Out Fractures.

Background: Negative vector orbit is defined as the most anterior globe portion protrudes past the malar eminence. The aim of the study was to evaluate the relationship between negative vector orbit and blow-out fracture location analyzing the distance between the anterior corneal surface and orbital bone with facial soft tissue in medial and orbital floor blow out fractures using orbital computed tomography (CT). Methods: Seventy-seven patients diagnosed with blow-out fractures involving the medial or orbital floor were included. Distances from the anterior cornea to lower lid fat, inferior orbital wall, inferior orbital rim, and anterior cheek mass were measured using orbital CT scans. The proportion of negative vector orbit and measured distanced were compared between medial wall fracture and orbital floor fracture. Medical records including age, sex, concomitant ophthalmic diagnosis, and nature of injury were retrospectively reviewed. Results: Forty-three eyes from 43 patients diagnosed with medial wall fracture and 34 eyes from 34 patients diagnosed with orbital floor fracture were included. There was no significant difference in the distance from the anterior cornea to lower lid fat (P = 0.574), inferior orbital wall (P = 0.494), or orbital rim (P = 0.685). The distance from anterior cornea to anterior cheek mass was significantly different in medial wall fracture (-0.19 +/- 3.49 mm) compared with orbital floor fracture (-1.69 +/- 3.70 mm), P = 0.05. Negative vector orbit was significantly higher in orbital floor fracture patients (24 among 34 patients, 70.6%) compared with those with medial wall fractures (19 among 43 patients, 44.2%) (P = 0.04). Conclusions: Patients presenting with a negative vector orbit relationship when the most anterior portion of globe protruded past the anterior cheek mass and malar eminence were more likely to develop orbital floor fracture than medial wall fracture. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jruLkx

The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort.

The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2f7WaGN

Cleft Lip and Palate Repair: Our Experience.

Introduction: Cleft lip and palate is the most frequent congenital craniofacial deformity. In this article, the authors describe their experience with cleft lip and palate repair. Methods: Data regarding patients presenting with primary diagnosis of cleft lip and/or palate, between 2009 and 2015, were reviewed. Details including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits were collected. Documented complications were reported. Caregivers' satisfaction was assessed with a survey. The survey used to assess satisfaction with cleft-related features was based on the cleft evaluation profile (CEP). In addition, 4 assessors used visual analog scale (VAS) to assess the aesthetic satisfaction. Results: Seven hundred fifty-two patients with primary diagnosis of cleft lip and/or palate underwent surgical correction at "S. Chiara" Hospital, 432 (57.45%) male and 320 (42.55%) female. The most common cleft types in our study were incomplete cleft palate (152 patients) and left unilateral complete cleft lip and palate (152 patients). Associated syndromes were found in 46 patients (6.12%). Cleft lip was repaired using a modified Tennison-Randall technique when the defect was unilateral, whereas a modified Mulliken technique was used for bilateral cleft lip. Cleft palate was repaired using the Bardach technique or Von Langenbeck technique at 5 to 6 months of age. Cleft lip and palate was repaired in several surgical steps. In total, complications were reported in 81 of 752 patients (14.16%). Average fathers' satisfaction score assessed using CEP was 4.5 (lip), 4.8 (nose), 4.7 (teeth), 4.8 (bite), 4.2 (breathing), 4.6 (profile). Average mothers' satisfaction score assessed using CEP was 4.3 (lip), 4.6 (nose), 4.4 (teeth), 4.5 (bite), 4.1 (breathing), 4.4 (profile). Average level of aesthetic satisfaction, assessed using VAS, was 8.7 (fathers), 8.1 (mothers), 7.9 (lay person), and 8.0 (senior cleft surgeon). Conclusion: The multidisciplinary management of children with oral cleft determinated good results, in terms of satisfaction and aesthetic appearance. From our experience, periosteoplasty and lip-adhesion are key surgical techniques. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jrqm13

Does Fat Grafting Influence Postoperative Edema in Orthognathic Surgery?.

Purpose: Autologous fat grafting is a useful adjunctive procedure to orthognathic surgery and may also confer anti-inflammatory properties. The purpose of this study is to answer the clinical question: among patients undergoing orthognathic operations, what are the effects of fat grafting on facial edema (magnitude, duration, and rate of decrease)? Methods: A retrospective cohort study was performed. Three-dimensional photos (Canfield, Fairfield, NJ) from preoperative and a series of postprocedure time-points were analyzed. The data set was divided into a fat-grafted cohort and a non-fat-grafted cohort and later analyzed using paired and unpaired t tests and linear regressions to determine significant correlations. Results: One hundred sixteen pre- and postoperative three-dimensional photo data sets were included. The sample included 29 subjects. The facial volume was analyzed both overall and comparing each subgroup (orthognathic vs. orthognathic + fat grafting group). Postoperative facial volume increase averaged 23.7% for the entire cohort (FG and nFG). By week 12, the swelling decreased about 62% from baseline. In all patients, there was a statistically significant decrease in facial volume with time. In the fat-grafted group, despite adding volume, the facial volume was equal to the non-fat-grafted group at week 1, yet the rate of decrease was faster through week 12. Conclusion: The majority of postoperative facial edema decreases by 12 weeks following orthognathic surgery. In this cohort of patients, despite the addition of volume, concurrent fat grafting lessened postoperative edema, and led to a greater magnitude and speed of resolution. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2f7oBoe

Mandibular Surgical Navigation: An Innovative Guiding Method.

Mandibular osteotomies are usually required to treat craniomaxillofacial disorders. Losses of mandibular continuity result in esthetic and functional deficiency. During the past 30 years, the spread of the computer-assisted surgery techniques, rapid prototyping, and surgical navigation technique has improved the reliability and the outcomes of mandibular resections and reconstructions, by providing realtime feedback to surgeon. Recent studies reported the feasibility and the precision of surgical navigation applied to mandibular surgical resection and reconstruction with fibula flap but none of them describes a method to navigate the jaw allowing its full motility during the operation. To our knowledge, this is the first-time description of such a kind of method to navigate the jaw positioning the dynamic reference frame directly on the mandibular branch to maintain the full mobility of the mandible. The method described in our series has allowed an accurate surgical navigation of the jaw without the need of intermaxillary fixation. This technique could greatly facilitate resection and reconstructive surgical procedures of the jaw while ensuring precision and accuracy. The encouraging results obtained in the present report suggest to further investigate the possibilities of this technique to better define the method and its indications. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jqve6p

A Novel Dissector and Needle Holder Within One Tool.

No abstract available

http://ift.tt/2f8Ihbf

Partial Scalp and Auricula Avulsion in a Child.

No abstract available

http://ift.tt/2jrfnoj

Tear Trough Deformity: Study of Filling Procedures for Its Correction.

The aim of this work is to discuss the anatomy of the tear trough region with relative danger areas, and to describe 2 different options to correct this deformity. The tear trough is a concave deformity of the orbital fat that is noticeable as a result of inherited anatomic differences and aging. However, the periorbital region is a complex area with its own septa and ligaments, fat compartments, muscles, vascularization, and lymphatic drainage and presents anatomic characteristics that must be taken into account in order to achieve good results and avoid complications. The use of hyaluronic acid gel or autologous fat for soft tissue correction is a good option. A total of 96 patients with periorbital hollowing were divided into 2 groups; each group received a different treatment, from December of 2013 to December of 2015, with hyaluronic- or lipo-filling. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2f6N8ts

Stagnant Water Is Bound to Corrupt.

No abstract available

http://ift.tt/2jqv0w5

Interobserver Consistency of Drug-Induced Sleep Endoscopy in Diagnosing Obstructive Sleep Apnea Using a VOTE Classification System.

Objectives: To explore the interobserver consistency of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) and review the current literature. Methods: In total, 55 patients with an apnea-hypopnea index >5, as determined by on overnight sleep study, were included in this study, 45 males and 10 females, with an average age of 46.87 +/- 10.06 years old (range, 19-71). For all OSAS patients, DISE was performed by the same surgeon, which was recorded digitally. The video recordings of DISE were evaluated independently by 3 experienced surgeons who were asked to note his or her decisions as the pattern, site, and degree of upper airway collapse using a VOTE (velum, oropharynx lateral wall, tongue base, and the epiglottis) classification system. Results: Interobserver consistency in the diagnosis of velum-related obstruction in anteroposterior, lateral, and concentric configurations ranged from poor to good. Only significant interobserver consistency among observers A and B was obtained in the diagnosis of oropharynx-related obstruction in the lateral configuration (concordance 60.0%, kappa: 0.365, P 0.20, all P values

http://ift.tt/2f8b8MY

A Three-Dimensional Study of Midfacial Changes Following Le Fort II Distraction With Zygomatic Repositioning in Syndromic Patients.

Le Fort II distraction with zygomatic repositioning introduced the ability to restore central midfacial height and convexity independent of changes in orbital morphology. This study analyzes midfacial and orbital morphology before and after Le Fort II distraction with zygomatic repositioning. All patients who underwent Le Fort II Distraction with zygomatic repositioning between 2013 and 2015 were included. Two- and 3-dimensional measurements were made using 3dMD Vultus software to assess canthal tilt, nasolabial angle, ratio of midfacial to lower facial height, and absolute change in nasal length. Presence of an open bite and Angle classification were assessed before and after surgery. Four patients underwent segmental midface advancement using Le Fort II distraction with zygomatic repositioning. Associated diagnoses included Apert syndrome, Goldenhar syndrome, and achondroplasia. Changes in facial dimensions included: 3.19[degrees] improvement in canthal tilt (range -4.7[degrees] to 8.4[degrees]), 9[degrees] change in nasolabial angle (range -1.0[degrees] to 19[degrees]), and 0.69 cm increase in absolute nasal length (range 0.2-0.94 cm). Mean ratio of midfacial to lower facial height was 0.79 preoperatively and 0.89 postoperatively. Preoperatively, all patients demonstrated Angle class III with 3 of 4 patients demonstrating anterior open bite. All achieved closure of open bite and demonstrated class I or II occlusion. No complications were observed. Le Fort II distraction with zygomatic repositioning resulted in normalization of midfacial soft tissue landmarks. This form of advancement demonstrates the ability to selectively improve midfacial height and canthal tilt while restoring normal occlusion. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jreX1d

Tissue Engineering Strategies for Auricular Reconstruction.

Simulating natural characteristics and aesthetics in reconstructed ears has provided a complex 3-dimensional puzzle for those treating patients with microtia. Costochondral grafts remain the gold standard for autologous reconstruction. However, other options such as Medpor and prosthetics are indicated depending on patient circumstances and personal choice. Research into tissue engineering offers an alternative method to a traditional surgical approach that may reduce donor-site morbidity. However, tissue engineering for microtia reconstruction brings new challenges such as cell sourcing, promotion of chondrogenesis, scaffold vascularization, and prevention of scaffold contraction. Advancements in 3D printing, nanofiber utilization, stem cell technologies, and decellularization techniques have played significant roles in overcoming these challenges. These recent advancements and reports of a successful clinical-scale study in an immunocompetent animal suggest a promising outlook for future clinical application of tissue engineering for auricular reconstruction. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2f8mccS

Checkpointinhibitoren beim nichtkleinzelligen Lungenkarzinom

Zusammenfassung

Hintergrund

Die moderne Immuntherapie mit Checkpointinhibitoren hat unaufhaltsam Einzug in die Behandlung des nichtkleinzelligen Lungenkarzinoms (NSCLC) gehalten.

Fragestellung

Studien zu Checkpointinhibitoren beim fortgeschrittenen NSCLC wurden auf ihre Ergebnisse hinsichtlich Effektivität und Toxizität analysiert und bewertet.

Material und Methode

Phase-I-, Phase-II- und Phase-III-Studienergebnisse zu neuen Checkpointinhibitoren beim fortgeschrittenen NSCLC wurden aus der Literatur (Pubmed) und aus Beiträgen auf großen internationalen Kongressen (ASCO, ESMO, WCLC) zusammengestellt.

Ergebnisse

Für die beiden PD-1-Antikörper Nivolumab und Pembrolizumab existieren bereits große Phase-III-Studien beim fortgeschrittenen NSCLC in der Second- und First-Line-Therapie. Zulassungen sind für Nivolumab (ohne Markerbezug, Zweitlinie) und Pembrolizumab (bei PD-L1-Expression ≥ 1 % „tumor proportion score", ​TPS; Zweit- und Drittlinie) beim fortgeschrittenen NSCLC und für Pembrolizumab in der Erstlinie bei Hochexpression des Immunmarkers PD-L1 (≥50 % TPS) von der EMA (European Medicines Agency) ausgesprochen worden. Erste Ergebnisse von Phase-III-Studien mit PD-L1-Antikörpern sind für das Atezolizumab bereits berichtet worden (OAK-Studie) oder werden für das Durvalumab aktuell noch erwartet (MYSTIC-Studie). Für Kombinationen mit konventioneller Chemotherapie und Kombinationen mit anderen Checkpointinhibitoren wie CTLA4-Antikörpern fehlen noch die abschließenden Ergebnisse von großen Phase-II- bzw. Phase-III-Studien.

Schlussfolgerungen

Die moderne Immuntherapie mit einem PD-1-Antikörper hat sich als integrale Behandlungsoption beim fortgeschrittenen NSCLC klar etabliert. In Zukunft wird die Suche nach besseren prädiktiven Faktoren und Markern für einen eher selektiven Einsatz dieser hochwirksamen, aber spezifischen Medikamente essenziell werden.

http://ift.tt/2xAKCDm

Efficacy and safety of ixekizumab for the treatment of moderate-to-severe plaque psoriasis: Results through 108 weeks of a randomized, controlled phase 3 clinical trial (UNCOVER-3)

Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin 17A, is efficacious in treating moderate-to-severe plaque psoriasis through 60 weeks.

http://ift.tt/2x1wSyy

A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management

Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse.

http://ift.tt/2f7qgdw

Serious infections among a large cohort of subjects with systemically treated psoriasis

Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection.

http://ift.tt/2x1wT5A

Uncovering burden disparity: A comparative analysis of the impact of moderate-to-severe psoriasis and hidradenitis suppurativa

Psoriasis and hidradenitis suppurativa (HS) exhibit distinct clinical features, but no studies have directly compared the health-related quality of life (HRQoL) in patients with moderate-to-severe manifestations of these conditions.

http://ift.tt/2wawnFd

Retrospective cohort study of combined approach for trunk reconstruction using arteriovenous loops and free flaps

Defect reconstruction of the trunk can be performed using microsurgical free flap transplantation. In cases of missing or inappropriate recipient vessels, microsurgical defect reconstruction of the trunk can be achieved by combining free flaps with arteriovenous loops. Here we present our 5-year experience of trunk reconstruction using AV loops and free flaps in a retrospective evaluation. We analyzed 32 cases of trunk reconstruction using a combined approach of free flap transplantation and arteriovenous loops between 2011 and 2016 regarding postoperative complications and perioperative course.

http://ift.tt/2xlEazj

Investigation of blood perfusion by laser speckle contrast imaging in stretched and rotated skin flaps in a porcine model

Dear Sir,

http://ift.tt/2h3JxNB

Lymphatic vessel density and VEGF-C expression as independent predictors of melanoma metastases: methodological issues

Dear Editor-in-Chief,

http://ift.tt/2xlE2jj

Current status and trends of breast reconstruction in argentina

Over the last decade, there has been an exponential increase in implant-based breast reconstructions correlated with a proportional decrease in autologous reconstruction in the US.1,2 We aimed to determine the breast reconstruction trends in Argentina through a survey of plastic surgeons who were invited to answer a multiple-choice anonymous questionnaire sent through email.

http://ift.tt/2h5bXXn

Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: results from a rat model

Venous super-drainage can improve flap survival not only because it prevents congestion, but also because it affects the dominant circulation in multi-territory thin skin flaps. We aimed to evaluate the survival of various flap areas and detect vascular changes in artery-based, four-territory skin flaps after different distal venous drainage procedures.

http://ift.tt/2xlVm7Q

Measuring the patient perspective on latissimus dorsi donor site outcomes following breast reconstruction

There is little evidence about the long-term donor site outcome of latissimus dorsi breast reconstruction and no patient-reported outcome measures designed specifically for the procedure.

http://ift.tt/2h3JnWv

The role of ultrasound technology in plastic surgery

The modern medical era is in part characterized by the increased availability of portable imaging devices. Ultrasound devices are used for either high-resolution non-invasive imaging or as a focused acoustic energy source capable of sculpting and shaping tissue. Given the broad scope of the field, plastic and reconstructive surgeons have the unique ability to implement and tailor the use of ultrasound in a variety of clinical situations. This article will review novel uses for ultrasound in the field of plastic surgery.

http://ift.tt/2xlK7wn

Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial

Abstract

Background: Major abdominal oncology surgery is associated with substantial postoperative loss of functional capacity, and exercise may be an effective intervention to improve outcomes. The aim of this study was to assess efficacy, feasibility and safety of a supervised postoperative exercise programme.Methods: We performed a single-blind, parallel-arm, randomized trial in patients who underwent major abdominal oncology surgery in a tertiary university hospital. Patients were randomized to an early mobilization postoperative programme based on supervised aerobic exercise, resistance and flexibility training or to standard rehabilitation care. The primary outcome was inability to walk without human assistance at postoperative day 5 or hospital discharge.Results: A total of 108 patients were enrolled, 54 into the early mobilization programme group and 54 into the standard rehabilitation care group. The incidence of the primary outcome was nine (16.7%) and 21 (38.9%), respectively (P=0.01), with an absolute risk reduction of 22.2% [95% confidence interval (CI) 5.9–38.6] and a number needed to treat of 5 (95% CI 3–17). All patients in the intervention group were able to follow at least partially the exercise programme, although the performance among them was rather heterogeneous. There were no differences between groups regarding clinical outcomes or complications related to the exercises.Conclusions: An early postoperative mobilization programme based on supervised exercises seems to be safe and feasible and improves functional capacity in patients undergoing major elective abdominal oncology surgery. However, its impact on clinical outcomes is still unclear.Clinical trial registration: NCT01693172.

http://ift.tt/2x2VMj2

Flared sign of flail mandible on computed tomography: an unstable fracture associated with a compromised airway

A mandibular fracture alone rarely causes a life-threatening injury. The aim of this paper was to emphasise the importance of prompt identification of the radiological signs of a flail mandible in a patient with maxillofacial trauma who eventually needed definitive management of her airway.

http://ift.tt/2jpRM7u

UK temporomandibular joint replacement database: a report on one-year outcomes

Alloplastic temporomandibular joint (TMJ) replacements are increasingly subspecialised, and supraregional centres that treat sufficient numbers to ensure high standards are emerging. Having recently reported the introduction of a national TMJ joint replacement database that is endorsed by the British Association of TMJ Surgeons (BATS), we now present the first-year outcomes. This was a review of all data in the BATS National Case Registration of TMJ Replacement as of June 2014. A total of 252 one-year outcome records were available.

http://ift.tt/2xlIyyv

Survival after surgery for oral cancer: a 30-year experience

Oral squamous cell carcinoma is the most common intraoral malignancy, for which we advocate radical primary resection with adjuvant treatment where indicated. The main aims of this paper are to identify the overall survival of a consecutive series of patients and to relate survival to clinical and pathological factors. Kaplan–Meier curves were produced for site, sex, TNM status, and use of postoperative radiotherapy. The data were analysed using IBM SPSS Statistics for Windows and probabilities of less than 0.05 were accepted as significant.

http://ift.tt/2jpMYyJ

Removal of recurrent intraorbital tumour using a system of augmented reality

The most crucial step in the management of pleomorphic adenoma of the lacrimal gland is choosing the optimal approach for excision. We report the successful removal of a recurrent pleomorphic adenoma of the lacrimal gland in a 42-year-old woman using a specific microscope-based system of augmented reality.

http://ift.tt/2xmadiO

Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial

Abstract

Background: Major abdominal oncology surgery is associated with substantial postoperative loss of functional capacity, and exercise may be an effective intervention to improve outcomes. The aim of this study was to assess efficacy, feasibility and safety of a supervised postoperative exercise programme.Methods: We performed a single-blind, parallel-arm, randomized trial in patients who underwent major abdominal oncology surgery in a tertiary university hospital. Patients were randomized to an early mobilization postoperative programme based on supervised aerobic exercise, resistance and flexibility training or to standard rehabilitation care. The primary outcome was inability to walk without human assistance at postoperative day 5 or hospital discharge.Results: A total of 108 patients were enrolled, 54 into the early mobilization programme group and 54 into the standard rehabilitation care group. The incidence of the primary outcome was nine (16.7%) and 21 (38.9%), respectively (P=0.01), with an absolute risk reduction of 22.2% [95% confidence interval (CI) 5.9–38.6] and a number needed to treat of 5 (95% CI 3–17). All patients in the intervention group were able to follow at least partially the exercise programme, although the performance among them was rather heterogeneous. There were no differences between groups regarding clinical outcomes or complications related to the exercises.Conclusions: An early postoperative mobilization programme based on supervised exercises seems to be safe and feasible and improves functional capacity in patients undergoing major elective abdominal oncology surgery. However, its impact on clinical outcomes is still unclear.Clinical trial registration: NCT01693172.

http://ift.tt/2x2VMj2

Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children

The prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes.

http://ift.tt/2xm81HK

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

Abstract

Purpose

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

Methods

By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

Results

Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85).

Conclusions

In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

http://ift.tt/2vVbXM1

Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit

Abstract

Background

Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected.

Patients and methods

In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade. We analyzed clinical characteristics, etiology, and severity of hypopituitarism in patients who presented with hyponatremia.

Results

Hyponatremia was recorded in 9.6% of our patients with hypopituitarism. In 80.7% it was the key to diagnosis of hypopituitarism. All patients with hyponatremia were steroid deficient with complete hypopituitarism compared to 75% (steroid deficient) and 60% (complete hypopituitarism) of the patients in the cohort. The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). Patients with hyponatremia were divided into two groups, based on the etiology of hypopituitarism: Group 1. with NFPA n = 15 (5F/10M), mean age 71.47 ± 4.8 years, who were significantly older compared to patients with hyponatremia from other rare causes of hypopituitarism in Group 2. n = 10 (8F/2M), mean age 40.2 ± 15.3 years (p < 0.01), such as: congenital hypopituitarism(n = 2), Sheehan's syndrome (n = 2), intracranial aneurysm (n = 2), lymphocytic hypophysitis (n = 1), traumatic brain injury (n = 1), surgery and radiotherapy for astrocytoma (n = 1), pituitary metastasis from bronchial carcinoma (n = 1). Hyponatremia was more severe in Group 2. compared to Group 1. (113.5 ± 10.9 mmol/L vs. 124.3 ± 8.1 mmol/L, p < 0.01). Older age (p = 0.0001) and number of endocrine deficiencies (p < 0.05) were identified as predictive factors for hyponatremia by multivariate analysis in patients with hypopituitarism.

Conclusion

Hyponatremia is an important presenting feature of pituitary disease and a strong indicator of life-threatening steroid deficiency. Old age and severity of hypopituitarism are major risk factors for hyponatremia. In older patients NFPA is the most common etiology, while other rare causes of hypopituitarism are more prevalent in younger patients with hyponatremia.

http://ift.tt/2eWKJOf

Correction

Publication date: Available online 13 September 2017
Source:Archives of Physical Medicine and Rehabilitation





http://ift.tt/2h4bJQv

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

Abstract

Purpose

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

Methods

By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

Results

Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85).

Conclusions

In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

http://ift.tt/2vVbXM1

Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit

Abstract

Background

Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected.

Patients and methods

In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade. We analyzed clinical characteristics, etiology, and severity of hypopituitarism in patients who presented with hyponatremia.

Results

Hyponatremia was recorded in 9.6% of our patients with hypopituitarism. In 80.7% it was the key to diagnosis of hypopituitarism. All patients with hyponatremia were steroid deficient with complete hypopituitarism compared to 75% (steroid deficient) and 60% (complete hypopituitarism) of the patients in the cohort. The most common etiology of hypopituitarism was non-functioning pituitary macro adenoma (NFPA) (n = 128, 49.2%). Patients with hyponatremia were divided into two groups, based on the etiology of hypopituitarism: Group 1. with NFPA n = 15 (5F/10M), mean age 71.47 ± 4.8 years, who were significantly older compared to patients with hyponatremia from other rare causes of hypopituitarism in Group 2. n = 10 (8F/2M), mean age 40.2 ± 15.3 years (p < 0.01), such as: congenital hypopituitarism(n = 2), Sheehan's syndrome (n = 2), intracranial aneurysm (n = 2), lymphocytic hypophysitis (n = 1), traumatic brain injury (n = 1), surgery and radiotherapy for astrocytoma (n = 1), pituitary metastasis from bronchial carcinoma (n = 1). Hyponatremia was more severe in Group 2. compared to Group 1. (113.5 ± 10.9 mmol/L vs. 124.3 ± 8.1 mmol/L, p < 0.01). Older age (p = 0.0001) and number of endocrine deficiencies (p < 0.05) were identified as predictive factors for hyponatremia by multivariate analysis in patients with hypopituitarism.

Conclusion

Hyponatremia is an important presenting feature of pituitary disease and a strong indicator of life-threatening steroid deficiency. Old age and severity of hypopituitarism are major risk factors for hyponatremia. In older patients NFPA is the most common etiology, while other rare causes of hypopituitarism are more prevalent in younger patients with hyponatremia.

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Racial and Insurer-Based Disparities of Care Exist Among Thyroid Cancer Patients in the United States

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 351-353.


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Large Retrospective Study Confirms the 2015 American Thyroid Association Guidelines for Classifying Small Thyroid Nodules on Ultrasound

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 344-347.


http://ift.tt/2jrznXA

Conflicting Occurrence of Thyroid-Stimulating or Blocking Antibodies Is Seen in 4 to 9% of Patients with Autoimmune Thyroid Disease

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 335-337.


http://ift.tt/2x2Fqqs

A Deiodinase 2 Polymorphism May Lower Serum T3 and Tissue T3 in Levothyroxine-Treated Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 338-340.


http://ift.tt/2x32hCj

Hypothyroid Symptoms in Pregnant Women Fail to Predict Hypothyroid Status

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 332-334.


http://ift.tt/2jqMpoz

Moderate-Risk versus High-Risk RET Mutation Does Not Impact Medullary Thyroid Cancer Outcomes in MEN2A Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 348-350.


http://ift.tt/2jqMp83

Is There a Distinct Pattern of Mutations in Benign Adenomatous Nodules?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 341-343.


http://ift.tt/2x2SrjG

Does Empathy, a Central Element of the Art of Medicine, Proscribe Using “Good Cancer” Themes in Clinical Practice?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 354-357.


http://ift.tt/2jq5hUx

Racial and Insurer-Based Disparities of Care Exist Among Thyroid Cancer Patients in the United States

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 351-353.


http://ift.tt/2x2mLuY

Large Retrospective Study Confirms the 2015 American Thyroid Association Guidelines for Classifying Small Thyroid Nodules on Ultrasound

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 344-347.


http://ift.tt/2jrznXA

Conflicting Occurrence of Thyroid-Stimulating or Blocking Antibodies Is Seen in 4 to 9% of Patients with Autoimmune Thyroid Disease

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 335-337.


http://ift.tt/2x2Fqqs

Hypothyroid Symptoms in Pregnant Women Fail to Predict Hypothyroid Status

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 332-334.


http://ift.tt/2jqMpoz

A Deiodinase 2 Polymorphism May Lower Serum T3 and Tissue T3 in Levothyroxine-Treated Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 338-340.


http://ift.tt/2x32hCj

Moderate-Risk versus High-Risk RET Mutation Does Not Impact Medullary Thyroid Cancer Outcomes in MEN2A Patients

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 348-350.


http://ift.tt/2jqMp83

Is There a Distinct Pattern of Mutations in Benign Adenomatous Nodules?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 341-343.


http://ift.tt/2x2SrjG

Does Empathy, a Central Element of the Art of Medicine, Proscribe Using “Good Cancer” Themes in Clinical Practice?

Clinical Thyroidology Sep 2017, Vol. 29, No. 9: 354-357.


http://ift.tt/2jq5hUx

Editorial Board

Publication date: September 2017
Source:Pathology - Research and Practice, Volume 213, Issue 9





http://ift.tt/2vV60yN

Full Monte Carlo-based biological treatment plan optimization system for intensity modulated carbon ion therapy on GPU

Publication date: Available online 12 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nan Qin, Chenyang Shen, Min-Yu Tsai, Marco Pinto, Zhen Tian, Georgios Dedes, Arnold Pompos, Steve B. Jiang, Katia Parodi, Xun Jia
PurposeOne of the major benefits of carbon ion therapy is enhanced biological effectiveness at the Bragg peak region. For intensity modulated carbon ion therapy (IMCT), it is desirable to employ Monte Carlo (MC) methods to compute properties of each pencil-beam spot for treatment planning, because of their accuracy in modeling physics processes and estimating biological effects. We have previously developed goCMC, a graphics processing unit (GPU)-oriented MC engine for carbon ion therapy. The purpose of this study is to build a biological treatment plan optimization system based on goCMC.Methods and MaterialsThe repair-misrepair-fixation model was implemented to compute spatial distribution of linear-quadratic model parameters for each spot. A treatment plan optimization module was developed to minimize the difference between the prescribed and actual biological effect. We employed a gradient-based algorithm to solve the optimization problem. The system was embedded in the Varian Eclipse treatment planning system under a client-server architecture to achieve a user-friendly planning environment. We tested the system with a 1-dimensional homogeneous water case and 3-dimensional patient cases.ResultsOur system generated treatment plans with biological spread-out Bragg peaks covering the targeted regions, while sparing critical structures. Using four NVidia GTX 1080 GPUs, total computation time including spot simulation, optimization, and final dose calculation was 0.6 hours for the prostate case (8282 spots), 0.2 hours for the pancreas case (3795 spots), and 0.3 hours for the brain case (6724 spots). The computation time was dominated by MC spot simulation.ConclusionsWe have built a biological treatment plan optimization system for IMCT that performs simulations by a fast MC engine, goCMC. To our knowledge, this is the first time that full MC-based IMCT inverse planning has been achieved in a clinically viable timeframe.



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BET-bromodomain inhibitors modulate epigenetic patterns at the diacylglycerol kinase alpha enhancer associated with radiation-induced fibrosis

Publication date: Available online 12 September 2017
Source:Radiotherapy and Oncology
Author(s): Gintvile Valinciute, Christoph Weigel, Marlon R. Veldwijk, Christopher C. Oakes, Carsten Herskind, Frederik Wenz, Christoph Plass, Peter Schmezer, Odilia Popanda
Background and purposeFibrosis is a frequent adverse effect of radiotherapy and no effective treatments are currently available to prevent or reverse fibrotic disease. We have previously identified altered epigenetic patterns at a gene enhancer of the diacylglycerol kinase alpha (DGKA) locus in normal skin fibroblasts derived from fibrosis patients. An open chromatin pattern related to radiation-inducibility of DGKA is associated with onset of radiation-induced fibrosis. Here, we explore epigenetic modulation of DGKA as a way to mitigate predisposition to fibrosis.Material and methodsWe studied the effect of the BET-bromodomain inhibitors (JQ1, PFI-1) on DGKA inducibility in primary fibroblasts. Hence, DGKA transcription was additionally induced by the radiomimetic drug bleomycin, and DGKA mRNA expression, histone H3K27 acetylation and downstream markers of profibrotic fibroblast activation after BET-bromodomain inhibition were determined.ResultsBET-bromodomain inhibition suppressed induction of DGKA in bleomycin-treated fibroblasts, reduced H3K27ac at the DGKA enhancer and repressed collagen marker gene expression. Alterations in fibroblast morphology and reduction of collagen deposition were observed.ConclusionFor the DGKA enhancer, we show that BET-bromodomain inhibitors can alter the epigenetic landscape of fibroblasts, thus counteracting profibrotic transcriptional events. Interference with epigenetic patterns of fibrosis predisposition may provide novel preventive therapies that improve radiotherapy.



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Lack of differences in radiation-induced immunogenicity parameters between HPV-positive and HPV-negative human HNSCC cell lines

Publication date: Available online 12 September 2017
Source:Radiotherapy and Oncology
Author(s): Karolin Schneider, Vanesa Bol, Vincent Grégoire
Background and purposeClinical studies indicate that patients with HPV/p16-associated head & neck squamous cell carcinoma (HNSCC) represent a subgroup with a better prognosis and improved response to conventional radiotherapy. Involvement of immune-based factors has been hypothesized. In the present study, we investigated radiation-induced differences in release of damage associated molecular patterns (DAMPs), cytokines and activation of dendritic cells (DCs) in HPV-positive and negative HNSCC cancer cell lines.Material and methodsCalreticulin (CRT) exposure was detected on cancer cell surface. ATP, HMGB1 and cytokines were measured in culture supernatants. Maturation marker CD83 surface exposure was determined on DCs after co-incubation with irradiated tumor cells.ResultsThere was no increase in DAMPs and cytokine profiles after radiation treatment and no difference between HPV+ and HPV− cell lines. The HPV/p16-positive SCC90 cells showed a trend for increased total CRT, HMGB1, and number of cytokines compared to all other cell lines. None of the irradiated cancer cell lines could affect DC maturation.ConclusionsRadiation treatment did not increase immunogenicity of HNSCC cell lines assessed by membrane CRT, ATP, HMGB1, cytokines production, and by activation of immature DCs. There was no difference between HPV-positive and HPV-negative cell lines.



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Stereotactic radiosurgery of early melanoma brain metastases after initiation of anti-CTL-4 treatment is associated with improved intracranial control

Publication date: Available online 12 September 2017
Source:Radiotherapy and Oncology
Author(s): Yi An, Wen Jiang, Betty Y.S. Kim, Jack M. Qian, Chad Tang, Penny Fang, Jennifer Logan, Neil M. D'Souza, Lauren E. Haydu, Xin A. Wang, Kenneth R. Hess, Harriet Kluger, Isabella C. Glitza, Anita Mahajan, James W. Welsh, Steven H. Lin, James B. Yu, Michael A. Davies, Patrick Hwu, Erik P. Sulman, Paul D. Brown, Veronica L.S. Chiang, Jing Li
BackgroundNumerous studies suggest that radiation can boost antitumor immune response by stimulating release of tumor-specific antigens. However, the optimal timing between radiotherapy and immune checkpoint blockade to achieve potentially synergistic benefits is unclear.Material and methodsMulti-institutional retrospective analysis was conducted of ninety-nine metastatic melanoma patients from 2007 to 2014 treated with ipilimumab who later received stereotactic radiosurgery (SRS) for new brain metastases that developed after starting immunotherapy. All patients had complete blood count acquired before SRS. Primary outcomes were intracranial disease control and overall survival (OS).ResultsThe median follow-up time was 15.5months. In the MD Anderson cohort, patients who received SRS after 5.5months (n=20) of their last dose of ipilimumab had significantly worse intracranial control than patients who received SRS within 5.5months (n=51) (median 3.63 vs. 8.09months; hazard ratio [HR] 2.07, 95% confidence interval [CI] 1.03–4.16, p=0.041). OS was not different between the two arms. The improvement in intracranial control was confirmed in an independent validation cohort of 28 patients treated at Yale-New Haven Hospital. Circulating absolute lymphocyte count before SRS predicted for treatment response as those with baseline counts >1000/µL had reduced risk of intracranial recurrence compared with those with ≤1000/µL (HR 0.46, 95% CI 0.0.23–0.94, p=0.03).ConclusionsIn this multi-institutional study, patients who received SRS for new brain metastases within 5.5months after ipilimumab therapy had better intracranial disease control than those who received SRS later. Moreover, higher circulating lymphocyte count was associated with improved intracranial disease control.



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Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy

Publication date: Available online 13 September 2017
Source:Radiotherapy and Oncology
Author(s): Yutaka Shiraishi, Cai Xu, Jinzhong Yang, Ritsuko Komaki, Steven H. Lin
PurposeTo compare heart and cardiac substructure radiation exposure using intensity-modulated radiotherapy (IMRT) vs. proton beam therapy (PBT) for patients with mid- to distal esophageal cancer who received chemoradiation therapy.Methods and materialsWe identified 727 esophageal cancer patients who received IMRT (n=477) or PBT (n=250) from March 2004 to December 2015. All patients were treated to 50.4Gy with IMRT or to 50.4 cobalt Gray equivalents with PBT. IMRT and PBT dose–volume histograms (DVHs) of the whole heart, atria, ventricles, and four coronary arteries were compared. For PBT patients, passive scattering proton therapy (PSPT; n=237) and intensity-modulated proton therapy (IMPT; n=13) DVHs were compared.ResultsCompared with IMRT, PBT resulted in significantly lower mean heart dose (MHD) and heart V5, V10, V20, V30, and V40as well as lower radiation exposure to the four chambers and four coronary arteries. Compared with PSPT, IMPT resulted in significantly lower heart V20, V30, and V40 but not MHD or heart V5 or V10. IMPT also resulted in significantly lower radiation doses to the left atrium, right atrium, left main coronary artery, and left circumflex artery, but not the left ventricle, right ventricle, left anterior descending artery, or right coronary artery. Factors associated with lower MHD included PBT (P<0.001), smaller planning target volume (PTV; P<0.001), and gastroesophageal junction (GEJ) tumor (P<0.001). Among PBT patients, factors associated with lower MHD included IMPT (P=0.038), beam arrangement other than AP/PA (P<0.001), smaller PTV (P<0.001), and GEJ tumor (P<0.001).ConclusionsIn patients with mid- to distal esophageal cancer, PBT results in significantly lower radiation exposure to the whole heart and cardiac substructures than IMRT. Long-term studies are necessary to determine how this cardiac sparing effect impacts the development of coronary artery disease and other cardiac complications.



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Long-term retention of ECM hydrogel after implantation into a sub-acute stroke cavity reduces lesion volume.

Publication date: Available online 13 September 2017
Source:Acta Biomaterialia
Author(s): Harmanvir Ghuman, Madeline Gerwig, Francesca J. Nicholls, Jessie Liu, Julia Donnelly, Stephen F. Badylak, Michel Modo
Salvaging or functional replacement of damaged tissue caused by stroke in the brain remains a major therapeutic challenge. In situ gelation and retention of a hydrogel bioscaffold composed of 8 mg/mL extracellular matrix (ECM) can induce a robust invasion of cells within 24 hours and potentially promote a structural remodeling to replace lost tissue. Herein, we demonstrate a long-term retention of ECM hydrogel within the lesion cavity. A decrease of approximately 32% of ECM volume is observed over 12 weeks. Lesion volume, as measured by magnetic resonance imaging and histology, was reduced by 28%, but a battery of behavioral tests (bilateral asymmetry test; footfault; rotameter) did not reveal a therapeutic or detrimental effect of the hydrogel. Glial scarring and peri-infarct astrocytosis were equivalent between untreated and treated animals, potentially indicating that permeation into host tissue is required to exert therapeutic effects. These results reveal a marked difference of biodegradation of ECM hydrogel in the stroke-damaged brain compared to peripheral soft tissue repair. Further exploration of these structure-function relationships is required to achieve a structural remodeling of the implanted hydrogel, as seen in peripheral tissues, to replace lost tissue and promote behavioral recovery.Statement of SignificanceIn situ gelation of ECM is essential for its retention within a tissue cavity. The brain is a unique environment with restricted access that necessitates image-guided delivery through a thin needle to access tissue cavities caused by stroke, as well as other conditions, such as traumatic brain injury or glioma resection. Knowledge about a brain tissue response to implanted hydrogels remains limited, especially in terms of long-term effects and potential impact on behavioral function. We here address the long-term retention of hydrogel within the brain environment, its impact on behavioral function, as well as its ability to reduce further tissue deformation caused by stroke. This study highlights considerable differences in the brain's long-term response to an ECM hydrogel compared to peripheral soft tissue. It underlines the importance of understanding the effect of the structural presence of a hydrogel within a cavity upon the host brain tissue and behavioral function. As demonstrated herein, ECM hydrogel can fill a cavity long-term to reduce further progression of the cavity, while potentially serving as a reservoir for local drug or cell delivery.

Graphical abstract

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In‐Hospital Outcomes of Tumor Lysis Syndrome: A Population‐Based Study Using the National Inpatient Sample

AbstractThe epidemiology and outcomes of tumor lysis syndrome (TLS) are understudied. We used the National Inpatient Sample (NIS), a nationally representative weighted sample of all U.S. hospital discharges, to study outcomes and predictors of mortality in hospitalized patients with TLS. The NIS was queried for patients with a discharge diagnosis of TLS (ICD‐9 code 277.88) from 2010–2013. Baseline characteristics and outcomes were analyzed. A multivariable logistic regression analysis was performed to identify predictors of mortality. From 2010–2013, 28,370 patients were discharged with a diagnosis of TLS. The most common malignancies were non‐Hodgkin lymphoma (30%), solid tumors (20%), acute myeloid leukemia (19%), and acute lymphocytic leukemia (13%). Overall in‐hospital mortality was 21%. The median length of stay was 10 days (IQR 5‐22). Sixty‐nine percent of patients experienced a severe complication, including sepsis (22%, 95% confidence interval [CI] 21–23), dialysis (15%, 95% CI 14–16), acute respiratory failure (23%, 95% CI 22–24), mechanical ventilation (16%, 95% CI 15–17), gastrointestinal hemorrhage (6%, 95% CI 5–7), cerebral hemorrhage (2%, 95% CI 2–3), seizures (1%, 95% CI 0.6–1), and cardiac arrest (2%, 95% CI 2–3). Predictors of mortality were derived from a multivariable logistic regression and included age, Elixhauser comorbidity score, insurance status, teaching versus nonteaching hospital, and cancer type. Predictors of increased length of stay included age, race, teaching versus nonteaching hospital, and cancer type. In the U.S., many patients with TLS develop life‐threatening complications and a quarter die during hospitalization. As more cancer treatments become available, strategies to improve the supportive care of patients with TLS should be a priority.

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Impact of Metastasectomy in the Multimodality Approach for BRAF V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience

AbstractBackground.BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC.Subjects, Materials, and Methods. Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan‐Meier method, log‐rank test, and Cox proportional hazard models.Results.Fifty‐two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right‐sided tumors, and 28% with liver‐limited metastasis. In the first‐line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, and BEV. Median overall survival (OS) for all 52 patients was 25 months with median progression‐free survival (PFS) of 9.3 months. With median follow‐up of 18.3 months, 21 patients underwent metastasectomy with longer OS (29.1 months vs. 22.7 months, hazard ratio [HR] = 0.33; confidence interval [CI], 0.12–0.78; p = .01) and PFS (13.6 months vs. 6.2 months, HR = 0.53, CI, 0.28–0.97; p = .03) compared with the non‐metastasectomy cohort. In multivariate analysis, metastasectomy remained significant for improved survival outcomes (HR = 0.52; 95% CI, 0.07–1.02; p = .02). Median disease‐free survival after metastasectomy was 9.7 months (95% CI, 5.5–19.5). Two patients remain disease‐free at the time of last follow‐up, with one patient without relapse for greater than 2 years (28.9 months).Conclusion.Multimodality therapy incorporating metastasectomy for BRAF V600E mCRC should be considered and might be associated with improved overall survival in select patients.Implications for Practice.BRAF V600E metastatic colorectal cancer (mCRC) represents an extremely difficult molecular subset of colorectal cancer to treat. To date, this subset remains refractory to standard chemotherapies, prompting extensive clinical investigation regarding novel treatment approaches and targeted modalities. While the use of metastasectomy for expanded RAS wild‐type and RAS mutated mCRC has resulted in improved overall survival for select patients, utilization of metastasectomy in patients with BRAF V600E mCRC remains controversial. We reviewed our experience with BRAF V600E mCRC to ascertain whether a multidisciplinary approach incorporating metastasectomy for well‐selected patients improves overall survival.

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FDA Approval Summary: Daratumumab for Treatment of Multiple Myeloma After One Prior Therapy

AbstractOn November 21, 2016, the U.S. Food and Drug Administration granted regular approval to daratumumab in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on two randomized, open‐label trials in which daratumumab was added to these backbone therapies. The MMY3003 trial demonstrated substantial improvement in progression‐free survival (PFS) when daratumumab was added to lenalidomide and dexamethasone compared with lenalidomide and dexamethasone alone. The estimated median PFS had not been reached in the daratumumab arm and was 18.4 months in the control arm (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.27–0.52; p < .0001), representing a 63% reduction in the risk of disease progression or death. Similar results were observed in the MMY3004 trial comparing the combination of daratumumab, bortezomib, and dexamethasone with bortezomib and dexamethasone. The estimated median PFS was not reached in the daratumumab arm and was 7.2 months in the control arm (HR = 0.39; 95% CI: 0.28–0.53; p < .0001), representing a 61% reduction in the risk of disease progression or death. The most frequently reported adverse reactions (greater than or equal to 20%) in MMY3003 were infusion reactions, diarrhea, nausea, fatigue, pyrexia, upper respiratory tract infection, muscle spasm, cough, and dyspnea. The most frequently reported adverse reactions (greater than or equal to 20%) in MMY3004 were infusion reactions, diarrhea, peripheral edema, upper respiratory tract infection, and peripheral sensory neuropathy. Neutropenia and thrombocytopenia have been added to the Warnings and Precautions of the drug label.Implications for Practice.Daratumumab, the first monoclonal antibody targeted against CD38, received U.S. Food and Drug Administration accelerated approval in 2015 based on data from single‐agent, single‐arm trials that provided response rate information. Results of the MMY3003 and MMY3004 trials established that daratumumab can be combined synergistically with some of the most highly active agents used to treat multiple myeloma, leading to daratumumab's regular approval in 2016. Daratumumab added to lenalidomide and dexamethasone, or bortezomib and dexamethasone, provides a substantial improvement in progression‐free survival in previously treated patients with multiple myeloma. These combinations will likely improve the survival outlook for patients with multiple myeloma.

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Letter from the Editor

Publication date: Available online 13 September 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Gabriela Gayer




http://ift.tt/2wr8UL5

Emerging Breast Imaging Technologies on the Horizon

Publication date: Available online 13 September 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Srinivasan Vedantham, Andrew Karellas
Early detection of breast cancers by mammography in conjunction with adjuvant therapy have contributed to reduction in breast cancer mortality. Mammography remains the 'gold-standard′ for breast cancer screening, but is limited by tissue superposition. Digital breast tomosynthesis and more recently, dedicated breast computed tomography have been developed to alleviate the tissue superposition problem. However, all of these modalities rely upon x-ray attenuation contrast to provide anatomical images and there are ongoing efforts to develop and clinically translate alternative modalities. These emerging modalities could provide for new contrast mechanisms and may potentially improve lesion detection and diagnosis. In this article, several of these emerging modalities are discussed with a focus on technologies that have advanced to the stage of in vivo clinical evaluation.



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Electrophilic fluorination of α-Fe2O3 nanostructures and influence on magnetic properties

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Gaurav Bahuguna, Vikash C. Janu, Vinay Uniyal, Nagaiah Kambhala, S. Angappane, Rakesh K. Sharma, Ritu Gupta
Dendritic nanostructures of fluorinated α-Fe2O3 are synthesized using Potassium Ferrocyanide along with Selectfluor™ (F-TEDA), HF, TBABF4, NaF and NH4F as Fe and F precursors respectively in an in-situ hydrothermal process. The choice of sources is based on the nature of fluorine; F-TEDA uniquely acts as a source for electrophilic fluorine while others are nucleophilic in nature. The effect of fluorination on α-Fe2O3 nanostructures is examined from the interplay between (110) and (104) growth direction and crystallite size by X-Ray diffraction analysis and the amount of fluorination is observed by elemental analysis. A significant change in the magnetic property of α-Fe2O3 is observed for different concentrations of F-TEDA. Pristine α-Fe2O3 undergoes an antiferromagnetic to ferromagnetic transition with saturation magnetization value of ~13emu/g and coercivity of 109.8Oe. However, α-Fe2O3 nanostructures prepared with HF, NH4F, TBABF4 and NaF in absence of fluorination remain antiferromagnetic despite of changes in preferred orientation and crystallite size. The interesting magnetic properties arising from F-TEDA is attributed to surface fluorination that results in uncompensated surface spins.

Graphical abstract

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Evolution of crystal structure of Cu precipitates in a low carbon steel

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): G. Han, Z.J. Xie, Z.Y. Li, B. Lei, C.J. Shang, R.D.K. Misra
Intercritical tempering at 680°C for different times was carried out in a low carbon copper-bearing steel to study the evolution of the crystal structure of Cu precipitates by high resolution transmission electron microscopy. With increased tempering time, four different types of crystal structure of copper precipitates with different sizes were observed, namely, (a) nano-ordered clusters comprised of B2 FeCu nano-ordered clusters (2–3nm) and weak ordered BCC Cu nanoclusters (2–3nm), (b) 9R Cu (5–12nm) - multiple twinned structure consisted of two, six or seven 9R twins with an orientation relationship of (1 1–4)9R∥(0 1 1)α, [−1 1 0]9R∥[1 −1 1]α, (c) detwinned 9R Cu (24–26nm) consisted of two 9R parts and a removable interface (1 1–4)9R, and (d) FCC Cu (~37nm) precipitates consisted of two parts of FCC Cu and a micro-twinned region. The evolution sequence of crystal structure of Cu precipitates was: nano-ordered clusters→9R Cu→detwinned 9R Cu→FCC Cu. The maximum contribution to precipitation hardening is attributed to nano-ordered clusters.

Graphical abstract

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Using glass powder to improve the durability of architectural mortar prepared with glass aggregates

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Jian-Xin Lu, Bao-Jian Zhan, Zhen-Hua Duan, Chi Sun Poon
This study designed a novel cement-based architectural tile prepared with more than 70% waste glass content (by weight). The waste glass was employed not only as decorative aggregates but also as a supplementary cementitious material in the architectural mortar. In terms of shrinkage, the incorporation of glass powder (GP) could significantly reduce the drying shrinkage of the glass mortars regardless of its fineness. When the glass mortars were subjected to high temperature (800°C), the inclusion of GP into the mortars was more able to mitigate the flexural and compressive strengths losses as compared to the control glass mortar prepared without the use of GP. Furthermore, using the GP and glass aggregates simultaneously could effectively improve the resistance of the glass mortars to sulfuric acid attack and the positive effect was more pronounced when finer GP was incorporated. In particular, an encouraging result shows that the replacement of 20% cement by fine GP successfully suppressed the deteriorative alkali-silica-reaction (ASR) expansion caused by the glass aggregates. Also, the glass mortars incorporated with fine GP exhibited comparable or even superior durability properties than that of the fly ash blended glass mortar.

Graphical abstract

http://ift.tt/2h2CWCU

Properties of perovskite ferroelectrics deposited on F doped SnO2 electrodes and the prospect of their integration into perovskite solar cells

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): I. Pintilie, V. Stancu, A. Tomulescu, R. Radu, C. Besleaga Stan, L. Trinca, L. Pintilie
The integration of ferroelectrics in perovskite solar cells is proposed as possible way to enhance charge collection efficiency. First results on solar cell manufactured with PbTiO3 (PTO) instead of TiO2 have shown negligible values for the power conversion efficiency (PCE). This is explained by the high serial resistance of sol-gel deposited PTO on F:SnO2 electrodes (FTO). Although PTO layer has remnant polarization of 22μC/cm², the high potential barrier (0.25±0.05eV) at the FTO/PTO interface and low carrier mobility (10⁻⁸cm²V⁻¹s⁻¹) compared to TiO2 leads to high serial resistance. Better results were obtained with thinner PTO layers grown by pulsed laser deposition, with PCE values up to 0.6%. Further enhancement was obtained by replacing PTO with BaTiO3 (BTO), with PCE value reaching about 0.8% after poling the cell with +3V. The most important finding was that the magnitude of the short circuit current increases with the amplitude of the poling voltage while the value of the open-circuit voltage remains about the same, around 0.9V. This is explained through more efficient collection of the charges generated under illumination in the absorber layer due to the polarization that is present in the ferroelectric film.

Graphical abstract

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Neutron residual stress measurement and numerical modeling in a curved thin-walled structure by laser powder bed fusion additive manufacturing

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Ke An, Lang Yuan, Laura Dial, Ian Spinelli, Alexandru D. Stoica, Yan Gao
Severe residual stresses in metal parts made by laser powder bed fusion additive manufacturing processes (LPBFAM) can cause both distortion and cracking during the fabrication processes. Limited data is currently available for both iterating through process conditions and design, and in particular, for validating numerical models to accelerate process certification. In this work, residual stresses of a curved thin-walled structure, made of Ni-based superalloy Inconel 625™ and fabricated by LPBFAM, were resolved by neutron diffraction without measuring the stress-free lattices along both the build and the transverse directions. The stresses of the entire part during fabrication and after cooling down were predicted by a simplified layer-by-layer finite element based numerical model. The simulated and measured stresses were found in good quantitative agreement. The validated simplified simulation methodology will allow to assess residual stresses in more complex structures and to significantly reduce manufacturing cycle time.

Graphical abstract

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Injection of oxytocin into paraventricular nucleus reverses depressive-like behaviors in the postpartum depression rat model

Publication date: 15 January 2018
Source:Behavioural Brain Research, Volume 336
Author(s): Tong Wang, Cuige Shi, Xiaoxiao Li, Pan Zhang, Bo Liu, Hao Wang, Yongjun Wang, Yutao Yang, Yan Wu, Hui Li, Zhi-Qing David Xu
Oxytocin (OXT) has been considered as a neuroregulator mediating social behaviors and stress-related disorders. Recent clinical studies suggest that OXT might also act as antidepressant in postpartum depression (PPD) patients, but the mechanism is still unknown. In the present study, we explored the effect of OXT in paraventricular nucleus (PVN) and possible signaling pathway involved in a PPD rat model induced by gestation restraint stress (GRS). PPD rats exhibited depressive-like behaviors with significantly longer immobility time, shorter climbing time, and lower sucrose consumption compared to the control rats. Plasma corticosterone (CORT) level was also higher in PPD rats. While PVN and supraoptic nucleus (SON) are main OXT synthesis regions in the brain, GRS-induced decrease of mRNA and peptide level of OXT was seen only in PVN. The expression of TrkB in PVN was increased in PPD rats. Local injection of OXT (20ng) into PVN reversed GRS-induced depressive-like behaviors and high plasma CORT level in PPD rats. Moreover, injection of OXT also reversed GRS-induced increase of TrkB in PVN of PPD rats. All those data suggest that OXT plays an antidepressant role by, at least in part, modulating HPA axis via TrkB in PVN of PPD rats.



http://ift.tt/2f68iYL

A facilitating role for the primary motor cortex in action sentence processing

Publication date: 15 January 2018
Source:Behavioural Brain Research, Volume 336
Author(s): Melody Courson, Joël Macoir, Pascale Tremblay
The involvement of the motor system in action language comprehension is a hotly debated topic in cognitive neuroscience and psychology. Recent studies suggest that primary motor cortex (M1) response to action language is context-sensitive rather than automatic and necessary. Specifically, semantic polarity (i.e. affirmative/negative valence) appears to modulate the intensity of this response, which is stronger for affirmative action sentences. The aim of our study was to examine further the context sensitivity of M1 response. More specifically, we aimed to determine whether M1 response follows semantic polarity or the core meaning of the sentence using two-part action sentences containing interacting polarities. Modulations of M1 activity were recorded using surface electromyography of the first dorsal interosseous muscle of the right hand in 22 healthy participants. Our results show an increase in M1 activity during the first part of the sentence, regardless of semantic polarity. This response was then modulated by the polarity of the second part of the sentence, which carried crucial information regarding the action. These observations suggest that M1 differentially responds to different aspects of action sentences, one response being automatic and the other following the core meaning of the sentence. Our results thus contribute to clarifying the nature of the motor response to action language, which is key to develop more comprehensive and plausible neurobiological models of language processing.



http://ift.tt/2jr5XZX

Trade-off between light availability and soil fertility determine refugial conditions for the relict light-demanding species in lowland forests

Publication date: November 2017
Source:Acta Oecologica, Volume 85
Author(s): Marcin Kiedrzyński, Józef Krzysztof Kurowski, Edyta Kiedrzyńska
Identifying potential refugial habitats in the face of rapid environmental change is a challenge faced by scientists and nature conservation managers. Relict populations and refugial habitats are the model objects in those studies. Based on the example of Actaea europaea from Central Poland, we analyse the habitat factors influencing relict populations of continental, light-demanding species in lowland forests and examine which habitats of studied species corresponding most closely to ancient vegetation. Our results indicate that the current refugial habitats of Actaea europaea include not only communities which are very similar to ancient open forest but also forests with a closed canopy. Although the populations are influenced by nitrogen and light availability, the co-occurrence of these two factors in forest communities is limited by dense canopy formation by hornbeam and beech trees on fertile soils and in more humid conditions. Our findings indicate that the future survival of relict, light-demanding communities in lowland forests requires low-intensity disturbances to be performed in tree-stands, according to techniques, which imitate traditional forests management.



http://ift.tt/2xzCh33

Spatial pattern of occurrence of epiphytic lichens on oaks in a heterogeneous landscape

Publication date: October 2017
Source:Acta Oecologica, Volume 84
Author(s): Lars M. Westerberg, Usman Haider Muhammadi, Karl-Olof Bergman, Per Milberg
Quercus robur (oaks) provides an important substrate for many epiphytic lichens, and with increasing age the bark becomes suitable for some rare species. These species may respond to environmental and landscape factors differently, and at different spatial scales. We tested the effect of factors related to the individual tree and the surrounding landscape on the occurrence and richness patterns of lichens species. The study system consisted of 213 oaks selected in a grid system within a 400 km² heterogeneous oak-rich area in south-eastern Sweden. Oaks had been selected to be relatively uniform in size (circumference 3.1–4.1 m), and as uniformly distributed as possible in the study area. Landscape factors were calculated for various spatial scales (circles with radius ranging from 28 to 1225 m from a studied oak). One of the landscape factors stands out as of general importance – oak density in the surrounding – while the others (amount of forest, water, houses and arable field) had no effects, or weak effects on only some species. Among the tree specific variables, circumference was consistently important (despite ranging from only 3.1–4.1 m) while inconsistent effects were seen by sun exposure of oak trunk (Chaenotheca phaeocephala, Ramalina baltica) and density of shrubs and trees near the tree (Ch. phaeocephala). The occurrence patterns of Cliostomum corrugatum, Ch. phaeocephala, R. baltica and richness (number of eleven target lichens) were best explained by the density of oaks within radii of 401, 199, 199 and 303 m, respectively. In conclusion, our study highlighted the importance of spatial scale for understanding the occurrence of epiphytic lichens and suggests spatial scales and oak densities that could be targeted for landscape and conservation planning.



http://ift.tt/2y6UWAl

A consensus-based approach to evidence-based clinical practice

Publication date: Available online 12 September 2017
Source:Dental Materials
Author(s): Jean-François Roulet




http://ift.tt/2joEHem

Academy of Dental Materials guidance—Resin composites: Part II—Technique sensitivity (handling, polymerization, dimensional changes)

Publication date: Available online 13 September 2017
Source:Dental Materials
Author(s): J.L. Ferracane, T.J. Hilton, J.W. Stansbury, D.C. Watts, N. Silikas, N. Ilie, S. Heintze, M. Cadenaro, R. Hickel
ObjectiveThe objective of this work, commissioned by the Academy of Dental Materials, was to review and critically appraise test methods to characterize properties related to critical issues for dental resin composites, including technique sensitivity and handling, polymerization, and dimensional stability, in order to provide specific guidance to investigators planning studies of these properties.MethodsThe properties that relate to each of the main clinical issues identified were ranked in terms of their priority for testing, and the specific test methods within each property were ranked. An attempt was made to focus on the tests and methods likely to be the most useful, applicable, and supported by the literature, and where possible, those showing a correlation with clinical outcomes. Certain methods are only briefly mentioned to be all-inclusive. When a standard test method exists, whether from dentistry or another field, this test has been identified. Specific examples from the literature are included for each test method.ResultsThe properties for evaluating resin composites were ranked in the priority of measurement as follows: (1) porosity, radiopacity, sensitivity to ambient light, degree of conversion, polymerization kinetics, depth of cure, polymerization shrinkage and rate, polymerization stress, and hygroscopic expansion; (2) stickiness, slump resistance, and viscosity; and (3) thermal expansion.SignificanceThe following guidance is meant to aid the researcher in choosing the most appropriate test methods when planning studies designed to assess certain key properties and characteristics of dental resin composites, specifically technique sensitivity and handling during placement, polymerization, and dimensional stability.



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Structural neuroimaging in sport-related concussion

Publication date: Available online 13 September 2017
Source:International Journal of Psychophysiology
Author(s): Erin D. Bigler
Structural neuroimaging of athletes who have sustained a sports-related concussion (SRC) can be viewed as either standard clinical imaging or with advanced neuroimaging methods that quantitatively assess brain structure. Negative findings from conventional computed tomography (CT) or magnetic resonance imaging (MRI) are the norm in SRC. Nonetheless, these conventional measures remain the first line of neuroimaging of the athlete as they do detect clinically significant pathologies, when present, such as hemorrhagic abnormalities in the form of hematomas, contusions and mircobleeds along with regions of focal encephalomalacia or other signal abnormalities, with CT best capable of detecting skull fractures. However, advanced neuroimaging techniques hold particular promise in detecting subtle neuropathology in the athlete which standard clinical neuroimaging cannot. To best understand what conventional as well as quantitative neuroimaging methods are detecting in SRC, this review begins by covering basic neuroanatomical principles associated with mild traumatic brain injury (mTBI) and the brain regions most vulnerable to injury from SRC, as these regions define where advanced neuroimaging methods most likely detect abnormalities. Advanced MRI techniques incorporate quantitative metrics that include volume, shape, thickness along with diffusion parameters that provide a more fine-grained analysis of brain structure. With advancements in image analysis, multiple quantitative neuroimaging metrics now can be utilized in assessing SRC. Such multimodality approaches are particularly relevant and important for assessing white matter and network integrity of the brain following injury, including SRC. This review focuses just on the structural side of neuroimaging in SRC, but these techniques also are being integrated with functional neuroimaging, where the combination of the two approaches may provide superior methods in assessing the pathological effects of SRC.



http://ift.tt/2xz87gf

Health risk assessment of an abandoned herbicide factory site for transportation use in Dalian, China

Abstract

An abandoned herbicide factory site was used as an example of how planning should be considered for development of the site for transportation use in Dalian, China. Exposure pathways and parameters for three types of transportation use (land for a traffic hub, land for an urban road, and land for a subway) were developed. Twenty-five sampling sites were selected and 38 soil samples were collected in March 2015. Hexachlorobenzene and benzo(a)pyrene which were extracted by Soxhlet extraction and detected by gas chromatography mass spectrometry were the most significant pollutants detected. The maximum concentration of the two pollutants in the surface layer (0–0.5 m) were 0.57 and 3.10 mg/kg, and in the bottom layer (1.0 m) were 2.57 and 3.72 mg/kg, respectively. In this study, risk assessment results based on the established exposure scenario and parameters showed that there was a significant difference in traffic hub land use under specific exposure pathway and common insensitive land use exposure pathways (direct ingestion of soil, dermal contact with soil, and inhalation of soil-derived dust). Commonly considered hexachlorobenzene and benzo(a)pyrene carcinogenic risk values exceeded the maximum acceptable level (10⁻⁶) and were found to be 23.9-fold and 189-fold higher than the carcinogenic risk values, respectively. Parameter sensitivity analysis data showed that for transportation use, the two parameters "EFOa" and "OSIRa" were the most significant factors associated with variation of the carcinogenic risk value. For traffic hub land use, urban road land use, and subway land use, the main exposure pathways were through "inhalation of soil vapors outdoors (from surface soil)," "direct ingestion of soil," and "inhalation of soil vapors indoors (from bottom soil)," which contributed 84.75, 73.00, and 100.00% to the total risk value, respectively.

http://ift.tt/2x0b2eH

On-site phytoremediation applicability assessment in Alur Ilmu, Universiti Kebangsaan Malaysia based on spatial and pollution removal analyses

Abstract

The present paper aims to assess the phytoremediation performance based on pollution removal efficiency of the highly polluted region of Alur Ilmu urban river for its applicability of on-site treatment. Thirteen stations along Alur Ilmu were selected to produce thematic maps through spatial distribution analysis based on six water quality parameters of Malaysia's Water Quality Index (WQI) for dry and raining seasons. The maps generated were used to identify the highly polluted region for phytoremediation applicability assessment. Four free-floating plants were tested in treating water samples from the highly polluted region under three different conditions, namely controlled, aerated and normal treatments. The selected free-floating plants were water hyacinth (Eichhornia crassipes), water lettuce (Pistia stratiotes), rose water lettuce (Pistia sp.) and pennywort (Centella asiatica). The results showed that Alur Ilmu was more polluted during dry season compared to raining season based on the water quality analysis. During dry season, four parameters were marked as polluted along Alur Ilmu, namely dissolve oxygen (DO), 4.72 mg/L (class III); ammoniacal nitrogen (NH₃–N), 0.85 mg/L (class IV); total suspended solid (TSS), 402 mg/L (class V) and biological oxygen demand (BOD), 3.89 mg/L (class III), whereas, two parameters were classed as polluted during raining season, namely total suspended solid (TSS), 571 mg/L (class V) and biological oxygen demand (BOD), 4.01 mg/L (class III). The thematic maps generated from spatial distribution analysis using Kriging gridding method showed that the highly polluted region was recorded at station AL 5. Hence, water samples were taken from this station for pollution removal analysis. All the free-floating plants were able to reduce TSS and COD in less than 14 days. However, water hyacinth showed the least detrimental effect from the phytoremediation process compared to other free-floating plants, thus made it a suitable free-floating plants to be used for on-site treatment.

http://ift.tt/2f6CDXp

Open Thoracic and Thoraco-abdominal Aortic Repair in Patients with Connective Tissue Disease

Publication date: Available online 13 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Paula R. Keschenau, Drosos Kotelis, Jeroen Bisschop, Mohammad E. Barbati, Jochen Grommes, Barend Mees, Alexander Gombert, Arnoud G. Peppelenbosch, Geert Willem H. Schurink, Johannes Kalder, Michael J. Jacobs
Objective/BackgroundThe aim is to present current results of open complex aortic repair in patients with connective tissue disease (CTD).MethodsThis was a retrospective cross-border, single centre study. From February 2000 to April 2016 72 aortic operations were performed on 65 patients with CTD (41 male, median age 41 years [range 19–70 years]). Fifty-six patients (86%) underwent at least one previous aortic repair (71 open, four endovascular), including 33 patients (51%) operated before at the site of the procedure reported here. The open procedures, counting eight emergency operations (11%), included aortic arch revision (n = 1; 1%), descending thoracic aortic repair (n = 11; 15%), TAAA type I repair (n = 12; 17%), type II repair (n = 29; 40%), type III repair (n = 12; 17%), and type IV repair (n = 5; 7%). Simultaneous repair of the ascending aorta and/or the aortic arch was performed in two (3%) and eight cases (11%), respectively. Seven patients (10%) underwent staged procedures. Median follow-up was 42 months (0.5–180 months).ResultsThe in hospital mortality was 14% (n = 9) as a result of haemorrhage (n = 3/9), neurological (n = 3/9), cardiac (n = 2/9), and pulmonary (n = 1/9) complications. Paraplegia and paraparesis occurred in one (2%) and three patients (5%), respectively. Seven patients (11%) required temporary dialysis; none needed permanent dialysis. Major complications were revision surgery for bleeding or haematoma (n = 20/65), sepsis (n = 10/65), myocardial infarction/severe cardiac arrhythmia (n = 2/65), stroke (n = 2/65), as well as multiorgan failure, abdominal compartment syndrome, mesenteric and peripheral ischaemia (all n = 1/65). Multivariate analysis identified an operating time > 7 hours (p = .006) as an independent predictor of increased mortality. Freedom from re-intervention was 85%, 1 year survival was 80%, and overall survival was 75%.ConclusionOpen TAA(A) repair is a durable therapy for patients with CTD. Often being performed as revision surgery, it can be associated with relevant risks and should therefore be reserved for specialised centres. Staged procedures and thus reducing operating time, if applicable, should be preferred.



http://ift.tt/2y6St93

Photoluminescent lateral flow based on non-radiative energy transfer for protein detection in human serum

Publication date: 15 February 2018
Source:Biosensors and Bioelectronics, Volume 100
Author(s): Alejandro Zamora-Gálvez, Eden Morales-Narváez, Javier Romero, Arben Merkoçi
A new paper-based lateral flow immunoassay configuration was engineered and investigated. The assay is intended for the detection of a model protein in human serum, that is, human immunoglobulin G, with the aim to demonstrate a virtually universal protein detection platform. Once the sample is added in the strip, the analyte is selectively captured by antibody-decorated silica beads (Ab-SiO2) onto the conjugate pad and the sample flows by capillarity throughout the strip until reaching the test line, where a sandwich-like immunocomplex takes place due to the presence of antibody-functionalized QDs (Ab-QDs) onto the test line. Eventually, GO is added as a revealing agent and the photoluminescence of those sites protected by the complex Ab-SiO2/Antigen/Ab-QDs will not be quenched, whereas those photoluminescent sites directly exposed are expected to be quenched by GO, including the control line, made of bare QDs, reporting that the assay occurred successfully. Hence, the photoluminescence of the test line is modulated by the formation of sandwich-like immunocomplexes. The proposed device achieves a limit of detection (LOD) of 1.35ngmL⁻¹ in standard buffer, which is lower when compared with conventional lateral flow technology reported by gold nanoparticles, including other amplification strategies. Moreover, the resulting device was proven useful in human serum analysis, achieving a LOD of 6.30ngmL⁻¹ in this complex matrix. This low-cost disposable and easy-to-use device will prove valuable for portable and automated diagnostics applications, and can be easily transferred to other analytes such as clinically relevant protein biomarkers.

Graphical abstract

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Supramolecular nano-sniffers for ultrasensitive detection of formaldehyde

Publication date: 15 February 2018
Source:Biosensors and Bioelectronics, Volume 100
Author(s): Uchangi Satyaprasad Akshath, Praveena Bhatt
Supramolecular nanoparticle hybrids for biosensing of analytes have been a major focus due to their tunable optical and surface properties. Quantum dots-Gold nanoparticle (QDs-GNP) based FRET probes involving turn on/off principles have gained immense interest due to their specificity and sensitivity. Recent focus is on applying these supramolecular hybrids for enzyme operated biosensors that can specifically turn-on fluorescence induced by co-factor or product formed from enzymatic reaction. The present study focuses on locking and unlocking the interaction between QD-GNP pair leading to differential fluorescent properties. Cationic GNPs efficiently quenched the anionic QD fluorescence by forming nanoparticle hybrid. Quenching interaction between QD-GNP pair was unlocked by NADH leading to QD fluorescence turn-on. This phenomenon was applied for the successful detection of formaldehyde using NAD⁺ dependent formaldehyde dehydrogenase. The proposed nano-sniffer could successfully detect formaldehyde from 0.001 to 100000ng/mL (R² = 0.9339) by the turn off-turn on principle. It could also detect formaldehyde in fruit juice and wine samples indicating its stability and sensitivity in real samples. The proposed nanoprobe can have wide applications in developing enzyme biosensors in future.

Graphical abstract

http://ift.tt/2xA81EY

From the bottom of the heart: Measuring liver iron concentration on cardiac MRI

Publication date: Available online 13 September 2017
Source:Clinical Imaging
Author(s): Stephanie Tan, Qi Peng, Mark C. Liszewski, Benjamin H. Taragin
Patients with hemochromatosis require regular surveillance of liver and cardiac iron concentration with liver and cardiac MRI. However, cardiac MRI includes a part of the liver in the field of view. The purpose of this retrospective and prospective study is to determine if liver T2* measured on cardiac MRI may be used as a surrogate for T2* obtained on standard liver MRI. Liver iron concentrations were measured on cardiac and liver MRI in 21 patients. Although statistically significant, the difference may be clinically insignificant as the same patients merited chelation therapy when relying on either the cardiac or liver MRI.



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The Younger Dryas black mat from Ojo de Agua, a geoarchaeological site in Northeastern Zacatecas, Mexico

Publication date: Available online 12 September 2017
Source:Quaternary International
Author(s): Ciprian F. Ardelean, Isabel Israde-Alcántara, Romel González-Hernández, Joaquin Arroyo-Cabrales, Corina Solis-Rosales, María Rodríguez-Ceja, Ben R. Pears, Jennifer Watling, Juan I. Macías-Quintero, Yam Zul E. Ocampo-Díaz
New explorations in the desert of northeastern Zacatecas, in central-northern Mexico, revealed dozens of archaeological and geoarchaeological sites. One of them, Ojo de Agua, contains the remains of a Pleistocene spring-fed hydrographic system located at the southeastern end of a large elongated endorheic basin. The locality yielded a particularly dark, highly organic stratigraphic layer commonly known in the Americas as Black Mat (BM), exposed on the natural profiles of a creek, but not associated with cultural materials. Several radiocarbon assessments confirmed the formation of the Ojo de Agua Black Mat during the Younger Dryas chronozone, with ten calibrated results clustering between 12,700–12,100 cal BP. This multi-proxy study confirmed the peculiarity of the deposit and found similarities and differences with other contexts of Younger Dryas age. The Ojo de Agua Black Mat (stratum C2) is far richer in charcoal specks than the related strata, but lacks phytoliths, diatoms or ostracods. No further biological remains were found in it, except for intrusive capillary roots. Clearly water-lain in a shallow pond, the stratum qualifies as a clayey silt with an acidic-to-neutral pH. Rich in heavy metals and with high contents of titanium, the Ojo de Agua Black Mat yielded significant indicators of intense wildfires during the Younger Dryas, but produced no carbon spherules or nanodiamonds supposedly linked to the impact theory.



http://ift.tt/2xzFq2S

Long term outcome after resection of liver metastases from squamous cell carcinoma

Publication date: Available online 13 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Kiyohiko Omichi, Takashi Mizuno, Masayuki Okuno, Ching-Wei D. Tzeng, Claudius Conrad, Yun Shin Chun, Thomas A. Aloia, Jean-Nicolas Vauthey
BackgroundSquamous cell carcinoma (SCC) liver metastases still remains a difficult challenge and the effectiveness of resection for SCC liver metastases is unclear. The aim of this study was to analyze long-term outcomes of surgically treated patients with SCC liver metastases.MethodsThe clinicopathological characteristics, overall survival (OS), and recurrence free survival (RFS) of all patients with SCC liver metastases resected between 1998 and 2015, were analyzed.ResultsAmong 28 patients who met inclusion criteria, there were 19 patients with anal cancer metastases (68%), 2 (7%) with cervix cancer metastases, 2 (7%) with tonsil cancer metastases, 2 (7%) with lung cancer metastases, 2 (7%) with primary unknown cancer metastases and 1 (4%) with vulvar cancer metastases. Four (14%) patients underwent major hepatectomy. There were no liver insufficiency cases or 90-day mortality. Cumulative 3- and 5-year OS rates were 52% and 47%. Cumulative 1- and 3-year RFS rates were 50% and 25%.ConclusionsLong-term outcomes after resection of SCC liver metastases compare favorably with those of colorectal or neuroendocrine liver metastases. Liver resection can be an effective treatment option for SCC liver metastases in appropriately selected patients after systemic therapy.



http://ift.tt/2h35XKY

The effectiveness of the 8th American Joint Committee on Cancer TNM classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 7th and 8th editions

Publication date: Available online 13 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Jun Lu, Chao-hui Zheng, Long-long Cao, Ping Li, Jian-wei Xie, Jia-bin Wang, Jian-xian Lin, Qi-yue Chen, Mi Lin, Chang-ming Huang
BackgroundThe 8^th edition of the AJCC TNM staging system for gastric cancer was released in 2016 and included major revisions, especially of stage III.Patients and MethodsData from 3,281 patients with GC who underwent R0 resection between December 2006 and November 2014 were reviewed. Of them, 1,579 patients with stage III according to the seventh edition were analyzed and the 7^th and 8^th TNM classifications were compared.ResultsThe most important tumor stages change observed in stage III GC. For stage III patients, the median number of lymph nodes (LNs) resected in stage III patients was 33 (range 5-112), and the optimal cut-off value for the number of LNs resected was 30. Although the 7^th edition classification had higher c-index, linear trend and likelihood ratioχ² scores, and smaller AIC values compared with those for the 8^th edition, which represented the optimum prognostic stratification, however, the differences between 7^th and 8^th edition seems to be not statistically significant, and AIC demonstrates similar trend as well. Further subgroup analysis found that the 8^th staging system generated the marginally better prognostic stratification only when LNs removed≥30.ConclusionThe 8^th TNM classification may provide better accuracy than 7^th edition in predicting the prognosis of stage III GC after R0 resection with LNs harvested≥30. However, further research in an external validation setting is warranted.



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An Audit Comparing The Reporting Of Staging MRI Scans For Rectal Cancer With The London Cancer Alliance (LCA) Guidelines

Publication date: Available online 13 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): M.R.S. Siddiqui, A.P. Shanmuganandan, S. Rasheed, P. Tekkis, G. Brown, A.M. Abulafi
BackgroundThis article focuses on the audit and assessment of clinical practice before and after introduction of MRI reporting guidelines. Standardised proforma based reporting may improve quality of MRI reports. Uptake of the use may be facilitated by endorsement from regional and national cancer organisations.MethodsThis audit was divided into 2 phases. MRI reports issued between April 2014 and June 2014 were included in the first part of our audit. Phase II included MRI reports issued between April 2015 and June 2015.Results14 out of 15 hospitals that report MRI scans in the LCA responded to our audit proposal. The completion rate of key MRI metrics/metrics was better in proforma compared to prose reports both before (98% vs 73%; p<0.05) and after introduction of the guidelines (98% vs 71%; p<0.05). There was an approximate doubling of proforma reporting after the introduction of guidelines and workshop interventions (39% vs 65%; p<0.05). Evaluation of locally advanced cancers (tumours extending to or beyond the circumferential resection margin) for beyond TME surgery was reported in 3% of prose reports vs. 42% in proformas.ConclusionsIncorporation of standardised reporting in official guidelines improved the uptake of proforma based reporting. Proforma based reporting captured more MRI reportable items compared to prose summaries, before and after the implementation of guidelines. MRI reporting of advanced cancers for beyond TME surgery falls short of acceptable standards but is more detailed in proforma based reports. Further work to improve completion especially in beyond TME reporting is required.



http://ift.tt/2h311ps

Management of the Central Compartment in Differentiated Thyroid Carcinoma

Publication date: Available online 13 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Ryan P. Goepfert, Gary L. Clayman
Management of differentiated thyroid carcinoma (DTC) is gradually evolving with considerations of de-escalation of treatment and/or active surveillance in a significant proportion of patients on the basis of an improved understanding of the long-term disease and functional outcomes from both surgical and non-surgical approaches. This is fueled by improved risk stratification, which increasingly couples analysis of clinicopathologic prognostic factors as determined through high resolution ultrasound and fine needle aspiration cytology. This paper discusses general recommendations for preoperative decision-making in the management of the central compartment in DTC with particular reference to micropapillary thyroid carcinoma and encapsulated follicular variant papillary thyroid carcinoma. Given the multitude of specific factors that must be considered for each patient, therapeutic decisions should occur in a multidisciplinary setting weighing the risks of treatment morbidity against the risks of disease progression or recurrence. Recurrent/persistent disease merits special attention with regard to pre-operative planning and surgical risk, and should be managed by high-volume thyroid surgeons.



http://ift.tt/2wXlnKS

Animal and human bite injuries: a 5-year retrospective study in a large urban public hospital in Venezuela

Abstract

Introduction

Animal bite injuries to the head and neck regions are an important public health problem. Most of these bites are from dogs. A 10-year retrospective study was undertaken to determine the prevalence of animal and human bites.

Materials and methods

This retrospective study was done from January 2011 to December 2016 and included 387 patients with a mean age of 21.51 years. Data collection included age, sex, days of hospitalization, lesion type, and clinical management.

Results

Majority of patients were in age group of 21–29 years, followed by 31–55 years. Out of the total 281 patients, 42 patients (51.60%) were males and 34 patients (48.40%) were females. Mean hospital stay was 7.2 days with a minimum of 5 days and a maximum of 12 days. Surgical management included cleansing and primary closure of the wound.

Conclusions

We concluded that the use of empiric antibiotic prophylaxis is essential for management of facial animal bite, and the antibiotic of first choice is amoxicillin-clavulanic acid. The aim of immediate surgical repair (< 6 h) is to avoid infections. The persistence of dog bite is public health problem in Venezuela.

http://ift.tt/2y6Be7E