Head and Neck Diseases by Alexandros G.Sfakianakis: 09/14/17

Πέμπτη 14 Σεπτεμβρίου 2017

Walking Forward: A Narrative from South Dakota

Publication date: Available online 14 September 2017
Source:Practical Radiation Oncology
Author(s): Daniel G Petereit

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Editorial.

No abstract available

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Management of Type I and Type II laryngeal clefts: controversies and evidence.

Purpose of review: To summarize the pediatric Type I and Type II laryngeal cleft literature, paying special attention to recent trends, including evolution of surgical techniques, standardization of outcome assessments, and utilization of management algorithms. Recent findings: There are a variety of options to choose from whenever considering Type I and Type II cleft repair, including endoscopic repair, transoral robotic surgery, and injection laryngoplasty. Conservative management including feeding therapy and treatment of comorbid medical conditions is recommended prior to repair. Validated outcome measures have arisen for swallow study interpretation and timing, as well as caregiver quality-of-life assessment. In addition, a series of medical algorithms have been proposed, which provide specific recommendations for diagnosis, treatment, and follow-up. Summary: For clefts that fail conservative management, endoscopic repair has become the gold standard. In addition, injection laryngoplasty appears to provide both a diagnostic and therapeutic option in the management of these patients. Transoral robotic-assisted endoscopic repair appears well tolerated and feasible, although broader implementation of this technology remains limited. The development and refinement of best practice algorithms can help standardize management and improve decision-making. Furthermore, incorporating validated outcome measures, recorded and followed over time, will improve both patient care and research efforts moving forward. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Acid–base safety during the course of a very low-calorie-ketogenic diet

Abstract

Background and Aims

Very low-calorie ketogenic (VLCK) diets have been consistently shown to be an effective obesity treatment, but the current evidence for its acid-base safety is limited. The aim of the current work was to evaluate the acid-base status of obese patients during the course of a VLCK diet.

Method

Twenty obese participants undertook a VLCK diet for 4 months. Anthropometric and biochemical parameters, and venous blood gases were obtained on four subsequent visits: visit C-1 (baseline); visit C-2, (1-2 months); maximum ketosis; visit C-3 (2-3 months), ketosis declining; and visit C-4 at 4 months, no ketosis. Results were compared with 51 patients that had an episode of diabetic ketoacidosis as well as with a group that underwent a similar VLCK diet in real life conditions of treatment.

Results

Visit C1 blood pH (7.37 ± 0.03); plasma bicarbonate (24.7 ± 2.5 mmol/l); plasma glucose (96.0 ± 11.7 mg/l) as well as anion gap or osmolarity were not statistically modified at four months after a total weight reduction of 20.7 kg in average and were within the normal range throughout the study. Even at the point of maximum ketosis all variables measured were always far from the cut-off points established to diabetic ketoacidosis.

Conclusion

During the course of a VLCK diet there were no clinically or statistically significant changes in glucose, blood pH, anion gap and plasma bicarbonate. Hence the VLCK diet can be considered as a safe nutritional intervention for the treatment of obesity in terms of acid-base equilibrium.

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Acid–base safety during the course of a very low-calorie-ketogenic diet

Abstract

Background and Aims

Method

Results

Conclusion

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Editorial.

No abstract available

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Management of Type I and Type II laryngeal clefts: controversies and evidence.

The efficacy and safety of a monophasic hyaluronic acid filler in the correction of nasolabial folds: A randomized, multicenter, single blinded, split-face study

Summary

Background

The different rheological properties of hyaluronic acid (HA) filler reflect their specific manufacturing processes and resultant physicochemical characteristics. However, there are few researches about the relationship between product differences and clinical outcome when HA fillers are used for nasolabial folds (NLFs).

Aims

This study sought to compare the rheological properties, efficacy and safety of a monophasic HA filler, and a well-studied biphasic HA filler, in the treatment of NLFs.

Patients/methods

A total of 72 Korean subjects with moderate to severe NLFs were randomized to receive injections with monophasic HA or biphasic HA on the left or right side of the face. Efficacy was evaluated by the change in the Wrinkle Severity Rating Scale (WSRS) at 2, 10, 18, 26, and 52 weeks. Safety was assessed on the basis of all abnormal reactions during the clinical test period. To compare the rheological characteristics of two cross-linked HA fillers, viscoelastic analysis was performed.

Results

At week 26, the mean WSRS was 2.26±0.56 for the monophasic HA side and 2.24±0.54 for the biphasic HA side. Both treatments were well tolerated. The adverse reactions were mild and transient. Monophasic HA filler had lower elasticity and higher viscosity than biphasic HA filler.

Conclusion

Despite a number of different rheological properties, monophasic HA is noninferior to biphasic HA in the treatment of moderate to severe NLFs for 52 weeks. Therefore, monophasic HA provides an alternative option for NLFs correction.

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Editorial.

No abstract available

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Management of Type I and Type II laryngeal clefts: controversies and evidence.

The efficacy and safety of a monophasic hyaluronic acid filler in the correction of nasolabial folds: A randomized, multicenter, single blinded, split-face study

Summary

Background

Aims

This study sought to compare the rheological properties, efficacy and safety of a monophasic HA filler, and a well-studied biphasic HA filler, in the treatment of NLFs.

Patients/methods

Results

Conclusion

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Study of the mechanism of remediation of Cd-contaminated soil by novel biochars

Abstract

This article used novel non-magnetized and magnetized biochars prepared under a CO₂ atmosphere returned to Cd-contaminated soil and compared these to the effects of conventional biochars prepared under a N₂ atmosphere with regard to Cd-contaminated soil remediation. A pot experiment with lettuce (Lactuca sativa) was conducted to investigate the relative soil remediation effects of these biochars. The soil used for the pot experiment was spiked with 20 mg kg⁻¹ Cd and amended with 5% of a biochar before sowing. Through these research works, some important results were obtained as follows: (1) applying biochar treated by pyrolysis under a CO₂ atmosphere can obtain the best remediation effect of Cd-contaminated soil that the content of cadmium in the lettuce roots, stems, and leaves was reduced 67, 62, and 63%, respectively; (2) the magnetic biochar aggregation for the soil is weak, so the heavy metal cadmium in the soil could not be immobilized well by the magnetic biochar; (3) The remediation mechanism of novel biochars is that biochar includes a large number of organic functional groups (−C–OH, −C=O, COO−) that can act in a complexing reaction with heavy metal Cd(II) and the inorganic salt ions (Si, S, Cl, etc.) that can combine with cadmium and generate a stable combination.

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Susceptibility to Dengue Virus and Genetic Polymorphisms of Tumor Necrosis Factor Alpha: A Comment

Viral Immunology , Vol. 0, No. 0.

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Chikungunya Virus-Induced Arthritis: Role of Host and Viral Factors in the Pathogenesis

Viral Immunology , Vol. 0, No. 0.

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Epidemiology and outcomes of nasopharyngeal carcinoma: Experience from a regional cancer center in Southern India

Rudresha Antapura Haleshappa, Aditi Harsh Thanky, Lakshmaiah Kuntegowdanahalli, Govind Babu Kanakasetty, Lokanatha Dasappa, Linu Jacob

South Asian Journal of Cancer 2017 6(3):122-124

Context: Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer with significant geographical variation. There are limited data on epidemiology and outcomes of NPC reported from Southern India. Settings and Design: Retrospective analysis. Materials and Methods: We analyzed our hospital data between January 2005 and December 2011 with NPC and analyzed their demographic parameters and outcomes with therapy. Results: A total 143 cases of NPC were identified. Median age at presentation was 35 years with male predominance. Majority (84%) of the cases had the WHO Type 3 histology. Nodal metastasis at presentation was seen in 90% of the cases, majority being bilateral. Distant metastasis was seen in 16% of the cases, most commonly at bone, lung, and liver. Concurrent chemoradiation with weekly cisplatin was offered to 84.7% of localized disease while 80% of these also received adjuvant chemotherapy. Complete remission and partial remission were achieved in 66.1% and 15.2% of the cases, respectively. Weekly cisplatin was well tolerated with Grade 3–4 toxicity seen in 22% of cases. At a median follow-up of 20 months, 2-year progression-free survival and overall survival were 67.2% and 79.5%, respectively. Statistical Analysis Used: SPSS software version 20. Conclusion: NPC is a rare head and neck malignancy in Southern India, presenting with advanced stage and more propensity to distant metastasis. It has good outcomes to concurrent chemoradiation with weekly schedule of cisplatin being well-tolerated regime. Further prospective studies to test this schedule and other novel agents in this potentially curable malignancy are warranted.

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Comparison of the applicability of Hasford score and European Treatment and Outcome Study score in Indian patients with chronic phase chronic myeloid leukemia on imatinib therapy

Neha Chopra Narang, Mrinalini Kotru, Meera Sikka, Usha Rusia

South Asian Journal of Cancer 2017 6(3):117-138

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Testicular metastasis in Wilms' tumor

Shikha Dhal, Maitrik J Mehta, Ankita Parikh, Maitri Bhagat, Aryakumar Banidutta

South Asian Journal of Cancer 2017 6(3):101-101

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Systemic and primary cutaneous anaplastic large cell lymphoma: Clinical features, morphological spectrum, and immunohistochemical profile

Kanwardeep Singh Kwatra, Preethi A. M. Paul, Nalini Calton, Joseph M John, James D Cotelingam

South Asian Journal of Cancer 2017 6(3):129-131

Background: T-cell lymphomas with anaplastic morphology typically comprise of anaplastic lymphoma kinase positive, anaplastic large cell lymphoma (ALK+ ALCL), ALK-negative ALCL (ALK- ALCL), and primary cutaneous ALCL (PC-ALCL). However, other entities such as diffuse large B-cell lymphoma, peripheral T-cell lymphoma, Hodgkin lymphoma, and undifferentiated carcinoma can also show similar anaplastic features. Aims: To study the clinical features and histological spectrum of ALCL and emphasize the role of immunohistochemistry (IHC) in their diagnosis and categorization. Setting and Design: Eight cases of ALCL diagnosed over a period of 4 years were selected for the study. Materials and Methods: Histopathological review and IHC was performed on all cases. Two ALK+ ALCL cases were tested by fluorescent in situ hybridization (FISH) for t(2;5)(p23;q35). Results: There were four cases of ALK+ ALCL and two each of ALK- ALCL and PC-ALCL. Histologically, all the subtypes showed pleomorphic and "hallmark" cells with strong CD30 expression and variable loss of T-cell antigens. One case of PC-ALCL was leukocyte common antigen (LCA) negative. Epithelial membrane antigen was positive in all the six systemic ALCL cases. Two cases tested for t(2;5)(p23;q35) by FISH were positive. Conclusions: Diagnosis of ALCL is based on recognizing the key morphological features, especially the presence of "hallmark" cells. IHC is essential for confirmation of diagnosis and excluding other malignancies with anaplastic morphology. The inclusion of CD30 in the initial IHC panel will help identify LCA negative cases and avoid misdiagnosis.

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Activation of phosphoinositide 3-kinase/Akt/mechanistic target of rapamycin pathway and response to everolimus in endocrine receptor-positive metastatic breast cancer – A retrospective pilot analysis and viewpoint

Jyoti Bajpai, Anant Ramaswamy, Arun Chandrasekharan, Surya Mishra, Tanuja Shet, Sudeep Gupta, RA Badwe

South Asian Journal of Cancer 2017 6(3):102-105

Introduction: Biomarkers predictive of response to mechanistic target of rapamycin (mTOR) inhibitor, everolimus, in endocrine receptor (ER)-positive metastatic breast cancer (MBC) are a work in progress. We evaluated the feasibility of directly measuring mTOR activity and phosphatase and tensin homolog (PTEN) expression and correlating their expression with response and survival. Materials and Methods: MBC patients who received everolimus with endocrine therapy (ET) after progression on an aromatase inhibitor and had adequate tissue preservation for estimation of mTOR activity and PTEN expression were selected for analysis from a prospectively maintained database. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier method, and correlation between mTOR activity and PTEN expression with survival was done by log-rank test. Results: Thirteen ER-positive MBC patients were available for analysis. PTEN expression was lost in 11/13 (84.6%) patients and retained in 2/13 patients (15.4%). mTOR activity was absent in four patients (30.7%), weak in six patients (46.1%), and moderate in 3 patients (23.2%). Median PFS for the entire population was 2.5 months while median OS was not reached. Patients with an absent mTOR activity showed a longer PFS (5 vs. 1.5 vs. 2 months) than those with weak and moderate activity, respectively (P = 0.043). There was no correlation between loss of PTEN expression and PFS. Conclusions: Measurement of direct mTOR activity in patients with MBC receiving everolimus/ET combination appears feasible. Absent mTOR activity may predict for longer PFS with everolimus-ET combination and requires further study.

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Primary intraosseous squamous cell carcinoma in a dentigerous cyst

Karthika Panneerselvam, Anantanarayanan Parameswaran, B Kavitha, Elavenil Panneerselvam

South Asian Journal of Cancer 2017 6(3):105-117

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Metastatic gastrointestinal stromal tumor: A regional cancer center experience of 44 cases

MC Suresh Babu, Tamojit Chaudhuri, K Govind Babu, KC Lakshmaiah, D Lokanatha, Linu Abraham Jacob, AH Rudresha, KN Lokesh, LK Rajeev

South Asian Journal of Cancer 2017 6(3):118-121

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Historically, a poor prognosis for metastatic disease has been reported with systemic chemotherapy. Significant advances have been made in the last decade, since the introduction of different tyrosine kinase inhibitors (TKIs). Unfortunately, even though the TKIs have been used for a long time, there are very few published data of the experience of TKI therapy in metastatic GIST from India. Materials and Methods: Patients diagnosed with metastatic GIST from January 2005 to October 2016 at our center, who received first-line therapy with imatinib 400 mg/day, were reviewed retrospectively. Patients' profile, response to treatment, toxicity of TKI therapy, time to progression, and survival were evaluated. Results: Of the 44 metastatic GIST patients, 23 (52.2%) were males. Median age at diagnosis was 48 years. The most common presenting symptom was an abdominal pain (52%), followed by weight loss (23%). Most frequently affected metastatic site was liver (57%), followed by peritoneum (16%), and lungs (4.5%). Metastases to both liver and peritoneum were found in 10 patients (22.5%). All patients were initially treated with imatinib at a dose of 400 mg/day. Disease stabilization was documented in 21 cases (48%), and 13 patients (29%) achieved a partial response. TKI therapy was well-tolerated in most cases. Median progression-free survival (PFS) was 26 months, and estimated median survival was 48 months. Patients with lung metastases have a significantly inferior median PFS and overall survival, in comparison to patients with other metastatic sites (P < 0.05). Conclusions: Imatinib therapy was well tolerated and induced a sustained clinical benefit in more than half of the patients with metastatic GIST. Lung metastases seemed to be a poor prognostic factor in this patient population.

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Breast cancer risk factor evaluation in a Western Himalayan state: A case–control study and comparison with the Western World

Purnima Thakur, Rajeev Kumar Seam, Manoj K Gupta, Manish Gupta, Mukesh Sharma, Vikas Fotedar

South Asian Journal of Cancer 2017 6(3):106-109

Context: Breast cancer incidence is increasing rapidly in India. The lifestyle, built, genetic makeup, reproductive and breastfeeding patterns are quite different in Indian females when compared to the Western population. Generalizing the Western data to the population residing in the Himalayan region would breed inaccuracies. Aim: The aim of our study was to identify risk factors in our own population in a Western Himalayan state of Himachal Pradesh, India. Subjects and Methods: A case–control study with 377 cases of invasive breast cancer and 346 hospital-based controls was conducted for 1 year. The data were collected by interviewing the individuals during their visit to hospital using a questionnaire. The data were analyzed using standard statistical techniques using SPSS version 17 software. Results: Factors found to have strong association with invasive breast cancer on multivariate analysis are late age at first childbirth >30 years, which is the strongest risk factor associated, late age of menopause > 50 years, high socioeconomic class, and age of female above 50 years. Conclusion: In our females, age >50 years, late age of menopause (>50 years), late age at first childbirth (>30 years), and high socioeconomic status were found to be major risk factors associated with breast cancer. Several factors implicated in the Western data were not found to be significant in our study. We need to identify such aspects in reproductive and breastfeeding patterns of women and spread awareness regarding the same.

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Serum alkaline phosphatase in oral squamous cell carcinoma and its association with clinicopathological characteristics

Swetha Acharya, Jyoti Kale, Pragati Rai, Venkatesh Anehosur, Kaveri Hallikeri

South Asian Journal of Cancer 2017 6(3):125-128

Context: Biochemical changes occur in biological fluids and tissues of different types of malignancies. Tumor markers in serum, tissue, and other body fluids during neoplastic process are of clinical value in the management of patients with cancers. Serum alkaline phosphatase (ALP) activity is potentially a useful indicator for detection of malignancies, but its status in oral squamous cell carcinoma (OSCC) is less explored. Aims: The aim of this study is to evaluate the serum level of ALP in OSCC patients and assess its relation with the clinicopathological features. Settings and Design: A total of 175 participants (145 OSCC patients and 30 healthy controls) were included in the study. One hundred and forty-five patients with OSCC who underwent treatment at our institution were included to obtain the clinicopathological data. Materials and Methods: Fasting blood ALP activity was evaluated using ALP assessment kit and biochemistry analyzer. Statistical Analysis Used: The data were analyzed by SPSS-21 software (SPSS Statistics for Windows, Version 21.0, Armonk, NY, USA), using t-test, Mann–Whitney U, and Kruskal–Wallis tests. Results: Raised ALP was seen in 24% of OSCC patients. The mean ALP in OSCC was significantly higher than the control. ALP level in patients with advanced stage was significantly higher than with early stage. The serum ALP level in OSCC patients with bone involvement (BI) by local extension of tumor was significantly higher than without BI. Conclusion: ALP showed statistically significant differences in relation to tumor stages and BI. Hence, ALP could be useful in advanced stage disease for expressing the endurance of patient and tumor expansion. Elevated ALP in OSCC patients may indicate BI.

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Clinical practice and outcomes in advanced gastrointestinal stromal tumor: Experience from an Indian tertiary care center

Subhadeep Bose, Anant Ramaswamy, Arvind Sahu, Omshree Shetty, Saurabh S Zanwar, Jimmy Mirani, Chaitali Nashikkar, Vikas Ostwal

South Asian Journal of Cancer 2017 6(3):110-112

Background: Management of advanced Gastrointestinal stromal tumors (GIST) has been revolutionized with the use of Imatinib guided by mutation analysis. Data from India remains scarce. Materials and Methods: Patients with metastatic GIST who were treated at Department of Gastro-intestinal & Hepaticopancreaticobiliary Oncology Unit at Tata Memorial Hospital, Mumbai between December, 2004 and December 2015 were included in the analysis. Clinical and radiological data was retrieved from stored medical records and charts. Results: A total of 83 patients with metastatic GIST were available for analysis. Median age was 54 years with a 3:1 male predominance. Stomach was the most common site of primary with liver being the most common site of metastasis. c-Kit mutation analysis results were available for 44 patients with exon 11 mutant being the most common mutation. With a median follow up of 33 months, the 10 years estimated progression free and overall survival (OS) was 18% and 51% respectively. Overall response rate to first line imatinib was 37.6% and estimated 3 years OS to first line therapy was significantly better for Exon 11 mutated patients (p=0.016). 34 patients received second line therapy in the form of either sunitinib, pazopanib or increased dose imatinib with a clinical benefit rate of 73.5%. C-Kit mutated patients had a better median OS compared to non mutated patients. Conclusions: GIST diagnosed and treated in the Indian subcontinent appears to show improved outcomes. The importance of c-Kit mutation analysis in determining the prognosis and outcomes of patients with advanced GIST is emphasized.

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A comparative study of bloodstream infections in acute myeloid leukemia according to different phases of treatment: Can we predict the organism?

Preetam Kalaskar, Asha Anand, Harsha Panchal, Apurva Patel, Sonia Parikh, Sandip Shah

South Asian Journal of Cancer 2017 6(3):132-133

Introduction: The treatment of acute myeloid leukemia (AML) consists of induction therapy with anthracyclines and cytarabine followed by two to four cycles of consolidation therapy with high-dose cytarabine after achieving remission. There have been very few studies comparing infections during induction and consolidation. We have analyzed blood cultures of patients with AML during episodes of fever occurring during induction and consolidation, for comparing the bloodstream infections in both the phases. Materials and Methods: Blood cultures of patients during febrile episodes were collected from central venous catheters and peripheral blood, both during induction and consolidation therapy of AML. Results: The study population included 52 AML patients. During induction, there were 52 episodes of fever and 25 (48%) blood cultures were positive, 15 of these blood cultures reported Gram-negative organisms, 9 reported Gram-positive organisms and 1 as yeast. During consolidation, 47 episodes of fever were recorded and blood cultures were positive in 12, of which 7 were Gram-negative, 5 were Gram-positive. Conclusion: The incidence of blood culture positive infections during therapy of AML at our center was higher. The predominant organism isolated was Gram-negative both during induction and consolidation. The incidence of blood culture positive infections had decreased by 50% during consolidation.

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Unraveling the spectrum of KIT mutations in gastrointestinal stromal tumors: An Indian Tertiary Cancer Center Experience

Trupti Pai, Munita Bal, Omshree Shetty, Mamta Gurav, Vikas Ostwal, Anant Ramaswamy, Mukta Ramadwar, Sangeeta Desai

South Asian Journal of Cancer 2017 6(3):113-117

Background: Primary mutations in the KIT gene are the driving force for gastrointestinal stromal tumors (GIST) tumorigenesis. Predictive role of KIT mutation status aids oncologists in patient management. There is a paucity of comprehensive data on the frequency of mutations in the KIT gene in GIST affecting Indian patients. The aims of this study were to determine the frequency and spectrum of molecular alterations affecting the KIT gene and assess their association with clinicopathologic features in a cohort of patients of GIST. Materials and Methods: Morphological and immunohistochemically confirmed GIST cases (n = 114) accessioned from August 2014-June 2015 were analyzed for mutations in KIT exons 9, 11, 13, and 17 and subjected to Sanger sequencing onto the ABI 3500 Genetic Analyzer. The sequences were analyzed using sequence analysis software: SeqScape® and Chromas Lite. Results: KIT mutations were seen in 70% of cases and the majority of KIT mutations involved exon 11 (57%), followed by exon 9 (10%), exon 13 (3%), and exon 17 (1%). Most common exon 11 mutations were in-frame deletions (61.4%) followed by substitution mutations (19.3%). Exon 9 mutations showed identical duplication of Ala-Tyr at codons 502–503. Simultaneous mutations affecting exon 11 and 13 were discovered. Novel variations, namely, p.Q556E (c.1666C>G), p.Q556dup (c.1666_1668dupCAG), p.K558_V559delinsS (c.1672_1677delAAGGTTinsAGT), p.Y503_F504insTY (c.1509_1510insACCTAT), and p.K642R (c.1925A>G) involving exons 11, 9, and 13, respectively, were observed. Interpretation and Conclusions: First study with complete analysis of all 4 exons of KIT (exons 9, 11, 13, and 17) in Indian GIST patients. Along with well-described KIT mutations, several rare double mutations as well as novel alterations were reported in this series.

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Pattern of occurrence and treatment outcome of second primary malignancies: A single center experience

Prekshi Chaudhary, Sweety Gupta, Nitin Leekha, Ruchir Tandon, Malay Nandy, Sudarsan De

South Asian Journal of Cancer 2017 6(3):137-138

Background: The incidence of cancer survivors is increasing, but these individuals, unfortunately, face the risk of second primary malignancies (SPMs). This increasing incidence can be credited to increased survival rates of cancer patients, environmental factors, host factors, and genetic predispositions. Hence, vigilance on the part of the patient as well as clinician for the development of new signs and symptoms is mandatory. Aims: Retrospective analysis of the pattern of incidence and clinical outcome of patients diagnosed with SPM and to review the literature. Settings and Design: A hospital-based retrospective collection of prospective data of patients diagnosed with SPM. Materials and Methods: Thirty-six patients with histopathologically proven SPM from January 2009 to July 2015 were included in this study. Factors such as age, sex, site, stage, histology, treatment received, and outcome were recorded. Statistical Analysis Used: Basic statistical tools have been used for analyzing the data. Results and Conclusions: The likelihood of occurrence of second malignancy, either synchronous or metachronous, should always be kept in mind while evaluating a cancer patient. Appearance of new signs and symptoms during the initial evaluation as well as during follow-up should raise a suspicion, and both patient and oncologist should have a low threshold for further assessment. Early diagnosis and treatment will reduce morbidity and mortality and lead to better survival outcome.

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Recurrence of Gastroesophageal Reflux After Laparoscopic Antireflux Surgery

This cohort study assesses the risk of recurrence of gastroesophageal reflux after laparoscopic antireflux surgery and risk factors for reflux recurrence.

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Feasibility and Efficacy of Mat Pilates on People with Mild-to-Moderate Parkinson's Disease: A Preliminary Study

Rejuvenation Research , Vol. 0, No. 0.

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Mast cells derived from human induced pluripotent stem cells are useful for allergen tests

Publication date: Available online 14 September 2017
Source:Allergology International
Author(s): Akira Igarashi, Yasuhiro Ebihara, Tomoaki Kumagai, Hiroyuki Hirai, Kinya Nagata, Kohichiro Tsuji
BackgroundSeveral methods have been developed to detect allergen-specific IgE in sera. The passive IgE sensitization assay using human IgE receptor-expressing rat cell line RBL-2H3 is a powerful tool to detect biologically active allergen-specific IgE in serum samples. However, one disadvantage is that RBL-2H3 cells are vulnerable to high concentrations of human sera. Only a few human cultured cell lines are easily applicable to the passive IgE sensitization assay. However, the use of human induced pluripotent stem cells (iPSCs) to generate human mast cells (MCs) has not yet been reported.MethodsThe nuclear factor-kappa B (NF-κB)-responsive luciferase reporter gene was stably introduced into a human iPSC line 201B7, and the transfectants were induced to differentiate into MCs (iPSC-MCs). The iPSC-MCs were sensitized overnight with sera from subjects who were allergic to cedar pollen, ragweed pollen, mites, or house dust, and then stimulated with an extract of corresponding allergens. Activation of iPSC-MCs was evaluated by β-hexosaminidase release, histamine release, or luciferase intensity.ResultsiPSCs-MCs stably expressed high-affinity IgE receptor and functionally responded to various allergens when sensitized with human sera from relevant allergic subjects. This passive IgE sensitization system, which we termed the induced mast cell activation test (iMAT), worked well even with undiluted human sera.ConclusionsiMAT may serve as a novel determining system for IgE/allergens in the clinical and research settings.

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The Minimal Clinically Important Difference for the Rasch Neuropsychiatric Inventory Irritability and Aggression Scale for Traumatic Brain Injury

Publication date: Available online 14 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): James F. Malec, Flora M. Hammond
ObjectiveTo determine the Minimal Clinically Important Difference (MCID) for a Rasch measure derived from the Irritability/Lability and Agitation/Aggression subscales of the Neuropsychiatric Inventory (NPI-TBI-IA).DesignDistribution-based statistical methods were applied to retrospective data to determine candidates for the MCID. These candidates were evaluated by anchoring the NPI-TBI-IA to Global Impression of Change (GIC) ratings by participants, significant others, and a supervising physician.Main Outcome MeasureNPI-TBI-IA.SettingPostacute rehabilitation outpatient clinic.Participants274 cases with observer ratings; 232 cases with self-ratings by participants with moderate-severe TBI at least 6 months post-injury.ResultsFor observer ratings on the NPI-TBI-IA, anchored comparisons found an improvement of ½ SD was associated with at least minimal general improvement on GIC by a significant majority (69-80%); ½ SD improvement on participant NPI-TBI-IA self-ratings was also associated with at least minimal improvement on the GIC by a substantial majority (77-83%). The percent indicating significant global improvement did not increase markedly on most ratings at higher levels of improvement on the NPI-TBI-IA.ConclusionsA ½ SD improvement on the NPI-TBI-IA indicates the MCID for both observer and participant ratings on this measure.

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Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Lower Back Pain in Service Members: A Pilot Randomized Control Trial

Publication date: Available online 14 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Krista Beth Highland, Audrey Schoomaker, Winifred Rojas, Josh Suen, Ambareen Ahmed, Zhiwei Zhang, Sarah Fink Carlin, Christian Calilung, Michael Kent, Chester Buckenmaier
ObjectiveTo examine the feasibility and preliminary effectiveness of an individualized yoga program.DesignPilot randomized control trial.SettingMilitary medical center.ParticipantsPatients (N=68) with chronic LBP.InterventionsRestorative Exercise and Strength Training for Operational Resilience and Excellence (RESTORE) program (9-12 individual yoga sessions) or treatment-as-usual (control) for 8-week period.Main Outcome MeasuresThe primary outcome was past 24-hour pain scores (Defense and Veterans Pain Rating Scale). Secondary outcomes included disability (Roland-Morris Disability Questionnaire), physical functioning, and symptom burden (Patient Reported Outcomes Measurement Information System-29 subscales). Assessment occurred at baseline, Week 4, Week 8, 3-month follow-up, and 6-month follow-up. Exploratory outcomes included the proportion of participants in each group reporting clinically meaningful changes at 3-month and 6-month follow-ups.ResultsGeneralized linear mixed models with sequential Bonferroni-corrected pairwise significance tests and chi-square analyses examined longitudinal outcomes. Secondary outcome significance tests were Bonferroni-adjusted for multiple outcome tests. The RESTORE group reported improved pain, compared to the control group. Secondary outcomes did not retain significance after Bonferroni-adjustments for multiple outcomes. Though, a greater proportion RESTORE participants reported clinically-meaningfully changes in all outcome at 3-month follow-up and symptom burden at 6-month follow-up.ConclusionRESTORE may be a viable non-pharmacologic approach to LBP with minimal side effects and research efforts are needed to compare effectiveness of RESTORE delivery formats (e.g., group versus individual) or to other treatment modalities.

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Rasch Analysis, Dimensionality, and Scoring of the Neuropsychiatric Inventory (NPI) Irritability and Aggression Subscales in Individuals with Traumatic Brain Injury

Publication date: Available online 14 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): James F. Malec, Timothy E. Stump, Patrick O. Monahan, Jacob Kean, Dawn Neumann, Flora M. Hammond
ObjectiveTo develop, for versions completed by individuals with traumatic brain injury (TBI) and an observer, a more precise metric for the Neuropsychiatric Inventory (NPI) Irritability and Aggression scales using all behavioral item ratings for use with individuals with TBI and address the dimensionality of the represented behavioral domains.DesignRasch and confirmatory factor analyses of retrospective baseline NPI data from three treatment studies.SettingPostacute rehabilitation clinic.Participants287 cases with observer ratings; 238 cases with self-ratings by participants with complicated mild, moderate or severe TBI at least 6 months post-injury.Main Outcome MeasureFrequency and severity ratings from NPI Irritability/Lability and Agitation/Aggression subscales.ResultsConfirmatory factor analyses of both observer and participant ratings showed good fit for either a one-factor or two-factor solution. Consistent with this, the Rasch model also fit the data well with aggression items indicating the more severe end of the construct and irritability items populating the milder end.ConclusionsIrritability and aggression appear to represent different levels of severity of a single construct. The derived Rasch metric offers a measure of this construct based on responses to all specific items that is appropriate for parametric statistical analysis and may be useful in research and clinical assessments of individuals with TBI.

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Evaluation of delivery costs for external beam radiation therapy and brachytherapy for locally advanced cervical cancer using time-driven activity-based costing

Publication date: Available online 14 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Kristine Bauer-Nilsen, Colin Hill, Daniel M. Trifiletti, Bruce Libby, Donna H. Lash, Melody Lain, Deborah Christodoulou, Constance Hodge, Timothy N. Showalter
PurposeThis study aims to evaluate the delivery costs, using time-driven activity-based costing (TDABC), and reimbursement for definitive radiation therapy for locally advanced cervical cancer.Methods and MaterialsProcess maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource, and then calculated the total cost of patient care based upon CCR and time for each resource. Costs were compared to 2016 Medicare reimbursement and relative value units (RVUs).ResultsThe total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs comprising 49.8%. Brachytherapy cost $8,610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). EBRT cost $4,055.01 in costs (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and EBRT delivery ($4,798.73 vs. $1,404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with IMRT or 135.90 RVUs with 3DCRT, with total reimbursement of $23,321.71 and $16,071.90 respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3DCRT (1.63 minutes) or IMRT (1.32 minutes).ConclusionTDABC was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources comprised the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We hypothesize that the significant discrepancy between treatment costs and physician effort versus reimbursement may be a potential driver of reported national trends towards poor compliance with brachytherapy and suggest re-evaluation of payment policies to incentivize quality care.

Teaser

Time-driven activity-based costing methodology was applied to calculate the delivery costs of definitive radiation therapy for locally advanced cervical cancer. Brachytherapy was more costly and consumed more attending radiation oncologist time than external beam radiation therapy. Comparison of the delivery costs and physician time requirements to current reimbursement revealed a financial disincentive against brachytherapy, which should be studied as a potential contributor to the reported national poor compliance rates for cervical cancer brachytherapy.

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Stereotactic Body Radiotherapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma

Publication date: Available online 14 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Eli Sapir, Yebin Tao, Matthew J. Schipper, Latifa Bazzi, Paula M. Novelli, Paulina Devlin, Dawn Owen, Kyle C. Cuneo, Theodore S. Lawrence, Neehar D. Parikh, Mary Feng
BackgroundThere is little data to guide non-surgical treatment selection for patients with HCC. Therefore, we conducted a large, single institutional comparison of transarterial chemoembolization (TACE) and SBRT outcomes in similar groups of patients.MethodsFrom 2006 to 2014, 209 patients with 1-2 tumors underwent TACE (n=84) to 114 tumors or image-guided SBRT (n=125) to 173 tumors. Propensity score analysis with inverse probability of treatment weighting was used to compare outcomes between treatments while adjusting for imbalances in treatment assignment. Local control (LC), toxicity, and overall survival (OS) were retrospectively analyzed.ResultsTACE and SBRT groups were similar with respect to the number of tumors treated per patient, underlying liver disease and baseline liver function. Patients treated with SBRT were older (65 vs 61 yrs, p=0.01) and had smaller tumors (2.3 vs 2.9 cm, p < 0.001), and less frequently underwent liver transplantation (8% vs. 18%, p = 0.01). 1- and 2-yr LC favored SBRT: 97% and 91% for SBRT and 47% and 23%, for TACE (HR 66.5, p < 0.001). For patients treated with TACE, higher AFP (HR 1.11 per doubling, p =0.008) and segmental portal vein thrombosis (HR 9.9, p < 0.001) were associated with worse LC. Predictors associated with LC after SBRT were not identified. Grade 3+ toxicity occurred after 13% and 8% of TACE and SBRT treatments, respectively (p = 0.05). There was no difference in OS between patients treated with TACE or SBRT.ConclusionSBRT is a safe alternative to TACE for 1-2 tumors, and provides better LC, with no observed difference in OS. Prospective comparative trials of TACE and SBRT are warranted.

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Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement

Thyroid Sep 2017, Vol. 27, No. 9: 1128-1134.

http://ift.tt/2jrtJoo

Disease Severity at Presentation in Patients with Disease-Related Mortality from Differentiated Thyroid Cancer: Implications for the 2015 ATA Guidelines

Thyroid Sep 2017, Vol. 27, No. 9: 1171-1176.

http://ift.tt/2f8TRmM

Future Meetings

Thyroid Sep 2017, Vol. 27, No. 9: 1211-1211.

http://ift.tt/2jucCmb

Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies

Thyroid Sep 2017, Vol. 27, No. 9: 1194-1200.

http://ift.tt/2f9lzA2

Intermittent Dosing of Dabrafenib and Trametinib in Metastatic BRAFV600E Mutated Papillary Thyroid Cancer: Two Case Reports

Thyroid Sep 2017, Vol. 27, No. 9: 1201-1205.

http://ift.tt/2juQ8RI

Clinical Implications of Immunoglobulin G4 to Graves' Ophthalmopathy

Thyroid Sep 2017, Vol. 27, No. 9: 1185-1193.

http://ift.tt/2faTojT

Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement

Thyroid Sep 2017, Vol. 27, No. 9: 1128-1134.

http://ift.tt/2jrtJoo

Disease Severity at Presentation in Patients with Disease-Related Mortality from Differentiated Thyroid Cancer: Implications for the 2015 ATA Guidelines

Thyroid Sep 2017, Vol. 27, No. 9: 1171-1176.

http://ift.tt/2f8TRmM

Future Meetings

Thyroid Sep 2017, Vol. 27, No. 9: 1211-1211.

http://ift.tt/2jucCmb

Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies

Thyroid Sep 2017, Vol. 27, No. 9: 1194-1200.

http://ift.tt/2f9lzA2

Intermittent Dosing of Dabrafenib and Trametinib in Metastatic BRAFV600E Mutated Papillary Thyroid Cancer: Two Case Reports

Thyroid Sep 2017, Vol. 27, No. 9: 1201-1205.

http://ift.tt/2juQ8RI

Clinical Implications of Immunoglobulin G4 to Graves' Ophthalmopathy

Thyroid Sep 2017, Vol. 27, No. 9: 1185-1193.

http://ift.tt/2faTojT

Mammary phyllodes tumor with six episodes of a relapse: a case report

Phyllodes tumor is a rare breast mass. Most phyllodes tumors are benign, but occasionally some show malignancy. Even if the tumors are benign, they can easily show recurrence.

http://ift.tt/2xoSnvt

Salvage brachytherapy for radiorecurrent prostate cancer: Searching for safety and success

Publication date: Available online 14 September 2017
Source:Brachytherapy
Author(s): Max Peters, Marinus A. Moerland, Jochem R.N. van der Voort van Zyp

http://ift.tt/2eZA858

The effects of needle damage on annulus fibrosus micromechanics

Publication date: Available online 14 September 2017
Source:Acta Biomaterialia
Author(s): Claudio Vergari, Jessica C. Mansfield, Daniel Chan, Andrew Clarke, Judith R. Meakin, Peter C. Winlove
Needle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration. Puncture's mechanical effects have been shown near the puncture site, mechanical effects should be observed far, relative to needle size, from the puncture site, given the disc-wide damage induced by the stab. The aim of this work was to quantify these far-field effects, and to observe the local structural damage provoked by the needle.Strips of cow tail annulus fibrosus underwent two consecutive mechanical loadings to 5% tensile strain; fifteen samples were punctured in a radial direction with a randomly assigned needle between the two loadings (needle gauges between 19 and 23). Ten samples (control group) were not punctured. During loading, the tissue strains were imaged using second harmonic generation microscopy in a <600x800µm region about 4.4mm from the puncture site. After mechanical testing, the puncture site was imaged in 3D.Puncture had no significant effect on annulus elastic modulus. Imaging showed a modest change in the shearing between fibre bundles however, the linear strain between bundles, intra-bundle shear and linear strain were not significantly affected. At the puncture site, detached lumps of tissue were present.These results suggest that the mechanical effects observed in intact discs are due to the depressurization of the disc, rather than the local damage to the annulus. Needle profiles could be designed, aiming at separating fibre bundles rather than cutting through them, to avoid leaving dying tissue behind.Statement of significanceNeedle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration, but the link between the local damage of the puncture and the disc-wide effects is not well understood. This work aimed at determining the micro–mechanical effects of the puncture far from its site, and to observe the damage induced by the puncture with high resolution imaging. Results show that the puncture had modest effect far from the puncture, but lumps of tissue were left by the needle, detached from the disc; these could cause further damage through friction and inflammation of the surrounding tissues. This suggests that the cascade leading to degeneration is probably driven by a biochemical response rather than disc-wide mechanical effects.

Graphical abstract

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Applicability of the grip strength and automated von Frey tactile sensitivity tests in the mouse photothrombotic model of stroke

Publication date: 15 January 2018
Source:Behavioural Brain Research, Volume 336
Author(s): Faisal F. Alamri, Abdullah Al Shoyaib, Abbie Biggers, Srinidhi Jayaraman, Josée Guindon, Vardan T. Karamyan
Improvement of impaired neurological function(s) is a primary endpoint in experimental stroke recovery studies, making the choice and nature of the functional tests crucial for proper execution and interpretation of such studies. Currently, there are a limited number of neurological tests which reliably evaluate functional deficit in mice over a long period of time after stroke. In this study, we evaluated the applicability of forepaw grip strength and automated von Frey tactile sensitivity tests to assess forelimb dysfunction in mice following photothrombosis in the sensorimotor cortex, and compared them with two well-established tests, grid-walking and cylinder, for up to 21days after stroke. Our results indicate that the length of time required to conduct the two new tests is comparable to that of the grid-walking and cylinder tests, however the data from the new tests is obtained and ready for analysis upon completion of the testing session. In addition, our observations indicate that the automated von Frey test detected substantial and sustained deficit in the withdrawal threshold of the mice on all evaluation days after stroke, whereas the forepaw grip strength test was only marginally sensitive to document functional impairment. Our data demonstrate that the automated von Frey tactile sensitivity test is a time efficient and sensitive method which can be used together with other established tests to evaluate long-term functional outcome in the mouse photothrombotic stroke model.

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Processing a glass-forming Zr-based alloy by selective laser melting

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): S. Pauly, C. Schricker, S. Scudino, L. Deng, U. Kühn
Compact specimens were produced by selective laser melting (SLM) from glass-forming Zr52.5Cu17.9Ni14.6Al10Ti5 powder. Below a critical energy density of Ecrit=15J/mm³ fully glassy samples were obtained. When the energy density is higher, the metastable big cube phase, stabilized by oxygen, precipitates next to other crystalline phases. We introduce density contour maps to identify the process window, which allows obtaining fully glassy samples with a high relative density of up to 98.5%. The systematic parameter variation illustrates the importance of laser power for obtaining dense SLM parts. Moreover, the distribution of pores in the present alloy is rather sensitive to the scanning strategy. The compressive strength of the SLM samples is comparable to values measured for as-cast glasses and even a distinct plastic strain is found. Finally, scaffolds were produced and high-energy X-ray diffraction proves that they are fully glassy irrespective of differences in the local cooling rates. Our experiments contribute to better understanding the behaviour of Zr52.5Cu17.9Ni14.6Al10Ti5 during SLM and for making glass-forming alloys progressively more accessible to laser-based additive manufacturing in order to overcome the intrinsic size limitation of bulk metallic glasses.

Graphical abstract

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Material process development for the fabrication of heterogeneous titanium structures with selective pore morphology by a hybrid additive manufacturing process

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Esmat Sheydaeian, Kaveh Sarikhani, Pu Chen, Ehsan Toyserkani
This paper addresses a new methodology to fabricate cellular structures with embedded close pores distributed in controlled fashion. A hybrid additive manufacturing system integrating binder jetting and material extrusion was employed to selectively incorporate a sacrificial polymer into the structures followed by a post-processing step to decompose the polymer. Four different polymer compositions mixture of bisphenol-A ethoxylated diacrylate and cellulose acetate butyrate (CAB) were prepared. From determining the rheological and interfacial properties of the polymers, the composition with the highest CAB concentration (20wt%) demonstrated lowest permeation inside powder porous media (0.03m²/s). The significance of the results is in retaining the quality of green substrate via a decrease in influence of the polymer shrinkage stress due to a reduction in the polymer - powders interface. The effect of binder jetting and design parameters on the quality of green samples manufactured by embedding the optimized composition revealed the direct influence of binder saturation level, layer thickness, and the number of powder layers covering encapsulated polymers. In the heat treatment of the samples (up to 1400°C), a high level of accuracy (1% error margin) in morphology of cavities, resulted from the decomposition of polymers (400°C), was achieved.

Graphical abstract

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A study of parametric calibration for low cost 3D printing: Seeking improvement in dimensional quality

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Leonardo Santana, Jorge Lino Alves, Aurélio da Costa Sabino Netto
Open source projects have helped extrusion-based Additive Manufacturing processes gain popularity in recent years. While they allow the design and development of low cost machines, one of the main difficulties users have found is the parametric calibration. A study was proposed to understand the best practices for the setup of "input parameters", since in the open software chain there are many available for setup. Through experimental design methods, the dimensional accuracy of a cubic structure was analysed by varying factors such as: slicing software, layer thickness, infill density, first layer, infill and perimeter speeds, as well as extrusion temperature and multiplier. A Prusa I3 Hephestos printer and a Polylactic Acid (PLA) filament were used, and the parts were evaluated with contact measurement, 3D scanning and mass measurement procedures. Statistical analysis showed that the dimensional accuracy of the components was mostly affected by the infill density and the extrusion multiplier. Both parameters highlight the influence of the slicing software on the planning and quality of the models. Instabilities in the amount and flow of material, characterized by excess deposition, were responsible for the distortions along the three fundamental directions of the cubes.

Graphical abstract

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Hyperbranched alkyd/magnetite-silica nanocomposite as a coating material

Publication date: 5 December 2017
Source:Materials & Design, Volume 135
Author(s): Mohamed S. Selim, Feng Q. Wang, Hui Yang, Yong Huang, Shigenori Kuga
Engineering innovative nanomaterials with low volatile organic content (VOC) has awarded great interest to control air pollutant emissions. We designed a highly branched alkyd matrix suitable for surface coating from castor oil via polyesterification. A simple A2+B3 (di- and tri-functional monomers) methodology was used to prepare the hyperbranched polyester from natural multifunctional monomers. Magnetite-coated silica (Fe3O4@SiO2) particles with 60–70nm average diameter were prepared by in situ method that binds magnetite nanoparticles to silica nanospheres. The magnetite size and attaching efficiency were controlled by the concentration of chemicals and reflux duration. The nanocomposite coating was prepared by solution casting. The structure-property relationship was studied for different concentrations of nanofiller in the alkyd matrix. The surface and anticorrosive properties were studied via contact angle and salt spray tests. Mechanical performance and thermal stability were assessed by various methods. The highest improvement was achieved with nanofiller insertion up to 0.5% Fe3O4@SiO2 nanospheres.

Graphical abstract

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Visualization of Accessory Lymphatic Pathways in Secondary Upper Extremity Lymphedema Using Indocyanine Green Lymphography

Introduction: The anatomical variations in accessory lymphatic pathways around the axillary region may work as a drainage route for excess lymphatic fluid accumulation in secondary upper extremity lymphedema. In this report, accessory lymphatic pathways extending to the shoulder, neck, and breast regions in secondary upper extremity lymphedema patients are shown using indocyanine green (ICG) lymphography. Patients and Methods: Between January 2012 and May 2015, 30 limbs of 29 patients with upper extremity lymphedema after malignant tumor resection were evaluated. ICG lymphography was performed after chronic lymphedema formation. Results: Of the 30 limbs, accessory lymphatic pathways were identified across the axillary region in 3 patients using ICG lymphography. In 2 of these 3 patients, accessory drainage lymphatics were connected to the cervical lymph nodes. In regard to the distribution of dermal backflow patterns, dermal backflow appeared in 26 patients—in the forearm in 26 patients and in the upper arm in 20 patients. Conclusions: Accessory lymphatic pathways are thought to be the drainage routes in the affected arm, which may prevent edema progression to the terminal stage. Variations in the lymphatic system are easily visualized using ICG lymphography. Understanding of accessory lymphatic routes in lymphedema patients may provide new insight for further understanding the pathophysiology of lymphedema.

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The Limitations of Implantable Mesh in Mastopexy

No abstract available

http://ift.tt/2xCE4El

Online Patient Resources for Gender Affirmation Surgery: An Analysis of Readability

Background: Gender affirmation surgery is an important treatment for patient with gender dysphoria. It consists of a series of complex procedures, and well-informed patients have been shown to have better outcomes. However, there are no published data regarding the readability of currently available online patient recourses for gender affirmation surgery. This study aims at identifying the most popular online resources and evaluating the readability of these documents in the context of average literacy within the United States. Methods: An online search with the terms "gender affirmation surgery," "gender reassignment surgery," "top surgery," and "bottom surgery" was performed. Location, cookies, and user account information was disabled before each search to avoid bias in the results. Readability assessment was performed using the 10 commonly used readability scales. Results: The overall mean readability level was 13.4. The mean reading level was 14 (range, 7.6–17.0) for the search term "gender affirmation surgery," 14.2 (range, 11.9–16.7) for the search term "gender reassignment surgery," 13 (range, 8.9–17.5) for the search term "top surgery," and 12.6 (range, 7.1–15.0) for the search term "bottom surgery." There was no statistically significant difference between the search terms. Conclusions: Our findings demonstrate that the articles most commonly seen by patients who perform an Internet search for information on gender reassignment surgery are more difficult than the recommended readability level.

http://ift.tt/2xChNGK

Reviewing the Evidence to Guide Clinical Care: Proliferative Breast Lesions in Breast Reduction Specimens

Abstract: The number of reduction mammoplasties performed in the United States continues to increase annually. Given the high incidence of breast cancer in women, it is routine practice for breast tissue excised during routine breast reductions procedures to be sent for pathology review. During pathology assessment, occult malignancy and on-occasion proliferative breast lesions of unknown and/or variable malignancy may also be present. We provide a review of commonly diagnosed atypical proliferative breast lesions in breast reduction specimens and a guide to plastic surgeons for further management.

http://ift.tt/2xCWbKx

Nonincisional Conjoint Fascial Sheath Suspension: A Novel Technique for Minimally Invasive Blepharoptosis Correction

Background: Mild to moderate blepharoptosis, or ptosis, is relatively common among Asians, and it is not uncommon to offer ptosis correction at the time of double-eyelid surgery in this patient population. The traditional open approaches to ptosis correction are subject to scarring and prolonged recovery time, whereas the newer nonincisional approaches are marred by issues of incomplete correction or recurrence. This study describes a new nonincisional technique that overcomes the limitations of current methods by using conjoint fascial sheath (CFS) for suspension. Methods: From January 2014 to April 2015, a retrospective review was conducted on 21 patients (41 eyelids) who underwent simultaneous nonincisional ptosis correction and double-eyelid surgery. All patients had either mild or moderate ptosis without excess skin hooding and excellent or good levator palpebrae function. Results: Mild ptosis correction (1-loop CFS suspension) was performed in 25 eyelids, and moderate ptosis correction (2-loop CFS suspension) was performed in 16 eyelids. At 6 months of follow-up, 23 eyelids (56.1 %) improved to "normal" with overall improvement seen in 33 eyelids (80.0%). The mean marginal reflex distance 1 increased from 3.16 ± 0.61 mm preoperatively to 4.11 ± 0.61 mm postoperatively, which was statistically significant (P

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Reconstruction of Anterolateral Thigh Defects Using Perforator-Based Propeller Flaps

Background: Usually, anterolateral thigh (ALT) defects with width more than 8 cm cannot be closed directly. Although several methods of using local flaps exist, flap mobility of these methods is limited. We introduced a perforator-based propeller flap for such reconstruction. Their maximal mobility, which minimizes their size, is their greatest advantage. In addition, we present our technical refinements including double-axes propeller flap, the use of indocyanine green real-time angiography, and supercharged propeller flap for safer flap transfer. Patients and Methods: Seven patients underwent perforator-based propeller flap reconstruction of ALT defects. Flaps were designed cranial or caudal to the defect according to the perforator locations. To maximize mobility, flaps were designed so that the perforator was located at the periphery and closer to the defect. After rotating the flap to the defect, indocyanine green angiography was performed to determine the need for supercharge. Results: In all cases, all flaps survived completely. Defect size ranged from 12 × 11 cm to 18 × 16 cm, and flap size ranged from 7 × 5 cm to 15 × 7 cm. The number of perforators in the flap was 1 in 3 cases and 2 in 4 cases. Supercharging was performed in 3 cases. Donor-site complications, including gait disturbance, were not observed. Conclusions: This method achieves ALT defect closure with minimal donor-site morbidity and can provide prompt and aesthetically acceptable results. Indocyanine green real-time angiography and supercharging technique are also useful for safer and reliable flap transfer.

http://ift.tt/2xDJlLO

Does the Use of Acellular Dermal Matrix Increase Postoperative Complications of the First-Stage Reconstruction of Immediate Expander-Implant Breast Reconstruction: A Matched Cohort Study

Purpose: Controversy exists regarding complications associated with the use of acellular dermal matrix (ADM). This likely stems from the heterogeneous and unmatched patient characteristics in study groups. The purpose of this study was to analyze complications in a matched cohort to identify whether ADM use increased postoperative complications of the first-stage immediate expander-implant breast reconstructions. Methods: A retrospective matched-cohort study was performed. We retrospectively reviewed prospectively collected data from patients who underwent immediate expander-implant breast reconstruction after mastectomy between February 2010 and January 2016. Independent variables included clinical characteristics, mastectomy weight, mastectomy type, expander size, initial inflation volume, number of days to drain removal, and adjuvant or neoadjuvant therapies. Different independent variables between the ADM and non-ADM groups were used for propensity score matching. After matching, a pairwise comparison of the 2 cohorts' independent variables was carried out using the Wilcoxon signed rank test and McNemar test. Incidence of complications was evaluated for the 2 matched cohorts. To adjust for ablative and reconstructive surgeons, a multivariable generalized estimating equation analysis was performed. Results: A total of 574 immediate expander-implant breast reconstructions in 533 patients were included in this study. We identified 398 reconstructions (199 for each group; ADM and non-ADM group) of matched cohorts using propensity score matching. Characteristics were similar between the 2 matched cohorts. In the matched analysis, there were no significant differences in the rate of skin flap complications (16.1% vs 16.1%, P > 0.999), seroma (4.0% vs 8.5%, P = 0.065), infection (3.0% vs 3.5%, P = 0.781), and overall complications (21.1% vs 26.1%, P = 0.251). Acellular dermal matrix was not associated with increased risk of complication when ablative and reconstructive surgeon factors were considered in a multivariable analysis (P = 0.511). Conclusions: A matched cohort analysis demonstrated that ADM usage is not associated with an increased risk of complications, including skin flap complications, seroma, and infection. Our result suggests that ADM can be safely used in immediate expander-implant breast reconstruction when necessary.

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Enhancing Nitric Oxide Bioavailability via Exogen Nitric Oxide Synthase and L-Arginine Attenuates Ischemia-Reperfusion–Induced Microcirculatory Alterations

Background: Nitric oxide (NO) is an important cytoprotective agent against ischemia and reperfusion injury (IRI). Enhancing NO bioavailability via exogen NO synthases (NOSs) and L-arginine promotes conversation to NO, circumventing the problem of nonfunctioning NOSs under hypoxic and acidic conditions. In this study, the authors evaluated the therapeutic efficacy of endothelial, inducible and neuronal NOS, and L-arginine on reperfusion-induced microcirculatory alterations and hemodynamic adverse effects in the microvasculature of skeletal muscle. Methods: Vascular pedicle isolated rat cremaster model was used that underwent 2 hours of warm ischemia followed by 1 hour of reperfusion. At 30 minutes before ischemia, normal saline (control group with/without ischemia), endothelial-, inducible-, and neuronal NOSs (2 IE) and L-arginine (50 mg/kg BW) were administered systemically (IV). Ischemia-reperfusion–induced microcirculatory alterations were measured after 1 hour of reperfusion. Mean arterial blood pressure and heart frequency were measured throughout the experiment to determine hemodynamic adverse effects. Results: The isoforms of NOSs and L-arginine attenuated ischemia-reperfusion–induced vasoconstriction, improved red blood cell velocity, capillary flow, and leukocyte adherence to the endothelium wall. Hemodynamics was stable throughout the experiment. Conclusions: Enhancing NO bioavailability via exogen application of NOSs and L-arginine significantly attenuated ischemia-reperfusion–induced microcirculatory alterations in the microvasculature of skeletal muscle. Significant hemodynamic adverse effects were not present, thus demonstrating this approach might be useful for therapeutic intervention. This "pharmacologic preconditioning" could be an easy and effective interventional strategy to uphold conversation of L-arginine to NO under ischemic conditions.

http://ift.tt/2h5d9df

Effect of Exercise Training on the Frequency of Contracture-Release Surgeries in Burned Children

Background: Intensive physical exercise (IPE) increases strength, lean body mass, aerobic capacity, and range of motion in children with extensive burns. However, whether IPE decreases the frequency of burn scar contracture-releasing procedures in children with extensive burns is unknown. Materials and Methods: Prospectively collected surgical records of 184 children who had undergone axilla, elbow, and/or wrist contracture-releasing procedures were reviewed. All children were 7 years or older and had sustained burns of at least 40% of the total body surface area. Eighty-two children completed an IPE program, and 102 children did not. For both groups, the axilla, elbow, and wrist were examined for tightness and restricted movement. Children with contractural difficulty were prescribed a releasing procedure. Logistic regression was used to model the relationship between multiple release surgeries and group. Results: Patients in both groups had comparable injury severity. A total of 120 releases were carried out in the 82 IPE patients. In contrast, 211 releases were needed in the 102 non-IPE patients. An approximately 60% decrease in the frequency of rerelease operations was noted in IPE patients (12.5% for the IPE group and 31.8% for non-IPE group; P

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Teledermatology: Is it Beneficial to Patients?

No abstract available

http://ift.tt/2h5ARGn

Outcomes of Geriatric Burns Treated as Outpatients

Objective: Most literature about geriatric burns has focused on inpatient management; therefore, our study investigated the effects of burn characteristics and preexisting medical comorbidities on treatment outcomes for geriatric burn patients treated as outpatients. Methods: A retrospective review was conducted for 391 patients over 65 years of age seen in the emergency department of Fukui Prefectural Hospital over a 10-year period. Charts were reviewed for age, sex, burn characteristics, burn mechanisms, preexisting medical comorbidities, and treatment outcomes. Multivariate regression analysis was used to examine the relationship between outcomes of outpatients and comorbidities, which were calculated by the Charlson comorbidity index. Results: Seventy-three patients aged 65 years and older were treated as outpatients at Fukui Prefectural Hospital. The majority (80%) of these patients had burns on less than 5% of their total body surface area. Scald burns accounted for 63% of burn mechanisms, with burns to the lower extremities being the most frequent. The mean percentage of total burn surface area was 4% in the outpatient group and 28% for the inpatient group. The mean time to healing was 24.3 days in outpatients. Of the 73 outpatients, 17 (23%) showed delayed healing. Of these 17 patients, 3 patients experienced wound infection and 2 patients had documented hypertrophic scarring. Four patients ultimately underwent excision and grafting. The common preexisting medical comorbidities in the outpatient group were congestive heart failure and diabetic mellitus. There were no significant differences for medical comorbidities between outpatients and inpatients. The Charlson comorbidity index for outpatients with delayed healing was higher than that for those without delayed healing. The Charlson comorbidity index was associated with delayed healing of outpatients, but age or total burn surface area were not. Conclusions: The characteristics of geriatric burn outpatients were distinct from those of inpatients. The weighted sum of preexisting medical comorbidities may affect wound healing among geriatric burn outpatients.

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Epineural Sheath Jacket as a New Surgical Technique for Neuroma Prevention in the Rat Sciatic Nerve Model

Background: Terminal neuromas resulting from severe nerve injuries and traumatic or surgical limb amputations can become a source of pain, and significantly impair patients' quality of life. Recently, the number of patients with peripheral nerve injuries increased due to modern war conflicts, natural disasters, and traffic accidents. This study investigated the efficacy of the epineural sheath jacket (ESJ) as a novel technique for neuroma prevention in the rat sciatic nerve model. Methods: A 20-mm segment of the right sciatic nerve was excised in 18 Lewis rats, and the animals were divided into 3 experimental groups (n = 6/group): group I—control, nerve stump without protection; group II—muscle burying group, nerve stump buried in the muscle; group III—ESJ group, nerve stump protected by ESJ. The ESJ was created from the excised sciatic nerve and applied as a "cap" over the proximal nerve stump. The presence of neuropathic pain was assessed weekly by pinprick test and Tinel sign, up to 24 weeks postsurgery. At 24 weeks, assessments, such as macroscopic evaluation, retrograde neuronal labeling analysis, histomorphometry, and neural/connective tissue ratio were performed. Results: Epineural sheath jacket significantly reduced neuroma formation, which was associated with decreased Tinel sign (16.7%, P

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The Crisis of Deficiency in Emergency Coverage for Hand and Facial Trauma: Exploring the Discrepancy Between Availability of Elective and Emergency Surgical Coverage

Introduction: Injuries are one of the most common reasons for emergency department visits, with approximately 40.2 million injury-related visits occurring in 2011. Facial, hand, and wrist injuries make up a large portion of these visits. Despite the high demand for specialists to attend to these injury-related emergency department visits, recent studies have suggested a discrepancy between elective surgical coverage and trauma care in general. The goal of this study was to determine if there was a difference between access to elective surgical procedures in comparison with on-call emergency care for facial and hand/wrist conditions in New York State. Methods: Hospitals throughout New York State, excluding New York City, were selected from the Department of Health Web site, hospitals.nyhealth.gov. A phone survey was administered between May 2012 and October 2013, to quantify the availability of elective and emergent procedures for facial and hand/wrist conditions. We compared the availability of emergency facial and hand/wrist surgical care based on hospital characteristics such as bed size and access to a surgical intensive care unit. Results: We selected 113 hospitals, and 52 hospitals participated for a response rate of 46%. A total of 88% of hospitals offered elective hand procedures, but only 27% had consistent coverage for emergency hand trauma. Furthermore, only 29 % of hospitals had a facial specialist consistently available whereas the availability for elective facial procedures was 79%. Conclusion: Our study results show a discrepancy between the availability of surgeons for elective procedures and on-call emergency care for facial and hand/wrist condition.

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Localized Arm Volume Index: A New Method for Body Type–Corrected Evaluation of Localized Arm Lymphedematous Volume Change

Background: Volume measurement is a common evaluation for upper extremity lymphedema. However, volume comparison between different patients with different body types may be inappropriate, and it is difficult to evaluate localized limb volume change using arm volume. Methods: Localized arm volumes (Vk, k = 1–5) and localized arm volume indices (LAVIk) at 5 points (1, upper arm; 2, elbow; 3, forearm; 4, wrist; 5, hand) of 106 arms of 53 examinees with no arm edema were calculated based on physical measurements (arm circumferences and lengths and body mass index [BMI]). Interrater and intrarater reliabilities of LAVIk were assessed, and Vk and LAVIk were compared between lower BMI (BMI, 0.98). Between lower and higher BMI groups, significant differences were observed in all Vk (V1 [P = 6.8 × 10−18], V2 [P = 3.1 × 10−13], V3 [P = 1.1 × 10−12], V4 [P = 8.3 × 10−12], and V5 [P = 3.0 × 10−14]). Regarding localized arm volume index (LAVI) between groups, significant differences were seen in LAVI1 (P = 9.7 × 10−6) and LAVI5 (P = 1.2 × 10−5); there was no significant difference in LAVI2 (P = 0.60), LAVI3 (P = 0.61), or LAVI4 (P = 0.22). Conclusions: Localized arm volume index is a convenient and highly reproducible method for evaluation of localized arm volume change, which is less affected by body physique compared with arm volumetry.

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Double Composite Tissue Z-plasty Technique for Anatomical Restoration of Severe Nasal Deformity in Secondary Unilateral Cleft Lip

Background: Patients with secondary unilateral cleft lip are regularly affected by serious nasal deformities especially of the alar and nasal floor. A large number of techniques for correction have been published, but symmetrical restoration of severe nasal deformation is difficult to achieve. We propose an innovative approach for anatomical restoration for this entity of nasal deformities to achieve long-term symmetrical appearance and muscular function. Methods: A total of 68 patients with severe nasal deformity due to secondary unilateral cleft lip underwent reconstructive surgery using a double composite tissue Z-plasty technique for anatomical restoration of cartilage, muscle, and soft tissue layers. Patient pictures were taken preoperatively and postoperatively to evaluate appearance and incisional wound healing. The surgical outcome was assessed based on a postoperative patient satisfaction survey. All occurring adverse effects were recorded. Results: All patients were followed up for at least 7 months up to 8 years; mean follow-up period was 14.6 months. Patients were highly satisfied with the aesthetic result and improved facial profile (97.1%) and healing of the incision site (94.1%). There were 4 cases of implant deviation and 2 cases of impaired ventilation due to hypertrophic scarring of the upper lip (2 patients) and relatively decreased nostril size after augmentation rhinoplasty (1 patient), respectively, requiring surgical revision 1 year postoperatively. No other complications such as bleeding, infection, flap necrosis, and sensory dysfunction were recorded. Conclusions: The double composite tissue Z-plasty technique allows for thorough anatomical restoration of cartilage, muscle, and skin layers in unilateral cleft lip nasal deformities. This single-step approach is a safe and technically easy therapeutic option that is associated with high patient satisfaction and acceptance.

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Comparison of Negative Pressure Wound Therapy and Conventional Therapy for Cranial Bone-exposed Wounds in Rabbits

Background: Bone-exposed wounds with intact or defected periosteum are difficult to heal. To provide relevant experimental evidence for guidance of clinical therapy, we established a rabbit model to compare the efficacies of negative pressure wound therapy (NPWT) and conventional guaze dressing therapy on the healing of cranial bone-exposed wounds. Methods: Full-thickness excisional circular wounds of 2.0 cm in diameter with exposed bones covered with or without periosteum were created at the parietal regions in 88 rabbits that were further randomly divided into the following treatment groups: periosteum-intact wounds treated with conventional vaseline gauze dressings (P + Control group), periosteum-intact wounds treated with NPWT (P + NPWT group), periosteum-lacking wounds treated with conventional vaseline gauze dressings (P-Control group), and periosteum-lacking wounds treated with NPWT (P-NPWT group). The wounds of NPWT groups were treated using a negative pressure therapy assembly that was set at a continuous pressure of −125 mm Hg for 7 days, then covered with vaseline gauze. The wound healing rates, wound infection rates, hydroxyproline content, and wound tissue histology were determined and evaluated. Results: The NPWT shortened the wound healing time by approximately 5 days when compared with the conventional gauze therapy. The histological characterization of wound tissues showed that NPWT decreased the inflammatory cells infiltration, accelerated reepithelialization and facilitated the organization of collagen fibers into neat layers on postoperative day (POD) 10. The NPWT enhanced bacterial clearances, reduced infection rates and increased the hydroxyproline contents in both types of wounds on PODs 10 and 15. The immunohistochemical staining of CD31 showed the NPWT treatment resulted in a significantly increased and persistent angiogenesis, and the wounds treated with NPWT showed well developed and more functional vessels at POD 7 compared with control. Conclusions: The NPWT is a more effective therapy for bone-exposed wounds than conventional guaze dressing therapy. The NPWT can promote bone-exposed wounds healing by increasing collagen contents and vessels densities while reducing inflammatory cells infiltration, reducing wound infection rates, and inducing an ordered collagen arrangement.

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Anatomical Reconstruction of the Nasal Floor in Complete Unilateral Cleft Lip Repair

Background: Numerous methods exist for repairing unilateral cleft lips and mainly focus on cutaneous design to achieve sufficient rotation of the medial (M) cleft lip and produce a natural Cupid's bow and philtrum. However, precise nasal floor reconstruction has not been described in detail. This is the first study to introduce a technique for repairing complete unilateral cleft lips with a focus on nasal floor reconstruction. Methods: In our technique, "Straight-Line Advanced Release Technique (StART)," the nasal floor is considered a 3-dimensional cuboid structure; the M mucosal and lateral (L) mucosal flaps constituted the posterior surface. The M flap became the roof of the orbicularis oris muscle sling and the posterior side of the nasal lining. The B flap met the L lip flap at the superior border of the M flap, and together they formed the roof and anterior surface. The B flap also formed a transitional zone connecting the columella and nasal floor. Results: Seventy-two patients with complete unilateral cleft lip were treated from 2003 to 2015. The difference in the height of the nostril sills between the cleft and non-cleft sides was not significantly different from that in control patients (P = 0.472) 1 year postoperatively. Twenty operations for secondary deformities were performed: 8 for nose deformities not involving the nasal floor. The transverse scar at the alar base was concealed within the nostril. Conclusions: Nasal floor reconstruction is important in complete unilateral cleft lip repair. Our technique provides a naturally shaped, symmetrical nasal floor without conspicuous scarring.

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Vascular Endothelial Growth Factor Induction of Muscle-Derived Stem Cells Enhances Vascular Phenotype While Preserving Myogenic Potential

Background: Previous work by our group and other laboratories have revealed that muscle-derived stem cells (MDSCs) may contain both myogenic and endothelial progenitors, making MDSCs a promising option for skeletal muscle regeneration. The purpose of this study was to investigate the impact of vascular endothelial growth factor (VEGF) induction on the vascular and myogenic potential of MDSCs. Methods: Muscle-derived stem cells were isolated from 4- to 8-week-old C57BL/6J mice using a preplate technique and recombinant human VEGFa was used as the induction agent. Cellular proliferation and migration were assessed using serial imaging and wound healing assays, respectively. Myosin heavy chain staining was performed to assess MDSC myotube formation. Vascular potential of MDSCs was measured by expression of CD31 and in vitro capillary tube formation. Results: Vascular endothelial growth factor stimulation led to a dose-dependent increase in MDSC proliferation (P

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The Periosteal Medial Femoral Condyle Free Flap: A New Option for Soft Tissue Reconstruction of the Distal Lower Extremity

Background: Small (

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Telemedicine: From Microsurgery and Free Flaps to Total Body Skin Examination

No abstract available

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Airflow Error Measurement Due to Pneumotachograph Mask Rim Leaks

Airflow during speech production is recorded using a pneumotachograph system wherein typically a mask is placed upon the face. Accurate measures of airflow require mask calibration and a complete seal of the mask rim to the face. Literature frequently cites mask rim leaks as causing flow measurement inaccuracies, but quantitative studies of the inaccuracies are needed.The purpose of this study was to determine the degree of inaccuracy of flow measurement using a Glottal Enterprises aerodynamic system for a variety of mask rim leak conditions.

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Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case‐Control Study in Northern and Eastern China and Implications for Chemoprevention

AbstractBackground.Obesity is a consideration in the pharmacologic intervention for estrogen receptor (ER) positive (ER+) breast cancer risk. Body mass index (BMI) and waist/hip ratio (WHR) have demonstrated different effects on breast cancer risk in relation to estrogen receptor (ER) status, but the results have been inconsistent. Furthermore, the situation in Chinese women remains unclear.Materials and Methods.We conducted a case‐control study including 1,439 breast cancer cases in Northern and Eastern China. Both ER and progesterone receptor (PR) statuses were available for 1,316 cases. Associations between body size‐related factors and breast cancer risk defined by receptor status were assessed by multiple polytomous unconditional logistic regression analysis.Results.Body mass index and WHR were positively associated with overall breast cancer risk. Body mass index was positively associated with both ER+/PR positive (PR+) and ER negative (ER−)/PR negative(PR−) subtype risks, although only significantly for ER+/PR+ subtype. Waist–hip ratio was only positively correlated with ER−/PR− subtype risk, although independent of BMI. Body mass index was positively associated with risk of ER+/PR+ and ER−/PR− subtypes in premenopausal women, whereas WHR was inversely correlated with ER+/PR− and positively with ER−/PR− subtype risks. Among postmenopausal women, WHR >0.85 was associated with increased risk of ER−/PR− subtype.Conclusions.Both general and central obesity contribute to breast cancer risk, with different effects on specific subtypes. General obesity, indicated by BMI, is more strongly associated with ER+/PR+ subtype, especially among premenopausal women, whereas central obesity, indicated by WHR, is more specific for ER−/PR− subtype, independent of menopausal status. These results suggest that different chemoprevention strategies may be appropriate in selected individuals.Implications for Practice.The results of this study suggest that general and central obesity may play different roles in different breast cancer subtypes, supporting the hypothesis that obesity affects breast carcinogenesis via complex molecular interconnections, beyond the impact of estrogens. The results also imply that different chemoprevention strategies may be appropriate for selected individuals, highlighting the need to be particularly aware of women with a high waist/hip ratio but normal body mass index. Given the lack of any proven pharmacologic intervention for estrogen receptor negative breast cancer, stricter weight‐control measures may be advised in these individuals.

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Comprehensive Genomic Profiling of 282 Pediatric Low‐ and High‐Grade Gliomas Reveals Genomic Drivers, Tumor Mutational Burden, and Hypermutation Signatures

AbstractBackground.Pediatric brain tumors are the leading cause of death for children with cancer in the U.S. Incorporating next‐generation sequencing data for both pediatric low‐grade (pLGGs) and high‐grade gliomas (pHGGs) can inform diagnostic, prognostic, and therapeutic decision‐making.Materials and Methods.We performed comprehensive genomic profiling on 282 pediatric gliomas (157 pHGGs, 125 pLGGs), sequencing 315 cancer‐related genes and calculating the tumor mutational burden (TMB; mutations per megabase [Mb]).Results.In pLGGs, we detected genomic alterations (GA) in 95.2% (119/125) of tumors. BRAF was most frequently altered (48%; 60/125), and FGFR1 missense (17.6%; 22/125), NF1 loss of function (8.8%; 11/125), and TP53 (5.6%; 7/125) mutations were also detected. Rearrangements were identified in 35% of pLGGs, including KIAA1549‐BRAF, QKI‐RAF1, FGFR3‐TACC3, CEP85L‐ROS1, and GOPC‐ROS1 fusions. Among pHGGs, GA were identified in 96.8% (152/157). The genes most frequently mutated were TP53 (49%; 77/157), H3F3A (37.6%; 59/157), ATRX (24.2%; 38/157), NF1 (22.2%; 35/157), and PDGFRA (21.7%; 34/157). Interestingly, most H3F3A mutations (81.4%; 35/43) were the variant K28M. Midline tumor analysis revealed H3F3A mutations (40%; 40/100) consisted solely of the K28M variant. Pediatric high‐grade gliomas harbored oncogenic EML4‐ALK, DGKB‐ETV1, ATG7‐RAF1, and EWSR1‐PATZ1 fusions. Six percent (9/157) of pHGGs were hypermutated (TMB >20 mutations per Mb; range 43–581 mutations per Mb), harboring mutations deleterious for DNA repair in MSH6, MSH2, MLH1, PMS2, POLE, and POLD1 genes (78% of cases).Conclusion.Comprehensive genomic profiling of pediatric gliomas provides objective data that promote diagnostic accuracy and enhance clinical decision‐making. Additionally, TMB could be a biomarker to identify pediatric glioblastoma (GBM) patients who may benefit from immunotherapy.Implications for Practice.By providing objective data to support diagnostic, prognostic, and therapeutic decision‐making, comprehensive genomic profiling is necessary for advancing care for pediatric neuro‐oncology patients. We present the largest cohort of pediatric low‐ and high‐grade gliomas profiled by next‐generation sequencing. We detected reportable alterations in 95% of patients, including diagnostically relevant lesions as well as novel oncogenic fusions and mutations. Additionally, we report tumor mutational burden (TMB), which identifies a subpopulation of hypermutated glioblastomas that harbor deleterious mutations in DNA repair genes. This provides support for TMB as a potential biomarker to identify patients who may preferentially benefit from immune checkpoint inhibitors.

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Histology of non-small cell lung cancer predicts the response to stereotactic body radiotherapy

Publication date: Available online 14 September 2017
Source:Radiotherapy and Oncology
Author(s): Juliane Hörner-Rieber, Denise Bernhardt, Julian Dern, Laila König, Sebastian Adeberg, Angela Paul, Claus Peter Heussel, Jutta Kappes, Hans Hoffmann, Felix J.P. Herth, Jürgen Debus, Arne Warth, Stefan Rieken
Background and purposeTo investigate the prognostic impact of different histological subtypes of non-small cell lung cancer (NSCLC) on outcome following stereotactic body radiotherapy (SBRT) for NSCLC patients.Materials and methodsWe analyzed 126 consecutive patients with early-stage adenocarcinoma or squamous cell carcinoma treated with SBRT from 2004 to 2016. Adenocarcinoma patients were further sub-classified as high-risk or low-risk tumors.ResultsWith a median follow-up time of 22months, 2-year overall survival (OS), local (LC), and distant control (DC) were 68%, 90% and 79%, respectively. For LC, histologic subtype was identified as major independent prognostic factor (p=0.033): while LC was 81% for squamous cell carcinoma patients, LC was significantly improved for high-risk and even more non-high-risk adenocarcinoma patients with 96% and 100%, respectively (p=0.026). The negative prognostic impact of the histologic subtype "squamous cell carcinoma" was not evident when patients received SBRT with higher total doses in EQD2 (2Gy equivalent dose): if patients were treated with a total dose in EQD2≥150Gy, no significant difference in LC for histologic subtypes was detected anymore (p=0.355).ConclusionIn the current study, histologic subtypes of NSCLC predicted local control probabilities following SBRT. Prospective, multi-center studies are needed to evaluate the prognostic impact of histology and consecutively the need for SBRT dose adaptation.

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Inter-observer agreement in GTV delineation of bone metastases on CT and impact of MR imaging: A multicenter study

Publication date: Available online 14 September 2017
Source:Radiotherapy and Oncology
Author(s): A.S. Gerlich, J.M. van der Velden, A.N.T.J. Kotte, C.L. Tseng, G. Fanetti, W.S.C. Eppinga, N. Kasperts, M.P.W. Intven, F.A. Pameijer, M.E.P. Philippens, H.M. Verkooijen, E. Seravalli
Background and purposeThe use of Stereotactic Body Radiotherapy (SBRT) for bone metastases is increasing rapidly. Therefore, knowledge of the inter-observer differences in tumor volume delineation is essential to guarantee precise dose delivery. The aim of this study is to compare inter-observer agreement in bone metastases delineated on different imaging modalities.Material and methodsTwenty consecutive patients with bone metastases treated with SBRT were selected. All patients received CT and MR imaging in treatment position prior to SBRT. Five observers from three institutions independently delineated gross tumor volume (GTV) on CT alone, CT with co-registered MRI and MRI alone. Four contours per imaging modality per patient were available, as one set of contours was shared by 2 observers. Inter-observer agreement, expressed in generalized conformity index [CIgen], volumes of contours and contours center of mass (COM) were calculated per patient and imaging modality.ResultsMean GTV delineated on MR (45.9±52.0cm³) was significantly larger compared to CT–MR (40.2±49.4cm³) and CT (34.8±41.8cm³). A considerable variation in CIgen was found on CT (mean 0.46, range 0.15–0.75) and CT–MRI (mean 0.54, range 0.17–0.71). The highest agreement was found on MRI (mean 0.56, range 0.20–0.77). The largest variations of COM were found in anterior–posterior direction for all imaging modalities.ConclusionsLarge inter-observer variation in GTV delineation exists for CT, CT–MRI and MRI. MRI-based GTV delineation resulted in larger volumes and highest consistency between observers.

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Ex vivo γH2AX radiation sensitivity assay in prostate cancer: Inter-patient and intra-patient heterogeneity

Publication date: Available online 14 September 2017
Source:Radiotherapy and Oncology
Author(s): Chiara De-Colle, Ala Yaromina, Joerg Hennenlotter, Howard Thames, Arndt-Christian Mueller, Tim Neumann, Arnulf Stenzl, Marcus Scharpf, Falko Fend, Umberto Ricardi, Michael Baumann, Daniel Zips, Apostolos Menegakis
IntroductionThe aim of the study is to assess inter-patient and intra-patient heterogeneity in tumour cell radiosensitivity using the ex vivo γH2AX assay in prostate cancer specimens.MethodsExcised specimens from untreated prostate cancer patients were cultivated 24h in media, irradiated ex vivo and fixed after 24h. Residual γH2AX foci were counted and the slope of the dose response was calculated. Intra-patient heterogeneity was studied from three to seven different biopsies.ResultsIn pathology-confirmed tumour samples from 21 patients the slope of residual γH2AX foci and radiation dose showed a substantial heterogeneity ranging from 0.82 to 3.17 foci/Gy. No correlation was observed between the slope values and the Gleason score (p=0.37), prostate specific antigen (p=0.48) and tumour stage (p=0.89). ANOVA indicated that only in 1 out of 9 patients, biopsies from different tumour locations yielded statistically significant differences. Variance component analysis indicated higher inter-patient than intra-patient variability. Bootstrap simulation study demonstrated that one biopsy is sufficient to estimate the mean value of residual γH2AX per dose level and account for intra-patient heterogeneity.ConclusionsIn prostate cancer inter-patient heterogeneity in tumour cell radiation sensitivity is pronounced and higher than intra-patient heterogeneity supporting the further development of the γH2AX ex vivo assay as a biomarker for individualized treatment.

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Stereotactic body radiotherapy for lung cancer patients with idiopathic interstitial pneumonias

Publication date: Available online 14 September 2017
Source:Radiotherapy and Oncology
Author(s): Yuichiro Tsurugai, Atsuya Takeda, Naoko Sanuki, Tatsuji Enomoto, Takeshi Kaneko, Yu Hara, Tomikazu Mizuno, Noriyuki Saeki, Yousuke Aoki, Yohei Oku, Takeshi Akiba, Etsuo Kunieda
PurposeTo compare toxicity and survival after stereotactic body radiotherapy (SBRT) between lung cancer patients with or without idiopathic interstitial pneumonias (IIPs), and to investigate the potential value of SBRT for the patients.MethodsAmong lung cancer patients receiving SBRT between 2005 and 2016, we evaluated those treated with a total dose of 40–60Gy in five fractions with curative intent who either were staged as cT1-4N0M0 or experienced postoperative isolated local recurrence. We analyzed the incidence of radiation pneumonitis (RP) in all patients and local recurrence and overall survival (OS) in T1a-2a patients.ResultsA total of 508 patients were eligible, including 42 with IIPs. The median follow-up was 32.3 (6.0–120.9) months. Significantly more patients with IIPs had grade ≥3RP than did those without IIPs (12% vs. 3%, p=0.009). The 2-year local recurrence rate was low in both groups (3.4% vs. 5.6%, p=0.38). The 2-year OS rate was significantly lower in the patients with IIPs (42.2% vs. 80.9%, p<0.001), although death from lung cancer was comparable (p=0.74).ConclusionSBRT achieved excellent local control with acceptable pulmonary toxicity in lung cancer patients with IIPs. SBRT can be a reasonable option for early lung cancer patients with IIPs.

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Πέμπτη 14 Σεπτεμβρίου 2017

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