Season Greetings

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Correction to: Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study

The following note was inadvertently omitted from the published paper: This work was performed in (partial) fulfillment of the requirements for the first author's obtaining the degree Dr. med. dent.

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Liquid-Biopsy-Based Identification of EGFR T790M Mutation-Mediated Resistance to Afatinib Treatment in Patients with Advanced EGFR Mutation-Positive NSCLC, and Subsequent Response to Osimertinib

Abstract

Background

Acquired epidermal growth factor receptor (EGFR) T790M mutation is the primary resistance mechanism to first-generation EGFR tyrosine kinase inhibitors (TKIs) used in advanced, EGFR mutation-positive non-small-cell lung cancer (NSCLC). Available data, predominantly in Asian patients, suggest that this mutation is also the major cause of resistance to the irreversible ErbB family blocker, afatinib. For EGFR T790M-positive patients who progress on EGFR TKI therapy, osimertinib is an effective treatment option. However, data on osimertinib use after afatinib are, to date, scarce.

Objective

To identify the prevalence of EGFR T790M mutations in predominantly Caucasian patients with stage IV EGFR mutation-positive NSCLC who progressed on afatinib, and to investigate the subsequent response to osimertinib.

Patients and Methods

In this single-center, retrospective analysis, EGFR T790M mutation status after afatinib failure was assessed using liquid biopsy and tissue rebiopsy. EGFR T790M-positive patients subsequently received osimertinib.

Results

Sixty-seven patients received afatinib in the first-, second-, or third-line (80.6%, 14.9%, and 4.5%, respectively). After afatinib failure, the T790M mutation was identified in 49 patients (73.1%). Liquid biopsy and tissue rebiopsy were concordant in 79.4% of cases. All patients with T790M-positive tumors received osimertinib (73.5% after first-line afatinib); 37 (75.5%) of these had an objective response (complete response: 22.4%; partial response: 53.1%). Response rate was independent of T790M copy number.

Conclusion

EGFR T790M mutation is a major mechanism of acquired resistance to afatinib. Osimertinib confers high response rates after afatinib failure in EGFR T790M-positive patients and its use in sequence potentially allows extended chemotherapy-free treatment.

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Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016

Laryngo-Rhino-Otol
DOI: 10.1055/a-0805-5846

Hintergrund Eine Umfrage aus dem Jahr 2009 zeigte, dass lediglich etwa 24 % aller deutschen HNO-Kliniken die Sialendoskopie anboten. Durch die Wiederholung der Untersuchung im Jahr 2016 sollte die Entwicklung der Sialendoskopie an deutschen HNO-Kliniken reevaluiert werden. Material und Methoden Erneut wurde ein selbstentwickelter Fragebogen mit elf Fragen an alle deutschen HNO-Kliniken verschickt. Der gleiche Fragebogen wurde bereits im Jahr 2009 verwendet. Die aktuellen Umfrageergebnisse wurden mit den Ergebnissen von damals verglichen und ausgewertet. Ergebnisse Die Zahl der sialendoskopierenden HNO-Kliniken konnte sich mehr als verdoppeln. Die Anzahl der Interventionen verdreifachte sich. Die Gründe dafür, dass eine Klinik keine Sialendoskopien durchführte, waren verschieden. Ein Hauptargument war ein Mangel an Patienten. Kaum Veränderungen ergaben sich bei ambulanten und stationären Therapien und der Eingriffsdauer. Die Sonographie wird unverändert von allen Kliniken präoperativ durchgeführt. Schlussfolgerung Auffallend ist, dass bei zunehmender Anzahl an Kliniken, die die Sialendoskopie anbieten und steigenden Fallzahlen, ein Teil der Kliniken einen Patientenmangel angibt. Dies könnte für die Etablierung von spezialisierten Zentren sprechen. Inzwischen werden neben der obstruktiven Sialadenitis weitere Krankheitsbilder durch die Sialendoskopie therapiert. Die Sonographie bleibt die präoperative Diagnostik der Wahl. Die Auswertung zeigt, dass die Sialendoskopie in den vergangenen sieben Jahren eine steigende Akzeptanz an deutschen HNO-Kliniken erfahren hat.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Donor-derived hepatocytes in human hematopoietic cell transplant recipients: evidence of fusion

Abstract

Reconstitution of hepatocytes by hematopoietic stem cells—a phenomenon which occurs in rodents under highly selective conditions—results from infrequent fusion between incoming myelomonocytes and host hepatocytes, with subsequent proliferation. Human hematopoietic stem cell transplant recipients have been little studied, with some support for transdifferentiation (direct differentiation). We studied routinely obtained autopsy liver tissue of four female hematopoietic cell transplant recipients with male donors, using a highly specific conjoint immunohistochemistry in situ hybridization light microscopic technique. Hepatocyte nuclei were identified by cytokeratin (Cam5.2) staining and evaluated for X and Y chromosome content. Over 1.6 million hepatocytes were assessed for rare instances of donor origin, revealing a Y chromosome in 67. Mixed tetraploids (XXXY) and their nuclear truncation products (XXY, XY, Y) were directly demonstrated, with no detection of the male tetraploids (XXYY) that may result from transdifferentiation with subsequent tetraploidization, nor their unique truncation products (XYY, YY), implicating fusion as the mechanism. To determine whether it is the sole mechanism, we modeled the chromosome distribution based on the same probability of detection of each X chromosome, deriving parameters of sensitivity and female tetraploidy by best fit. We then hypothesized that the distribution of Y chromosome–containing cells could be predicted by a similar model. After modification to account for "clumpy" Y chromosomes, the observed results were in accord with the predicted results (p = 0.6). These results suggest that all the Y-containing cells, including apparent XY cells, derive from mixed tetraploids, consistent with fusion as the sole mechanism.

https://ift.tt/2RTkA4M

Management of abnormal deep inferior epigastric vessels in microsurgical breast reconstruction: a report of 3 complex cases

Abstract

The deep inferior epigastric artery perforator flap is the gold standard in microsurgical breast reconstruction. It is now increasingly offered in patients with previous abdominal scars and in such cases, computed tomography angiography (CTA) is routinely implemented. However, previous injury of the deep inferior epigastric vessels may be difficult to detect with CTA. We report three cases of successful bilateral breast reconstruction, in which a unilateral DIEA was found to be abnormal. In the first two cases, the unilateral DIE vessels were found to be damaged and the flaps salvaged based on the deep superior epigastric artery. In the third patient, previous DIEA injury resulted in vessel recanalization, which was only evident following initial anastomotic failure. In this case, the damaged DIEA segment was subsequently removed and the flap successfully revascularized. All three patients had an uneventful post-operative recovery and all flaps survived with no complications. Based on our experience, we believe that awareness of the potential pitfalls and careful planning for lifeboats are essential to avoid flap loss in such circumstances.

Level of Evidence: Level V, therapeutic study.

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Developmental toxicity and apoptosis in zebrafish embryos induced by low-dose γ-ray irradiation

Abstract

In this paper, the developmental toxicity and apoptosis in zebrafish (Danio rerio) embryos induced by 0.01, 0.05, and 0.10-Gy γ-ray irradiation were investigated and verified by single cell gel electrophoresis, acridine orange staining, flow cytometry, transmission electron microscopy, digital gene expression sequencing, and Western blot analysis. DNA damage, deformity rates, and apoptosis of zebrafish embryos were found to increase significantly with the increase of irradiation dose, and survival and hatching rates significantly decreased when the irradiation dose exceeds 0.10 and 0.05 Gy, respectively. Exposure to 0.10-Gy γ-ray irradiation resulted in the swelling of cell mitochondria of zebrafish embryos and changes in their intracellular vacuoles. mRNA and protein expression levels of Shh (sonic hedgehog 19 KDa) and Smo (smoothened 86 KDa) of Hh signaling pathway associated with the development of early embryos significantly increased with the increase of irradiation dose. Expression of the AKT (56 KDa) and PiK3r3 (55 KDa) genes, which are anti-apoptotic and involved with the PI3K/Akt signaling pathway, significantly decreased, while expression of the bada gene, which is pro-apoptotic, significantly increased. The results show that γ-ray irradiations of 0.01 and 0.05 Gy can induce developmental toxicity and apoptosis in zebrafish embryos via Hh and PI3K/Akt signaling pathways, respectively.

https://ift.tt/2UC36Mc

Lesions to the Fronto-Parietal Network Impact Alpha-Band Phase Synchrony and Cognitive Control

Abstract

Long-range phase synchrony in the α-oscillation band (near 10 Hz) has been proposed to facilitate information integration across anatomically segregated regions. Which areas may top-down regulate such cross-regional integration is largely unknown. We previously found that the moment-to-moment strength of high-α band (10–12 Hz) phase synchrony co-varies with activity in a fronto-parietal (FP) network. This network is critical for adaptive cognitive control functions such as cognitive flexibility required during set-shifting. Using electroencephalography (EEG) in 23 patients with focal frontal lobe lesions (resected tumors), we tested the hypothesis that the FP network is necessary for modulation of high-α band phase synchrony. Global phase-synchrony was measured using an adaptation of the phase-locking value (PLV) in a sliding window procedure, which allowed for measurement of changes in EEG-based resting-state functional connectivity across time. As hypothesized, the temporal modulation (range and standard deviation) of high-α phase synchrony was reduced as a function of FP network lesion extent, mostly due to dorsolateral prefrontal cortex (dlPFC) lesions. Furthermore, patients with dlPFC lesions exhibited reduced cognitive flexibility as measured by the Trail-Making Test (set-shifting). Our findings provide evidence that the FP network is necessary for modulatory control of high-α band long-range phase synchrony, and linked to cognitive flexibility.

https://ift.tt/2EoxXqB

Characterization of the Inner and Outer Fiber Layers in the Developing Cerebral Cortex of Gyrencephalic Ferrets

Abstract

Changes in the cerebral cortex of mammals during evolution have been of great interest. Ferrets, monkeys, and humans have more developed cerebral cortices compared with mice. Although the features of progenitors in the developing cortices of these animals have been intensively investigated, those of the fiber layers are still largely elusive. By taking the advantage of our in utero electroporation technique for ferrets, here we systematically investigated the cellular origins and projection patterns of axonal fibers in the developing ferret cortex. We found that ferrets have 2 fiber layers in the developing cerebral cortex, as is the case in monkeys and humans. Axonal fibers in the inner fiber layer projected contralaterally and subcortically, whereas those in the outer fiber layer sent axons to neighboring cortical areas. Furthermore, we performed similar experiments using mice and found unexpected similarities between ferrets and mice. Our results shed light on the cellular origins, the projection patterns, the developmental processes, and the evolution of fiber layers in mammalian brains.

https://ift.tt/2EcRbyu

Development and Emergence of Individual Variability in the Functional Connectivity Architecture of the Preterm Human Brain

Abstract

Individual variability in human brain networks underlies individual differences in cognition and behaviors. However, researchers have not conclusively determined when individual variability patterns of the brain networks emerge and how they develop in the early phase. Here, we employed resting-state functional MRI data and whole-brain functional connectivity analyses in 40 neonates aged around 31–42 postmenstrual weeks to characterize the spatial distribution and development modes of individual variability in the functional network architecture. We observed lower individual variability in primary sensorimotor and visual areas and higher variability in association regions at the third trimester, and these patterns are generally similar to those of adult brains. Different functional systems showed dramatic differences in the development of individual variability, with significant decreases in the sensorimotor network; decreasing trends in the visual, subcortical, and dorsal and ventral attention networks, and limited change in the default mode, frontoparietal and limbic networks. The patterns of individual variability were negatively correlated with the short- to middle-range connection strength/number and this distance constraint was significantly strengthened throughout development. Our findings highlight the development and emergence of individual variability in the functional architecture of the prenatal brain, which may lay network foundations for individual behavioral differences later in life.

https://ift.tt/2Epthkl

The Role of the Human Auditory Corticostriatal Network in Speech Learning

Abstract

We establish a mechanistic account of how the mature human brain functionally reorganizes to acquire and represent new speech sounds. Native speakers of English learned to categorize Mandarin lexical tone categories produced by multiple talkers using trial-by-trial feedback. We hypothesized that the corticostriatal system is a key intermediary in mediating temporal lobe plasticity and the acquisition of new speech categories in adulthood. We conducted a functional magnetic resonance imaging experiment in which participants underwent a sound-to-category mapping task. Diffusion tensor imaging data were collected, and probabilistic fiber tracking analysis was employed to assay the auditory corticostriatal pathways. Multivariate pattern analysis showed that talker-invariant novel tone category representations emerged in the left superior temporal gyrus (LSTG) within a few hundred training trials. Univariate analysis showed that the putamen, a subregion of the striatum, was sensitive to positive feedback in correctly categorized trials. With learning, functional coupling between the putamen and LSTG increased during error processing. Furthermore, fiber tractography demonstrated robust structural connectivity between the feedback-sensitive striatal regions and the LSTG regions that represent the newly learned tone categories. Our convergent findings highlight a critical role for the auditory corticostriatal circuitry in mediating the acquisition of new speech categories.

https://ift.tt/2EeVKZh

Temporally Unconstrained Decoding Reveals Consistent but Time-Varying Stages of Stimulus Processing

Abstract

In this article, we propose a method to track trial-specific neural dynamics of stimulus processing and decision making with high temporal precision. By applying this novel method to a perceptual template-matching task, we tracked representational brain states associated with the cascade of neural processing, from early sensory areas to higher order areas that are involved in integration and decision making. We address a major limitation of the traditional decoding approach: that it relies on consistent timing of these processes over trials. Using a TUDA approach, we found that the timing of the cognitive processes involved in perceptual judgments can vary considerably over trials. This revealed that the sequence of processing states was consistent for all subjects and trials, even when the timing of these states varied. Furthermore, we found that the specific timing of states on each trial was related to the quality of performance over trials. Altogether, this work not only highlights the serious pitfalls and misleading interpretations that result from assuming stimulus processing to be synchronous across trials but can also open important avenues to investigate learning and quantify plasticity.

https://ift.tt/2Eg5p1N

Age-Related Differences in Brain Morphology and the Modifiers in Middle-Aged and Older Adults

Abstract

Brain structural morphology differs with age. This study examined age-differences in surface-based morphometric measures of cortical thickness, volume, and surface area in a well-defined sample of 8137 generally healthy UK Biobank participants aged 45–79 years. We illustrate that the complexity of age-related brain morphological differences may be related to the laminar organization and regional evolutionary history of the cortex, and age of about 60 is a break point for increasing negative associations between age and brain morphology in Alzheimer's disease (AD)-prone areas. We also report novel relationships of age-related cortical differences with individual factors of sex, cognitive functions of fluid intelligence, reaction time and prospective memory, cigarette smoking, alcohol consumption, sleep disruption, genetic markers of apolipoprotein E, brain-derived neurotrophic factor, catechol-O-methyltransferase, and several genome-wide association study loci for AD and further reveal joint effects of cognitive functions, lifestyle behaviors, and education on age-related cortical differences. These findings provide one of the most extensive characterizations of age associations with major brain morphological measures and improve our understanding of normal structural brain aging and its potential modifiers.

https://ift.tt/2Epv5Kc

Transcriptomic Landscape of von Economo Neurons in Human Anterior Cingulate Cortex Revealed by Microdissected-Cell RNA Sequencing

Abstract

The von Economo neurons (VENs) are specialized large bipolar projection neurons with restricted distribution in the human brain, and they are far more abundant in humans than in non-human primates. However, VEN functions remain elusive due to the difficulty of isolating VENs and dissecting their connections in the brain. Here, we combined laser-capture-microdissection with RNA sequencing to describe the transcriptomic profile of VENs from human anterior cingulate cortex (ACC). Using pyramidal neurons as reference cells, we identified 344 genes with VEN-associated expression differences, including 215 higher and 129 lower expression genes. Functional enrichment and protein–protein interaction network analyses showed that these genes with VEN-associated expression differences are involved in VEN morphogenesis and functions, such as dendrite branching and axon myelination, and many of them are associated with human social-emotional disorders. With the use of in situ hybridization and immunohistochemistry assays, we validated four novel VEN markers (VAT1L, CHST8, LYPD1, and SULF2). Collectively, we generated a full-spectrum expression profile of VENs from human ACC, greatly enlarging the pool of genes with VEN-associated expression differences that can help researchers to understand the role of VENs in normal and disordered human brains.

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Early Loss of Vision Results in Extensive Reorganization of Plasticity-Related Receptors and Alterations in Hippocampal Function That Extend Through Adulthood

Abstract

Although by adulthood cortical structures and their capacity for processing sensory information have become established and stabilized, under conditions of cortical injury, or sensory deprivation, rapid reorganization occurs. Little is known as to the impact of this kind of adaptation on cellular processes related to memory encoding. However, imaging studies in humans suggest that following loss or impairment of a sensory modality, not only cortical but also subcortical structures begin to reorganize. It is likely that these processes are supported by neurotransmitter receptors that enable synaptic and cortical plasticity. Here, we explored to what extent the expression of plasticity-related proteins (GABA-A, GABA-B, GluN1, GluN2A, GluN2B) is altered following early vision loss, and whether this impacts on hippocampal function. We observed that in the period of 2–4 months postnatally in CBA/J-mice that experience hereditary postnatal retinal degeneration, systematic changes of GABA-receptor and NMDA-receptor subunit expression occurred that emerged first in the hippocampus and developed later in the cortex, compared to control mice that had normal vision. Changes were accompanied by significant impairments in hippocampal long-term potentiation and hippocampus-dependent learning. These data indicate that during cortical adaptation to early loss of vision, hippocampal information processing is compromised, and this status impacts on the acquisition of spatial representations.

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Different Decision-Making Responses Occupy Different Brain Networks for Information Processing: A Study Based on EEG and TMS

Abstract

This study used large-scale time-varying network analysis to reveal the diverse network patterns during the different decision stages and found that the responses of rejection and acceptance involved different network structures. When participants accept unfair offers, the brain recruits a more bottom-up mechanism with a much stronger information flow from the visual cortex (O2) to the frontal area, but when they reject unfair offers, it displayed a more top-down flow derived from the frontal cortex (Fz) to the parietal and occipital cortices. Furthermore, we performed 2 additional studies to validate the above network models: one was to identify the 2 responses based on the out-degree information of network hub nodes, which results in 70% accuracy, and the other utilized theta burst stimulation (TBS) of transcranial magnetic stimulation (TMS) to modulate the frontal area before the decision-making tasks. We found that the intermittent TBS group demonstrated lower acceptance rates and that the continuous TBS group showed higher acceptance rates compared with the sham group. Similar effects were not observed after TBS of a control site. These results suggest that the revealed decision-making network model can serve as a potential intervention model to alter decision responses.

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Dorsolateral Prefrontal Cortex Enables Updating of Established Memories

Abstract

Updating established memories in light of new information is fundamental for memory to guide future behavior. However, little is known about the brain mechanisms by which existing memories can be updated. Here, we combined functional magnetic resonance imaging and multivariate representational similarity analysis to elucidate the neural mechanisms underlying the updating of consolidated memories. To this end, participants first learned face–city name pairs. Twenty-four hours later, while lying in the MRI scanner, participants were required to update some of these associations, but not others, and to encode entirely new pairs. Updating success was tested again 24 h later. Our results showed increased activity of the dorsolateral prefrontal cortex (dlPFC) specifically during the updating of existing associations that was significantly stronger than when simple retrieval or new encoding was required. The updating-related activity of the dlPFC and its functional connectivity with the hippocampus were directly linked to updating success. Furthermore, neural similarity for updated items was markedly higher in the dlPFC and this increase in dlPFC neural similarity distinguished individuals with high updating performance from those with low updating performance. Together, these findings suggest a key role of the dlPFC, presumably in interaction with the hippocampus, in the updating of established memories.

https://ift.tt/2EtRvKi

Early Excitatory Activity-Dependent Maturation of Somatostatin Interneurons in Cortical Layer 2/3 of Mice

Abstract

GABAergic interneurons perform distinct functions during cortical development in the mouse brain. Among the diverse GABAergic neurons present in the brain, early-born somatostatin (SST)-expressing inhibitory interneurons, which are innervated by other interneurons and local pyramidal cells (PCs), act in a neural computational role in circuitry regulation. The synapses between the SST⁺ interneurons and other cells form gradually during development. Here, we traced the developmental course of the electrophysiological properties of SST⁺ interneurons at layer 2/3 of the neocortical secondary motor area (M2) in mouse, and the synaptic connectivity between SST⁺ interneurons and PCs. Also, we used toxin-mediated and genetic method to suppress the activities of PCs, and demonstrate that decreasing excitatory input at early stage (before P1) rather than late stage (after P8) would delay the functional maturation of SST⁺ interneurons. In conclusion, our results indicate that early functional activity of PCs is crucial for the intrinsic maturation of SST⁺ interneurons, following which these interneurons participate in local circuitry.

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Neurons in the Macaque Dorsal Premotor Cortex Respond to Execution and Observation of Actions

Abstract

We identified neurons in dorsal premotor cortex (PMd) of the macaque brain that respond during execution and observation of reaching-to-grasp actions, thus fulfilling the mirror neuron (MirN) criterion. During observation, the percentage of grip-selective MirNs in PMd and area F5 were comparable, and the selectivity indices in the two areas were similar. During execution, F5-MirNs were more selective than PMd–MirNs for grip, which was reflected in the higher selectivity indices in F5 than in PMd. PMd displayed grip-related information earlier than F5 during both conditions. In both areas, the number of neurons exhibiting congruent visual and motor selectivity did not differ from that expected by chance. However, both the PMd and F5 neuronal ensembles provided observation–execution matching, suggesting that the congruency may be achieved in a distributed fashion across the selective elements of the population. Furthermore, representational similarity analysis revealed that grip encoding in PMd and F5 is alike during both observation and execution. Our study provides direct evidence of mirror activity in PMd during observation of forelimb movements, and suggests that PMd is a node of the MirN circuit.

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Oxytocin Modulates the Intrinsic Dynamics Between Attention-Related Large-Scale Networks

Abstract

Attention and salience processing have been linked to the intrinsic between- and within-network dynamics of large-scale networks engaged in internal (default network [DN]) and external attention allocation (dorsal attention network [DAN] and salience network [SN]). The central oxytocin (OXT) system appears ideally organized to modulate widely distributed neural systems and to regulate the switch between internal attention and salient stimuli in the environment. The current randomized placebo (PLC)-controlled between-subject pharmacological resting-state fMRI study in N = 187 (OXT, n = 94; PLC, n = 93; single-dose intranasal administration) healthy male and female participants employed an independent component analysis approach to determine the modulatory effects of OXT on the within- and between-network dynamics of the DAN–SN–DN triple network system. OXT increased the functional integration between subsystems within SN and DN and increased functional segregation of the DN with both attentional control networks (SN and DAN). Whereas no sex differences were observed, OXT effects on the DN–SN interaction were modulated by autistic traits. Together, the findings suggest that OXT may facilitate efficient attention allocation by modulating the intrinsic functional dynamics between DN components and large-scale networks involved in external attentional demands (SN and DAN).

https://ift.tt/2Eg5fY4

Emergence of Coordinated Activity in the Developing Entorhinal–Hippocampal Network

Abstract

Correlated activity in the entorhinal–hippocampal neuronal networks, supported by oscillatory and intermittent population activity patterns is critical for learning and memory. However, when and how correlated activity emerges in these networks during development remains largely unknown. Here, we found that during the first postnatal week in non-anaesthetized head-restrained rats, activity in the superficial layers of the medial entorhinal cortex (MEC) and hippocampus was highly correlated, with intermittent population bursts in the MEC followed by early sharp waves (eSPWs) in the hippocampus. Neurons in the superficial MEC layers fired before neurons in the dentate gyrus, CA3 and CA1. eSPW current-source density profiles indicated that perforant/temporoammonic entorhinal inputs and intrinsic hippocampal connections are co-activated during entorhinal–hippocampal activity bursts. Finally, a majority of the entorhinal–hippocampal bursts were triggered by spontaneous myoclonic body movements, characteristic of the neonatal period. Thus, during the neonatal period, activity in the entorhinal cortex (EC) and hippocampus is highly synchronous, with the EC leading hippocampal activation. We propose that such correlated activity is embedded into a large-scale bottom-up circuit that processes somatosensory feedback resulting from neonatal movements, and that it is likely to instruct the development of connections between neocortex and hippocampus.

https://ift.tt/2EoxVyZ

Perioperative Intravenous Fluid in Children Undergoing Brain Tumor Resection: Balancing the Threats to Homeostasis

No abstract available

https://ift.tt/2B9Ie6b

Epidemiology and Resource Utilization of Simple Febrile Seizure-associated Hospitalizations in the United States, 2003-2012

Background: Simple febrile seizure (SFS) affects 2% to 4% of children under 6 years of age. The purpose of this study is to examine the epidemiologic patterns and resource utilization of SFS-associated hospitalizations in children aged younger than 6 years of age in the United States. Materials and Methods: This study is a serial, retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Databases for the years 2003, 2006, 2009, and 2012. SFS-associated hospitalizations were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 780.31. We calculated the proportion of hospitalizations in pediatric patients under 6 years of age due to SFS and all other nonbirth causes, the rate of SFS-associated hospitalizations per 100,000 population, the mean length of stay and inflation-adjusted hospital costs of SFS-associated hospitalizations, as well as patient demographics and hospital characteristics. Results: From 2003 to 2012, the weighted proportion of hospitalizations due to SFS declined from 0.83% to 0.41% (P

https://ift.tt/2C4ItAW

Developmental Neurotoxicity: An Update

In the section of "Developmental Neurotoxicity: An Update" of the Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) symposium 2018 the speakers presented the current literature in translational and clinical research. Dr. Brambrink spoke about translational research in anesthetic neurotoxicity, beginning with discovery in the rodent model, then focusing on evidence from nonhuman primates. Dr. Waspe applied the methodology of Adverse Outcome Pathways from the field of toxicology to developmental neurotoxicity of anesthetics. Dr. O'Leary presented relevant clinical studies that were published in 2017 divided by a focus on academic performance, clinical outcomes or diagnoses, or neuropsychological testing.

https://ift.tt/2UB5bbh

Engaging Stakeholders to Promote Safe Anesthesia and Sedation Care in Young Children

An important aspect of any research endeavor is engaging various stakeholders to work toward the common goal of pushing knowledge forward about the question at hand. Research into pediatric anesthetic neurotoxicity could benefit greatly from interventions designed to improve the efforts and dedication of government agencies, pharmaceutical companies, research communities, and most importantly, patients. The Pediatric Anesthesia Neurodevelopment Assessment (PANDA) symposium is a biennial meeting where updates in research in the field are presented, and issues relevant to the community are discussed in round table discussions. Here, we summarize a discussion that took place at the 2018 meeting regarding new methods of engaging various stakeholders, as well as perspectives from other stakeholders. Topics discussed included an online portal to better reach patients, experiences with a public-private partnership, steps by the National Institutes of Health to improve engagement with research and improve the dissemination of results, and the experiences of the United States Food and Drug Administration attempting to improve stakeholder engagement following the passage of a new law to promote drug development. The round table discussion provided interesting insights into a critical research topic, and shared first-hand experience of attempts to improve engagement with a variety of stakeholders.

https://ift.tt/2Uvl7M2

Phenytoin-induced Excessive Sedation During Awake Craniotomy: An Unusual Observation

No abstract available

https://ift.tt/2UCbDyP

Anesthesia and Neurodevelopment in Children: Many Important Questions Remain Unanswered

No abstract available

https://ift.tt/2B9I7HN

Introduction to “Anesthesia and Neurodevelopment in Children”: A Supplement from the Sixth Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium

No abstract available

https://ift.tt/2UAvoXn

Using Neuroimaging to Study the Effects of Pain, Analgesia, and Anesthesia on Brain Development

Neuroimaging has been increasingly used as a modality to study the impact of pain, analgesia, and anesthetics on pediatric neurodevelopment. The sixth biennial Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium addressed the 2016 US Food and Drug Administration drug safety warning regarding the potential neurotoxic effects of commonly used anesthetic and sedative medications in children, and included a session discussing the use of various neuroimaging techniques, to detect structural, metabolic, and functional brain changes that can occur with exposure to pain and to anesthetic medications. The presenters concluded that advanced multimodal magnetic resonance imaging techniques are useful in detecting the aforementioned changes, which were found to be pain-specific and anesthetic agent-specific.

https://ift.tt/2UCDMpb

The Best of the Old With Promise of the New: The Format of the Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care is Changing

No abstract available

https://ift.tt/2UDTY9J

Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee

Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee.

https://ift.tt/2BeABvk

Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures

Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients.

https://ift.tt/2B9HZrN

Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial

Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection. Methods: In total, 53 patients (age range, 6 mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations (post-preopΔCl−) measured after surgery and at baseline. Secondary outcomes included the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema. Results: Saline infusion increased post-preopΔCl (6 [3.5; 8.5] mmol/L) compared with balanced crystalloid (0 [−1.0; 3.0] mmol/L; P

https://ift.tt/2B9HWfB

The Effects of Leukocyte Filtration on Cell Salvaged Autologous Blood Transfusion on Lung Function and Lung Inflammatory and Oxidative Stress Reactions in Elderly Patients Undergoing Lumbar Spinal Surgery

Background: This study was designed to investigate the effects of leukocyte filtration of autologous salvaged blood on lung function, lung inflammatory reaction, and oxidative stress reaction in elderly patients undergoing lumbar spinal surgery. Materials and Methods: Sixty elderly patients undergoing lumbar spinal surgery were randomly divided into 2 groups: Leukocyte Filter group and Control group. Serum levels of inflammatory markers including white blood cell and polymorphonuclear count, neutrophil elastase, serum surfactant protein A, methane dicarboxylic aldehyde, superoxide dismutase, interleukin (IL)-6, IL-8, tumor necrosis factor-α, and respiratory function markers including dynamic respiratory system compliance, oxygenation index, and respiratory index were measured immediately before induction of anesthesia (T0), immediately before blood transfusion (T1), and 1 (T2), 6 (T3), and 12 hours (T4) after end of blood transfusion. Results: The Leukocyte Filter group had higher dynamic respiratory system compliance at T2, oxygenation index at T2 and T3, respiratory index and superoxide dismutase at T2, T3, and T4 than those in the Control group (P

https://ift.tt/2B9HTjV

Outcomes of Anesthesia Selection in Endovascular Treatment of Acute Ischemic Stroke

Background: The association between anesthesia type and outcomes in patients with acute ischemic stroke undergoing endovascular treatment (EVT) remains a subject of ongoing debate. Methods: This prospective nonrandomized controlled trial included 149 consecutive patients with acute anterior circulation stroke who underwent EVT. The primary outcome was functional independence assessed by the modified Rankin Scale (mRS) after 3 months. Results: A total of 105 (70.5%) and 44 (29.5%) patients undergoing EVT who received conscious sedation (CS) and general anesthesia (GA), respectively. The patients who received GA had similar demographics and basic National Institute of Health Stroke Scale scores (17 vs. 16, P>0.05) as the patients who received CS. The recanalization time (304 vs. 311 min, P=0.940) and the recanalization rate (86.4% vs. 84.1%, P=0.170) did not differ between the patients receiving the different types of anesthesia. The National Institute of Health Stroke Scale at 24 hours was lower in the patients who received CS than in those who received GA (β=−2.26, 95% confidence interval, −5.30 to 0.79). The independence (modified Rankin Scale score 0 to 2) at 3 months was equal between patients who received GA and those who received CS (odds ratio=0.73, 95% confidence interval, 0.32-1.68). The mortality and the morbidity rates did not differ. Conclusions: The data indicated that the selection of GA or CS during EVT had no impact on the independent outcomes of patients with anterior circulation occlusion.

https://ift.tt/2B9lwuW

Prolonged Anesthetic Exposure in Children and Factors Associated With Exposure Duration

Introduction: Anesthetic exposure duration has come under scrutiny because of a Food and Drug Administration warning against prolonged use of anesthesia in children, defined as exposures longer than 3 hours. Methods: Data for 2,613,344 pediatric anesthetic records from the American Society of Anesthesiologist's National Anesthesia Clinical Outcomes Registry from 2010 to 2015 were analyzed to describe anesthetic duration and the prevalence of prolonged exposures in children. Common pediatric inpatient procedures were independently assessed to determine factors associated with exposure duration. Results: The overall mean pediatric anesthetic duration was 83.3±107.4 minutes (median, 57 min). Prolonged exposures comprised 7% of pediatric anesthetic records, and 15% of anesthetic records in infants. After restricting to common pediatric inpatient procedures (n=96,603) and adjusting for procedure type using a Poisson model, compared with children 10 years or older, exposures in infants were 20.5% longer (anesthetic duration ratio [ADR], 1.205; 95% confidence interval [CI], 1.202–1.208). Longer exposures were also seen with a variety of other patient and hospital factors including ASA 4 patients versus ASA 1 patients, (ADR, 1.381; 95% CI, 1.376-1.386), and university hospitals versus surgery centers (ADR, 1.241; 95% CI, 1.236-1.246). Conclusions: Most pediatric anesthetic exposures last

https://ift.tt/2UAPIYD

Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients

Background: Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients. Materials and Methods: Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade ≥III. Results: Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80. Conclusions: Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients.

https://ift.tt/2B9HM7Z

A Summary of Preclinical Poster Presentations at the Sixth Biennial Pediatric Anesthesia Neurodevelopment Assessment (PANDA) Symposium

The potential for long-term neurotoxic effects of anesthetics on the developing human brain has led to intensified research in this area. To date, the human evidence has been inconclusive, but a large body of animal evidence continues to demonstrate cause for concern. On April 14 and 15, 2018 the sixth biennial Pediatric Anesthesia and Neurodevelopmental Assessment (PANDA) study symposium was held at Morgan Stanley Children's Hospital of New York. This symposium brought together clinicians and researchers and served as a platform to review preclinical and clinical data related to anesthesia and neurotoxicity in developing brains. The program participants included many active investigators in the field of anesthesia neurotoxicity as well as stakeholders from different backgrounds with the common interest of potential anesthetic neurotoxicity in children. The moderated poster session included presentations of preclinical animal research studies. These studies focused on defining the anesthetic-induced neurotoxicity phenotype, understanding the mechanism of injury and discovering potential inhibitors of neurotoxic effects.

https://ift.tt/2UyZcDK

Analgesia Nociception Index Monitoring During Supratentorial Craniotomy

Background: Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nociception Index (ANI) monitor based on the high frequency component of heart rate variability has been launched into clinical practice. We monitored analgesia during craniotomy using ANI monitor and compared it with cardiovascular parameters and response entropy (RE) of entropy monitor. Materials and Methods: In 21 patients undergoing a craniotomy for a supratentorial lesion, we monitored ANI, heart rate (HR), mean arterial pressure (MAP), state entropy, and RE throughout the surgery. Also, ANI, hemodynamic variables and spectral entropy values were noted at the times of maximal stimulation, such as induction, intubation, head pin fixation, skin incision, craniotomy, durotomy, and skin closure. We also compared ANI with RE during administration of bolus doses of fentanyl. Results: There was an inverse correlation between ANI values and the hemodynamic changes. When the HR and MAP increased, ANI decreased suggesting a good correlation between hemodynamics and ANI values during the times of maximal stimulation. State entropy and RE did not change significantly in response to bolus doses of fentanyl administered during the course of surgery, while ANI increased significantly. Conclusion: In neurosurgical patients undergoing elective supratentorial craniotomy, ANI measures response to noxious stimuli with at least as much reliability as hemodynamic variables and changes in ANI parallel the changes in HR and MAP. ANI is superior to RE for measurement of response to noxious stimuli.

https://ift.tt/2BaEWzn

Chemical Eye Injury in a Case of Cervical Spine Surgery

No abstract available

https://ift.tt/2UBYSnG

The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy

Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.

https://ift.tt/2Bc9DV2

Aerosol and pollutant characteristics in Delhi during a winter research campaign

Abstract

Urban areas in developing countries are major sources of carbonaceous aerosols and air pollutants, pointing out the need for a detailed assessment of their levels and origin close to the source. A multi-instrument research campaign was performed in Delhi during December 2015–February 2016 aimed at exploring the pollution levels and the contribution of various sources to particulate matter (PM) concentrations, black carbon (BC) aerosols, and trace gases. The weak winds (< 5–6 m s⁻¹) along with the shallow boundary layer favoured the formation of thick and persistent fog conditions, which along with the high BC (24.4 ± 12.2 μg m⁻³) concentrations lead to the formation of smog. Very high pollution levels were recorded during the campaign, with mean PM₁₀, PM_2.5, CO, NO, and O₃ concentrations of 245.5 ± 109.8 μg m⁻³, 145.5 ± 69.5 μg m⁻³, 1.7 ± 0.5 ppm, 7.9 ± 2.3 ppb, and 31.3 ± 18.4 ppb, respectively. This study focuses on examining the daily/diurnal cycles of the aerosol optical properties (extinction, scattering, absorption coefficients, single scattering albedo), as well as of PM and other pollutant concentrations, along with changes in meteorology (mixing-layer height and wind speed). In addition, the hot-spot pollution sources in the greater Delhi area were determined via bivariate plots and conditional bivariate probability function (CBPF), while the distant sources were examined via the concentration weighted trajectory (CWT) analysis. The results show that the highest aerosol absorption and scattering coefficients, PM, and trace gas concentrations are detected for weak winds (< 2 m s⁻¹) with a preference for eastern directions, revealing high contribution from local sources and accumulation of pollutants within urban Delhi.

https://ift.tt/2zSYKHM

Reliability and intra-examiner agreement of orthodontic model analysis with a digital caliper on plaster and printed dental models

Abstract

Objective

To investigate if orthodontic model analysis with a digital caliper can be interchangeably performed between plaster and printed dental models.

Materials and methods

Forty-eight plaster models were digitized with orthoX®scan (DENTAURUM) and 48 counterparts were printed with Objet30 Dental Prime (Stratasys). One examiner performed five repeated orthodontic model analyses (41 outcomes) with a digital caliper in each plaster and the corresponding printed model and was externally validated by a second examiner. Inter- and intra-examiner reliability and error were evaluated with intraclass correlation coefficients (ICCs) and Dahlberg's formula, intra-examiner agreement with Bland-Altman analyses and Lin's correlation coefficients (CCCs), and changing bias with regression analyses.

Results

Inter- and intra-examiner ICCs and Dahlberg's error were ≥ 0.75 and ≤ 0.5 mm, respectively, for most outcomes in both plaster and printed models. Intra-examiner agreement (systematic bias) between plaster and printed models ranged from − 0.45 to 0.45 mm. Ranges of limits of agreement were wide for cumulative outcomes, such as crowding maxilla and mandible (2.69 mm and 3.07 mm around zero, respectively). Tooth widths were measured slightly larger in printed models. Lin's CCCs were ≥ 0.87 for all the outcomes between plaster and printed models, while no changing bias was detected.

Conclusion

If orthodontic model analyses are consistently performed, plaster casts and their corresponding printed models obtained with orthoX®scan and Objet30 Dental Prime can be interchangeably used for clinical purposes in orthodontics.

Clinical relevance

Orthodontic model analysis is important in treatment planning and printed dental models need to be validated regarding this diagnostic procedure.

https://ift.tt/2Py9ZKG

The role of the skin microbiome in atopic dermatitis

Atopic dermatitis (AD) is a common inflammatory skin disease associated with significant medical burden, affecting 15-20% of children and 1-3% of adults worldwide.1 The prevalence of AD has increased by 2-3 folds during the past decade in Western countries. While the cause of this increase remains unknown, meta-analyses have indicated that the risk of AD is lower when associated with potentially protective environmental factors during childhood such as three or more siblings, day care, pet ownership and farm residence.

https://ift.tt/2rtUaes

The Asthma Controller Step-down Yardstick

Guidelines for asthma recommend a series of treatment steps (Figure 1) as a framework for disease management.1,2 The steps allow individualized adjustments in controller therapy in an upward or downward manner in response to a patient's level of asthma control over a period of time. For patients with inadequately controlled asthma, a step-up is recommended.1,2 Strategies for stepping up controller therapy are described in detail in the adult and pediatric Asthma Yardsticks.3,4 For patients whose asthma has been well controlled for at least 3 months (or longer for the highest risk patients), controller treatment may be stepped down.

https://ift.tt/2G8qmOv

Basic chemical peeling—superficial and medium-depth peels

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

https://ift.tt/2En8TjK

Advanced chemical peels: phenol-croton oil peel

Once considered the gold standard for deep facial resurfacing, the classical Baker-Gordon phenol-croton oil peel has largely been replaced by formulas with lower concentrations of phenol and croton oil. The improved safety profile of deep peels has ushered in a new era in chemical peeling. Wrinkles can be improved and skin tightened with more subtle and natural results. No longer does a deep peel denote "alabaster white" facial depigmentation with complete effacement of wrinkles. The research of Dr.

https://ift.tt/2EcFx6K

Access to Dermatology Services at Free Medical Clinics, A Nationwide Cross-sectional Survey

https://ift.tt/2EsRgis

Tezepelumab, an anti-TSLP monoclonal antibody, in the treatment of moderate to severe atopic dermatitis: A randomized phase 2a clinical trial

•Thymic stromal lymphopoietin may initiate inflammation and therefore be a key target for atopic dermatitis treatmentHere, thymic stromal lymphopoietin blockade shows limited efficacy after 12 weeks' treatment; findings at later time points suggest that future clinical trials may require longer treatment periods to determine a significant treatment effect

https://ift.tt/2Ee387e

Interfering with bromodomain epigenome readers as therapeutic option in mucoepidermoid carcinoma

Abstract

Purpose

Emerging evidence indicates that bromodomains comprise a conserved class of epigenome readers involved in cancer development and inflammation. Bromodomains are associated with epigenetic modifications of gene transcription through interactions with lysine residues of histone tails. Particularly, the bromodomain and extra-terminal domain (BET) family member BRD4 has been found to be involved in the control over oncogenes, including c-MYC, and in the maintenance of downstream inflammatory processes. The objective of this study was to evaluate the effect of pharmacologically displacing BRD4 in mucoepidermoid carcinoma (MEC) cells.

Methods

We assessed the presence of BRD4 levels in a panel of human MEC tissue samples in conjunction with histological grading and clinical information. In vitro studies were carried out using human MEC-derived cell lines. The BET inhibitor iBET762 was administered to MEC cells to assess the impact of disrupted BRD4 signaling on colony forming capacities and cell cycle status. The activation of cellular senescence induced by iBET762 was determined by immunohistochemical staining for p16^ink4. Flow cytometry was used to identify populations of cancer stem cells in MEC-derived cell lines.

Results

We found that primary human MECs and MEC-derived cell lines are endowed with high BRD4 expression levels compared to those in normal salivary glands. We also found that, by displacing BRD4 from chromatin using the BET inhibitor iBET762, MEC cells lose their colony forming capacities and undergo G1 cell cycle arrest and senescence. Finally, we found that targeted displacement of BRD4 from chromatin results in depletion of cancer stem cells from the overall MEC cell populations.

Conclusions

Our findings indicate that bromodomain-mediated gene regulation constitutes an epigenetic mechanism that is deregulated in MEC cells and that the use of BET inhibitors may serve as a feasible therapeutic strategy to manage MECs.

https://ift.tt/2Qrrth1

Optical coherence tomography imaging of melanoma skin cancer

Abstract

No consensus guidelines exist on the use of optical coherence tomography (OCT) for diagnosis of cutaneous melanoma. The objectives of this review are to provide a descriptive review of the literature on characteristics of cutaneous melanomas seen on high-definition OCT (HD-OCT), speckle variance OCT (SV-OCT), and conventional OCT and to compare their diagnostic ability with that of histopathology. A review of PubMed and Google Scholar identified all available literature on OCT in melanoma skin cancer that included all in vivo and ex vivo studies on human or human tissues and excluded all studies on non-human subjects or animal studies. Two hundred nine abstracts were considered for evaluation, 31 abstracts were selected for manuscript review, and 14 abstracts were included that met all criteria. Diagnoses of MIS and MM using HD-OCT and SV-OCT were consistently reported to correlate with histopathology. However, accuracy of diagnosis using conventional OCT varied. Most authors agreed that it was difficult to differentiate MM from benign nevi using conventional OCT. HD-OCT, SV-OCT, and conventional OCT show promise for visualizing cutaneous melanoma. The use of OCT in diagnosis of melanoma is rarely reported in the literature. There is a need to increase and standardize reporting of OCT for diagnosis of cutaneous melanoma.

https://ift.tt/2B8yA3C

Parameter-efficient bioclogging model: calibration and comparison with laboratory data

Abstract

A parameter-efficient bioclogging model coupled with hydrodynamics was developed with a stepwise numerical calculation. Column lab tests were carried out to calibrate and verify the bioclogging model developed in this paper. The results showed that the experimental data fit well with the simulation data, which indicated that the developed model was reasonable. According to the sensitivity analysis of the parameters, the BOD (biochemical oxygen demand) loading rate and deposition coefficient are the key parameters for bioclogging. The results illustrate how the clogging is impacted by changing the BOD loading rate and can predict the biofilm accumulation within the substrate, the microbial saturation along the substrate profile over time, and the biofilter longevity based on the biomass growth. The model could dynamically describe the entire process of biological clogging and could quantitatively predict the amount of biofilm accumulated in the pores with the increasing operation time, which provides a basis for the prediction of biological clogging.

Graphical abstract

https://ift.tt/2Gb0MbL

Estrogen receptor gene is associated with dental fluorosis in Brazilian children

Abstract

Objectives

The aim of this study was investigate the association between genetic polymorphisms in ESR1, ESR2, and ESRRB and dental fluorosis (DF) in a well-characterized sample of children from Curitiba, Brazil.

Material and methods

From a representative sample of 538 children, 12-year-old were evaluated. DF was assessed in erupted permanent teeth by the Dean's index modified. Fourteen polymorphisms were selected in intronic and intergenic regions of ESR1, ESR2, and ESRRB and genotyped in genomic DNA source from saliva using TaqMan chemistry and end-point analysis. Allele and genotype distributions between DF and DF free groups were analyzed using the Epi Info 7.2. Chi-square or Fisher's exact tests at a level of significance of 5% and odds ratios calculations with 95% confidence intervals were used to determine the statistical associations.

Results

Among 538 children, 147 were DF and 391 were DF free. Genotype distribution for the polymorphism rs12154178 in ESR1 was different between the two groups (p = 0.037; OR = 0.91; CI = 0.67–1.22). The dominant model analysis (AA+AC vs. CC) demonstrated that CC is a protective factor for DF (p = 0.038; OR = 0.51, 0.27–0.97 95% CI). We did not find differences in frequency distributions in the other evaluated polymorphisms.

Conclusion

This study provides evidence that ESR1 is associated with DF.

Clinical relevance

Dental fluorosis is an important condition that affects the mineralized tissues of the teeth. In severe cases, the treatment takes time and is extremely costly. This research provides evidences that there are genetic factors involved in dental fluorosis and will help professionals to plan more precise strategies to reduce dental fluorosis occurrence.

https://ift.tt/2rvSsJu

Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy

Abstract

Objectives

To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status.

Materials and methods

Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Levels of IL-6, IL-10, IL-1β, TNF-α, and MMP-8 were quantified through ELISA.

Results

RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1β, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC.

Conclusions

The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis.

Clinical relevance

Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.

https://ift.tt/2GdNFXn

Epithelioid cell granuloma with caseating necrosis possibly caused by periapical periodontitis: a case report

Epithelioid cell granuloma with caseating necrosis is a typical pathological finding in tuberculosis. While specific inflammation, including that related to tuberculosis, can induce caseating granuloma formati...

https://ift.tt/2QT3U0l

The effects of repeated applications of antimicrobial photodynamic therapy in the treatment of residual periodontal pockets: a systematic review

Abstract

The aim of this study was to assess the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) on the non-surgical periodontal treatment of residual pockets. This work was performed and reported according to the Cochrane and PRISMA recommendations, respectively, and registered at the PROSPERO registry (number CRD42017058403). An extensive search of the biomedical literature was conducted on four databases from January 1960 to August 2018, followed by hand searching. Analysis of the quality of the selected studies was based on the risk of bias. Only two randomised controlled clinical trials (RCTs) met the inclusion criteria although they had unclear risk of bias. One study showed that repeated applications of aPDT in association with conventional non-surgical treatment during periodontal maintenance improved all clinical outcomes after 6 months. The other study, which assessed the effects of repeated applications of aPDT in association with ultrasound debridement on periodontal pathogens, showed no significant reduction of the main pathogens after 3–6 months but reported reductions of probing pocket depth and C-reactive protein after 3 and 6 months, respectively, compared to mechanical therapy alone. Concluding, it was not possible to state that repeated applications of aPDT, in association with non-surgical treatment of residual pockets, have effective clinical effects in the periodontal maintenance therapy. Although one can consider that aPDT is a promising adjuvant therapy, it is still necessary to carry out more RCTs with low risk of bias in order to confirm or refute the benefits of multiple applications for residual periodontal pockets.

https://ift.tt/2QKVFD9

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Abstract

Objectives

This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.

Materials and methods

A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient's questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher's exact test, respectively.

Results

After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).

Conclusion

Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.

Clinical relevance

Direct pulp capping can be done successfully with this type of calcium silicate cement.

https://ift.tt/2ry8D9g

Use of mature compost as filter media and the effect of packing depth on hydrogen sulfide removal from composting exhaust gases by biofiltration

Abstract

A study was conducted to investigate the utilization of mature compost as a biofilter medium for the removal of hydrogen sulfide (H₂S) from the exhaust gases of the composting process. Source-selected kitchen waste from municipal solid waste was composted in a reactor, and the exhaust gas was passed through a biofilter packed with a 1:4 (wet weight) mixture of mature compost and sand. Two treatments were applied under sterilized and unsterilized conditions to quantify the contribution of microbial activity. The effect of packing depth on H₂S removal efficiency was also studied. A global H₂S removal efficiency of 51% was obtained in the biofilter for loading rates in the range of 0–429 mg H₂S m⁻³ h⁻¹. The adsorption capacity was the main factor affecting H₂S removal efficiency, contributing 64.2% to the total removal efficiency, with microbial activity contributing 35.8%. The relationship between the cumulative amount of H₂S removed and the packing height was well-described by a linear equation. The equation indicated that 99% H₂S removal efficiency could be achieved using a packing height of 96 cm for unsterilized packing material or 158 cm for sterilized packing material.

https://ift.tt/2SEkQVi

Hydrothermal carbonization of arecanut husk biomass: fuel properties and sorption of metals

Abstract

In this study, hydrothermal carbonization of arecanut husk and its potential application as an alternate solid fuel and heavy metal sorption (adsorbent) was attempted. Arecanut husk (AH) treated with citric acid for 9 h resulted in the hydrochar yield of 58.7% with increased fixed carbon from 17 to 39.7% and HHV from 16.98 to 21.14 MJ kg⁻¹ compared to the parent biomass. The arecanut husk hydrochar (AHH) had H/C of 1.27, O/C ratio of 0.59 with an energy yield of 72.81%, and energy densification ratio of 1.24, and the values have the similar fuel characteristics of lignite. The pH, zeta potential, and surface of the hydrochar were 5.56, − 22.60 mV, and 0.98 m² g⁻¹ respectively. Hydrochar with a dosage of 0.1% showed a maximum rate of adsorption for Pb²⁺ (79.86 mg g⁻¹) at the initial concentration of 100 mg L⁻¹ in the aqueous solution compared to Zn²⁺, Cr⁶⁺, and Ni²⁺. SEM with EDAX and FT-IR spectroscopy results confirmed the presence of Pb²⁺ and changes in functional groups in arecanut husk hydrochar after adsorption of heavy metals in the aqueous solution.

https://ift.tt/2QKLKNV

Preparation of chitosan/Co-Fe-layered double hydroxides and its performance for removing 2,4-dichlorophenol

Abstract

Chitosan/Co-Fe-layered double hydroxides (CS/LDHs) were prepared by coprecipitation method, which is a kind of composite material with excellent properties. The structure of CS/LDHs was characterized by SEM, FTIR, and XRD, which proved that chitosan (CS) was successfully induced into hydrotalcite and CS/LDHs still possess the structural characteristics of hydrotalcite. The adsorption of 2,4-dichlorophenol (2,4-DCP) was studied with CS/LDHs and LDHs as adsorbent separately. The activity of immobilized laccase (L-CS/LDHs) with CS/LDHs as carrier is significantly better than that of the one (L-LDHs) using LDHs as carrier. Under the optimum conditions (pH = 6, 55 °C, 48 h), L-CS/LDHs exhibited better removal performance for 2,4-DCP (81.53%, 100 mg/L) than LDHs (63.55%); the removal of 2,4-DCP by L-CS/LDHs is excellent, exceeding 97% as its initial concentration below 60 mg/L. It includes the catalytic action of laccase and dechlorination of Fe³⁺ and Co²⁺, and the adsorption can be ignored under the optimal conditions. After 5 cycles, it maintained 67% (L-CS/LDHs) and 54% (L-LDHs) of the original removal.

https://ift.tt/2QOpmTU

Isotretinoin and Candida immunotherapy for recalcitrant warts in solid organ transplant recipients

Abstract

Treatment of recalcitrant warts in solid organ transplant recipients (SOTR) can pose a therapeutic challenge for dermatologists. Successful treatment of recalcitrant warts can serve as secondary prevention for skin cancer in those with chronic immunosuppression. Given the heterogeneity of associated comorbid conditions in SOTR, clinical trials are difficult to conduct in this high‐risk population, therefore, our clinical practice is mostly driven by observed responses from studies in immunocompetent patients or from case reports of immunocompromised patients. The combination of systemic retinoids and candida immunotherapy likely provide the most effective treatment for recalcitrant warts in SOTR. However, many SOTR have chronic renal insufficiency and are not candidates for Acitretin therapy. We provide two cases of recalcitrant warts in SOTR successfully treated with Isotretinoin in the setting of impaired renal function.

This article is protected by copyright. All rights reserved.

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Deep-learning classification using convolutional neural network for evaluation of maxillary sinusitis on panoramic radiography

Abstract

Objectives

To apply a deep-learning system for diagnosis of maxillary sinusitis on panoramic radiography, and to clarify its diagnostic performance.

Methods

Training data for 400 healthy and 400 inflamed maxillary sinuses were enhanced to 6000 samples in each category by data augmentation. Image patches were input into a deep-learning system, the learning process was repeated for 200 epochs, and a learning model was created. Newly-prepared testing image patches from 60 healthy and 60 inflamed sinuses were input into the learning model, and the diagnostic performance was calculated. Receiver-operating characteristic (ROC) curves were drawn, and the area under the curve (AUC) values were obtained. The results were compared with those of two experienced radiologists and two dental residents.

Results

The diagnostic performance of the deep-learning system for maxillary sinusitis on panoramic radiographs was high, with accuracy of 87.5%, sensitivity of 86.7%, specificity of 88.3%, and AUC of 0.875. These values showed no significant differences compared with those of the radiologists and were higher than those of the dental residents.

Conclusions

The diagnostic performance of the deep-learning system for maxillary sinusitis on panoramic radiographs was sufficiently high. Results from the deep-learning system are expected to provide diagnostic support for inexperienced dentists.

https://ift.tt/2zWqtqW

Isotretinoin and Candida immunotherapy for recalcitrant warts in solid organ transplant recipients

Abstract

Treatment of recalcitrant warts in solid organ transplant recipients (SOTR) can pose a therapeutic challenge for dermatologists. Successful treatment of recalcitrant warts can serve as secondary prevention for skin cancer in those with chronic immunosuppression. Given the heterogeneity of associated comorbid conditions in SOTR, clinical trials are difficult to conduct in this high‐risk population, therefore, our clinical practice is mostly driven by observed responses from studies in immunocompetent patients or from case reports of immunocompromised patients. The combination of systemic retinoids and candida immunotherapy likely provide the most effective treatment for recalcitrant warts in SOTR. However, many SOTR have chronic renal insufficiency and are not candidates for Acitretin therapy. We provide two cases of recalcitrant warts in SOTR successfully treated with Isotretinoin in the setting of impaired renal function.

This article is protected by copyright. All rights reserved.

https://ift.tt/2SFMils

Anticaries effect of toothpaste with nano-sized sodium hexametaphosphate

Abstract

Objective

To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ.

Methods

This crossover double-blind study consisted of four phases (7 days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100 ppm F (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student–Newman–Keuls' test (p < 0.001).

Results

1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001).

Conclusion

1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste.

Clinical relevance

This toothpaste could be a viable alternative to patients at high risk of caries.

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Identification of salivary metabolites for oral squamous cell carcinoma and oral epithelial dysplasia screening from persistent suspicious oral mucosal lesions

Abstract

Objective

To identify salivary metabolite biomarkers to differentiate patients with oral squamous cell carcinoma and oral epithelial dysplasia (OSCC/OED) from those with persistent suspicious oral mucosal lesions (PSOML).

Subjects and methods

Whole unstimulated saliva samples were collected from age-, sex-, and race-matched patients who had a lesion in the oral cavity and for whom open biopsies were performed. The patients included OSCC (n = 6), OED (n = 10), and PSOML (n = 32). Hydrophilic metabolites in saliva samples were comprehensively analyzed using capillary electrophoresis mass spectrometry. To evaluate the discrimination ability of a combination of multiple markers, a multiple logistic regression (MLR) model was developed to differentiate OSCC/OED from PSOML.

Results

Six metabolites were significantly different in OSCC/OED compared with PSOML. From these six metabolites, ornithine, o-hydroxybenzoate, and ribose 5-phosphate (R5P) were used to develop the MLR model, which resulted in a high value for the area under receiver operating characteristic curve (AUC 0.871, 95% confidential interval (CI) 0.760–0.982; p < 0.001) to discriminate OSCC/OED from PSOML.

Conclusions

This is the first study to identify salivary metabolites that discriminate OSCC/OED from PSOML rather than from healthy controls. The profiles of salivary metabolites were significantly different between OSCC/OED and PSOML. The ability to discriminate OSCC/OED from PSOML is important for dentists who are not oral surgery specialists. These salivary metabolites showed potential for non-invasive screening to discriminate OSCC/OED from PSOML.

Clinical relevance

Salivary metabolites in this study showed potential for non-invasive screening to discriminate OSCC/OED from PSOML.

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Otopathology in Angiosarcoma of the Temporal Bone

Objectives/Hypothesis

Investigate the otopathology of angiosarcoma of the temporal bone, which has not been previously described in the literature.

Study Design

Postmortem evaluation and literature review.

Methods

Postmortem histological evaluation of the temporal bones and review of the literature for the treatment and prognosis of this rare disease were performed.

Results

A 50‐year‐old male with right chronic otitis media presented with progressive hearing loss, disequilibrium, otalgia, and acute facial paresis. Biopsy of the external auditory canal was unrevealing, but specimens from a canal wall down tympanomastoidectomy later showed high‐grade angiosarcoma. Magnetic resonance imaging demonstrated an unresectable middle ear and mastoid mass extending superiorly into the temporal lobe. The patient received induction chemotherapy followed by proton beam radiation therapy and concurrent paclitaxel and bevacizumab. His course was complicated by a cerebrospinal fluid leak and cauda equina syndrome from leptomeningeal sarcomatosis. The patient died after developing meningitis and a temporal lobe abscess. Postmortem otopathology revealed persistent angiosarcoma in the internal auditory canal, although none was found in the middle ear or mastoid. There was inflammatory infiltrate throughout the mastoid, with direct extension of neutrophils and bacteria into the cochlea and through the tegmen into the middle cranial fossa.

Conclusions

Angiosarcoma of the temporal bone can arise in the setting of chronic otitis media. In this case, postmortem temporal bone sections demonstrated viable cancer despite chemoradiation. Inflammatory infiltrates crossing from the middle ear/mastoid into the labyrinth and central nervous system illustrate pathways for the development of otogenic meningitis.

Level of Evidence

4 Laryngoscope, 2018

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In Response to Altered Molecular Profile in Thyroid Cancers From Patients Affected by Three Mile Island Nuclear Accident

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Osteitis is associated with dysregulated pro‐osteoblastic activity in patients with nasal polyps

Objectives/Hypothesis

The overlying inflammatory mucosa plays a crucial role in the initiation of osteitis; however, the molecular mechanism is unclear. The objective of this study was to explore the bone morphogenetic protein (BMP) pathway and to correlate the expression of key signaling molecules with the degree of osteitis in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

Study Design

Prospective experimental analysis.

Methods

This was an institutional review board–approved study in which mucosal samples were obtained from sites of osteitis in CRSwNP and compared to nonosteitic healthy controls (n = 10/group). Protein expression of key BMP pathway was quantified by aptamer‐based protein array and confirmed by a set of selected mRNA analyses. Degree of osteitis was assessed using both Kennedy Osteitis Score and Global Osteitis Score (GOS).

Results

Pro‐osteoblastic expression of BMP7 (fold change [FC] = −1.18, P = .017) and BMP9 (FC = −1.32, P = .023), their receptors, BMP receptor type‐1A (BMPR1A) (FC = −2.56, P = .005) and BMP receptor type‐2 (FC = −1.28, P = .022), and two enhancers of BMP signaling pathway, the repulsive guidance molecule domain family member B (FC = −1.13, P = .008) and the chordin‐like protein 1 (FC = −1.18, P = .027), were all significantly downregulated in CRSwNP. Conversely, the pro‐osteoclastic factor, tartrate‐resistant acid phosphatase type 5 (ACP5) (FC = 2.36, P = .001), was significantly increased in CRSwNP. GOS was inversely correlated with levels of BMP7 (r = −0.684, P =  .005) and BMPR1A (r = −0.864, P =  .005) and positively correlated with levels of ACP5 (r = 0.815, P =  .004). The FCs among the proteins studied significantly and positively correlated with the FCs of their mRNA expression (r = 0.908, P =  .002).

Conclusions

Downregulated pro‐osteoblastic mucosal BMP signaling is strongly and significantly associated with increased osteitis in CRSwNP.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2Qve3ks

Supraglottic Squamous Cell Carcinoma: A Population‐Based Study of 22,675 Cases

Objectives/Hypothesis

The authors used the Surveillance, Epidemiology, and End Results (SEER) database to analyze epidemiological features of patients presenting with supraglottic squamous cell carcinoma (SCCa) and to evaluate treatment trends and outcomes.

Methods

The SEER database was queried for patients with supraglottic SCCa from 1973 to 2013. Information on demographics; tumor size; histologic grade; American Joint Committee on Cancer (AJCC) stage; SEER local, regional, distant stage; and treatment modality were analyzed.

Results

There were 22,675 cases of primary supraglottic SCCa identified. The mean age at diagnosis was 62.3 years, with males accounting for 70.3% of all cases. A high percentage of patients presented with stage IV disease (44.9%). The most common treatment modality was radiotherapy (46.6%), followed by combination of surgery and radiotherapy (29.2%) and surgery alone (15.0%). Overall 5‐year disease‐specific survival (DSS) for all cases was 54.0%. When stratified by treatment modality, 5‐year DSS was best for patients receiving surgery alone (64.2%). However, for patients with AJCC stage IV disease, survival was significantly better with combined surgery and radiotherapy (52.5%).

Conclusion

In general, supraglottic SCCa is treated most commonly with radiotherapy, followed by surgery and radiotherapy. Patients managed surgically had better 5‐year DSS when compared to patients treated by other modalities. However, when stratified by stage, patients with AJCC stage IV disease had significantly better survival with combined surgery and radiotherapy. Of patients receiving surgery, supraglottic laryngectomy was found to have a significantly better 5‐year DSS when compared to both total laryngectomy and laryngectomy, not otherwise specified.

Level of Evidence

NA. Laryngoscope, 2018

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Preparation of ion exchange resin using soluble starch and acrylamide by graft polymerization and hydrolysis

Abstract

Based on soluble starch and acrylamide by performing graft polymerization in aqueous solution and hydrolysis step, a low-cost ion exchange resin has been synthesized to remove the heavy metal ions of Cr³⁺ and Ni²⁺. The hydrolysis progresses by adding NaOH to convert -CONH₂ to -COONa, and the adsorption experiments confirmed that the functional group to adsorb heavy metals is -COO⁻, rather than -CONH₂. During the determination of heavy metal adsorption, the Na⁺ concentration diffused by SR-16 into the solution was also analysed to investigate the ion exchange process. The composition and morphology of SR-16 was characterized by FT-IR, SEM, elemental analyser and EDS, and the results showed that SR-16 has an excellent adsorption capacity to the removal of heavy metal pollution; the adsorption mechanism of SR-16 could be explained by ion exchange progress with -COONa attached on the network structure.

https://ift.tt/2BcJVzy

Effects of multiple environmental factors on elimination of fenvalerate and its cis-trans isomers in aquaculture water

Abstract

Fenvalerate (FV) is widely used in aquaculture because of their broad spectrums and high efficiency. However, little is known regarding the elimination of FV influenced by environment factors in aquaculture water, especially its cis-trans isomers (cis-FV and trans-FV). In the present study, factors influencing the aquaculture environment (open type, temperature, pH and light) were selected, and the elimination dynamics of FV and its cis-trans isomers in aquaculture water using orthogonal experiments were investigated. The results showed that the half-life and elimination rate range of FV were 4.75–11.95 days and 65–93%, respectively, while those of trans-FV were 4.60–11.82 days and 67–93% and those of cis-FV were 4.94–12.04 days and 64–92%, respectively. The elimination rate of trans-FV was better than that of cis-FV. Additionally, analysis of variance (ANOVA) of the orthogonal experimental data indicated that the environmental factors of open type, temperature, and pH significantly influenced the elimination rate of cis- and trans-FV (P < 0.05), that is, in the aquaculture season, high temperature and pH facilitate to eliminate FV. This study would improve our understanding of natural degradation associated with FV and guide safe to use associated with pesticide in aquaculture.

https://ift.tt/2UzIfZX

Effects of different types of extracellular polysaccharides isolated from cyanobacterial blooms on the colony formation of unicellular Microcystis aeruginosa

Abstract

In this study, two types of extracellular polysaccharides (EPS), namely, mixed EPS (MX-EPS) and tightly bound EPS (TB-EPS), were extracted from cyanobacterial blooms using different methods. To evaluate their compositional differences, elemental composition, FTIR, and TG/DTA profile were measured for both EPS samples. Following that, unicellular Microcystis aeruginosa was cultured in a medium containing EPS, Ca²⁺ ion, and Mg²⁺ ion, and the effect of each type of EPS on the colony formation of M. aeruginosa was examined. Results showed that TB-EPS had more carboxy groups than MX-EPS, and that the TB-EPS medium contained Ca²⁺ and Mg²⁺ ions. These cations were not detected in the MX-EPS medium. During the colony formation experiment, colonies were observed when Ca²⁺ and Mg²⁺ ions were present at 250 mg/L concentration each. In addition, colony density increased when TB-EPS was added, compared to that of MX-EPS. Colonies were also observed in the medium containing only TB-EPS (100 mg/L), indicating that M. aeruginosa can form colonies using Ca²⁺ ion present in TB-EPS. During the MX-EPS extraction, Ca²⁺ ion chelated with EDTA was removed during ethanol precipitation. Therefore, the extraction protocol followed for TB-EPS was better than that of MX-EPS for maintaining Ca²⁺ ions, and thereby maintaining an EPS composition that enables for colony formation.

https://ift.tt/2BcKeKI

Acute triflumuron exposure induces oxidative stress responses in liver and kidney of Balb/C mice

Abstract

Triflumuron (TFM) is one of the most widely used insecticides over the world. It is a benzoylphenyl urea that belongs to the class of insect growth regulators. This insecticide acts by inhibiting insect's chitin synthesis and by consequences, making insect more susceptible to pathogens and malformations. TFM effects have been reported in mammalians and crops. However, studies that reveal its toxicity mechanisms are limited. In this line, the current study aimed to determine the implication of oxidative stress in the toxicity induced by TFM and particularly in the perturbation of biochemical parameters in male Balb/C mice. Male Balb/C mice were divided into three groups receiving TFM at doses of 250, 350, and 500 mg/kg bw respectively. The occurrence of oxidative stress in both kidney and liver tissues was monitored by measuring of oxidative stress markers. TFM caused an increase as protein carbonyls generation, malondialdehyde induction (MDA) and catalase (CAT), superoxide dismutase (SOD), glutathion peroxidase (Gpx), as well as glutathion S transferase (GST) activities. In the same conditions, we have evaluated the effect of TFM treatment on biochemical parameters. In response to the three TFM doses, we showed significant dose dependent inductions in all tested oxidative stress markers. However, TFM caused an increase in the liver enzyme activities as aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), g-glutamyltranspeptidase (GTT), and total bilirubin (BILT) in a dose-dependent manner. Equally, renal markers as urea, uric acid, albumin, and creatinine were increased in the same manner. We can conclude that oxidative damage seems to be a key determinant of TFM-induced toxicity in both liver and kidney of male Balb/C mice. Moreover, the oxidative stress is more pronounced in the liver than in the kidney. Thus, TFM may be considered as a hepatotoxic insecticide.

https://ift.tt/2Uz9tQq

The potential protective effect of two actinomycete extracts against carbon tetrachloride-induced hepatotoxicity in rats

Abstract

The aim of this study was to investigate the potential protective effect of two extracts derived from two soil actinomycete strains, designated S19 and G30, against CCl4-induced hepatotoxicity in male rats. Sixty-four male rats were divided into four groups of 16 rats per group. The first group was a control group given corn oil and the nutritive medium which is composed of a mixture of the two used media. The second group received CCl₄ only, the third group was administered CCl₄ and the extract S19, and the fourth group was administered CCl₄ and the extract G30. The results were taken after a treatment period of 8 weeks. Our data demonstrated that the two actinomycete extracts significantly (P < 0.01) lowered the CCl₄-induced elevation of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) after 8 weeks of treatment. The extract S19 had no effect on serum lactate dehydrogenase (LDH) and total bilirubin, whereas the extract G30 significantly decreased (P < 0.01) the elevated levels of these parameters in the serum, especially after 4 weeks of treatment. The levels of hepatic glutathione (GSH), glutathione peroxidase (GSH-Px), peroxidase (Px), catalase (CAT), and superoxide dismutase (SOD) significantly increased (P < 0.01), while those of malondialdehyde (MDA) markedly decreased in rats treated with the two extracts. Furthermore, histopathological lesions in the liver, including necrosis, inflammatory cell infiltration, hydropic degeneration, and congestion of the central vein, were partially reversed by treatment with the two microbial extracts. Our results provided evidence for the protective effect of the two used actinomycete extracts against CCl₄-induced liver damage occurred through the reduction of oxidative stress and improvement of antioxidant defense markers.

https://ift.tt/2Qn8Yul

Antioxidant enzyme activity in responses to environmentally induced oxidative stress in the 5th instar nymphs of Aiolopus thalassinus (Orthoptera: Acrididae)

Abstract

The response of antioxidant enzymes to oxidative environmental stress was determined in 5th instar nymphs of Aiolopus thalassinus (Orthoptera: Acrididae) collected from sites with different level of pollution with heavy metals, PO₄³⁻, and SO₄²⁻. The high polluted site induced higher DNA damage to individuals compared to the control site. The highest values of tail length (TL), tail moment (TM), and percent of DNA in tail (TDNA) were found in the gut of 5th instar nymphs from a high polluted site. Also, protein carbonyls and lipid peroxide levels were significantly higher in insects collected from polluted sites compared to those from the control site. A strong positive correlation between both protein carbonyl and lipid peroxide concentration and the pollution level of the sites was found in all tissues of the insects. The activity of superoxide dismutase (SOD) in the brain of insects collected from the high polluted site was significantly higher than that in the thoracic muscles and gut. We observed strong inhibition of catalase (CAT) activity. This effect was apparently caused by pollutants present at the high polluted site. The level of pollution significantly influenced polyphenol oxidase (PPO) activity in A. thalassinus nymphs in all examined tissues. The highest values were observed in the brain. The relationship between pollution and ascorbate peroxidase (APOX) activity in the examined tissues had no clear tendency. However, the lowest APOX activity was observed in individuals from the low polluted site. Level of pollution of sampling sites, oxidative stress biomarkers, and enzymatic response in A. thalanthsis 5th instar were negatively or positively correlated. Oxidative damage parameters, especially the percent of severed cells, lipid peroxides, and the activity of APOX, can be perceived as good markers of environmental multistress.

https://ift.tt/2RLbQh8

Ocular Complications from Retained Intraocular Ointment Discovered 33 Months after Cataract Surgery

Topical antibiotic and steroid ointments are sometimes used topically at the conclusion of intraocular surgery, and inadvertent entry into the eye has been reported. Dispersed ointment droplets or consolidated globules in the anterior chamber (AC) can sometimes be visualized on exam. Occasionally, intraocular ointment is found incidentally without apparent toxic effect, but retained ointment usually presents with early or delayed intraocular inflammation, pressure rise, macular edema, or corneal edema. The usual treatment for toxicity from retained ointment is removal of the ointment. While the complication of ointment-induced cystoid macular edema has been reported, there is paucity of literature on the anatomical response and eventual visual outcome of patients who have been treated for long-standing edema from retained ointment. We present a case of a patient who presented with history of poor vision since the time of cataract surgery 33 months prior, who had cystoid macular edema, reduced endothelial cell count, and apparent Maxitrol ointment (neomycin, polymyxin B sulfate, and dexamethasone in paraffin vehicle; Novartis Pharmaceuticals UK) floating in the AC. The patient was treated with AC washout and sub-Tenon injection of triamcinolone. His vision, retinal architecture by optical coherence tomography, endothelial cell count, and pachymetry has been followed for 9 months following this treatment.
Case Rep Ophthalmol 2018;9:493–498

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