Head and Neck Diseases by Alexandros G.Sfakianakis: 04/05/16

Τρίτη 5 Απριλίου 2016

Impact of β-glucan on the Fecal Water Genotoxicity of Polypectomized Patients.

Impact of β-glucan on the Fecal Water Genotoxicity of Polypectomized Patients.

Nutr Cancer. 2016 Apr 4;:1-8

Authors: Turunen KT, Pletsa V, Georgiadis P, Triantafillidis JK, Karamanolis D, Kyriacou A

Abstract
The aim of the study was to determine the effect of β-glucan on the cytotoxicity and genotoxicity of polypectomized patient's fecal water (FW). Polypectomized volunteers (n = 69) were randomly assigned to consume bread with or without β-glucan, for 3 months. FW was collected at the beginning (t = 0), the 30th and 90th day and 2 wk after the intervention. Cytotoxicity and genotoxicity were estimated on Caco-2 cells, using trypan blue exclusion test and comet assay, respectively. Gastrointestinal symptoms were recorded and subjects kept a 3-day food diary at baseline and after completion. Trypan blue exclusion test revealed cell survival of approximately 87% after incubation with FW. The FW samples showed 49% genotoxicity at the baseline. Genotoxicity in the intervention group decreased during the trial reaching statistical significance on the 90th day compared to control. An increase was noticed 2 wk after the trial, but it still remained significantly lower compared to control. Group-specific analysis for β-glucan also revealed significant decrease in the genotoxicity on the 90th day compared to baseline. β-glucan ingestion in polypectomized patients significantly decreased the genotoxicity of their FW. Our findings suggest that β-glucan consumption could possibly provide protection against colon cancer development.

PMID: 27043932 [PubMed - as supplied by publisher]

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Issue Information - TOC

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Assessing student usage, perception, and the utility of a Web-based simulation in a third-year medical school clerkship

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The goals of this study were to assess students' usage data of Web-based simulation (WBS), to determine if it can fill gaps in clinical experience-based medical education, and to determine students' perceived value of this kind of simulation during a clinical clerkship.

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Recombinant Human Plasminogen Activator Inhibitor-1 Accelerates Odontoblastic Differentiation of Human Stem Cells from Apical Papilla

Tissue Engineering Part A , Vol. 0, No. 0.

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Extracorporeal shockwave therapy promotes chondrogenesis in cartilage tissue engineering: A hypothesis based on previous evidence

Publication date: Available online 5 April 2016
Source:Medical Hypotheses
Author(s): Qiaodan Ji, Chengqi He
The dearth of intrinsic regenerative capacity of articular cartilage makes it a challenge to deal with the cartilage defects. Among all the recommended clinical options, cartilage tissue engineering (CTE) which is highlighted of dominant features and less drawbacks for functional cartilage restoration, has been emphasized recently. Shock waves, a mode of therapeutic mechanical forces, utilized in extracorporeal shockwave therapy (ESWT), is hypothesized to enhance proliferation, chondrogenic differentiation, and cartilage extracellular matrix production of target cells seeded on bioactive scaffolds.The hypothesis is firstly based on cellular mechanotransduction by which cells convent the shockwave mechanical signals into biochemical responses via integrins, iron channels, cytoskeletal filaments, growth factor receptors and nuclei. Secondly, by modulating gene expression and up-regulating the release of various growth factors which are of vital importance in three-dimensional cartilage culture environment, ESWT holds a promising potential to favor the cell sources (e.g. chondrocytes and stem cells) to mimic the optimal functional cartilage.In all, on the basis of cellular mechanotransduction and previous evidence, the hypothesis is developed to support the beneficial effects of ESWT on chondrogenesis in CTE. If this hypothesis is confirmed, shockwaves may allow a better success in combination with other stimulating factors for cartilage repair. There is a paucity of studies investigating the assistant role of shockwave stimulation in CTE. Further research is required to elucidate the mechanisms, and explore effectiveness and appropriate protocols of this novel stimulative factor in cartilage tissue engineering.

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Dietary Fatty Acids from Leaves of Clerodendrum Volubile Induce Cell Cycle Arrest, Downregulate Matrix Metalloproteinase-9 Expression, and Modulate Redox Status in Human Breast Cancer.

Dietary Fatty Acids from Leaves of Clerodendrum Volubile Induce Cell Cycle Arrest, Downregulate Matrix Metalloproteinase-9 Expression, and Modulate Redox Status in Human Breast Cancer.

Nutr Cancer. 2016 Apr 4;:1-12

Authors: Erukainure OL, Zaruwa MZ, Choudhary MI, Naqvi SA, Ashraf N, Hafizur RM, Muhammad A, Ebuehi OA, Elemo GN

Abstract
The antiproliferative effect of the fatty acid components of Clerodendrum volubile leaves as well as its antioxidant effect on MCF-7 and MDA-MB-231 human breast cancer cell lines were investigated. Fatty acids extracted from C. volubile leaf oil were subjected to gas chromatography mass spectrometry (GCMS) analysis. The cells were cultured and treated with the fatty acids for 48 h, after which the antiproliferation effect was ascertained via MTT assay and cell viability analysis using BD fluorescence activated cells sorting (FACS) Calibur. Cell cycle was analyzed by flow cytometry on FACS Calibur. Western blotting was used in determining expression of proteins in the cell lines. The treated cell lines were assessed for reduced glutathione level, catalase, superoxide dismutase, and lipid peroxidation. The fatty acids significantly inhibited cell proliferation, arrested G0/G1 phase, downregulated the expression of MMP-9, and attenuated oxidative stress in of MCF-7 cell lines but had little or no effect on MDA-MB-231 cell lines. These results indicate the therapeutic potential of the fatty acids components of the leaves of C. volubile on human breast cancer, which may be explored further in drug development.

PMID: 27043182 [PubMed - as supplied by publisher]

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Glycone-rich Soy Isoflavone Extracts Promote Estrogen Receptor Positive Breast Cancer Cell Growth.

Glycone-rich Soy Isoflavone Extracts Promote Estrogen Receptor Positive Breast Cancer Cell Growth.

Nutr Cancer. 2016 Apr 4;:1-12

Authors: Johnson KA, Vemuri S, Alsahafi S, Castillo R, Cheriyath V

Abstract
Due to the association of hormone replacement therapy (HRT) with breast cancer risk, estrogenically active soy isoflavones are considered as an HRT alternative to alleviate menopausal symptoms. However, several recent reports challenged the health benefits of soy isoflavones and associated them with breast cancer promotion. While glyconic isoflavones are the major constituents of soybean seeds, due to their low cell permeability, they are considered to be biologically inactive. The glyconic isoflavones may exert their effects on membrane-bound estrogen receptors or could be converted to aglycones by extracellular β-glucosidases. Therefore, we hypothesized that despite their low cell permeability, soybean cultivars with high glyconic isoflavones may promote breast cancer cell growth. To test this, composition and estrogenic activity of isoflavones from 54 commercial soybean cultivars were determined. Soybean seeds produced in identical climate and growth conditions were used to minimize the effects of extraneous factors on isoflavone profile and concentrations. The glyconic daidzin concentration negatively correlated with genistin and with other aglycones. Relative to control, isoflavone extracts from 51 cultivars were estrogenic and promoted the growth of estrogen receptor positive (ER+) breast cancer cell line MCF-7 from 1.14 to 4.59 folds and other three cultivars slightly reduced the growth. Among these, extracts from three cultivars were highly estrogenic and promoted MCF-7 cell growth by 2.59-4.64 folds (P<0.005). Among six isoflavones, daidzin was positively associated with MCF-7 cell growth (P<0.005, r = 0.13966), whereas the negative correlation between genistin and MCF-7 cell growth was nearly significant (P≤0.0562, r = -0.026141). Furthermore, in drug interaction studies daidzin-rich isoflavone extracts antagonized tamoxifen, an ER inhibitor. Taken together, our results suggest that the glyconic daidzin-rich soy isoflavone extracts may exert estrogenic effects and promote ER+ breast cancer growth.

PMID: 27043076 [PubMed - as supplied by publisher]

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Impact of respiratory-correlated CT sorting algorithms on the choice of margin definition for free-breathing lung radiotherapy treatments

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To investigate the impact of Toshiba phase- and amplitude-sorting algorithms on the margin strategies for free-breathing lung radiotherapy treatments in the presence of breathing variations.

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The use of sugammadex in a pregnant patient with Wolff-Parkinson-White syndrome

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Wolff-Parkinson-White (WPW) syndrome is a rare pre-excitation syndrome which develops when atrioventricular conduction occurs through a pathologic accessory pathway known as the bundle of Kent instead of atrioventricular node, hence resulting in tachycardia. Patients with WPW syndrome may experience various symptoms arising from mild-to-moderate chest disease, palpitations, hypotension, and severe cardiopulmonary dysfunction. These patients are most often symptomatic because of cardiac arrhythmias.

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Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block

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The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs).

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Asymmetric hearing loss is common and benign in patients aged 95 years and older.

Asymmetric hearing loss is common and benign in patients aged 95 years and older.

Laryngoscope. 2016 Apr 4;

Authors: Leskowitz MJ, Caruana FF, Siedlecki B, Qian ZJ, Spitzer JB, Lalwani AK

Abstract
OBJECTIVES/HYPOTHESIS: The objective of our study was to investigate age-specific auditory function in the patient population aged 95 years and older.
STUDY DESIGN: Retrospective chart review at a tertiary medical center.
METHODS: Medical records of 51 patients older than 95 years (82% female, 18% male) who underwent audiologic testing were reviewed. The following information was collected: age at time of most recent audiogram and prior audiograms; results of pure tone, immittance, and speech audiometry; and findings on radiologic imaging.
RESULTS: None of the subjects had hearing in the normal range. For the poorer hearing ear, average low-frequency, high-frequency, and overall pure tone averages (PTA) for the population were 67.9, 82.1, and 74.9 dB hearing level, respectively. Mean word recognition score (WRS) was 57.6% and deteriorated with increasing PTA (P = .0002). Asymmetry, defined by a 10-dB difference at two frequencies, was present in 39.2% of the sample, and WRS asymmetry, defined as a difference of 12% in WRS between ears, was present in 33.0% of the sample. Retrocochlear evaluation did not identify pathology in any of the cases tested. In the poorer hearing ear, average decline in PTA per year was 2.9 dB.
CONCLUSIONS: In individuals >95 years of age, hearing loss was universal, moderately severe to profound in magnitude, and associated with substantial loss of speech recognition. Hearing loss progresses at a rate greater than for younger cohorts. In this "oldest old" population, asymmetry of loss and WRS was common and is not indicative of retrocochlear pathology.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27040356 [PubMed - as supplied by publisher]

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Statement of Retraction.

Statement of Retraction.

Acta Otolaryngol. 2016 Mar;136(3):iii

Authors:

PMID: 27042961 [PubMed - as supplied by publisher]

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Clinical and morphological aspects of adenocarcinomas of the intestinal type in the inner nose: a retrospective multicenter analysis.

Clinical and morphological aspects of adenocarcinomas of the intestinal type in the inner nose: a retrospective multicenter analysis.

Eur Arch Otorhinolaryngol. 2016 Apr 4;

Authors: Donhuijsen K, Kollecker I, Petersen P, Gaßler N, Wolf J, Schroeder HG

Abstract
Clinical and histological parameters from 117 patients with wood dust-related sinonasal adenocarcinomas of intestinal type (ITAC) were analyzed and correlated with a follow-up period of 5 years at least. The rate of survival for 5 years was 53.1 % and for 10 years 30.2 %. Only 33 patients were free of disease. 74.2 % of patients with recurrences died in relation to ITAC. As expected, tumors of T4-category had the worst prognosis. The mucus content of a tumor was the most important histological parameter. Endonasal methods of surgery had no more positive survival rates after 5 years. An effect of radiotherapy has to be in discussion. The high incidence of tumor recurrences requires control examinations consistently.

PMID: 27040559 [PubMed - as supplied by publisher]

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Initial severity of motor and non-motor disabilities in patients with facial palsy: an assessment using patient-reported outcome measures.

Initial severity of motor and non-motor disabilities in patients with facial palsy: an assessment using patient-reported outcome measures.

Eur Arch Otorhinolaryngol. 2016 Apr 4;

Authors: Volk GF, Granitzka T, Kreysa H, Klingner CM, Guntinas-Lichius O

Abstract
Patients with facial palsy (FP) not only suffer from their facial movement disorder, but also from social and psychological disabilities. These can be assessed by patient-reported outcome measures (PROMs) like the quality-of-life Short-Form 36 Item Questionnaire (SF36) or FP-specific instruments like the Facial Clinimetric Evaluation Scale (FaCE) or the Facial Disability Index (FDI). Not much is known about factors influencing PROMs in patients with FP. We identified predictors for baseline SF36, FaCE, and FDI scoring in 256 patients with unilateral peripheral FP using univariate correlation and multivariate linear regression analyses. Mean age was 52 ± 18 years. 153 patients (60 %) were female. 90 patients (31 %) and 176 patients (69 %) were first seen <90 or >90 days after onset, respectively, i.e., with acute or chronic FP. House-Brackmann grading was 3.9 ± 1.4. FaCE subscores varied from 41 ± 28 to 71 ± 26, FDI scores from 65 ± 20 to 70 ± 22, and SF36 domains from 52 ± 20 to 80 ± 24. Older age, female gender, higher House-Brackmann grading, and initial assessment >90 days after onset were independent predictors for lower FaCE subscores and partly for lower FDI subscores (all p < 0.05). Older age and female gender were best predictors for lower results in SF36 domains. Comorbidity was associated with lower SF General health perception and lower SF36 Emotional role (all p < 0.05). Specific PROMs reveal that older and female patients and patients with chronic FP suffer particularly from motor and non-motor disabilities related to FP. Comorbidity unrelated to the FP could additionally impact the quality of life of patients with FP.

PMID: 27040558 [PubMed - as supplied by publisher]

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Photocatalytic processes assisted by artificial solar light for soil washing effluent treatment

Abstract

Contaminated soil has become a growing issue in recent years. The most common technique used to remove contaminants (such as metals) from the soil is the soil washing process. However, this process produces a final effluent containing chelating agents (i.e., ethylenediaminedisuccinic acid, also known as EDDS) and extracted metals (i.e., Cu, Fe, and Zn) at concentrations higher than discharge limits allowed by the Italian and Brazilian environmental law. Therefore, it is necessary to develop further treatments before its proper disposal or reuse. In the present study, soil washing tests were carried out through two sequential paths. Moreover, different artificial sunlight-driven photocatalytic treatments were used to remove Cu, Zn, Fe, and EDDS from soil washing effluents. Metal concentrations after the additional treatment were within the Brazilian and Italian regulatory limits for discharging in public sewers. The combined TiO₂-photocatalytic processes applied were enough to decontaminate the effluents, allowing their reuse in soil washing treatment. Ecotoxicological assessment using different living organisms was carried out to assess the impact of the proposed two-step photocatalytic process on the effluent ecotoxicity.

Graphical Abstract

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Effects of Full-Neck Volumetric Modulated Arc Therapy versus Split-Field Intensity Modulated Head and Neck Radiation Therapy on Low Neck Targets and Structures.

Effects of Full-Neck Volumetric Modulated Arc Therapy versus Split-Field Intensity Modulated Head and Neck Radiation Therapy on Low Neck Targets and Structures.

Br J Radiol. 2016 Apr 4;:20160009

Authors: Anamalayil SJ, Teo BK, Lin A, Robert LA, Ahn PH

Abstract
OBJECTIVES: While split-field Intensity Modulated Radiation Therapy (SF-IMRT) decreases dose to low neck (LAN) structures such as glottic larynx compared to full-neck IMRT, it is unknown whether SF-IMRT affords superior dose avoidance to organs compared to whole neck-field Volumetric Modulated Arc Therapy (WF-VMAT).
METHODS: Ten patients treated definitively with radiation for oropharyngeal, oral cavity, or nasopharyngeal carcinoma were compared. Only patients ideally suited for SF-IMRT plans were included. Glottic larynx, supraglottic larynx, arytenoids, pharyngeal constrictors, esophagus, brachial plexus and target volume coverage in the low neck were compared between WF-VMAT and SF-IMRT.
RESULTS: VMAT yielded statistically significant decreases in maximum dose to the arytenoids and mean dose to the esophagus. There was no difference in dose to the glottic larynx, supraglottic larynx, pharyngeal constrictors, and the brachial plexus.WF-VMAT led to improved coverage to 50Gy/2Gy fraction equivalent in low neck compared to SF-IMRT using an AP LAN field, but no difference to the 60Gy/2Gy fraction equivalent between SF-IMRT and WF-VMAT using AP/PA LAN boost.
CONCLUSIONS: WF-VMAT affords equivalent glottic and supraglottic larynx dose, and lower dose to the arytenoids and esophagus. WF-VMAT better covers most low neck target structures. Given these findings as well as concerns with matchline cold or hotspots with SF-IMRT, patients requiring comprehensive elective nodal irradiation should typically be treated with WF-VMAT. Advances in Knowledge: Split-field IMRT for larynx-sparing has better dosimetric results to normal structures than whole-neck IMRT, but with increased matchline recurrence risk. We show dosimetric equivalence or superiority of whole-neck VMAT compared to split-field IMRT.

PMID: 27043353 [PubMed - as supplied by publisher]

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Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review.

Comparison of the therapeutic effects of total laryngectomy and a larynx-preservation approach in patients with T4a laryngeal cancer and thyroid cartilage invasion: A multicenter retrospective review.

Head Neck. 2016 Apr 4;

Authors: Choi YS, Park SG, Song EK, Cho SH, Park MR, Park KU, Lee KH, Song IC, Lee HJ, Jo DY, Kim S, Yun HJ, Korean South West Oncology Group (KSWOG) Investigators

Abstract
BACKGROUND: In T4a laryngeal cancer with thyroid cartilage invasion, no optimal frontline treatment has yet been defined in controlled trials.
METHODS: We reviewed data from 89 patients with T4a laryngeal cancer featuring thyroid cartilage invasion who were treated initially with either total laryngectomy (n = 53) or a larynx-preservation strategy (n = 36).
RESULTS: The median progression-free survival (PFS) of the total laryngectomy group had not been attained at the time of analysis and was thus significantly longer than that of the larynx-preservation group (8.7 months). The median overall survival (OS) of patients who underwent total laryngectomy was 87.2 months, significantly longer than that of the larynx-preservation group (31.3 months). The survival benefit of primary surgery compared to a larynx-preservation strategy was more striking in patients of lower N classifications.
CONCLUSION: Total laryngectomy may be a better therapeutic option to treat T4a laryngeal cancer featuring thyroid cartilage invasion, especially in patients exhibiting limited nodal involvement (N0/N1). © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27043228 [PubMed - as supplied by publisher]

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Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance.

Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance.

J Clin Diagn Res. 2016 Feb;10(2):XC05-XC07

Authors: Iype EM, Jagad V, Nochikattil SK, Varghese BT, Sebastian P

Abstract
INTRODUCTION: Intraoperative management of thyroid gland in laryngeal and hypopharyngeal cancer is controversial.
AIM: The objectives of this study were to determine the incidence of thyroid gland invasion in patients undergoing surgery for laryngeal or hypopharyngeal carcinoma, to assess predictive factors and to assess the prognosis in patients with and without thyroid gland invasion.
MATERIALS AND METHODS: One hundred and thirty-three patients who underwent surgery for carcinoma larynx and hypopharynx from 2006 to 2010 were reviewed retrospectively. Surgical specimens were examined to determine the incidence of thyroid gland invasion and predictive factors were analysed. The recurrence rate and the survival in patients with and without thyroid gland invasion were also analysed.
RESULTS: Out of the 133 patients with carcinoma larynx and hypopharynx who underwent surgery, histological thyroid gland invasion was observed in 28/133 (21%) patients. Significant relationship was found between histological thyroid gland invasion and preoperative evidence of thyroid cartilage erosion by CT scan and also when gross thyroid gland involvement observed during surgery. There is significant association between thyroid gland invasion when there is upper oesophageal or subglottic involvement.
CONCLUSION: After analysing the retrospective data from our study, we would like to suggest that thyroid gland need not be removed routinely in all laryngectomies, unless there is advanced disease with thyroid cartilage erosion and gross thyroid gland involvement or disease with significant subglottic or oesophageal involvement.

PMID: 27042568 [PubMed]

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Effect of Dissection of the Recurrent Laryngeal Nerves on Parathyroid Insufficiency during Total Thyroidectomy for Multinodular Goitre.

Effect of Dissection of the Recurrent Laryngeal Nerves on Parathyroid Insufficiency during Total Thyroidectomy for Multinodular Goitre.

J Clin Diagn Res. 2016 Feb;10(2):PC01-3

Authors: Sukumaran V, Teli B, Avula S, Pavuluru J

Abstract
INTRODUCTION: Total thyroidectomy is the accepted standard treatment for benign goitrous enlargements. The surgical skill and technique is one of the most important factor which affect the outcome in thyroid surgery. Hypocalcaemia due to parathyroid insufficiency remains a significant postoperative morbidity after total thyroidectomy. The primary cause is unintentional damage to, or devascularization of, one or more parathyroid glands during surgery.
AIM: To study the risk of hypocalcaemia due to recurrent laryngeal nerves (RLNs) dissection during total thyroidectomy for benign multinodular goitre (MNG).
MATERIALS AND METHODS: The study is a non-randomized control trial, where 100 patients with benign MNG were divided into two groups (group A and group B) each consisting of 50 patients. All 100 patients underwent total thyroidectomy by a subcapsular dissection. In patients of group A, both RLNs were clearly dissected for a minimum length of 2cm down from its entry into the larynx before total thyroidectomy was performed. In group B, each patient had total thyroidectomy without making any deliberate attempt to dissect and demonstrate the RLNs. The patients in the two groups were followed up for the incidence of clinically significant hypocalcaemia in the postoperative period.
RESULTS: A total of 30% of patients in group A developed clinical and biochemical manifestations of hypocalcaemia but the incidence of hypocalcaemia was only 6% in the group B. Three (6%) patients out of those who developed hypocalcaemia in group A had a prolonged hypocalcaemia for upto six months. p-value is 0.003 and odds ratio is 6.59.
CONCLUSION: Routine dissection to identify the RLNs could predispose to a higher incidence of postop hypocalcaemia. Subcapsular dissection of the thyroid safely preserves the parathyroid glands.

PMID: 27042514 [PubMed]

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Regional homogeneity changes in patients with primary insomnia

Abstract

Purpose

The study aimed to explore the regional spontaneous activity changes in primary insomnia (PI) patients.

Materials and methods

Based on the resting-state fMRI datasets acquired from 59 PI patients and 47 healthy controls, a two-sample t-test was performed on individual normalized regional homogeneity (ReHo) maps. Relationships between abnormal ReHo values and the Pittsburgh Sleep Quality Index (PSQI), the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were investigated with Pearson correlation analysis.

Results

In PI patients, we found increased ReHo in the left insula, right anterior cingulate gyrus, bilateral precentral gyrus and left cuneus, as well as decreased ReHo in the right middle cingulate cortex and left fusiform (p < 0.05, AlphaSim-corrected). We also found a significant positive correlation between increased ReHo in the left insula and SAS scores, decreased ReHo in the right middle cingulated cortex and SDS, SAS scores as well as a negative correlation between increased ReHo in the right precentral gyrus and SDS scores (p < 0.05).

Conclusions

Our study found abnormal spontaneous activities in multiple brain regions, especially in emotion-related areas in PI patients. Alterative activities in these regions might contribute to an understanding the intrinsic functional architecture of insomnia and its clinical features.

Key Points

• Regional spontaneous activity changes were detected in PI patients.

• Decreased or increased ReHo of some regions was identified in PI patients.

• Significant correlations between mean ReHo and SDS scores were found.

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TotalTrack video intubating laryngeal mask in super-obese patients - series of cases.

TotalTrack video intubating laryngeal mask in super-obese patients - series of cases.

Ther Clin Risk Manag. 2016;12:335-8

Authors: Gaszynski T

Abstract
BACKGROUND: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts.
PATIENTS AND METHODS: Twenty-four super-obese patients (body mass index >50 kg/m(2)) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack.
RESULTS: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases.
CONCLUSION: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients.

PMID: 27042078 [PubMed]

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Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy - A case report.

Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy - A case report.

Auris Nasus Larynx. 2016 Mar 31;

Authors: Ikeda R, Hidaka H, Miyazaki H, Kawase T, Katori Y, Kobayashi T

Abstract
Abnormal auditory sensations or tinnitus caused by abnormal middle ear muscle contraction are extremely rare and uncomfortable for patients. A 67-year-old man who performed paint and body work for cars presented at our hospital with complaint of an audible and annoying abnormal sound that was synchronous with the striking of his hammer against the metal of the car body during his work. The patient reported that the sound was audible of left ear with a split-second delay after his hammer struck the metal. Preoperative subjective and objective testing failed to reveal any abnormal findings in our case. The patient's symptom was successfully cured by selective transection of the stapedius tendon. The characteristic nature of tinnitus with a split-second delay after striking the metal helped our diagnosis and method of intervention in this case.

PMID: 27040425 [PubMed - as supplied by publisher]

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Introducing a 3-dimensionally Printed, Tissue-Engineered Graft for Airway Reconstruction: A Pilot Study.

Introducing a 3-dimensionally Printed, Tissue-Engineered Graft for Airway Reconstruction: A Pilot Study.

Otolaryngol Head Neck Surg. 2015 Dec;153(6):1001-6

Authors: Goldstein TA, Smith BD, Zeltsman D, Grande D, Smith LP

Abstract
OBJECTIVE: To use 3-dimensional (3D) printing and tissue engineering to create a graft for laryngotracheal reconstruction (LTR).
STUDY DESIGN: In vitro and in vivo pilot animal study.
SETTING: Large tertiary care academic medical center.
SUBJECTS AND METHODS: A 3D computer model of an anterior LTR graft was designed. That design was printed with polylactic acid on a commercially available 3D printer. The scaffolds were seeded with mature chondrocytes and collagen gel and cultured in vitro for up to 3 weeks. Scaffolds were evaluated in vitro for cell viability and proliferation. Anterior graft LTR was performed on 9 New Zealand white rabbits with the newly created scaffolds. Three animals were sacrificed at each time point (4, 8, and 12 weeks). The in vivo graft sites were assessed via bronchoscopy and histology.
RESULTS: The in vitro cell proliferation assay demonstrated initial viability of 87.5%. The cells proliferated during the study period, doubling over the first 7 days. Histology revealed that the cells retained their cartilaginous properties during the 21-day study period. In vivo testing showed that all animals survived for the duration of the study. Bronchoscopy revealed a well-mucosalized tracheal lumen with no evidence of scarring or granulation tissue. Histology indicated the presence of newly formed cartilage in the region where the graft was present.
CONCLUSIONS: Our results indicate that it is possible to produce a custom-designed, 3D-printed, tissue-engineered graft for airway reconstruction.

PMID: 26392025 [PubMed - indexed for MEDLINE]

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[Occupational Hearing Loss (BK-No. 2301) - A Retrospective Analysis of 100 Consecutive Cases].

[Occupational Hearing Loss (BK-No. 2301) - A Retrospective Analysis of 100 Consecutive Cases].

Laryngorhinootologie. 2016 Apr 4;

Authors: Reiter R, Brosch S

Abstract
Introduction: In order for a diagnosis of Occupational Hearing Loss (BK-no. 2301) to be made certain criteria must be fulfilled to establish that the hearing loss is occupational in origin. This work compares 2 groups, those who fulfil the criteria (BKE) and those who do not (BKNE). Methods: A 100 consecutive reports ("Lärmgutachten BK-no. 2301") written by the authors were examined retrospectively. These recorded audiometric examination, an analysis of any tinnitus and noise exposure plus use of hearing protection. Pre- and post-noise exposure status together with an expert assessment of work limitations was made to produce a 7 point score. Results: 67% of the group fulfilled the conditions for occupational hearing loss (9% were entitled to compensation). In the BKE group 82% showed typical audiometric signs of noise damage with 75% of them fulfilling at least 6 criteria of occupational disease no. 2301. Tinnitus typical for noise exposure was found in 26%. Discussion: A 7 point score could be useful in the future as a method of helping distinguish hearing loss and tinnitus from occupational as opposed to other causes.

PMID: 27043186 [PubMed - as supplied by publisher]

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Reduction of metallic coil artefacts in computed tomography body imaging: effects of a new single-energy metal artefact reduction algorithm

Abstract

Objectives

We evaluated the effect of a single-energy metal artefact reduction (SEMAR) algorithm for metallic coil artefact reduction in body imaging.

Methods

Computed tomography angiography (CTA) was performed in 30 patients with metallic coils (10 men, 20 women; mean age, 67.9 ± 11 years). Non-SEMAR images were reconstructed with iterative reconstruction alone, and SEMAR images were reconstructed with the iterative reconstruction plus SEMAR algorithms. We compared image noise around metallic coils and the maximum diameters of artefacts from coils between the non-SEMAR and SEMAR images. Two radiologists visually evaluated the metallic coil artefacts utilizing a four-point scale: 1 = extensive; 2 = strong; 3 = mild; 4 = minimal artefacts.

Results

The image noise and maximum diameters of the artefacts of the SEMAR images were significantly lower than those of the non-SEMAR images (65.1 ± 33.0 HU vs. 29.7 ± 10.3 HU; 163.9 ± 54.8 mm vs. 10.3 ± 19.0 mm, respectively; P < 0.001). Better visual scores were obtained with the SEMAR technique (3.4 ± 0.6 vs. 1.0 ± 0.0, P < 0.001).

Conclusions

The SEMAR algorithm significantly reduced artefacts caused by metallic coils compared with the non-SEMAR algorithm. This technique can potentially increase CT performance for the evaluation of post-coil embolization complications.

Key Points

• The new algorithm involves a raw data- and image-based reconstruction technique.

• The new algorithm mitigates artefacts from metallic coils on body CT images.

• The new algorithm significantly reduced artefacts caused by metallic coils.

• The metal artefact reduction algorithm improves CT image quality after coil embolization.

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Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

Abstract

Objectives

To assess MRI-pathology concordance and factors influencing tumour size measurement in breast cancer.

Materials and methods

MRI tumour size (greatest diameter in anatomical planes (MRI-In-Plane) and greatest diameter along main tumour axis (MRI-MPR)) of 115 consecutive breast lesions (59 invasive lobular carcinoma, 46 invasive ductal carcinoma, and 10 ductal carcinoma in situ) was retrospectively compared to size measured at histopathology (pT size (Path-TNM) and greatest tumour diameter as relevant for excision (Path-Diameter; reference standard)). Histopathological tumour types, preoperative palpability, surgical management, additional high-risk lesions, and BI-RADS lesion type (mass versus non-mass enhancements) were assessed as possible influencing factors.

Results

Systematic errors were most pronounced between MRI-MPR and Path-TNM (7.1 mm, limits of agreement (LoA) [-21.7; 35.9]), and were lowest between MRI-In-Plane and Path-Diameter (0.2 mm, LoA [-19.7; 20.1]). Concordance rate of MRI-In-Plane with Path-Diameter was 86 % (97/113), overestimation 9 % (10/113) and underestimation 5 % (6/113); BI-RADS mass lesions were overestimated in 7 % (6/81) versus 41 % (13/32) for non-mass enhancements. On multivariate analysis only BI-RADS lesion type significantly influenced MRI-pathology concordance (p < 0.001). 2/59 (3 %) ILC did not enhance.

Conclusion

Concordance rate varies according to the execution of MRI and histopathological measurements. Beyond this only non-mass enhancement significantly predicted discordance.

Key Points

• Execution and scope of MRI and histopathological size measurements influence concordance rate.

• Non-mass like enhancement predicts discordance.

• Additional high-risk lesions in proximity of tumour do not cause measurement discordance.

• Low percentage of ILC do not enhance at all.

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Prognostic significance of increased bone marrow microcirculation in newly diagnosed multiple myeloma: results of a prospective DCE-MRI study

Abstract

Objectives

Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM).

Methods

We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant k _ep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures.

Results

Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and k _ep. Additionally, A was negatively correlated with haemoglobin levels and k _ep was positively correlated with LDH levels. Higher baseline k _ep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival.

Conclusion

DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications.

Key Points

• Qualitative parameters from DCE-MRI are correlated with established factors of disease activity

• Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures

• Amplitude A is an independent predictor for shortened overall survival

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Prostate diffusion-weighted imaging at 3T: effect of intravenous gadobutrol administration

Abstract

Objective

To investigate whether gadolinium-based contrast agent (GBCA) administration significantly affects diffusion-weighted imaging (DWI) at 3 T in the evaluation of prostate cancer and benign tissue.

Method

Thirty-four consecutive patients with surgically proven prostate cancer underwent preoperative DWI at 3 T before and after GBCA administration. Exponential apparent diffusion coefficient (EADC) and ADC maps were developed from DWI data. The ADC and EADC values pre- and post-contrast were measured in the cancer and benign tissue, respectively. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated on pre- and post-contrast DWI.

Results

The ADC and EADC values of the cancer and benign transition zone were not significantly different between pre- and post-contrast, respectively (P > 0.05), while those in the benign peripheral zone were significantly different (P = 0.030 and 0.037, respectively). In all tissues, the SNRs and CNRs of the DWI, ADC map and EADC map were not significantly different between pre- and post-contrast (P > 0.05). Between pre- and post-contrast, ADC and EADC values showed excellent agreement (intraclass correlation coefficient ≥ 0.894) and variability of ≤3.2 %.

Conclusion

Prostate 3 T-DWI after GBCA administration may be used without a significant difference in SNR or CNR, with minimal variability of the cancer ADC and EADC values.

Key Points

• ADCs and EADCs have excellent agreement before and after gadobutrol administration.

• SNRs of prostate DWI are similar before and after gadobutrol administration.

• CNRs of cancers are similar between pre- and post-contrast DWI.

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Changes in classification of follicular thyroid cancers.

Changes in classification of follicular thyroid cancers.

Thyroid. 2016 Apr 4;

Authors: Hakala TT, Kholová I

Abstract
During the last decades the histopathological classification of thyroid gland tumors has changed with stricter criteria for follicular thyroid carcinoma (FTC), an establishment of poorly differentiated carcinoma and superposition of nuclear atypia of papillary thyroid carcinoma (PTC) above architecture. Furthermore, an increase in imaging of neck area revealed the frequency of thyroid nodules, which nevertheless harbor cancer only in 5% of the cases. In recent issues of Thyroid, both thyroid cancer epidemiology and FTC reclassification were interestingly covered (1,2). Vaccarella et al. estimated that diagnostic changes may account for ≥60% of thyroid cancer cases diagnosed during recent years in certain developed countries. In a study by Cipriani et al., FTC cases diagnosed during 1965-2007 were re-evaluated by three pathologists. A remarkable 71% of FTC cases were re-classified as follicular adenomas or PTCs. Elimination of follicular adenomas and PTCs led to decreased survival of re-classified FTC patients. Inter- and intraobserver variability in histologic interpretation leads to diagnostic challenges in follicular lesions. We analyzed thyroid cancer in Pirkanmaa region of Finland. During 1981-2002, a total of 495 patients with differentiated thyroid cancer were treated in Tampere University Hospital, Finland (3). We performed registry-based follow-up until December 2011. In our material, 71 (13%) tumors were initially classified as FTCs. In the patient with FTC, disease-specific mortality was 19 (27%) and overall mortality 38 (54%) cases. We performed re-classification of FTCs according to latest WHO guidelines with following results: five (7%) of 71 tumors were re-classified to follicular adenomas and 3 (4%) tumors were reclassified as PTCs. None of the re-classified cases with follicular adenoma or PTC died of thyroid malignancy. In re-classified FTC patients, 19 (30%) patients had FTC-related death, and overall mortality was 36 (57%) cases during the observation period. Our results corroborate that the diagnosis of FTC in may be inaccurate in previous pathology reports. However, in our series, the number of re-classified cases was only 8 out of 71 (11%). These figures are much lower than in the study of Cipriani et al., in which considerable 71% of FTC cases were re-classified to follicular adenomas or PTCs.

PMID: 27043936 [PubMed - as supplied by publisher]

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Misdiagnosis of Graves' disease with apparent severe hyperthyroidism in a patient taking biotin megadoses.

Misdiagnosis of Graves' disease with apparent severe hyperthyroidism in a patient taking biotin megadoses.

Thyroid. 2016 Apr 4;

Authors: Barbesino G

Abstract
BACKGROUND: Accurate immunoassays measuring minute quantities of hormones are the cornerstone of the practice of endocrinology. Despite tremendous advances in this field, novel pitfalls in these tests emerge from time to time. Oral biotin can interfere with immunoassays of several hormones. The purpose of this report is to relate an extreme case of such interference.
PATIENT FINDINGS: A patient with progressive multiple sclerosis was found to have extremely elevated free thyroxine (FT4), triiodothyronine (T3) and suppressed thyrotropin (TSH) levels. His TSH receptor binding inhibiting antibody (TBII) level was also elevated. This constellation of laboratory findings suggested a diagnosis of severe Graves' disease. All of the assays yielding abnormal results employed the biotin-streptavidin affinity in their design. The patient had no symptoms of hyperthyroidism and detailed review of his medications revealed intake of megadoses of biotin. Temporary discontinuation of biotin treatment resulted in complete resolution of the biochemical abnormalities.
CONCLUSIONS: Non-physiologic biotin supplementation may interfere with several immunoassays, including thyroid hormones, TSH, thyroglobulin (Tg) and TBII leading to erroneous diagnoses. Questioning for biotin intake should be part of the evaluation for patients undergoing endocrine tests. Interruption of biotin supplementation for at least 2 days prior to biotin-sensitive tests should be sufficient to avoid major misdiagnoses.

PMID: 27043844 [PubMed - as supplied by publisher]

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"Asian Pac J Cancer Prev"[jour]; +112 new citations

112 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Asian Pac J Cancer Prev"[jour]

These pubmed results were generated on 2016/04/05

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Neoadjuvant radiation in primary extremity liposarcoma: correlation of MRI features with histopathology

Abstract

Objective

To evaluate MRI features of response of primary extremity liposarcoma (LPS) to neoadjuvant radiation therapy (RT) with histopathologic correlation.

Methods

In this IRB-approved study including 125 patients with extremity LPS treated with neoadjuvant RT from 2000 to 2013, MRI of the primary tumour in 18 patients (5 pleomorphic LPS, 13 myxoid LPS) before and after RT were reviewed by two radiologists by consensus. Histopathology of the surgical specimens was reviewed by a pathologist with expertise in sarcomas.

Results

In the pleomorphic LPS cohort, 3/5 tumours increased in size; 3/5 decreased in enhancing component; and 3/5 increased in peritumoral oedema, intratumoral haemorrhage, and necrosis. In the myxoid LPS cohort, 12/13 tumours decreased in size, 8/13 decreased in enhancing component, and 5/13 increased in internal fat following RT. Histopathology showed ≥50 % residual tumour in 1/5 pleomorphic LPS and 2/13 myxoid LPS. Hyalinization/necrosis of ≥75 % was noted in 4/5 pleomorphic LPS and 11/13 myxoid LPS. Cytodifferentiation was noted in 1/5 pleomorphic and 9/13 myxoid LPS.

Conclusion

While pleomorphic LPS showed an increase in size, peritumoral oedema, intratumoral haemorrhage, and necrosis on MRI following neoadjuvant RT, myxoid LPS showed a decrease in size and enhancement with an increase in internal fat.

Key Points

• Pleomorphic LPS commonly increase in size and necrosis on MRI following RT.

• Myxoid LPS commonly decrease in size and enhancement on MRI following RT.

• Myxoid LPS often increase in fatty component on MRI following RT.

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Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes

Abstract

Objectives

We categorised spontaneous cervical artery dissection (sCAD) by radiological features and investigated factors associated with favourable outcomes.

Methods

We retrospectively analysed 128 patients with sCAD with a median follow-up duration of 25 months. Twenty-nine constituted the aneurysm group, 52 the stenotic group, and 47 the occlusive group. Various relevant factors, including National Institute of Health Stroke Scale (NIHSS) scores, type of antithrombotic therapy, stroke progression in the first week, and transcranial Doppler (TCD) flow-waveforms (in the occlusive subgroup) were analysed. Favourable outcomes were defined as a 1-year modified Rankin-Scale score of 0–1. Favourable anatomical outcomes were defined as a reversal of dissection-associated stenosis during follow-up.

Results

The aneurysm and stenotic groups showed favourable outcomes, while the occlusive group outcomes were less favourable. In the stenotic group, anticoagulation, an NIHSS score ≥4, and stroke progression were inversely associated with favourable long-term outcomes. Remarkably, in the occlusive group, flow abnormality more severe than minimal flow was associated with stroke progression, unfavourable long-term outcome, and arterial irreversibility.

Conclusions

The outcome of sCAD depends on its radiological subtype. In the occlusive subtype, which is associated with the worst outcome, TCD flow analysis may predict acute stroke progression and long-term outcome.

Key Points

• Outcomes in cervical artery dissection may be determined by radiological subtypes.

• The aneurysm and stenotic groups had favourable outcomes.

• The occlusive group had less favourable functional outcomes.

• Flow-waveform analysis by TCD could predict functional and anatomical outcomes.

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Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now

Abstract

Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation.

Key Points

• Intra-articular contrast agent injection can be performed using different imaging modalities

• Fluoroscopy is widely used, but uses ionizing radiation

• Ultrasound is an accurate, quick, and radiation-free modality for joint injection

• X-rays should be avoided when other radiation-free modalities can be used

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Obituary for Prof. Torsten Almén

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Subtracted Dynamic MR Perfusion Source Images (sMRP-SI) provide Collateral Blood Flow Assessment in MCA Occlusions and Predict Tissue Fate

Abstract

Objectives

Collateral blood flow is accepted as a predictive factor of tissue fate in ischemic stroke. Thus, we aimed to evaluate a new method derived from MR perfusion source images to assess collateral flow in patients with ICA/MCA occlusions.

Methods

A total of 132 patients of the prospective 1000+ study were examined. MR perfusion source images were assessed according to Δimg_n = img_n + 1 − img_n − 1 using the five-grade Higashida collateral flow rating system. Higashida scores were correlated to mismatch (MM) volume, mismatch ratio, day 6 FLAIR lesion volumes and day 90 mRS.

Results

Patients with Higashida scores 3 and 4 had significantly lower admission NIHSS, smaller FLAIR day 6 lesion volumes (p < 0.001) and higher rates of better long-term outcome (mRS 0–2, p = 0.002). There was a linear trend for the association of Higashida grade 1 (p = 0.002) and 2 (p = 0.001) with unfavourable outcome (day 90 mRS 3–6), but no significant association was found for MM volume, MM ratio and day 90 mRS. Inter-rater agreement was 0.58 (95 % CI 0.43–0.73) on day 1, 0.70 (95 % CI 0.58–0.81) on day 2.

Conclusion

sMRP-SI Higashida score offers a non-invasive collateral vessel and tissue perfusion assessment of ischemic tissue. The predictive value of Higashida rating proved superior to MM with regard to day 90 mRS.

Key points

• Assessment of collateral flow using subtracted dynamic MR perfusion source imaging (sMRP-SI).

• sMRP-SI offers additional information about morphological characteristics of ischemic brain tissue.

• sMRP-SI collateral flow assessment proves superior to mismatch volume.

• Better collateral flow was significantly associated with better outcome (day 90 mRS).

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7 Tesla quantitative hip MRI: T1, T2 and T2* mapping of hip cartilage in healthy volunteers

Abstract

Objectives

To evaluate the technical feasibility and applicability of quantitative MR techniques (delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2 mapping, T2* mapping) at 7 T MRI for assessing hip cartilage.

Methods

Hips of 11 healthy volunteers were examined at 7 T MRI with an 8-channel radiofrequency transmit/receive body coil using multi-echo sequences for T2 and T2* mapping and a dual flip angle gradient-echo sequence before (T1₀) and after intravenous contrast agent administration (T1_Gd; 0.2 mmol/kg Gd-DTPA²⁻ followed by 0.5 h of walking and 0.5 h of rest) for dGEMRIC. Relaxation times of cartilage were measured manually in 10 regions of interest. Pearson's correlations between R1_delta = 1/T1_Gd − 1/T1₀ and T1_Gd and between T2 and T2* were calculated. Image quality and the delineation of acetabular and femoral cartilage in the relaxation time maps were evaluated using discrete rating scales.

Results

High correlations were found between R1_delta and T1_Gd and between T2 and T2* relaxation times (all p < 0.01). All techniques delivered diagnostic image quality, with best delineation of femoral and acetabular cartilage in the T2* maps (mean 3.2 out of a maximum of 4 points).

Conclusions

T1, T2 and T2* mapping of hip cartilage with diagnostic image quality is feasible at 7 T. To perform dGEMRIC at 7 T, pre-contrast T1 mapping can be omitted.

Key Points

• dGEMRIC of hip cartilage with diagnostic image quality is feasible at 7 T.

• To perform dGEMRIC at 7 T, pre-contrast T1 mapping can be omitted.

• T2(*) mapping of hip cartilage with diagnostic image quality is feasible at 7 T.

• T2 and T2* relaxation times of cartilage were highly correlated at 7 T.

• Best delineation of femoral and acetabular cartilage was found in T2* maps.

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Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method

Abstract

Objectives

To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements.

Methods

Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers.

Results

Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17 %; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM mesurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed.

Conclusions

Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods.

Key Points

• Threshold-based left ventricular segmentation provides time-efficient assessment of left ventricular parameters

• The threshold-based method can discriminate between blood and papillary muscles

• This method provides improved accuracy compared to aortic flow measurements as a reference

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Cerebrospinal fluid volumetric MRI mapping as a simple measurement for evaluating brain atrophy

Abstract

Objectives

To assess whether volumetric cerebrospinal fluid (CSF) MRI can be used as a surrogate for brain atrophy assessment and to evaluate how the T₂ of the CSF relates to brain atrophy.

Methods

Twenty-eight subjects [mean age 64 (sd 2) years] were included; T₁-weighted and CSF MRI were performed. The first echo data of the CSF MRI sequence was used to obtain intracranial volume, CSF partial volume was measured voxel-wise to obtain CSF volume (V_CSF) and the T₂ of CSF (T_2,CSF) was calculated. The correlation between V_CSF / T_2,CSF and brain atrophy scores [global cortical atrophy (GCA) and medial temporal lobe atrophy (MTA)] was evaluated.

Results

Relative total, peripheral subarachnoidal, and ventricular V_CSF increased significantly with increased scores on the GCA and MTA (R = 0.83, 0.78 and 0.78 and R = 0.72, 0.62 and 0.86). Total, peripheral subarachnoidal, and ventricular T₂ of the CSF increased significantly with higher scores on the GCA and MTA (R = 0.72, 0.70 and 0.49 and R = 0.60, 0.57 and 0.41).

Conclusion

A fast, fully automated CSF MRI volumetric sequence is an alternative for qualitative atrophy scales. The T₂ of the CSF is related to brain atrophy and could thus be a marker of neurodegenerative disease.

Key points

• A 1:11 min CSF MRI volumetric sequence can evaluate brain atrophy.

• CSF MRI provides accurate atrophy assessment without partial volume effects.

• CSF MRI data can be processed quickly without user interaction.

• The measured T ₂of the CSF is related to brain atrophy.

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Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamic cardiac CT

Abstract

Objectives

The aim of this study was to evaluate variations in anatomy and function according to age and gender using cardiac computed tomography (CT) in a large prospective cohort of healthy patients.

Background

The left atrial appendage (LAA) is considered the most frequent site of intracardiac thrombus formation. However, variations in normal in vivo anatomy and function according to age and gender remain largely unknown.

Methods

Three-dimensional (3D) cardiac reconstructions of the LAA were performed from CT scans of 193 consecutive patients. Parameters measured included LAA number of lobes, anatomical position of the LAA tip, angulation measured between the proximal and distal portions, minimum (iVol_min) and maximum (iVol_max) volumes indexed to body surface area (BSA), and ejection fraction (LAAEF). Relationship with age was assessed for each parameter.

Results

We found that men had longer and wider LAAs. The iVol_min and iVol_max increased by 0.23 and 0.19 ml per decade, respectively, while LAAEF decreased by 2 % per decade in both sexes.

Conclusions

Although LAA volumes increase, LAAEF decreases with age in both sexes.

Key Points

• Variations in normal left atrial appendage in vivo anatomy and function remain largely unknown.

• Cardiac CT is reliable for left atrial appendage volume measurements.

• Although LAA volumes increase, LAAEF decreases with age in both sexes.

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A retrospective analysis of eye conditions among children attending St. John Eye Hospital, Hebron, Palestine

Eye diseases are important causes of medical consultations, with the spectrum varying in different regions. This hospital-based descriptive study aimed to determine the profile of childhood eye conditions at S...

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Correction to Determination of DNA and RNA Methylation in Circulating Tumor Cells by Mass Spectrometry

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b01215

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Microchannel Voltammetry in the Presence of Large External Voltages and Electric Fields

TOC Graphic

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b00399

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Optical Monitoring of Living Nerve Terminal Labeling in Hair Follicle Lanceolate Endings of the Ex Vivo Mouse Ear Skin

Here we describe a novel preparation for imaging live lanceolate sensory terminals of palisade endings that innervate mouse ear skin hair follicles during staining and destaining with styryl pyridinium dyes.

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Belly Breathing to Reduce Stress

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Fitness

Mercy Clinic

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Bethany Pope

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Place one hand on your chest and the other
on your stomach to feel the air moving down into your
belly pushing that hand upward.

Contributed by Dr. Paul Angleton, a Mercy Clinic primary care physician.

Patients are often surprised when I tell them I'm going to teach them how to breathe. I get a lot of comments like, "Doc, I wouldn't have made it to 50 if I couldn't breathe." Most of them end up a little surprised when they learn they've been doing it wrong all those years.

There's some debate in modern medicine about whether stress itself is a killer, or whether it's more of how we respond to, or even embrace, stress. It's clear, though, that a negative response to stress can wreak havoc on our physical and mental health.

Increased levels of stress hormones like cortisol and adrenaline can lead to elevations in blood pressure, obesity, fatigue, anxiety, insomnia, irritability and muscle tightness. Even if we aren't showing any outward signs, we can all benefit from breaking this cycle. Relaxation, meditation, massage, regular exercise and prayer can all be helpful, but so can breathing if you do it right.

Diaphragmatic breathing is also known as belly breathing. A lot of people think the concept is just too simple to have any real benefit. However, the science is clear with several studies showing reductions in stress hormones and improved immune function along with a reduction in muscle tension, reduction in blood pressure, better blood flow to muscles and improved concentration. I usually recommend targeting 10 minutes in the morning and 10 minutes in the evening. You can get some benefit in as little as a minute of intentional, focused diaphragmatic breathing.

So how is this type of breathing different? When most people take a deep breath, we will feel our shoulders rise and fall, but if we are breathing correctly, our shoulders should remain still and the belly should extend outward with the inhale and back in as we breathe out. We tend to hold our bellies in tight when we sit or stand (either for good posture or to make ourselves look skinnier) so the easiest way to learn this skill is lying down. Get comfortable, some may need to bend their knees to get the belly to feel soft even when lying down. Place one hand on your chest and one on your stomach. Breathe though your nose and as you inhale, feel the air moving down into your belly pushing that hand upward. The hand on the chest should move little to none until the very end of the breath. When you exhale, use your abdominal muscles to force all of the air out of your lungs. At first you may need to even push with your hand a little to force the air out. Then, let the next breath in, picturing the air moving into and raising the hand on your belly.

Now that you know how to breathe properly, it's important to practice it daily – even if you don't feel stressed. That way, you can master this skill and use it for the more difficult days.

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Neuromuscular Impairments Contributing to Persistently Poor and Declining Lower-Extremity Mobility among Older Adults: New Findings Informing Geriatric Rehabilitation

Publication date: Available online 4 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Rachel E. Ward, Marla K. Beauchamp, Nancy K. Latham, Suzanne G. Leveille, Sanja Percac-Lima, Laura Kurlinski, Pengsheng Ni, Richard Goldstein, Alan M. Jette, Jonathan F. Bean
ObjectiveTo identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late-life.DesignLongitudinal cohort study.SettingResearch clinic.ParticipantsCommunity-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry.Intervention(s)Not applicable.Main Outcome Measure(s)Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. "The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), ROM (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis)."ResultsThe largest effect sizes were found for baseline weaker leg strength (OR [95% CI]: 3.45 [1.72-6.95]), trunk extensor endurance (2.98 [1.56-5.70]), and slower leg velocity (2.35 [1.21-4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10-2.70], 1.83 [1.56-5.70], 2.03 [1.24-3.35]).ConclusionOlder adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the ground work for developing interventions aimed at optimizing rehabilitative care and disability prevention and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).

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Episode-based Payment for the Medicare Outpatient Therapy Benefit

Publication date: Available online 5 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Peter Amico, Gregory C. Pope, Ann Meadow, Pamela West
ObjectiveTo conduct an analysis of Medicare outpatient therapy episodes of care and associated payment implications.DesignRetrospective observational design using Medicare claims data. To descriptively analyze the composition of outpatient therapy episodes, we explore both variable and fixed length episodes. The variable-length episode definition organizes services into episodes based on the time pattern of therapy service utilization, using 60-day clean periods. We also examine fixed length episodes, beginning with the first therapy utilization in CY 2010 and extending 30, 60 and 90 days.SettingThe study is focused on community dwelling users of outpatient therapy.ParticipantsThe sample includes all Medicare patients who used outpatient therapy beginning at any point in 2010.InterventionsNot applicableMain OutcomeMeasures Mean episode payments and episode lengths in calendar days.ResultsVariable length outpatient therapy episodes have a mean payment of $881. On average, outpatient therapy episodes last 43 calendar days. Mean therapy duration for the 30, 60 and 90 day fixed-length episode is 20, 31 and 38 calendar days. The 30, 60 and 90 day fixed length initial episodes account for 40, 55 and 63 percent of total Medicare payments. Simulations of episode based payment illustrate the difficulty of avoiding a large number of substantial underpayments, due to the right-skewed distribution of total actual payments.ConclusionsA strength of episode payment is reducing cost and potentially wasteful variation within episodes. Given the substantial variation in therapy episode expenditures, absent improvements in available data and in predictive information, pure lump sum episode payment would result in substantial revenue changes for many episodes. Additional data is needed to better explain the wide variation in episode expenditures.

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The effects of HIV self-testing on the uptake of HIV testing and linkage to antiretroviral treatment among adults in Africa: a systematic review protocol

HIV is still a global public health problem. More than 75 % of HIV-infected people are in Africa, and most of them are unaware of their HIV status, which is a barrier to accessing antiretroviral treatment. Our...

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Resective surgery for focal cortical dysplasia in children: a comparative analysis of the utility of intraoperative magnetic resonance imaging (iMRI)

Abstract

Purpose

Seizure freedom following resection of focal cortical dysplasia (FCD) correlates with complete resection of the dysplastic cortical tissue. However, difficulty with intraoperative identification of the lesion may limit the ability to achieve the surgical objective of complete extirpation of these lesions. Intraoperative magnetic resonance imaging (iMRI) may aid in FCD resections. The objective of this study is to compare rates of postoperative seizure freedom, completeness of resection, and need for reoperation in patients undergoing iMRI-assisted FCD resection versus conventional surgical techniques.

Methods

We retrospectively reviewed the medical records of pediatric subjects who underwent surgical resection of FCD at Children's National Medical Center between March 2005 and April 2015.

Results

At the time of the last postoperative follow-up, 11 of the 12 patients (92 %) in the iMRI resection group were seizure free (Engel Class I), compared to 14 of the 42 patients (33 %) in the control resection group (p = 0.0005). All 12 of the iMRI patients (100 %) achieved complete resection, compared to 24 of 42 patients (57 %) in the control group (p = 0.01). One (8 %) patient from the iMRI-assisted resection group has required reoperation, compared to 17 (40 %) patients in the control resection group.

Conclusion

Our results suggest that the utilization of iMRI during surgery for resection of FCD results in improved postoperative seizure freedom, completeness of lesion resection, and reduction in the need for reoperation.

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Ex Vivo Optogenetic Dissection of Fear Circuits in Brain Slices

Optogenetic approaches are widely used to manipulate neural activity and assess the consequences for brain function. Here, a technique is outlined that upon in vivo expression of the optical activator Channelrhodopsin, allows for ex vivo analysis of synaptic properties of specific long range and local neural connections in fear-related circuits.

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Αρχειοθήκη ιστολογίου

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Η λίστα ιστολογίων μου

Τρίτη 5 Απριλίου 2016

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