Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic.

Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic.

Radiat Oncol. 2016;11(1):55

Authors: Curtis KK, Ross HJ, Garrett AL, Jizba TA, Patel AB, Patel SH, Wong WW, Halyard MY, Ko SJ, Kosiorek HE, Foote RL

Abstract
BACKGROUND: We reviewed outcomes of patients with loco-regionally recurrent (LRR) or new primary (NP) squamous cell carcinoma of the head and neck (SCCHN) treated at our institution with reirradiation (RRT).
METHODS: Patients received definitive RRT (DRRT) or post-operative RRT following salvage surgery (PRRT) from 2003 to 2011. Measured survival outcomes included loco-regional relapse free survival (LRFS) and overall survival (OS).
RESULTS: Among 81 patients (PRRT, 42; DRRT, 39), median PRRT and DRRT doses were 60 Gy (12-70 Gy) and 69.6 Gy (48-76.8 Gy). The majority of patients received IMRT-based RRT (n = 77, 95 %). With median follow-up of 78.1 months (95 % CI, 56-96.8 months), 2-year OS was 53 % with PRRT and 48 % with DRRT (p = 0.12); 23 % of patients were alive at last follow-up. LRFS at 2 years was 60 %, and did not differ significantly between PRRT and DRRT groups. A trend toward inferior LRFS was noted among patients receiving chemotherapy with RRT versus RRT alone (p = 0.06). Late serious toxicities were uncommon, including osteoradionecrosis (2 patients) and carotid artery bleeding (1 patient, non-fatal).
CONCLUSIONS: OS of PRRT- and DRRT-treated patients in this series appears superior to the published literature. We used IMRT for the majority of patients, in contrast to several series and trials previously reported, which may account in part for this difference. Future studies should seek to improve outcomes among patients with LRR/NP SCCHN via alternative therapeutic modalities such as proton radiotherapy and by incorporating novel systemic agents.

PMID: 27061083 [PubMed - in process]

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Concurrent cetuximab and postoperative radiation in resected high-risk squamous cell carcinomas of the head and neck: A single-institution experience.

Concurrent cetuximab and postoperative radiation in resected high-risk squamous cell carcinomas of the head and neck: A single-institution experience.

Head Neck. 2016 Apr 7;

Authors: Araki D, Redman MW, Martins R, Eaton K, Baik C, Chow L, Goulart B, Lee S, Santana-Davila R, Liao J, Parvathaneni U, Laramore G, Futran N, Mendez E, Bhrany A, Rodriguez CP

Abstract
BACKGROUND: Postoperative cisplatin and radiation is the standard of care for high-risk squamous cell carcinoma of the head and neck (SCCHN). We have used cetuximab and radiation in the postoperative setting for patients deemed poor candidates for cisplatin.
METHODS: We retrospectively identified 40 patients who received cetuximab and radiation for resected locoregionally advanced SCCHN between 2006 and 2013 at our institution.
RESULTS: The 2-year Kaplan-Meier estimates were: overall survival (OS) 41%, recurrence-free survival (RFS) 34%, locoregional control 63%, and distant metastatic control 59%. Eastern Cooperative Oncology Group (ECOG) performance status ≥1 predicted for inferior OS (hazard ratio [HR] = 5.43; p = .003), RFS (HR = 4.07; p = .007), and locoregional control (HR = 4.92; p = .04) in multivariate analysis.
CONCLUSION: Patients with resected high-risk SCCHN treated with postoperative cetuximab and radiation have suboptimal therapeutic outcomes. Further study of the efficacy and cost-effectiveness compared to radiation alone is warranted. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061333 [PubMed - as supplied by publisher]

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Tumour thickness as a determinant of nodal metastasis in oral tongue carcinoma.

Tumour thickness as a determinant of nodal metastasis in oral tongue carcinoma.

ANZ J Surg. 2016 Apr 8;

Authors: Wang K, Veivers D

Abstract
BACKGROUND: Tumour thickness is a strong predictor for cervical node involvement in oral cavity squamous cell carcinomas (SCCs), with a recent meta-analysis concluding a 4-mm optimal prognostic cut-off point. No consensus has been reached for the tumour thickness cut-off for oral tongue SCCs.
METHODS: A retrospective review of prospectively collected data from 112 patients by the Northern Sydney Cancer Centre (Australia) with primary oral tongue SCC was conducted. Tumour thickness was measured by standard histopathological techniques and cervical node involvement was determined either from neck dissection histopathology or by clinical and radiological follow-up.
RESULTS: Neck dissection was performed in 78 patients (70%). Tumour thickness was a significant predictor of cervical node disease (P < 0.01), with a median tumour thickness of 5.5 mm. Cervical node metastasis rates for tumours <2, 2-3.9 and ≥4 mm thick were 10%, 42.1% and 46.5%, respectively. The rate of cervical node metastasis was significantly higher for patients with tumours thicker than a cut-off of 2 mm (odds ratio: 7.53, P < 0.01). A 4-mm thickness cut-off was also statistically significant (P < 0.05); however, the odds ratio was smaller at 2.52.
CONCLUSION: Despite some previous evidence for a 4-mm tumour thickness cut-off in oral tongue SCCs, thinner tumours (2-3.9 mm) can also have a propensity for cervical node metastasis. Patients in this category require close monitoring for regional recurrence if they do not have a neck dissection.

PMID: 27061344 [PubMed - as supplied by publisher]

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Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma.

Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma.

Head Neck. 2016 Apr 7;

Authors: Gweon HM, Koo HR, Son EJ, Kim JA, Youk JH, Hong SW, Lim BJ

Abstract
BACKGROUND: The purpose of this study was to investigate the role of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) as a prognostic marker in conventional papillary thyroid carcinoma (PTC).
METHODS: A total of 397 patients who underwent ultrasound-guided fine-needle aspiration biopsy (FNAB) and surgery for conventional PTCs were enrolled. The association between the Bethesda category and histopathologic result was evaluated.
RESULTS: Among the Bethesda categories, a significant difference was found in the presence of extrathyroidal extension (Bethesda category III, 3.2% [7 of 220]; category V, 19.1% [42 of 220]; and category VI, 77.7% [171 of 220]; p < .001) and lymph node metastasis (Bethesda category III, 3.8% [6 of 156]; category V, 16.7% [26 of 156]; and category VI, 79.5% [124 of 156]; p < .001). Multivariate analysis showed that the Bethesda category was independently predictive of extrathyroidal extension (p = .013) and lymph node metastasis (p = .035).
CONCLUSION: Conventional PTC with a higher Bethesda category at the time of cytology diagnosis would be poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062195 [PubMed - as supplied by publisher]

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Human papilloma virus status evaluation and survival description in selected oropharyngeal and laryngeal squamous cell carcinoma patients from Hungary.

Human papilloma virus status evaluation and survival description in selected oropharyngeal and laryngeal squamous cell carcinoma patients from Hungary.

J BUON. 2016 Jan-Mar;21(1):168-74

Authors: Reka Fejer E, Abram Z, Zs Egyed J, Voidazan S, Toth E, Szentirmay Z, Kasler M

Abstract
PURPOSE: Many patients with oropharyngeal squamous cell carcinomas do not have any of the traditional risk factors associated with head and neck squamous cell cancers (HNSCC). Epidemiologic and molecular studies have identified human papillomavirus (HPV) as a causative agent, viral tumors presenting a better survival and being important risk factors together with the long established ones, tobacco and alcohol consumption, in head and neck cancers. The purpose of this study was to establish the incidence of HPV-associated HNSCCs, to identify the most frequent HPV type and to evaluate the overall survival and recurrence rates of HPV-positive cases in comparison with HPV-negative HNSCCs.
METHODS: A retrospective analysis from the database of the National Institute of Oncology from Budapest was performed and the following parameters were analyzed: age, age at diagnosis, gender, primary tumor location, tumor histopathology, TNM stage, HPV status, date of recurrence, last visit and date of death.
RESULTS: Out of 81 patients with HNSCCs 55 (67.9%) were male and 26 (32.1%) female. HNSCCs were more frequent in men (2.11:1) and the majority of the patients (81.7%) were diagnosed in advanced stages (TNM III and IV). HPV status was evaluated in nearly half (48.14%) of the patients and HNSCCs were positive for HPV in 43.6% of the cases. These were more frequent in patients over 50 years (76.66%), in men (76.47%) and in oropharyngeal location (94.1%). HPV-16 type was associated with malignancy in 82.35% of the cases. Disease recurrence was more frequent in HPV-negative (31.81%) vs HPV-positive cases (29.41%) and mortality rate was inferior in HPV-positive 33.33% vs negative (38.09%) tumors (p=0.52).
CONCLUSIONS: In Hungary HNSCCs are more frequent in men than in women. HPV positivity is higher in men vs women and in oropharyngeal vs laryngeal location. Overall survival rate was superior in HPV-positive vs HPV-negative cases. Disease recurrence was more frequent in HPV-negative vs HPV-positive cases.

PMID: 27061545 [PubMed - in process]

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Volumetric regression ratio of the primary tumor and metastatic lymph nodes after induction chemotherapy predicts overall survival in head and neck squamous cell carcinoma: a retrospective analysis.

Volumetric regression ratio of the primary tumor and metastatic lymph nodes after induction chemotherapy predicts overall survival in head and neck squamous cell carcinoma: a retrospective analysis.

J BUON. 2016 Jan-Mar;21(1):175-81

Authors: Elicin O, Schmucking M, Bromme J, Rauch D, Ambarcioglu P, Plasswilm L, Geretschlager A, Ghadjar P, Giger R, Aebersold DM

Abstract
PURPOSE: We looked for any predictive value of change in primary tumor and metastatic lymph node volumes after induction chemotherapy (IC) on oncologic outcome in head and neck squamous cell carcinoma (HNSCC).
METHODS: Nineteen patients with stage IVA/B HNSCC treated between 2004 and 2010 with at least one cycle of IC (docetaxel, cisplatin and 5-fluorouracil / TPF) and concomitant chemoradiotherapy (CRT) with cisplatin were retrospectively analyzed. Volumes were calculated separately for primary tumor (Vtm), lymph node metastases (Vln) and their sum (Vsum) on computed tomography (CT) images before and after IC. The effect of volumetric changes on locoregional failure (LRF), distant metastasis (DM) and overall survival (OS) was assessed. P values <0.05 were considered as statistically significant.
RESULTS: The median follow-up of surviving patients was 25 months (range: 10.7-83.3). The median number of cycles and duration of TPF was 3 (range: 1-4) and 44 days (range: 4-116), respectively. Empirical area under the curve (AUC) analyses for death, LRF and DM revealed optimal cut-off values of Vtm diminution (30.54%, AUC: 87%) and Vsum decrease (35.45%, AUC: 64.55%) only for OS (p <0.05). Among those, a reduction in Vsum more than 35.4% between pre- and post-IC was significantly correlated with better OS (100 vs 43% at 2 years, p <0.05).
CONCLUSION: Volumetric shrinkage of the tumor load after IC assessed with CT seems to predict OS. The assessment of volumetric shrinkage upon IC might be used to decide whether to offer patients alternative strategies like palliative/de-intensified treatments or more aggressive combined modalities after IC.

PMID: 27061546 [PubMed - in process]

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Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence.

Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence.

Head Neck. 2016 Apr 7;

Authors: Cho YY, Jang HW, Jang JY, Kim TH, Choe JH, Kim JH, Kim JS, Kim SW, Chung JH

Abstract
BACKGROUND: Persistent hypercalcitoninemia is reported in 40% to 60% of patients with medullary thyroid cancer (MTC) after initial therapy, but their clinical outcomes have not been clearly studied. We evaluated the outcomes of MTC with hypercalcitoninemia and assessed the cutoffs of postoperative serum calcitonin for predicting structural recurrence.
METHODS: A dynamic risk assessment system was used to categorize clinical outcomes in this retrospective study. Receiver operating characteristic (ROC) curve analysis was used to calculate the calcitonin cutoffs for predicting structural recurrence.
RESULTS: Among 120 patients operated on, 30 (25%) had persistent hypercalcitoninemia. Of that group, 18 (60%) had biochemical persistent disease and 11 (37%) developed structural identified disease, including 1 death (3%). Postoperative calcitonin <29 pg/mL predicted structural disease with 100% sensitivity, 90.5% specificity, and 100% negative predictive value.
CONCLUSION: One third of the patients with MTC with hypercalcitoninemia experienced structural recurrence, and postoperative basal serum calcitonin might be a simple tumor marker to predict structural recurrence. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062421 [PubMed - as supplied by publisher]

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Intraoperative Frozen Biopsy of Central Lymph Node in the Management of Papillary Thyroid Microcarcinoma.

Intraoperative Frozen Biopsy of Central Lymph Node in the Management of Papillary Thyroid Microcarcinoma.

Indian J Otolaryngol Head Neck Surg. 2016 Mar;68(1):56-59

Authors: Lee DH, Yoon TM, Kim HK, Lee JK, Kang HC, Lim SC

Abstract
The purpose of this study was to evaluate the usefulness and accuracy of intraoperative frozen section examination in the diagnosis of metastatic central lymph nodes in comparison to the final histopathological findings. A retrospective review was performed to evaluate patients with a preoperative diagnosis of papillary thyroid microcarcinoma (PTMC) and a plan to perform thyroid lobectomy at our Hospital from September 2011 to September 2013. Sixteen patients were identified. Intraoperative frozen section examination diagnosed ten patients as negative malignant cells of the central lymph node and the remaining six patients as metastatic central lymph node. The final histopathological results corresponded with intraoperative frozen section examination. Intraoperative frozen section examination had a sensitivity, specificity and accuracy of 100 % for diagnosing metastatic central lymph nodes of PTMC. Intraoperative frozen section examination of central lymph nodes is a useful and accurate adjunct for determining the operation method in PTMC.

PMID: 27066412 [PubMed - as supplied by publisher]

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Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma.

Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma.

Head Neck. 2016 Apr 7;

Authors: Ko HH, Cheng SL, Lee JJ, Chen HM, Wang CW, Cheng SJ, Kok SH

Abstract
BACKGROUND: Although second primary tumors are common in patients with oral squamous cell carcinoma (OSCC), their predisposing factors and treatment guideline remain uncertain.
METHODS: Three hundred ninety-four patients with OSCC who received radical surgery from January 2002 to December 2009 were retrospectively reviewed.
RESULTS: Forty-five patients developed oral second primary tumors. Areca quid chewing, tongue tumors, and nodal metastasis were risk factors for second primary tumors. Multivariate analyses revealed that no second primary tumor (hazard ratio [HR] = 5.046; 95% confidence interval [CI] = 3.704-12.246; p = .003), contralateral neck dissection for ipsilateral second primary tumors (HR = 6.254; 95% CI = 3.027-13.365; p = .007), and postoperative radiotherapy (RT; HR = 3.987; 95% CI = 1.099-10.381; p = .040) were independent favorable prognostic factors.
CONCLUSION: Areca quid chewing, tongue tumors, and nodal metastasis predisposed patients with OSCC to second primary tumor development. Elective dissection of the contralateral neck in patients with second primary tumors ipsilateral to index tumors and postoperative RT for eligible patients should always be considered in the management of oral second primary tumors. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061604 [PubMed - as supplied by publisher]

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Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck.

Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck.

Head Neck. 2016 Apr 9;

Authors: Miroir J, Biau J, Saroul N, Moreira JF, Russier M, Lapeyre M

Abstract
BACKGROUND: Perioperative brachytherapy after salvage surgery is a therapeutic option in patients with cervical relapse of a primary, controlled, previously irradiated head and neck squamous cell carcinoma. The purpose of this study was to analyze the outcome of this treatment.
METHODS: Between 2008 and 2013, 8 patients underwent cervical brachytherapy after neck dissection. The mean node size was 5.5 cm. Recurrence occurred in an irradiated field (median dose, 50 Gy). Brachytherapy was performed with (192) iridium and dosimetry in accord with the rules of the Paris system. The dose was 60 to 62.7 Gy on the reference isodose.
RESULTS: The mean follow-up was 17 months. The median overall survival (OS) was 12 months. The OS was 19% at 2 years and 0% at 5 years. A grade 5 postoperative adverse event occurred in 1 patient. At 6 months, all patients had a grade 3 neck soft tissue fibrosis. One patient had a lethal hemorrhage at 56 months.
CONCLUSION: Brachytherapy is toxic in this population with poor OS. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061855 [PubMed - as supplied by publisher]

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Printing of Three-Dimensional Tissue Analogs for Regenerative Medicine

Abstract

Three-dimensional (3-D) cell printing, which can accurately deposit cells, biomaterial scaffolds and growth factors in precisely defined spatial patterns to form biomimetic tissue structures, has emerged as a powerful enabling technology to create live tissue and organ structures for drug discovery and tissue engineering applications. Unlike traditional 3-D printing that uses metals, plastics and polymers as the printing materials, cell printing has to be compatible with living cells and biological matrix. It is also required that the printing process preserves the biological functions of the cells and extracellular matrix, and to mimic the cell–matrix architectures and mechanical properties of the native tissues. Therefore, there are significant challenges in order to translate the technologies of traditional 3-D printing to cell printing, and ultimately achieve functional outcomes in the printed tissues. So it is essential to develop new technologies specially designed for cell printing and in-depth basic research in the bioprinted tissues, such as developing novel biomaterials specifically for cell printing applications, understanding the complex cell–matrix remodeling for the desired mechanical properties and functional outcomes, establishing proper vascular perfusion in bioprinted tissues, etc. In recent years, many exciting research progresses have been made in the 3-D cell printing technology and its application in engineering live tissue constructs. This review paper summarized the current development in 3-D cell printing technologies; focus on the outcomes of the live printed tissues and their potential applications in drug discovery and regenerative medicine. Current challenges and limitations are highlighted, and future directions of 3-D cell printing technology are also discussed.

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State-of-the-Art Review of 3D Bioprinting for Cardiovascular Tissue Engineering

Abstract

3D bioprinting is a group of rapidly growing techniques that allows building engineered tissue constructs with complex and hierarchical structures, mechanical and biological heterogeneity. It enables implementation of various bioinks through different printing mechanisms and precise deposition of cell and/or biomolecule laden biomaterials in predefined locations. This review briefly summarizes applicable bioink materials and various bioprinting techniques, and presents the recent advances in bioprinting of cardiovascular tissues, with focusing on vascularized constructs, myocardium and heart valve conduits. Current challenges and further perspectives are also discussed to help guide the bioink and bioprinter development, improve bioprinting strategies and direct future organ bioprinting and translational applications.

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Osteogenic Treatment Initiating a Tissue-Engineered Cartilage Template Hypertrophic Transition

Abstract

Hypertrophic chondrocytes play a critical role in endochondral bone formation as well as the progress of osteoarthritis (OA). An in vitro cartilage hypertrophy model can be used as a platform to study complex molecular mechanisms involved in these processes and screen new drugs for OA. To develop an in vitro cartilage hypertrophy model, we treated a tissue-engineered cartilage template, living hyaline cartilaginous graft (LhCG), with osteogenic medium for hypertrophic induction. In addition, endothelial progenitor cells (EPCs) were seeded onto LhCG constructs to mimic vascular invasion. The results showed that osteogenic treatment significantly inhibited the synthesis of endostatin in LhCG constructs and enhanced expression of hypertrophic marker-collagen type X (Col X) and osteogenic markers, as well as calcium deposition in vitro. Upon subcutaneous implantation, osteogenic medium-treated LhCG constructs all stained positive for Col X and showed significant calcium deposition and blood vessel invasion. Col X staining and calcium deposition were most obvious in osteogenic medium-treated only group, while there was no difference between EPC-seeded and non-seeded group. These results demonstrated that osteogenic treatment was of the primary factor to induce hypertrophic transition of LhCG constructs and this model may contribute to the establishment of an in vitro cartilage hypertrophy model.

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An Invariant-Based Damage Model for Human and Animal Skins

Abstract

Constitutive modelling of skins that account for damage effects is important to provide insight for various clinical applications, such as skin trauma and injury, artificial skin design, skin aging, disease diagnosis, surgery, as well as comparative studies of skin biomechanics between species. In this study, a new damage model for human and animal skins is proposed for the first time. The model is nonlinear, anisotropic, invariant-based, and is based on the Gasser–Ogden–Holzapfel constitutive law initially developed for arteries. Taking account of the mean collagen fibre orientation and its dispersion, the new model can describe a wide range of skins with damage. The model is first tested on the uniaxial test data of human skin and then applied to nine groups of uniaxial test data for the human, swine, rabbit, bovine and rhino skins. The material parameters can be inversely estimated based on uniaxial tests using the optimization method in MATLAB with a root mean square error ranged between 2.15% and 12.18%. A sensitivity study confirms that the fibre orientation dispersion and the mean fibre angle are among the most important factors that influence the behaviour of the damage model. In addition, these two parameters can only be reliably estimated if some histological information is provided. We also found that depending on the location of skins, the tissue damage may be brittle controlled by the fibre breaking limit (i.e., when the fibre stretch is greater than 1.13–1.32, depending on the species), or ductile (due to both the fibre and the matrix damages). The brittle damages seem to occur mostly in the back, and the ductile damages are seen from samples taken from the belly. The proposed constitutive model may be applied to various clinical applications that require knowledge of the mechanical response of human and animal skins.

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Genetic signatures of Mycobacterium tuberculosis Nonthaburi genotype revealed by whole genome analysis of isolates from tuberculous meningitis patients in Thailand

Genome sequencing plays a key role in understanding the genetic diversity of Mycobacterium tuberculosis (M.tb). The genotype-specific character of M. tb contributes to tuberculosis severity and emergence of drug resistance. Strains of M. tb complex can be classified into seven lineages. The Nonthaburi (NB) genotype, belonging to the Indo-Oceanic lineage (lineage 1), has a unique spoligotype and IS6110-RFLP pattern but has not previously undergone a detailed whole genome analysis. In addition, there is not much information available on the whole genome analysis of M. tb isolates from tuberculous meningitis (TBM) patients in public databases. Isolates CSF3053, 46-5069 and 43-13838 of NB genotype were obtained from the cerebrospinal fluids of TBM Thai patients in Siriraj Hospital, Bangkok. The whole genomes were subjected to high throughput sequencing. The sequence data of each isolate were assembled into draft genome. The sequences were also aligned to reference genome, to determine genomic variations. Single nucleotide polymorphisms (SNPs) were obtained and grouped according to the functions of the genes containing them. They were compared with SNPs from 1,601 genomes, representing the seven lineages of M. tb complex, to determine the uniqueness of NB genotype. Susceptibility to first-line, second-line and other antituberculosis drugs were determined and related to the SNPs previously reported in drug-resistant related genes. The assembled genomes have an average size of 4,364,461 bp, 4,154 genes, 48 RNAs and 64 pseudogenes. A 500 base pairs deletion, which includes ppe50, was found in all isolates. RD239, specific for members of Indo Oceanic lineage, and RD147c were identified. A total of 2,202 SNPs were common to the isolates and used to classify the NB strains as members of sublineage 1.2.1. Compared with 1,601 genomes from the seven lineages of M. tb complex, mutation G2342203C was found novel to the isolates in this study. Three mutations (T28910C, C1180580T and C152178T) were found only in Thai NB isolates, including isolates from previous study. Although drug susceptibility tests indicated pan-susceptibility, non-synonymous SNPs previously reported to be associated with resistance to anti-tuberculous drugs; isoniazid, ethambutol, and ethionamide were identified in all the isolates. Non-synonymous SNPs were found in virulence genes such as the genes playing roles in apoptosis inhibition and phagosome arrest. We also report polymorphisms in essential genes, efflux pumps associated genes and genes with known epitopes. The analysis of the TBM isolates and the availability of the variations obtained will provide additional resources for global comparison of isolates from pulmonary tuberculosis and TBM. It will also contribute to the richness of genomic databases towards the prediction of antibiotic resistance, level of virulence and of origin of infection.

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Fine scale patterns of genetic partitioning in the rediscovered African crocodile, Crocodylus suchus (Saint-Hilaire 1807)

Landscape heterogeneity, phylogenetic history, and stochasticity all influence patterns of geneflow and connectivity in wild vertebrates. Fine-scale patterns of genetic partitioning may be particularly important for the sustainable management of widespread species in trade, such as crocodiles. We examined genetic variation within the rediscovered African crocodile, Crocodylus suchus, across its distribution in West and Central Africa. We genotyped 109 individuals at nine microsatellite loci from 16 sampling localities and used three Bayesian clustering techniques and an analysis of contemporary gene flow to identify population structure across the landscape. We identified up to eight genetic clusters that largely correspond to populations isolated in coastal wetland systems and across large distances. Crocodile population clusters from the interior were readily distinguished from coastal areas, which were further subdivided by distance and drainage basin. Migration analyses indicated contemporary migration only between closely positioned coastal populations. These findings indicate high levels of population structure throughout the range of C. suchus and we use our results to suggest a role for molecular tools in identifying crocodile conservation units for this species. Further research, including additional sampling throughout the Congo and Niger drainages, would clarify both the landscape connectivity and management of this species.

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Jaw anatomy of Potamogale velox (Tenrecidae, Afrotheria) with a focus on cranial arteries and the coronoid canal in mammals

Afrotheria is a strongly supported clade within placental mammals, but morphological synapomorphies for the entire group have only recently come to light. Soft tissue characters represent an underutilized source of data for phylogenetic analysis, but nonetheless provide features shared by some or all members of Afrotheria. Here, we investigate the developmental anatomy of Potamogale velox (Tenrecidae) with histological and computerized tomographic data at different ontogenetic ages, combined with osteological data from other mammals, to investigate patterns of cranial arterial supply and the distribution of the coronoid canal. Potamogale is atypical among placental mammals in exhibiting a small superior stapedial artery, a primary supply of the posterior auricular by the posterior stapedial artery, and the development of vascular plexuses (possibly with relevance for heat exchange) in the posterior and dorsal regions of its neck. In addition, the posterior aspect of Meckel's cartilage increases its medial deflection in larger embryonic specimens as the mandibular condyle extends mediolaterally during embryogenesis. We also map the distribution of the coronoid canal across mammals, and discuss potential confusion of this feature with alveoli of the posterior teeth. The widespread distribution of the coronoid canal among living and fossil proboscideans, sirenians, and hyracoids supports previous interpretations that a patent coronoid canal is a synapomorphy of paenungulates, but not afrotherians as a whole.

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The statistical properties of gene-set analysis

Nature Reviews Genetics. doi:10.1038/nrg.2016.29

Authors: Christiaan A. de Leeuw, Benjamin M. Neale, Tom Heskes & Danielle Posthuma

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Genetic screens: Combination screens for combination therapies

Nature Reviews Genetics. doi:10.1038/nrg.2016.52

Author: Darren J. Burgess

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Small RNAs: Regulating transgenerational epigenetics

Nature Reviews Genetics. doi:10.1038/nrg.2016.51

Author: Denise Waldron

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Synthetic biology: Automating genetic circuit design

Nature Reviews Genetics. doi:10.1038/nrg.2016.50

Author: Ross Cloney

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Genetic signatures of Mycobacterium tuberculosis Nonthaburi genotype revealed by whole genome analysis of isolates from tuberculous meningitis patients in Thailand

Genome sequencing plays a key role in understanding the genetic diversity of Mycobacterium tuberculosis (M.tb). The genotype-specific character of M. tb contributes to tuberculosis severity and emergence of drug resistance. Strains of M. tb complex can be classified into seven lineages. The Nonthaburi (NB) genotype, belonging to the Indo-Oceanic lineage (lineage 1), has a unique spoligotype and IS6110-RFLP pattern but has not previously undergone a detailed whole genome analysis. In addition, there is not much information available on the whole genome analysis of M. tb isolates from tuberculous meningitis (TBM) patients in public databases. Isolates CSF3053, 46-5069 and 43-13838 of NB genotype were obtained from the cerebrospinal fluids of TBM Thai patients in Siriraj Hospital, Bangkok. The whole genomes were subjected to high throughput sequencing. The sequence data of each isolate were assembled into draft genome. The sequences were also aligned to reference genome, to determine genomic variations. Single nucleotide polymorphisms (SNPs) were obtained and grouped according to the functions of the genes containing them. They were compared with SNPs from 1,601 genomes, representing the seven lineages of M. tb complex, to determine the uniqueness of NB genotype. Susceptibility to first-line, second-line and other antituberculosis drugs were determined and related to the SNPs previously reported in drug-resistant related genes. The assembled genomes have an average size of 4,364,461 bp, 4,154 genes, 48 RNAs and 64 pseudogenes. A 500 base pairs deletion, which includes ppe50, was found in all isolates. RD239, specific for members of Indo Oceanic lineage, and RD147c were identified. A total of 2,202 SNPs were common to the isolates and used to classify the NB strains as members of sublineage 1.2.1. Compared with 1,601 genomes from the seven lineages of M. tb complex, mutation G2342203C was found novel to the isolates in this study. Three mutations (T28910C, C1180580T and C152178T) were found only in Thai NB isolates, including isolates from previous study. Although drug susceptibility tests indicated pan-susceptibility, non-synonymous SNPs previously reported to be associated with resistance to anti-tuberculous drugs; isoniazid, ethambutol, and ethionamide were identified in all the isolates. Non-synonymous SNPs were found in virulence genes such as the genes playing roles in apoptosis inhibition and phagosome arrest. We also report polymorphisms in essential genes, efflux pumps associated genes and genes with known epitopes. The analysis of the TBM isolates and the availability of the variations obtained will provide additional resources for global comparison of isolates from pulmonary tuberculosis and TBM. It will also contribute to the richness of genomic databases towards the prediction of antibiotic resistance, level of virulence and of origin of infection.

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Fine scale patterns of genetic partitioning in the rediscovered African crocodile, Crocodylus suchus (Saint-Hilaire 1807)

Landscape heterogeneity, phylogenetic history, and stochasticity all influence patterns of geneflow and connectivity in wild vertebrates. Fine-scale patterns of genetic partitioning may be particularly important for the sustainable management of widespread species in trade, such as crocodiles. We examined genetic variation within the rediscovered African crocodile, Crocodylus suchus, across its distribution in West and Central Africa. We genotyped 109 individuals at nine microsatellite loci from 16 sampling localities and used three Bayesian clustering techniques and an analysis of contemporary gene flow to identify population structure across the landscape. We identified up to eight genetic clusters that largely correspond to populations isolated in coastal wetland systems and across large distances. Crocodile population clusters from the interior were readily distinguished from coastal areas, which were further subdivided by distance and drainage basin. Migration analyses indicated contemporary migration only between closely positioned coastal populations. These findings indicate high levels of population structure throughout the range of C. suchus and we use our results to suggest a role for molecular tools in identifying crocodile conservation units for this species. Further research, including additional sampling throughout the Congo and Niger drainages, would clarify both the landscape connectivity and management of this species.

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Jaw anatomy of Potamogale velox (Tenrecidae, Afrotheria) with a focus on cranial arteries and the coronoid canal in mammals

Afrotheria is a strongly supported clade within placental mammals, but morphological synapomorphies for the entire group have only recently come to light. Soft tissue characters represent an underutilized source of data for phylogenetic analysis, but nonetheless provide features shared by some or all members of Afrotheria. Here, we investigate the developmental anatomy of Potamogale velox (Tenrecidae) with histological and computerized tomographic data at different ontogenetic ages, combined with osteological data from other mammals, to investigate patterns of cranial arterial supply and the distribution of the coronoid canal. Potamogale is atypical among placental mammals in exhibiting a small superior stapedial artery, a primary supply of the posterior auricular by the posterior stapedial artery, and the development of vascular plexuses (possibly with relevance for heat exchange) in the posterior and dorsal regions of its neck. In addition, the posterior aspect of Meckel's cartilage increases its medial deflection in larger embryonic specimens as the mandibular condyle extends mediolaterally during embryogenesis. We also map the distribution of the coronoid canal across mammals, and discuss potential confusion of this feature with alveoli of the posterior teeth. The widespread distribution of the coronoid canal among living and fossil proboscideans, sirenians, and hyracoids supports previous interpretations that a patent coronoid canal is a synapomorphy of paenungulates, but not afrotherians as a whole.

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Magnetic resonance imaging findings in Guillain-Barré syndrome caused by Zika virus infection

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Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction

Abstract

Introduction

We aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions.

Methods

Fifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n = 15) and conventional CAS (n = 153) groups.

Results

The technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n = 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n = 31, 1036 ± 571 mGy) (p < 0.001). The mean duration of CAS procedure was not significantly different between the duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min).

Conclusion

Duplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.

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Investigation of the Impact of Art Therapy Methodology Applied to the Elderly Individuals with Dementia on Cognitive State

2016-04-12T01-52-11Z
Source: Journal of Contemporary Medicine
Serap Bulduk, Yeliz Dinçer, Esra Usta, Sevgi Bayram.
Purpose: Dementia is one of the most important health problems on a global scale. The fact that the treatment options and their effectiveness led to studies about enhancing the quality of life through non-pharmacological interventions. The impacts of the art therapy, one of such interventions, on the mood and cognitive features of the elderly with dementia has been investigated within the scope of various studies. In line with this, this study was conducted on 16 elderly individuals with slight dementia in order to investigate the impact of art therapy technique that is applied to the elderly on the cognitive state of elderly individuals with slight dementia as a quasi-experimental study. Material and method: The data of the study was collected through Individual Information Form, which was prepared by the researchers and the Standardized Mini-Mental Test (SMMT). During the study, Art Therapy was implemented by a researcher who received education on art using such techniques as painting, sculpture, painting objects-living things, collage, etc. Conclusion: The average age of the participants is 73.0±7.70. The mean score of the elderly from the SMMT before art therapy implementation is 21, while this figure is 20 three months after the implementation. These scores are in the reference interval of slight dementia For the SMMT and no significant change was observed following the implementation. Considering the progressive feature of the disease, the fact that the SMMT scores of the elderly did not regularly in small groups of elderly individuals with dementia, it becomes a significant acquisition for their socialization.


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Future Internet, Vol. 8, Pages 11: Environmental Factors Affecting Where People Geocache

Outdoor leisure activities are important for public health as well as family cohesiveness, yet environmental factors may easily affect someone's ability to participate in such activities. We explored this with a focus on the social web-based treasure hunt game called Geocaching. We collected data on all US and Canadian geocaches from OpenCaching.com and conducted an online survey with twenty geocachers as a follow-up to our data analysis. Data analysis showed that geocaches were more often found in areas that were wealthier, better educated, younger, and more urban, and had higher population density and better weather. Survey results showed similar trends: Most people actively thought about where they would cache and tried to minimize risks, despite cache hiders thinking less about these concerns. These results further emphasize the importance of environmental factors when it comes to participation in outdoor activities and leads to Human–Computer Interaction design implications for location-based online social activities.

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Polymers, Vol. 8, Pages 140: Supported Catalysts Useful in Ring-Closing Metathesis, Cross Metathesis, and Ring-Opening Metathesis Polymerization

Ruthenium and molybdenum catalysts are widely used in synthesis of both small molecules and macromolecules. While major developments have led to new increasingly active catalysts that have high functional group compatibility and stereoselectivity, catalyst/product separation, catalyst recycling, and/or catalyst residue/product separation remain an issue in some applications of these catalysts. This review highlights some of the history of efforts to address these problems, first discussing the problem in the context of reactions like ring-closing metathesis and cross metathesis catalysis used in the synthesis of low molecular weight compounds. It then discusses in more detail progress in dealing with these issues in ring opening metathesis polymerization chemistry. Such approaches depend on a biphasic solid/liquid or liquid separation and can use either always biphasic or sometimes biphasic systems and approaches to this problem using insoluble inorganic supports, insoluble crosslinked polymeric organic supports, soluble polymeric supports, ionic liquids and fluorous phases are discussed.

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C, Vol. 2, Pages 12: Graphene-Oxide Nano Composites for Chemical Sensor Applications

Of late, graphene has occupied the attention of almost all researchers working globally in the area of materials science. Graphene nanocomposites are the latest additions to the wonder applications of graphene. One of the promising applications of the graphene-oxide nanocomposites is chemical sensing which is useful for monitoring the toxicity, inflammability, and explosive nature of chemicals. Well known binary oxides like ZnO, TiO2, SnO2, WO3, and CuO when combined with graphene in the form of nanocomposites have excellent potential for detecting trace amounts of hazardous gases and chemicals. In this article the preparations, characterizations, and the chemical sensor applications of graphene-oxide nanocomposites are presented in detail.

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JCM, Vol. 5, Pages 46: First Time Seizure in the Setting of a Congenital Heart Abnormality and MCA Mycotic Aneurysms

A 37 year-old man presented to the Emergency Department (ED) with new onset seizure and fall from standing.[...]

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Marine Drugs, Vol. 14, Pages 75: Jellyfish Bioactive Compounds: Methods for Wet-Lab Work

The study of bioactive compounds from marine animals has provided, over time, an endless source of interesting molecules. Jellyfish are commonly targets of study due to their toxic proteins. However, there is a gap in reviewing successful wet-lab methods employed in these animals, which compromises the fast progress in the detection of related biomolecules. Here, we provide a compilation of the most effective wet-lab methodologies for jellyfish venom extraction prior to proteomic analysis—separation, identification and toxicity assays. This includes SDS-PAGE, 2DE, gel chromatography, HPLC, DEAE, LC-MS, MALDI, Western blot, hemolytic assay, antimicrobial assay and protease activity assay. For a more comprehensive approach, jellyfish toxicity studies should further consider transcriptome sequencing. We reviewed such methodologies and other genomic techniques used prior to the deep sequencing of transcripts, including RNA extraction, construction of cDNA libraries and RACE. Overall, we provide an overview of the most promising methods and their successful implementation for optimizing time and effort when studying jellyfish.

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IJERPH, Vol. 13, Pages 417: Frontal Cortex Transcriptome Analysis of Mice Exposed to Electronic Cigarettes During Early Life Stages

Electronic cigarettes (e-cigarettes), battery-powered devices containing nicotine, glycerin, propylene glycol, flavorings, and other substances, are increasing in popularity. They pose a potential threat to the developing brain, as nicotine is a known neurotoxicant. We hypothesized that exposure to e-cigarettes during early life stages induce changes in central nervous system (CNS) transcriptome associated with adverse neurobiological outcomes and long-term disease states. To test the hypothesis, pregnant C57BL/6 mice were exposed daily (via whole body inhalation) throughout gestation (3 h/day; 5 days/week) to aerosols produced from e-cigarettes either with nicotine (13–16 mg/mL) or without nicotine; following birth, pups and dams were exposed together to e-cigarette aerosols throughout lactation beginning at postnatal day (PND) 4–6 and using the same exposure conditions employed during gestational exposure. Following exposure, frontal cortex recovered from ~one-month-old male and female offspring were excised and analyzed for gene expression by RNA Sequencing (RNA-Seq). Comparisons between the treatment groups revealed that e-cigarette constituents other than nicotine might be partly responsible for the observed biological effects. Transcriptome alterations in both offspring sexes and treatment groups were all significantly associated with downstream adverse neurobiological outcomes. Results from this study demonstrate that e-cigarette exposure during early life alters CNS development potentially leading to chronic neuropathology.

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Religions, Vol. 7, Pages 39: A Commentary on Michael King. “The Challenge of Research into Religion and Spirituality.” Journal for the Study of Spirituality 4 (2014): 106–20

King's publication based on a key note presentation at the 2014 British Association of the Study of Spirituality (BASS) conference, a well written and thought provoking paper, leads us to consider the contribution of this critique of spirituality research to contemporary debates on the topic The views expressed within the paper are important and foster debate about the validity of research in the field of spirituality and religion. However, at the same time, this debate is reminiscent of the negative responses sometimes expressed about research publications in this field. At the same time, it must be recognised that there is a view held that there is an extra yard stick required for researchers in this field, who can be subjected to much higher standards and expectations than other researchers simply because of the topic and the deep seated conflicting views that advocates and critics hold. This paper considers the merits and challenges of this paper in light of this.

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The Minds Construction: The Ontology of Mind and Mental Action, by Matthew Soteriou.

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Reference and Existence, by Saul Kripke.

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Inhibition of Intestinal Thiamin Transport in Rat Model of Sepsis.

Objectives: Thiamin deficiency is highly prevalent in patients with sepsis, but the mechanism by which sepsis induces thiamin deficiency is unknown. This study aimed to determine the influence of various severity of sepsis on carrier-mediated intestinal thiamin uptake, level of expressions of thiamin transporters (thiamin transporter-1 and thiamin transporter-2), and mitochondrial thiamin pyrophosphate transporter. Design: Randomized controlled study. Setting: Research laboratory at a Veterans Affairs Medical Center. Subjects: Twenty-four Sprague-Dawley rats were randomized into controls, mild, moderate, and severe sepsis with equal number of animals in each group. Interventions: Sepsis was induced by cecal ligation and puncture with the cecum ligated below the cecal valve at 25%, 50%, and 75% of cecal length, defined as severe, moderate, and mild sepsis, respectively. Control animals underwent laparotomy only. Measurements and Main Results: After 2 days of induced sepsis, carrier-mediated intestinal thiamin uptake was measured using [3H]thiamin. Expressions of thiamin transporter-1, thiamin transporter-2, and mitochondrial thiamin pyrophosphate transporter proteins and messenger RNA were measured. Proinflammatory cytokines (interleukin-1[beta] and interleukin-6) and adenosine triphosphate were also measured. Sepsis inhibited [3H]thiamin uptake, and the inhibition was a function of sepsis severity. Both cell membrane thiamin transporters and mitochondrial thiamin pyrophosphate transporter expression levels were suppressed; also levels of adenosine triphosphate in the intestine of animals with moderate and severe sepsis were significantly lower than that of sham-operated controls. Conclusions: For the first time, we demonstrated that sepsis inhibited carrier-mediated intestinal thiamin uptake as a function of sepsis severity, suppressed thiamin transporters and mitochondrial thiamin pyrophosphate transporter, leading to adenosine triphosphate depletion. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Coping as a Multifaceted Construct: Associations With Psychological Outcomes Among Family Members of Mechanical Ventilation Survivors.

Objectives: To develop and evaluate a preliminary multifaceted model for coping among family members of patients who survive mechanical ventilation. Design and Setting: In this multicenter cross-sectional survey, we interviewed family members of mechanically ventilated patients at the time of transfer from the ICU to the hospital ward. We constructed a theoretic model of coping that included characteristics attributable to family members, family-clinician rapport, and patients. We then explored relationships between coping factors and symptoms of psychological distress (anxiety, depression, and posttraumatic stress). Subjects: Fifty-six family members of survivors of mechanical ventilation. Measurements and Main Results: Psychological distress measured by the Hospital Anxiety and Depression Scale and Posttraumatic Stress Scale. Optimism measured using the Life Orientation Test scale, resiliency by Conner-Davidson Resilience Scale, and social support using the Patient Reported Outcomes Measurement Information System inventory. Family members had moderate levels of psychological distress with median total Hospital Anxiety and Depression Scale equal to 14 (interquartile range, 5-20) and Posttraumatic Stress Scale equal to 22 (interquartile range, 15-31). Among family member characteristics, greater optimism (p = 0.001, Hospital Anxiety and Depression Scale; p = 0.010, Posttraumatic Stress Scale), resilience (p = 0.012, Hospital Anxiety and Depression Scale), and social support (p = 0.013, Hospital Anxiety and Depression Scale) were protective against psychological distress. On the contrary, characteristics of family-clinician rapport such as communication quality and presence of conflict did not have any associations with psychological distress. Conclusion: To our knowledge, this is the first study to explore coping as a multifaceted construct and its relationship with family psychological outcomes among survivors of mechanical ventilation. We found certain family characteristics of coping such as optimism, resilience, and social support to be associated with less psychological distress. Further research is warranted to identify potentially modifiable aspects of coping that might guide future interventions. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Paricalcitol Attenuates Cardiac Fibrosis and Expression of Endothelial Cell Transition Markers in Isoproterenol-Induced Cardiomyopathic Rats.

Objectives: Acute cardiomyopathy is a health problem worldwide. Few studies have shown an association between acute cardiomyopathy and low vitamin D status. Paricalcitol, a vitamin D receptor activator, clinically benefits patients with advanced kidney disease. The effect of paricalcitol supplement on cardiac remodeling in cardiomyopathic rats is unknown. This experimental study investigated the effect of paricalcitol in rats with cardiomyopathy induced by isoproterenol. Design: Prospective, randomized, controlled experimental study. Setting: Hospital-affiliated animal research institution. Subjects: Eight-week-old male Wistar-Kyoto rats. Interventions: Male Wistar-Kyoto rats were first injected intraperitoneally with isoproterenol to create a rat model of acute cardiomyopathy. Then paricalcitol was administered intraperitoneally to isoproterenol-injected rats at a dosage of 200 ng three times a week for 3 weeks. Relevant cardiomyopathy-related variables were measured regularly in three groups of rats, controls, isoproterenol, and isoproterenol plus paricalcitol. Rat hearts were obtained for evaluation of cardiac fibrosis using Masson trichrome staining and commercially available software, and evaluation of cell transition using immunofluorescence staining analysis. Measurements and Main Results: Isoproterenol infusions generated significant cardiac fibrosis (p

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Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: Bolus administration of opioids via a patient-controlled analgesia (PCA) device is widely used in the postoperative pediatric population. PCA devices have been shown to provide superior analgesia and greater patient satisfaction compared with intermittent administration. Studies comparing the efficacy of PCA with and without a background infusion for postoperative analgesia in children vary considerably in terms of dosing and methodologic quality, making it difficult for practitioners to derive clinically useful information. The purpose of this meta-analysis was to assess whether the addition of a background infusion to PCA bolus administration of an opioid analgesic is more effective (defined as lower pain scores) than PCA bolus alone in the postoperative population specific to children. METHODS: We searched Medline, Embase, and CENTRAL from inception to January 2015 for registered and ongoing trials included in the meta-Register of Controlled Trials and ClinicalTrials.gov, and reference lists of review articles and included articles. Study selection was randomized controlled studies comparing PCA bolus with PCA bolus plus background infusion for postoperative analgesia in children aged 0 to 18 years and adolescents aged 13 to 21 years undergoing any form of surgery that used patient-reported pain scores as an outcome measure. Two reviewers independently extracted data on patient and study characteristics, interventions, and outcomes from included studies using standardized data extraction forms. Seven trials met our eligibility criteria. Data were analyzed using Review Manager version 5.3. Meta-analyses were performed for outcomes that were defined similarly and reported in 2 or more studies, including patient-reported pain scores, nausea and/or vomiting, sedation, and opioid consumption. We independently assessed the risk of bias for each outcome and the certainty in the estimates of effect for critically important outcomes (pain scores, nausea and/or vomiting, excessive sedation) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Subgroup analyses based on dose of background infusion (high versus low dose) and risk of bias (low versus high/unclear) were performed. RESULTS: There were no significant differences found with respect to pain scores 12 and 24 hours after surgery, opioid consumption, or risk of adverse events with the addition of a background opioid infusion to PCA opioid bolus doses. The quality of the evidence was deemed to be low to very low. CONCLUSIONS: There was no significant difference in outcomes with the addition of an opioid background infusion to PCA bolus doses of opioid. Further high-quality studies are required. (C) 2016 International Anesthesia Research Society

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What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Abouzayd M, Smith PF, Moreau S, Hitier M

Abstract
Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.

PMID: 27059840 [PubMed - as supplied by publisher]

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A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials.

A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Lou ZC

PMID: 27059839 [PubMed - as supplied by publisher]

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Concerning: Subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy (Wu SH et al., Eur Arch Otorhinolaryngol. 2015;272(11):3295-8. doi:10.1007/s00405-014-2991-9. Epub 2014 Mar 12).

Concerning: Subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy (Wu SH et al., Eur Arch Otorhinolaryngol. 2015;272(11):3295-8. doi:10.1007/s00405-014-2991-9. Epub 2014 Mar 12).

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Wittekindt C, Kroll T

PMID: 27059838 [PubMed - as supplied by publisher]

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The challenges of implementing electronic health records for anesthesia use outside the operating room.

Purpose of review: The nonoperating room environment presents a number of distinct challenges for anesthesiologists in the implementation of electronic health records (EHRs). These include documentation compliance, billing, and room design. Recent findings: EHRs offer multiple opportunities for improved continuity of care, expedited preoperative evaluation, and seamless transitions between anesthesia and nonanesthesia providers. Additionally, data gathered through adoption of EHRs provide the promise of future analysis and research, allowing for data-driven improvements in quality of care and value optimization. Institutions adopting a new EHR in areas where anesthesia is provided outside of the operating room should plan wisely to address these matters. Summary: The needs of anesthesiology practice should be carefully incorporated into future EHR builds as demands for anesthesia care outside of the operating room expand. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Kappa Opioid Receptor is Co-localized in GnRH and KNDy Cells in the Female Ovine and Rat Brain

Endocrinology, Early Release.


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Finding the pathogen in community-acquired pneumonia

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Applied Sciences, Vol. 6, Pages 107: Methods of In-Process On-Machine Auto-Inspection of Dimensional Error and Auto-Compensation of Tool Wear for Precision Turning

The purpose of this study is mainly to develop an information and communication technology (ICT)-based intelligent dimension inspection and tool wear compensation method for precision tuning. With the use of vibration signal processing/characteristics analysis technology combined with ICT, statistical analysis, and diagnosis algorithms, the method can be used to proceed with an on-line dimension inspection and on-machine tool wear auto-compensation for the turning process. Meanwhile, the method can also monitor critical tool life to identify the appropriate time for cutter replacement to reduce machining costs and improve the production efficiency of the turning process. Compared to the traditional ways, the method offers the advantages of requiring less manpower, and having better production efficiency, high tool life, fewer scrap parts, and low costs for inspection instruments. Algorithms and diagnosis threshold values for the detection, cutter wear compensation, and cutter life monitoring were developed. In addition, a bilateral communication module utilizing FANUC Open CNC (computer numerical control) Application Programming Interface (API) Spec was developed for the on-line extraction of instant NC (numerical control) codes for monitoring and transmit commands to CNC controllers for cutter wear compensation. With use of local area networks (LAN) to deliver the detection and correction information, the proposed method was able to remotely control the on-machine monitoring process and upload the machining and inspection data to a remote central platform for further production optimization. The verification experiments were conducted on a turning production line. The results showed that the system provided 93% correction for size inspection and 100% correction for cutter wear compensation.

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A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome

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A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome

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Energies, Vol. 9, Pages 280: Simultaneous Fault Detection and Sensor Selection for Condition Monitoring of Wind Turbines

Data collected from the supervisory control and data acquisition (SCADA) system are used widely in wind farms to obtain operation and performance information about wind turbines. The paper presents a three-way model by means of parallel factor analysis (PARAFAC) for wind turbine fault detection and sensor selection, and evaluates the method with SCADA data obtained from an operational farm. The main characteristic of this new approach is that it can be used to simultaneously explore measurement sample profiles and sensors profiles to avoid discarding potentially relevant information for feature extraction. With K-means clustering method, the measurement data indicating normal, fault and alarm conditions of the wind turbines can be identified, and the sensor array can be optimised for effective condition monitoring.

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