Erratum to: Are the motor features of verb meanings represented in the precentral motor cortices? Yes, but within the context of a flexible, multilevel architecture for conceptual knowledge.
Psychon Bull Rev. 2016 Jun 9;
Authors: Kemmerer D
PMID: 27282992 [PubMed - as supplied by publisher]
Neurobiology of Everyday Communication: What Have We Learned From Music?
Neuroscientist. 2016 Jun 9;
Authors: Kraus N, White-Schwoch T
Abstract
Sound is an invisible but powerful force that is central to everyday life. Studies in the neurobiology of everyday communication seek to elucidate the neural mechanisms underlying sound processing, their stability, their plasticity, and their links to language abilities and disabilities. This sound processing lies at the nexus of cognitive, sensorimotor, and reward networks. Music provides a powerful experimental model to understand these biological foundations of communication, especially with regard to auditory learning. We review studies of music training that employ a biological approach to reveal the integrity of sound processing in the brain, the bearing these mechanisms have on everyday communication, and how these processes are shaped by experience. Together, these experiments illustrate that music works in synergistic partnerships with language skills and the ability to make sense of speech in complex, everyday listening environments. The active, repeated engagement with sound demanded by music making augments the neural processing of speech, eventually cascading to listening and language. This generalization from music to everyday communications illustrates both that these auditory brain mechanisms have a profound potential for plasticity and that sound processing is biologically intertwined with listening and language skills. A new wave of studies has pushed neuroscience beyond the traditional laboratory by revealing the effects of community music training in underserved populations. These community-based studies reinforce laboratory work highlight how the auditory system achieves a remarkable balance between stability and flexibility in processing speech. Moreover, these community studies have the potential to inform health care, education, and social policy by lending a neurobiological perspective to their efficacy.
PMID: 27284021 [PubMed - as supplied by publisher]
 | Related Articles |
Head and neck cancer patients' perceptions of swallowing following chemoradiotherapy.
Support Care Cancer. 2015 Dec;23(12):3531-8
Authors: Patterson JM, McColl E, Wilson J, Carding P, Rapley T
Abstract
PURPOSE: The study aims to describe patients' experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time.
METHODS: A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data.
RESULTS: Patients' reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0-3 months) and late (6-18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle.
CONCLUSIONS: Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.
PMID: 25851803 [PubMed - indexed for MEDLINE]
Developmental Screening-Evaluation of an m-Health Version of the Parents Evaluation Developmental Status Tools.
Telemed J E Health. 2016 Jun 10;
Authors: Maleka BK, Van Der Linde J, Glascoe FP, Swanepoel W
Abstract
BACKGROUND: Developmental delays are more prevalent in low-income countries and access to developmental screening is severely limited.
INTRODUCTION: This study evaluated an m-Health version of a standard developmental screening tool, Parents Evaluation Developmental Status (PEDS) and PEDS:Developmental Milestones (PEDS:DM) for use by community health workers (CHWs) in terms of (1) correspondence with conventional paper-based testing by a speech language pathologist (SLP) and (2) inter-rater reliability compared to an SLP.
METHOD: CHWs were trained in a primary healthcare (PHC) setting to administer the newly developed smartphone application version of the PEDS tools. One SLP and two CHWs recruited 207 caregivers who were attending a baby wellness clinic. Caregivers were tested by one CHW using the smartphone application of the PEDS tools; a qualified SLP simultaneously recorded and scored the PEDS tools on the same participants.
RESULTS: High positive (100%) and negative correspondence (96%) was found between the paper-based PEDS tools and the smartphone application PEDS tools and between the SLP and CHW. Almost perfect (Cohen's Kappa) inter-rater agreement between conditions was demonstrated (κ = 0.873 to κ = 0.961).
CONCLUSION: Outcomes of the smartphone application, operated by a CHW, corresponded closely to the gold standard PEDS tools operated by a health professional. Trained CHWs can conduct accurate developmental screening using the smartphone version of the PEDS tools.
PMID: 27286191 [PubMed - as supplied by publisher]
10.1080/09553002.2016.1186303<br/>Aleksey V. Larionov
from #ORL-Sfakianakis via xlomafota13 on Inoreader http://ift.tt/1XNBkL2
via IFTTT
Related Articles
Oral melanocytic nevi: a clinicopathologic study of 100 cases.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Sep;120(3):358-67
Authors: Ferreira L, Jham B, Assi R, Readinger A, Kessler HP
Abstract
OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of oral melanocytic nevi (OMN).
STUDY DESIGN: One hundred cases of OMN were retrieved from the files of two oral pathology services, and the data were analyzed with regard to histologic type and clinical features.
RESULTS: Intramucosal nevus was the most common type (61%), followed by common blue nevus (23%), compound nevus (7%), and junctional nevus (3%). Combined nevus and cellular blue nevus were rare (2% each). The hard palate was the most commonly affected site (33%), followed by the buccal mucosa (18%), vermilion border of the lip (18%), and gingiva (15%). An interesting case of intramucosal nevus with lipomatosus-like changes and neurotization and two cases of oral dysplastic nevus are also reported.
CONCLUSIONS: Intramucosal and common blue nevi are the most common types of OMN. Dysplastic nevus, which is recognized as a marker for melanoma in the skin, can rarely involve the oral cavity. Accordingly, dentists, especially oral and maxillofacial pathologists, should become familiar with the clinical and histopathologic features of this entity.
PMID: 26297393 [PubMed - indexed for MEDLINE]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
MiR-7a is an important mediator in Fas-associated protein with death domain (FADD)-regulated expression of focal adhesion kinase (FAK).
Oncotarget. 2016 Jun 6;
Authors: Liu Y, Cui H, Huang X, Zhu B, Guan S, Cheng W, Lai Y, Zhang X, Hua ZC
Abstract
Fas-associated protein with death domain (FADD), a classical adaptor protein mediating apoptotic stimuli-induced cell death, has been reported to engage in several non-apoptotic processes such as T cell and cardiac development and tumorigenesis. Recently, there are several reports about the FADD's involvement in cell migration, however the underlying mechanism remains elusive. Here, we present a new finding that FADD could regulate the expression of FAK, a non-receptor protein tyrosine kinase overexpressed in many cancers, and played an important role in cell migration in murine MEF and melanoma cells with different metastatic potential, B16F10 and B16F1. Moreover, miR-7a, a tumor suppressor which prohibits cell migration and invasion, was up-regulated in FADD-deficient cells. And FAK was verified to be the direct target gene of miR-7a in B16F10 cells. Furthermore, we demonstrate that miR-7a was a necessary mediator in FADD-regulated FAK expression. In contrast to its classical apoptotic role, FADD interference could reduce the rate of cell migration, which could be rescued by inhibiting miR-7a expression. Taken together, our data provide a novel explanation regarding how FADD regulates cell migration in murine melanoma cells.
PMID: 27286445 [PubMed - as supplied by publisher]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
Injection of Syngeneic Murine Melanoma Cells to Determine Their Metastatic Potential in the Lungs.
J Vis Exp. 2016;(111)
Authors: Timmons JJ, Cohessy S, Wong ET
Abstract
Approximately 90% of human cancer deaths are linked to metastasis. Despite the prevalence and relative harm of metastasis, therapeutics for treatment or prevention are lacking. We report a method for the establishment of pulmonary metastases in mice, useful for the study of this phenomenon. Tail vein injection of B57BL/6J mice with B16-BL6 is among the most used models for melanoma metastases. Some of the circulating tumor cells establish themselves in the lungs of the mouse, creating "experimental" metastatic foci. With this model it is possible to measure the relative effects of therapeutic agents on the development of cancer metastasis. The difference in enumerated lung foci between treated and untreated mice indicates the efficacy of metastases neutralization. However, prior to the investigation of a therapeutic agent, it is necessary to determine an optimal number of injected B16-BL6 cells for the quantitative analysis of metastatic foci. Injection of too many cells may result in an overabundance of metastatic foci, impairing proper quantification and overwhelming the effects of anti-cancer therapies, while injection of too few cells will hinder the comparison between treated and controls.
PMID: 27285567 [PubMed - as supplied by publisher]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
The National Institute for Health and Care Excellence (NICE) invited the manufacturer of vortioxetine (Lundbeck) to submit clinical and cost-effectiveness evidence for vortioxetine for the treatment of major depressive episodes (MDEs), as part of the Institute's Single Technology Appraisal (STA) process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA367 issued in November 2015. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. Two phase III randomised controlled trials for a second-line population involving vortioxetine were identified—REVIVE and TAK318. These two trials represent only 972 of over 7000 patients included in trials of vortioxetine. In REVIVE, there was a statistically significant difference in depression scores favouring vortioxetine compared with agomelatine [mean Montgomery–Åsberg Depression Rating Scale (MADRS) score difference of 2.16 points; 95 % confidence interval 0.81–3.51]. The ERG concluded that, based on all the evidence, rather than the substantially restricted subset of evidence originally considered by the manufacturer, vortioxetine is likely to be similar in efficacy to other analysed antidepressants [citalopram, sertraline, escitalopram and venlafaxine extended release (XR)], and may be more efficacious than agomelatine and inferior to duloxetine. The ERG concluded that vortioxetine may be more tolerable than other analysed antidepressants (sertraline, venlafaxine XR and bupropion), although the limited data prevent firm conclusions. The base-case incremental cost-effectiveness ratio (ICER) of vortioxetine reported by the manufacturer was £378 per quality-adjusted life-year (QALY) compared with venlafaxine. Given considerable concerns about the indirect treatment comparison undertaken by the manufacturer, the use of only a restrictive subset of the available evidence, and concerns regarding comparators and structural model assumptions, the ERG believes that this is not a valid estimate of the cost effectiveness of vortioxetine. Following corrections made to the model made by the ERG, the estimated cost effectiveness of vortioxetine was sensitive to the source of evidence used, in addition to whether certain comparators were excluded. The NICE thus asked the manufacturer to provide a revised economic model, which incorporated the broader evidence base and considered the cost effectiveness of vortioxetine as a third-line treatment. Assuming equal efficacy, vortioxetine was shown to be less costly and generate a higher QALY gain than relevant comparators at the third-line of treatment owing to its tolerability and adverse event profile. The NICE Appraisal Committee recommended vortioxetine as an option for treating MDEs in adults whose condition has responded inadequately to two antidepressants within the current episode.
from Cancer via ola Kala on Inoreader
via IFTTT
Small caliber covered self-expanding metal stents in the management of malignant dysphagia.
J Gastrointest Oncol. 2016 Jun;7(3):411-9
Authors: Kucera S, Barthel J, Klapman J, Shridhar R, Hoffe S, Harris C, Almhanna K, Meredith K
Abstract
BACKGROUND: Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia.
METHODS: Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death through May 2011.
RESULTS: DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases.
CONCLUSIONS: In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.
PMID: 27284474 [PubMed]
| Related Articles |
Head and neck cancer patients' perceptions of swallowing following chemoradiotherapy.
Support Care Cancer. 2015 Dec;23(12):3531-8
Authors: Patterson JM, McColl E, Wilson J, Carding P, Rapley T
Abstract
PURPOSE: The study aims to describe patients' experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time.
METHODS: A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data.
RESULTS: Patients' reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0-3 months) and late (6-18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle.
CONCLUSIONS: Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.
PMID: 25851803 [PubMed - indexed for MEDLINE]
 | Related Articles |
Current views on chronic rejection after lung transplantation.
Transpl Int. 2015 Oct;28(10):1131-9
Authors: Verleden GM, Vos R, Vanaudenaerde B, Dupont L, Yserbyt J, Van Raemdonck D, Verleden S
Abstract
Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.
PMID: 25857869 [PubMed - indexed for MEDLINE]
Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls.
Onco Targets Ther. 2016;9:3025-30
Authors: Lu YF, Lin YC, Chen KH, Shueng PW, Yeh HP, Hsieh CH
Abstract
Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm(3). The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis.
PMID: 27284253 [PubMed]
  | Related Articles |
Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?
Trials. 2015;16:395
Authors: Van Nuffelen G, Van den Steen L, Vanderveken O, Specenier P, Van Laer C, Van Rompaey D, Guns C, Mariën S, Peeters M, Van de Heyning P, Vanderwegen J, De Bodt M
Abstract
BACKGROUND: Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply.
METHODS/DESIGN: This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires.
DISCUSSION: This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN14447678.
PMID: 26340887 [PubMed - indexed for MEDLINE]
Prurigo nodularis (PN) is a chronic dermatoses characterized by intensely pruritic, excoriated, or lichenified nodules. Standard therapy includes corticosteroids, antihistamines, and phototherapy; however, treatment results are often inadequate or transient. Thalidomide and its analogue lenalidomide are immunomodulatory drugs that have successfully been used to treat refractory cases of PN. A systematic review was performed evaluating the use of thalidomide and lenalidomide for PN. Eighteen articles were included in this study in which a total of 106 patients were evaluated, of whom 76 (71.7%) had moderate to significant improvement of PN with the use of thalidomide, lenalidomide, or both. Patients given thalidomide were treated with doses of 50–300 mg daily for 1–142 months, with the majority being treated for less than 1 year. Patients treated with lenalidomide were given a daily dose of 5–10 mg from 3 to 24 months. The most common side effects observed were sedation, gastrointestinal symptoms, and transient peripheral neuropathy. While thalidomide and lenalidomide are drugs that have shown promising results in these studies, caution should be taken in prescribing these medications and patients should be informed about the potential side effects. As such, large-scale randomized controlled trials with long-term follow-up are needed to determine appropriate dosing, efficacy, and toxicity profiles.
| Related Articles |
[Function preserving gastrectomy].
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Feb;19(2):233-7
Authors: Xu D, Xu J, Zhu C, Li M, Zhao E, Yu F, Zhao G, Cao H
Abstract
Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
PMID: 26831890 [PubMed - indexed for MEDLINE]
 | Related Articles |
Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
Eur J Intern Med. 2015 Sep;26(7):534-9
Authors: You ZH, Perng CL, Hu LY, Lu T, Chen PM, Yang AC, Tsai SJ, Huang YS, Chen HJ
Abstract
BACKGROUND: Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
OBJECTIVE: We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
METHODS: We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
RESULTS: The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
CONCLUSIONS: GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
PMID: 26021838 [PubMed - indexed for MEDLINE]
Related Articles
Oral melanocytic nevi: a clinicopathologic study of 100 cases.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Sep;120(3):358-67
Authors: Ferreira L, Jham B, Assi R, Readinger A, Kessler HP
Abstract
OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of oral melanocytic nevi (OMN).
STUDY DESIGN: One hundred cases of OMN were retrieved from the files of two oral pathology services, and the data were analyzed with regard to histologic type and clinical features.
RESULTS: Intramucosal nevus was the most common type (61%), followed by common blue nevus (23%), compound nevus (7%), and junctional nevus (3%). Combined nevus and cellular blue nevus were rare (2% each). The hard palate was the most commonly affected site (33%), followed by the buccal mucosa (18%), vermilion border of the lip (18%), and gingiva (15%). An interesting case of intramucosal nevus with lipomatosus-like changes and neurotization and two cases of oral dysplastic nevus are also reported.
CONCLUSIONS: Intramucosal and common blue nevi are the most common types of OMN. Dysplastic nevus, which is recognized as a marker for melanoma in the skin, can rarely involve the oral cavity. Accordingly, dentists, especially oral and maxillofacial pathologists, should become familiar with the clinical and histopathologic features of this entity.
PMID: 26297393 [PubMed - indexed for MEDLINE]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
MiR-7a is an important mediator in Fas-associated protein with death domain (FADD)-regulated expression of focal adhesion kinase (FAK).
Oncotarget. 2016 Jun 6;
Authors: Liu Y, Cui H, Huang X, Zhu B, Guan S, Cheng W, Lai Y, Zhang X, Hua ZC
Abstract
Fas-associated protein with death domain (FADD), a classical adaptor protein mediating apoptotic stimuli-induced cell death, has been reported to engage in several non-apoptotic processes such as T cell and cardiac development and tumorigenesis. Recently, there are several reports about the FADD's involvement in cell migration, however the underlying mechanism remains elusive. Here, we present a new finding that FADD could regulate the expression of FAK, a non-receptor protein tyrosine kinase overexpressed in many cancers, and played an important role in cell migration in murine MEF and melanoma cells with different metastatic potential, B16F10 and B16F1. Moreover, miR-7a, a tumor suppressor which prohibits cell migration and invasion, was up-regulated in FADD-deficient cells. And FAK was verified to be the direct target gene of miR-7a in B16F10 cells. Furthermore, we demonstrate that miR-7a was a necessary mediator in FADD-regulated FAK expression. In contrast to its classical apoptotic role, FADD interference could reduce the rate of cell migration, which could be rescued by inhibiting miR-7a expression. Taken together, our data provide a novel explanation regarding how FADD regulates cell migration in murine melanoma cells.
PMID: 27286445 [PubMed - as supplied by publisher]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
Injection of Syngeneic Murine Melanoma Cells to Determine Their Metastatic Potential in the Lungs.
J Vis Exp. 2016;(111)
Authors: Timmons JJ, Cohessy S, Wong ET
Abstract
Approximately 90% of human cancer deaths are linked to metastasis. Despite the prevalence and relative harm of metastasis, therapeutics for treatment or prevention are lacking. We report a method for the establishment of pulmonary metastases in mice, useful for the study of this phenomenon. Tail vein injection of B57BL/6J mice with B16-BL6 is among the most used models for melanoma metastases. Some of the circulating tumor cells establish themselves in the lungs of the mouse, creating "experimental" metastatic foci. With this model it is possible to measure the relative effects of therapeutic agents on the development of cancer metastasis. The difference in enumerated lung foci between treated and untreated mice indicates the efficacy of metastases neutralization. However, prior to the investigation of a therapeutic agent, it is necessary to determine an optimal number of injected B16-BL6 cells for the quantitative analysis of metastatic foci. Injection of too many cells may result in an overabundance of metastatic foci, impairing proper quantification and overwhelming the effects of anti-cancer therapies, while injection of too few cells will hinder the comparison between treated and controls.
PMID: 27285567 [PubMed - as supplied by publisher]
from Melanoma2 via ola Kala on Inoreader
via IFTTT
The National Institute for Health and Care Excellence (NICE) invited the manufacturer of vortioxetine (Lundbeck) to submit clinical and cost-effectiveness evidence for vortioxetine for the treatment of major depressive episodes (MDEs), as part of the Institute's Single Technology Appraisal (STA) process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA367 issued in November 2015. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. Two phase III randomised controlled trials for a second-line population involving vortioxetine were identified—REVIVE and TAK318. These two trials represent only 972 of over 7000 patients included in trials of vortioxetine. In REVIVE, there was a statistically significant difference in depression scores favouring vortioxetine compared with agomelatine [mean Montgomery–Åsberg Depression Rating Scale (MADRS) score difference of 2.16 points; 95 % confidence interval 0.81–3.51]. The ERG concluded that, based on all the evidence, rather than the substantially restricted subset of evidence originally considered by the manufacturer, vortioxetine is likely to be similar in efficacy to other analysed antidepressants [citalopram, sertraline, escitalopram and venlafaxine extended release (XR)], and may be more efficacious than agomelatine and inferior to duloxetine. The ERG concluded that vortioxetine may be more tolerable than other analysed antidepressants (sertraline, venlafaxine XR and bupropion), although the limited data prevent firm conclusions. The base-case incremental cost-effectiveness ratio (ICER) of vortioxetine reported by the manufacturer was £378 per quality-adjusted life-year (QALY) compared with venlafaxine. Given considerable concerns about the indirect treatment comparison undertaken by the manufacturer, the use of only a restrictive subset of the available evidence, and concerns regarding comparators and structural model assumptions, the ERG believes that this is not a valid estimate of the cost effectiveness of vortioxetine. Following corrections made to the model made by the ERG, the estimated cost effectiveness of vortioxetine was sensitive to the source of evidence used, in addition to whether certain comparators were excluded. The NICE thus asked the manufacturer to provide a revised economic model, which incorporated the broader evidence base and considered the cost effectiveness of vortioxetine as a third-line treatment. Assuming equal efficacy, vortioxetine was shown to be less costly and generate a higher QALY gain than relevant comparators at the third-line of treatment owing to its tolerability and adverse event profile. The NICE Appraisal Committee recommended vortioxetine as an option for treating MDEs in adults whose condition has responded inadequately to two antidepressants within the current episode.
from Cancer via ola Kala on Inoreader
via IFTTT
Small caliber covered self-expanding metal stents in the management of malignant dysphagia.
J Gastrointest Oncol. 2016 Jun;7(3):411-9
Authors: Kucera S, Barthel J, Klapman J, Shridhar R, Hoffe S, Harris C, Almhanna K, Meredith K
Abstract
BACKGROUND: Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia.
METHODS: Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death through May 2011.
RESULTS: DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases.
CONCLUSIONS: In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.
PMID: 27284474 [PubMed]
| Related Articles |
Head and neck cancer patients' perceptions of swallowing following chemoradiotherapy.
Support Care Cancer. 2015 Dec;23(12):3531-8
Authors: Patterson JM, McColl E, Wilson J, Carding P, Rapley T
Abstract
PURPOSE: The study aims to describe patients' experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time.
METHODS: A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data.
RESULTS: Patients' reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0-3 months) and late (6-18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle.
CONCLUSIONS: Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.
PMID: 25851803 [PubMed - indexed for MEDLINE]
| Related Articles |
Current views on chronic rejection after lung transplantation.
Transpl Int. 2015 Oct;28(10):1131-9
Authors: Verleden GM, Vos R, Vanaudenaerde B, Dupont L, Yserbyt J, Van Raemdonck D, Verleden S
Abstract
Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.
PMID: 25857869 [PubMed - indexed for MEDLINE]
Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls.
Onco Targets Ther. 2016;9:3025-30
Authors: Lu YF, Lin YC, Chen KH, Shueng PW, Yeh HP, Hsieh CH
Abstract
Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm(3). The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis.
PMID: 27284253 [PubMed]
| | Related Articles |
Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?
Trials. 2015;16:395
Authors: Van Nuffelen G, Van den Steen L, Vanderveken O, Specenier P, Van Laer C, Van Rompaey D, Guns C, Mariën S, Peeters M, Van de Heyning P, Vanderwegen J, De Bodt M
Abstract
BACKGROUND: Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply.
METHODS/DESIGN: This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires.
DISCUSSION: This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN14447678.
PMID: 26340887 [PubMed - indexed for MEDLINE]
Anti-U3 ribonucleoprotein antibody-positive inflammatory myopathy: a case report.
J Med Case Rep. 2016;10:169
Authors: Murata KY, Nakatani K, Yananeki M, Nakanishi I, Ito H
Abstract
BACKGROUND: The discovery of myositis-specific autoantibodies and myositis-associated autoantibodies has led to a new serological classification. Human U3 RNP, which consists of the U3 small nucleolar RNA and anti-U3 RNP antibody, is directed against one of the subunits. Anti-U3 RNP antibodies have been detected in 5-8 % of patients with systemic sclerosis, and antibody-positive patients with systemic sclerosis have shown more frequent skeletal muscle involvement than that of antibody-negative patients with systemic sclerosis.
CASE PRESENTATION: A 74-year-old Japanese man positive for anti-U3 RNP antibody was referred to our hospital because of gait disturbance and dysphagia. His serum myoglobin and creatine kinase levels were elevated, and myopathic changes were observed in his proximal legs by needle electromyography. A muscle biopsy was performed at the quadriceps femoris muscle, which showed high signal intensity on fat-suppressed and T2-weighted magnetic resonance images. The patient was diagnosed with probable polymyositis because CD8-positive lymphocytes had invaded only the endomysium and not into the muscle fibers. Severe proliferation of the interstitial connective tissue and edematous changes were observed. Oral prednisolone therapy was started, and the patient's muscle weakness of the proximal limbs improved remarkably within 1 month. Dysphagia caused by incomplete function of the cricopharyngeal muscle persisted for 5 years.
CONCLUSIONS: Our findings indicate that mild muscle weakness with steroid-resistant dysphagia may be a clinical feature of patients with anti-U3 RNP antibody-positive inflammatory myopathy.
PMID: 27283724 [PubMed - in process]
Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy.
J Laparoendosc Adv Surg Tech A. 2016 Jun 10;
Authors: Andolfi C, Kavitt RT, Herbella FA, Patti MG
Abstract
BACKGROUND: Dysphagia and regurgitation are considered typical symptoms of achalasia. However, there is mounting evidence that some achalasia patients may also experience respiratory symptoms such as cough, wheezing, and hoarseness.
AIMS: The aims of this study were to determine: (1) what percentage of achalasia patients experience respiratory symptoms and (2) the effect of a laparoscopic Heller myotomy and Dor fundoplication on the typical and respiratory symptoms of achalasia.
PATIENTS AND METHODS: Between May 2008 and December 2015, 165 patients with achalasia were referred for treatment to the Center for Esophageal Diseases of the University of Chicago. Patients had preoperatively a barium swallow, endoscopy, and esophageal manometry. All patients underwent a Heller myotomy and Dor fundoplication.
RESULTS: Based on the presence of respiratory symptoms, patients were divided into two groups: group A, 98 patients (59%) without respiratory symptoms and group B, 67 patients (41%) with respiratory symptoms. The preoperative Eckardt score was similar in the two groups (6.5 ± 2.1 versus 6.4 ± 2.0). The mean esophageal diameter was 27.7 ± 10.8 mm in group A and 42.6 ± 20.1 mm in group B (P < .05). The operation consisted of a myotomy that extended for 5 cm on the esophagus and 2.5 cm onto the gastric wall. At a median postoperative follow-up of 17 months, the Eckardt score improved significantly and similarly in the two groups (0.3 ± 0.8 versus 0.3 ± 1.0). Respiratory symptoms improved or resolved in 62 patients (92.5%).
CONCLUSIONS: The results of this study showed that: (1) respiratory symptoms were present in 41% of patients; (2) patients with respiratory symptoms had a more dilated esophagus; and (3) surgical treatment resolved or improved respiratory symptoms in 92.5% of patients. This study underlines the importance of investigating the presence of respiratory symptoms along with the more common symptoms of achalasia and of early treatment before lung damage occurs.
PMID: 27285485 [PubMed - as supplied by publisher]
| Related Articles |
[Function preserving gastrectomy].
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Feb;19(2):233-7
Authors: Xu D, Xu J, Zhu C, Li M, Zhao E, Yu F, Zhao G, Cao H
Abstract
Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
PMID: 26831890 [PubMed - indexed for MEDLINE]
| Related Articles |
[Function preserving gastrectomy].
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Feb;19(2):233-7
Authors: Xu D, Xu J, Zhu C, Li M, Zhao E, Yu F, Zhao G, Cao H
Abstract
Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
PMID: 26831890 [PubMed - indexed for MEDLINE]
| Related Articles |
Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
Eur J Intern Med. 2015 Sep;26(7):534-9
Authors: You ZH, Perng CL, Hu LY, Lu T, Chen PM, Yang AC, Tsai SJ, Huang YS, Chen HJ
Abstract
BACKGROUND: Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
OBJECTIVE: We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
METHODS: We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
RESULTS: The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
CONCLUSIONS: GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
PMID: 26021838 [PubMed - indexed for MEDLINE]
| Related Articles |
Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
Eur J Intern Med. 2015 Sep;26(7):534-9
Authors: You ZH, Perng CL, Hu LY, Lu T, Chen PM, Yang AC, Tsai SJ, Huang YS, Chen HJ
Abstract
BACKGROUND: Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
OBJECTIVE: We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
METHODS: We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
RESULTS: The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
CONCLUSIONS: GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
PMID: 26021838 [PubMed - indexed for MEDLINE]
from Cancer via ola Kala on Inoreader
via IFTTT
| Related Articles |
Head and neck cancer patients' perceptions of swallowing following chemoradiotherapy.
Support Care Cancer. 2015 Dec;23(12):3531-8
Authors: Patterson JM, McColl E, Wilson J, Carding P, Rapley T
Abstract
PURPOSE: The study aims to describe patients' experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time.
METHODS: A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data.
RESULTS: Patients' reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0-3 months) and late (6-18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle.
CONCLUSIONS: Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.
PMID: 25851803 [PubMed - indexed for MEDLINE]
Small caliber covered self-expanding metal stents in the management of malignant dysphagia.
J Gastrointest Oncol. 2016 Jun;7(3):411-9
Authors: Kucera S, Barthel J, Klapman J, Shridhar R, Hoffe S, Harris C, Almhanna K, Meredith K
Abstract
BACKGROUND: Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia.
METHODS: Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death through May 2011.
RESULTS: DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases.
CONCLUSIONS: In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.
PMID: 27284474 [PubMed]
| Related Articles |
Current views on chronic rejection after lung transplantation.
Transpl Int. 2015 Oct;28(10):1131-9
Authors: Verleden GM, Vos R, Vanaudenaerde B, Dupont L, Yserbyt J, Van Raemdonck D, Verleden S
Abstract
Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.
PMID: 25857869 [PubMed - indexed for MEDLINE]
Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls.
Onco Targets Ther. 2016;9:3025-30
Authors: Lu YF, Lin YC, Chen KH, Shueng PW, Yeh HP, Hsieh CH
Abstract
Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm(3). The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis.
PMID: 27284253 [PubMed]
| | Related Articles |
Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?
Trials. 2015;16:395
Authors: Van Nuffelen G, Van den Steen L, Vanderveken O, Specenier P, Van Laer C, Van Rompaey D, Guns C, Mariën S, Peeters M, Van de Heyning P, Vanderwegen J, De Bodt M
Abstract
BACKGROUND: Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply.
METHODS/DESIGN: This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires.
DISCUSSION: This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN14447678.
PMID: 26340887 [PubMed - indexed for MEDLINE]
Anti-U3 ribonucleoprotein antibody-positive inflammatory myopathy: a case report.
J Med Case Rep. 2016;10:169
Authors: Murata KY, Nakatani K, Yananeki M, Nakanishi I, Ito H
Abstract
BACKGROUND: The discovery of myositis-specific autoantibodies and myositis-associated autoantibodies has led to a new serological classification. Human U3 RNP, which consists of the U3 small nucleolar RNA and anti-U3 RNP antibody, is directed against one of the subunits. Anti-U3 RNP antibodies have been detected in 5-8 % of patients with systemic sclerosis, and antibody-positive patients with systemic sclerosis have shown more frequent skeletal muscle involvement than that of antibody-negative patients with systemic sclerosis.
CASE PRESENTATION: A 74-year-old Japanese man positive for anti-U3 RNP antibody was referred to our hospital because of gait disturbance and dysphagia. His serum myoglobin and creatine kinase levels were elevated, and myopathic changes were observed in his proximal legs by needle electromyography. A muscle biopsy was performed at the quadriceps femoris muscle, which showed high signal intensity on fat-suppressed and T2-weighted magnetic resonance images. The patient was diagnosed with probable polymyositis because CD8-positive lymphocytes had invaded only the endomysium and not into the muscle fibers. Severe proliferation of the interstitial connective tissue and edematous changes were observed. Oral prednisolone therapy was started, and the patient's muscle weakness of the proximal limbs improved remarkably within 1 month. Dysphagia caused by incomplete function of the cricopharyngeal muscle persisted for 5 years.
CONCLUSIONS: Our findings indicate that mild muscle weakness with steroid-resistant dysphagia may be a clinical feature of patients with anti-U3 RNP antibody-positive inflammatory myopathy.
PMID: 27283724 [PubMed - in process]
Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy.
J Laparoendosc Adv Surg Tech A. 2016 Jun 10;
Authors: Andolfi C, Kavitt RT, Herbella FA, Patti MG
Abstract
BACKGROUND: Dysphagia and regurgitation are considered typical symptoms of achalasia. However, there is mounting evidence that some achalasia patients may also experience respiratory symptoms such as cough, wheezing, and hoarseness.
AIMS: The aims of this study were to determine: (1) what percentage of achalasia patients experience respiratory symptoms and (2) the effect of a laparoscopic Heller myotomy and Dor fundoplication on the typical and respiratory symptoms of achalasia.
PATIENTS AND METHODS: Between May 2008 and December 2015, 165 patients with achalasia were referred for treatment to the Center for Esophageal Diseases of the University of Chicago. Patients had preoperatively a barium swallow, endoscopy, and esophageal manometry. All patients underwent a Heller myotomy and Dor fundoplication.
RESULTS: Based on the presence of respiratory symptoms, patients were divided into two groups: group A, 98 patients (59%) without respiratory symptoms and group B, 67 patients (41%) with respiratory symptoms. The preoperative Eckardt score was similar in the two groups (6.5 ± 2.1 versus 6.4 ± 2.0). The mean esophageal diameter was 27.7 ± 10.8 mm in group A and 42.6 ± 20.1 mm in group B (P < .05). The operation consisted of a myotomy that extended for 5 cm on the esophagus and 2.5 cm onto the gastric wall. At a median postoperative follow-up of 17 months, the Eckardt score improved significantly and similarly in the two groups (0.3 ± 0.8 versus 0.3 ± 1.0). Respiratory symptoms improved or resolved in 62 patients (92.5%).
CONCLUSIONS: The results of this study showed that: (1) respiratory symptoms were present in 41% of patients; (2) patients with respiratory symptoms had a more dilated esophagus; and (3) surgical treatment resolved or improved respiratory symptoms in 92.5% of patients. This study underlines the importance of investigating the presence of respiratory symptoms along with the more common symptoms of achalasia and of early treatment before lung damage occurs.
PMID: 27285485 [PubMed - as supplied by publisher]
| Related Articles |
[Function preserving gastrectomy].
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Feb;19(2):233-7
Authors: Xu D, Xu J, Zhu C, Li M, Zhao E, Yu F, Zhao G, Cao H
Abstract
Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
PMID: 26831890 [PubMed - indexed for MEDLINE]
| Related Articles |
[Function preserving gastrectomy].
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Feb;19(2):233-7
Authors: Xu D, Xu J, Zhu C, Li M, Zhao E, Yu F, Zhao G, Cao H
Abstract
Under the premise of radical resection in the treatment, it is of great significance to preserve partial gastric function so that the early gastric cancer (EGC) patients' postoperative quality of life (QOL) can be improved. In the patients with EGC in the upper third of the stomach, the emphasis is on the prevention of reflux esophagitis caused by bile and gastric juice reflux. Pylorus-preserving gastrectomy (PPG) is applicable to the patients with EGC in the middle third of the stomach. In the patients with EGC in the lower third of the stomach, distal gastrectomy (DG) is performed in general. Various anastomosis ways are applied to reduce the negative impact of pylorus resection after DG. Furthermore, it should also be considered that reasonable vagal nerves preservation and lymph node dissection are both important for function preserving gastrectomy of EGC. Rational use of laparoscopy-assisted gastrectomy has advantages of lower invasiveness, faster recovery, etc. And the amplification effect of laparoscope can contribute to preserving nerves and gastric function.
PMID: 26831890 [PubMed - indexed for MEDLINE]
| Related Articles |
Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
Eur J Intern Med. 2015 Sep;26(7):534-9
Authors: You ZH, Perng CL, Hu LY, Lu T, Chen PM, Yang AC, Tsai SJ, Huang YS, Chen HJ
Abstract
BACKGROUND: Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
OBJECTIVE: We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
METHODS: We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
RESULTS: The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
CONCLUSIONS: GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
PMID: 26021838 [PubMed - indexed for MEDLINE]
| Related Articles |
Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study.
Eur J Intern Med. 2015 Sep;26(7):534-9
Authors: You ZH, Perng CL, Hu LY, Lu T, Chen PM, Yang AC, Tsai SJ, Huang YS, Chen HJ
Abstract
BACKGROUND: Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of subsequent psychiatric disorders.
OBJECTIVE: We explored the relationship between gastroesophageal reflux disease (GERD) and the subsequent development of psychiatric disorders including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders.
METHODS: We investigated patients who were diagnosed with GERD according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised patients without GERD who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on the diagnoses of psychiatrists.
RESULTS: The GERD cohort consisted of 3813 patients, and the comparison cohort comprised 15,252 matched control patients without GERD. The risks of depressive disorder (HR=3.37, 95% confidence interval [CI]=2.49-4.57), anxiety disorder (HR=2.99, 95% CI=2.12-4.22), and sleep disorder (HR=2.69, 95% CI=1.83-3.94), were higher in the GERD cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive, anxiety, and sleep disorders remained significantly increased in all of the stratified follow-up durations (0-1, ≥1year).
CONCLUSIONS: GERD may increase the risks of subsequent depressive, anxiety, and sleep disorders. These psychiatric disorders have a negative effect on people's quality of life. Clinicians should pay a particular attention to psychiatric comorbidities in GERD patients.
PMID: 26021838 [PubMed - indexed for MEDLINE]
