Head and Neck Diseases by Alexandros G.Sfakianakis: 01/19/17

Πέμπτη 19 Ιανουαρίου 2017

Emotion dysregulation as an underlying mechanism of impulsive aggression: Reviewing empirical data to inform treatments for veterans who perpetrate violence

Publication date: Available online 19 January 2017
Source:Aggression and Violent Behavior
Author(s): Shannon R. Miles, Carla Sharp, Andra Teten Tharp, Matthew Stanford, Melinda Stanley, Karin E. Thompson, Thomas A. Kent
Violence can lead to posttraumatic stress disorder (PTSD), which in turn is related to perpetration of aggression. Importantly, not all aggression is motivated by the same mechanisms, and understanding the driving force behind the aggression is imperative in order to select treatments that will assist the individual in decreasing the behavior. PTSD is specifically related to impulsive aggression, or aggression that is emotionally charged and uncontrolled, rather than premeditated aggression, which is planned, unemotional, and goal-directed. Emotion regulation, or the ability to recognize emotions, accept them, and control emotion-related behaviors, is related to both PTSD and impulsive aggression. This conceptual paper uses the Catalyst Model to review the literature on PTSD, impulsive aggression, and emotion regulation. Because of their high rates of PTSD, veterans are presented as a demonstration of the relationship between emotion regulation and impulsive aggression. The integrative model can be viewed as an alternative to the traditional model that proposes anger is the primary underlying mechanism of impulsive aggression in adults. Treatment recommendations, such as helping clients develop emotion regulation skills, are offered for providers who are working with individuals who have experienced trauma and who are now perpetrating impulsive aggression.

http://ift.tt/2k9lOM8

Adult protective services and victim services: A review of the literature to increase understanding between these two fields

Publication date: Available online 19 January 2017
Source:Aggression and Violent Behavior
Author(s): Shelly L. Jackson
Adult protective services (APS) is designated in each state to respond to elder abuse. As elder abuse is increasingly conceptualized as a crime, and victim services expands to encompass victims of elder abuse, these two fields will increasingly cross paths. The fields of APS and victim services are each guided by federal legislation, although the path to that legislation differed for each field. The historical development of each field helps to explain the existence of a sometimes challenging relationship between these two fields. A literature review was undertaken to compare these two fields across three domains: 1) the service providers, 2) the recipients of those services, and 3) how a case typically flows from reporting to outcomes. Four areas of possible contention were identified: mandatory reporting, APS investigation, cognitive capacity of victims, and involuntary interventions. It is anticipated that by illuminating these differences and providing an explanation for them, some tension between the fields may be assuaged. This article concludes, however, that in the myriad other ways in which comparisons were made, no meaningful differences emerged. Increasing an understanding of each other's field is intended to facilitate building relationships between these two fields, with the ultimate goal of benefiting victims.

http://ift.tt/2jeHOBj

Cortical Thickness and Local Gyrification in Children with Developmental Dyslexia

Developmental dyslexia is frequently associated with atypical brain structure and function within regions of the left hemisphere reading network. To date, few studies have employed surface-based techniques to evaluate cortical thickness and local gyrification in dyslexia. Of the existing cortical thickness studies in children, many are limited by small sample size, variability in dyslexia identification, and the recruitment of prereaders who may or may not develop reading impairment. Further, no known study has assessed local gyrification index (LGI) in dyslexia, which may serve as a sensitive indicator of atypical neurodevelopment. In this study, children with dyslexia (n = 31) and typically decoding peers (n = 45) underwent structural magnetic resonance imaging to assess whole-brain vertex-wise cortical thickness and LGI. Children with dyslexia demonstrated reduced cortical thickness compared with controls within previously identified reading areas including bilateral occipitotemporal and occipitoparietal regions. Compared with controls, children with dyslexia also showed increased gyrification in left occipitotemporal and right superior frontal cortices. The convergence of thinner and more gyrified cortex within the left occipitotemporal region among children with dyslexia may reflect its early temporal role in processing word forms, and highlights the importance of the ventral stream for successful word reading.

http://ift.tt/2jFtx3v

mGluR2 versus mGluR3 Metabotropic Glutamate Receptors in Primate Dorsolateral Prefrontal Cortex: Postsynaptic mGluR3 Strengthen Working Memory Networks

The newly evolved circuits in layer III of primate dorsolateral prefrontal cortex (dlPFC) generate the neural representations that subserve working memory. These circuits are weakened by increased cAMP-K⁺ channel signaling, and are a focus of pathology in schizophrenia, aging, and Alzheimer's disease. Cognitive deficits in these disorders are increasingly associated with insults to mGluR3 metabotropic glutamate receptors, while reductions in mGluR2 appear protective. This has been perplexing, as mGluR3 has been considered glial receptors, and mGluR2 and mGluR3 have been thought to have similar functions, reducing glutamate transmission. We have discovered that, in addition to their astrocytic expression, mGluR3 is concentrated postsynaptically in spine synapses of layer III dlPFC, positioned to strengthen connectivity by inhibiting postsynaptic cAMP-K⁺ channel actions. In contrast, mGluR2 is principally presynaptic as expected, with only a minor postsynaptic component. Functionally, increase in the endogenous mGluR3 agonist, N-acetylaspartylglutamate, markedly enhanced dlPFC Delay cell firing during a working memory task via inhibition of cAMP signaling, while the mGluR2 positive allosteric modulator, BINA, produced an inverted-U dose–response on dlPFC Delay cell firing and working memory performance. These data illuminate why insults to mGluR3 would erode cognitive abilities, and support mGluR3 as a novel therapeutic target for higher cognitive disorders.

http://ift.tt/2iR9T0f

Connectivity of the Cingulate Sulcus Visual Area (CSv) in the Human Cerebral Cortex

The human cingulate sulcus visual area (CSv) responds selectively to visual and vestibular cues to self-motion. Although it is more selective for visual self-motion cues than any other brain region studied, it is not known whether CSv mediates perception of self-motion. An alternative hypothesis, based on its location, is that it provides sensory information to the motor system for use in guiding locomotion. To evaluate this hypothesis we studied the connectivity pattern of CSv, which is completely unknown, with a combination of diffusion MRI and resting-state functional MRI. Converging results from the 2 approaches suggest that visual drive is provided primarily by areas hV6, pVIP (putative intraparietal cortex) and PIC (posterior insular cortex). A strong connection with the medial portion of the somatosensory cortex, which represents the legs and feet, suggests that CSv may receive locomotion-relevant proprioceptive information as well as visual and vestibular signals. However, the dominant connections of CSv are with specific components of the motor system, in particular the cingulate motor areas and the supplementary motor area. We propose that CSv may provide a previously unknown link between perception and action that serves the online control of locomotion.

http://ift.tt/2iQXVE3

Fine Motor Skill Mediates Visual Memory Ability with Microstructural Neuro-correlates in Cerebellar Peduncles in Prematurely Born Adolescents

Adolescents born preterm (PT) with no evidence of neonatal brain injury are at risk of deficits in visual memory and fine motor skills that diminish academic performance. The association between these deficits and white matter microstructure is relatively unexplored. We studied 190 PTs with no brain injury and 92 term controls at age 16 years. The Rey–Osterrieth Complex Figure Test (ROCF), the Beery visual-motor integration (VMI), and the Grooved Pegboard Test (GPT) were collected for all participants, while a subset (40 PTs and 40 terms) underwent diffusion-weighted magnetic resonance imaging. PTs performed more poorly than terms on ROCF, VMI, and GPT (all P < 0.01). Mediation analysis showed fine motor skill (GPT score) significantly mediates group difference in ROCF and VMI (all P < 0.001). PTs showed a negative correlation (P < 0.05, corrected) between fractional anisotropy (FA) in the bilateral middle cerebellar peduncles and GPT score, with higher FA correlating to lower (faster task completion) GPT scores, and between FA in the right superior cerebellar peduncle and ROCF scores. PTs also had a positive correlation (P < 0.05, corrected) between VMI and left middle cerebellar peduncle FA. Novel strategies to target fine motor skills and the cerebellum may help PTs reach their full academic potential.

http://ift.tt/2jFMR0r

The Rich-Club Organization in Rat Functional Brain Network to Balance Between Communication Cost and Efficiency

Network analyses of structural connectivity in the brain have highlighted a set of highly connected hubs that are densely interconnected, forming a "rich-club" substrate in diverse species. Here, we demonstrate the existence of rich-club organization in functional brain networks of rats. Densely interconnected rich-club regions are found to be distributed in multiple brain modules, with the majority located within the putative default mode network. Rich-club members exhibit high wiring cost (as measured by connection distance) and high metabolic running cost (as surrogated by cerebral blood flow), which may have evolved to achieve high network communications to support efficient brain functions. Furthermore, by adopting a forepaw electrical stimulation paradigm, we find that the rich-club organization of the rat functional network remains almost the same as in the resting state, whereas path motif analysis reveals significant differences, suggesting the rat brain reorganizes its topological routes by increasing locally oriented shortcuts but reducing rich-club member-involved paths to conserve metabolic running cost during unimodal stimulation. Together, our results suggest that the neuronal system is organized and dynamically operated in an economic way to balance between cost minimization and topological/functional efficiency.

http://ift.tt/2iR5jPR

Task Context Overrules Object- and Category-Related Representational Content in the Human Parietal Cortex

The dorsal, parietal visual stream is activated when seeing objects, but the exact nature of parietal object representations is still under discussion. Here we test 2 specific hypotheses. First, parietal cortex is biased to host some representations more than others, with a different bias compared with ventral areas. A prime example would be object action representations. Second, parietal cortex forms a general multiple-demand network with frontal areas, showing similar task effects and representational content compared with frontal areas. To differentiate between these hypotheses, we implemented a human neuroimaging study with a stimulus set that dissociates associated object action from object category while manipulating task context to be either action- or category-related. Representations in parietal as well as prefrontal areas represented task-relevant object properties (action representations in the action task), with no sign of the irrelevant object property (category representations in the action task). In contrast, irrelevant object properties were represented in ventral areas. These findings emphasize that human parietal cortex does not preferentially represent particular object properties irrespective of task, but together with frontal areas is part of a multiple-demand and content-rich cortical network representing task-relevant object properties.

http://ift.tt/2jFF8Qa

Transcriptome Analysis Identifies Multifaceted Regulatory Mechanisms Dictating a Genetic Switch from Neuronal Network Establishment to Maintenance During Postnatal Prefrontal Cortex Development

The prefrontal cortex (PFC) is one of the latest brain regions to mature, which allows the acquisition of complex cognitive abilities through experience. To unravel the underlying gene expression changes during postnatal development, we performed RNA-sequencing (RNA-seq) in the rat medial PFC (mPFC) at five developmental time points from infancy to adulthood, and analyzed the differential expression of protein-coding genes, long intergenic noncoding RNAs (lincRNAs), and alternative exons. We showed that most expression changes occur in infancy, and that the number of differentially expressed genes reduces toward adulthood. We observed 137 differentially expressed lincRNAs and 796 genes showing alternative exon usage during postnatal development. Importantly, we detected a genetic switch from neuronal network establishment in infancy to maintenance of neural networks in adulthood based on gene expression dynamics, involving changes in protein-coding and lincRNA gene expression as well as alternative exon usage. Our gene expression datasets provide insights into the multifaceted transcriptional regulation of the developing PFC. They can be used to study the basic developmental processes of the mPFC and to understand the mechanisms of neurodevelopmental and neuropsychiatric disorders. Our study provides an important contribution to the ongoing efforts to complete the "brain map", and to the understanding of PFC development.

http://ift.tt/2iQZZMs

MRI Shows that Exhaustion Syndrome Due to Chronic Occupational Stress is Associated with Partially Reversible Cerebral Changes

The present study investigates the cerebral effects of chronic occupational stress and its possible reversibility. Forty-eight patients with occupational exhaustion syndrome (29 women) and 80 controls (47 women) underwent structural magnetic resonance imaging (MRI) and neuropsychological testing. Forty-four participants (25 patients, 19 controls) also completed a second MRI scan after 1–2 years. Only patients received cognitive therapy. The stressed group at intake had reduced thickness in the right prefrontal cortex (PFC) and left superior temporal gyrus (STG), enlarged amygdala volumes, and reduced caudate volumes. Except for the caudate volume, these abnormalities were more pronounced in females. They were all related to perceived stress, which was similar for both genders. Thickness of the PFC also correlated with an impaired ability to down-modulate negative emotions. Thinning of PFC and reduction of caudate volume normalized in the follow-up. The amygdala enlargement and the left STG thinning remained. Longitudinal changes were not detected among controls. Chronic occupational stress was associated with partially reversible structural abnormalities in key regions for stress processing. These changes were dynamically correlated with the degree of perceived stress, highlighting a possible causal link. They seem more pronounced in women, and could be a substrate for an increased cerebral vulnerability to stress-related psychiatric disorders.

http://ift.tt/2iR70g5

Stimulus-Tuned Structure of Correlated fMRI Activity in Human Visual Cortex

Processing units are interconnected in the visual system, where a sensory organ and downstream cortical regions communicate through hierarchical connections, and local sites within the regions communicate through horizontal connections. In such networks, neural activities at local sites are likely to influence one another in complex ways and thus are intricately correlated. Recognizing the functional importance of correlated activity in sensory representation, spontaneous activities have been studied via diverse local or global measures in various time scales. Here, measuring functional magnetic resonance imaging (fMRI) signals in human early visual cortex, we explored systematic patterns that govern the correlated activities arising spontaneously. Specifically, guided by previously identified biases in anatomical connection patterns, we characterized all possible pairs of gray matter sites in 3 relational factors: "retinotopic distance," "cortical distance," and "stimulus tuning similarity." By evaluating and comparing the unique contributions of these factors to the correlated activity, we found that tuning similarity factors overrode distance factors in accounting for the structure of correlated fMRI activity both within and between V1, V2, and V3, irrespective of the presence or degree of visual stimulation. Our findings indicate that the early human visual cortex is intrinsically organized as a network tuned to the stimulus features.

http://ift.tt/2jFxhlD

Processing of Egomotion-Consistent Optic Flow in the Rhesus Macaque Cortex

The cortical network that processes visual cues to self-motion was characterized with functional magnetic resonance imaging in 3 awake behaving macaques. The experimental protocol was similar to previous human studies in which the responses to a single large optic flow patch were contrasted with responses to an array of 9 similar flow patches. This distinguishes cortical regions where neurons respond to flow in their receptive fields regardless of surrounding motion from those that are sensitive to whether the overall image arises from self-motion. In all 3 animals, significant selectivity for egomotion-consistent flow was found in several areas previously associated with optic flow processing, and notably dorsal middle superior temporal area, ventral intra-parietal area, and VPS. It was also seen in areas 7a (Opt), STPm, FEFsem, FEFsac and in a region of the cingulate sulcus that may be homologous with human area CSv. Selectivity for egomotion-compatible flow was never total but was particularly strong in VPS and putative macaque CSv. Direct comparison of results with the equivalent human studies reveals several commonalities but also some differences.

http://ift.tt/2iR7kLQ

Maxillary sinus opacification (MSO),Unilateral sphenoid sinus opacification (SSO) : Isolated MSO and SSO is a marker of neoplasia in 18% and malignancy in 7–10% of patients presenting with these radiologic findings. Clinicians should be wary of conservative management given the high incidence of neoplasia and consider a lower threshold for early surgical intervention.

http://otorhinolaryngology-crete.blogspot.com/2017/01/maxillary-sinus-opacification.html

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

6948891480

alsfakia@gmail.com

Tubulin-binding dibenz[c,e]oxepines: Part 2.1 Structural variation and biological evaluation as tumour vasculature disrupting agents

Publication date: Available online 19 January 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Steven B. Rossington, John A. Hadfield, Steven D. Shnyder, Timothy W. Wallace, Kaye J. Williams
5,7-Dihydro-3,9,10,11-tetramethoxybenz[c,e]oxepin-4-ol 1, prepared from a dibenzyl ether precursor via Pd-catalysed intramolecular direct arylation, possesses broad-spectrum in vitro cytotoxicity towards various tumour cell lines, and induces vascular shutdown, necrosis and growth delay in tumour xenografts in mice at sub-toxic doses. The biological properties of 1 and related compounds can be attributed to their ability to inhibit microtubule assembly at the micromolar level, by binding reversibly to the same site of the tubulin αβ-heterodimer as colchicine 2 and the allocolchinol, N-acetylcolchinol 4.

Graphical abstract

http://ift.tt/2jSL069

Lynamicin D an Antimicrobial Natural Product Affects Splicing by Inducing the Expression of SR Protein Kinase 1

Publication date: Available online 19 January 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Ioanna Sigala, George Ganidis, Savvas Thysiadis, Alexandros L. Zografos, Thomas Giannakouros, Vasiliki Sarli, Eleni Nikolakaki
The first total synthesis of the antimicrobial natural product lynamicin D has been developed using a Suzuki coupling to construct the bisindole pyrrole skeleton. An evaluation of the biological activity of lynamicin D reveals that it has a minor effect on cell viability but it can modulate splicing of pre-mRNAs. We provide evidence that this effect is mainly due to the ability of lynamicin D to alter the levels of SRPK1, the key kinase involved in both constitutive and alternative splicing.

Graphical abstract

http://ift.tt/2jSPh9R

A Strategy for Dual Inhibition of the Proteasome and Fatty Acid Synthase with Belactosin C-Orlistat Hybrids

Publication date: Available online 19 January 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Mingzhao Zhu, Wayne D. Harshbarger, Omar Robles, Joanna Krysiak, Kenneth G. Hull, Sung Wook Cho, Robyn D. Richardson, Yanyan Yang, Andres Garcia, Lindsey Spiegelman, Bianca Ramirez, Christopher T. Wilson, Ju Anne Yau, James T. Moore, Caitlen B. Walker, James C. Sacchettini, Wenshe Liu, Stephan A. Sieber, Jeffrey W. Smith, Daniel Romo
The proteasome, a validated cellular target for cancer, is central for maintaining cellular homeostasis, while fatty acid synthase (FAS), a novel target for numerous cancers, is responsible for palmitic acid biosynthesis. Perturbation of either enzymatic machine results in decreased proliferation and ultimately cellular apoptosis. Based on structural similarities, we hypothesized that hybrid molecules of belactosin C, a known proteasome inhibitor, and orlistat, a known inhibitor of the thioesterase domain of FAS, could inhibit both enzymes. Herein, we describe proof-of-principle studies leading to the design, synthesis and enzymatic activity of several novel, β-lactone-based, dual inhibitors of these two enzymes. Validation of dual enzyme targeting through activity-based proteome profiling with an alkyne probe modeled after the most potent inhibitor, and preliminary serum stability studies of selected derivatives are also described. These results provide proof of concept for dual targeting of the proteasome and FAS-TE enabling a new approach for the development of drug-candidates with potential to overcome resistance.

Graphical abstract

http://ift.tt/2jSLY2a

Adult human retinal Müller glia display distinct peripheral and macular expression of CD117 and CD44 stem cell-associated proteins

Publication date: Available online 19 January 2017
Source:Acta Histochemica
Author(s): Lay Khoon Too, Gary Gracie, Enisa Hasic, Julia H. Iwakura, Svetlana Cherepanoff
Experimental evidence suggests human Müller glia exhibit neural progenitor properties in vitro. CD117 and CD44 are known to be expressed by stem cells, the survival of which appears to depend critically on interactions with hyaluronan-rich extracellular matrix (ECM). Here, we characterise Müller glia expression of CD117 and CD44 in normal adult human retina and describe how it correlates with hyaluronan distribution in ocular ECM. By using chromogen-based immunohistochemistry, CD117 expression was found in entire Müller glia cytoplasm spanning from inner to outer limiting membrane in both peripheral retina (PR) and macular retina (MR), mirroring expression of the established Müller glia marker vimentin. Unlike vimentin, CD117 was also strongly expressed by Müller glia nuclei. Relative to total inner nuclear layer (INL) nuclei, more CD117+ Müller glia nuclei were seen in PR than MR. By contrast, CD44 expression was found predominantly in Müller glia apical processes of PR; no expression was found in MR. Astral blue staining demonstrated the presence of hyaluronan in cortical vitreous and the interphotoreceptor matrix (IPM) in both MR and PR. Our findings demonstrate that: (i) both CD117 and CD44 are expressed by human adult Müller glia; (ii) CD117 is a robust nuclear and cytoplasmic immunohistochemical marker of Müller glia; and (iii) that while CD117 is expressed by the entire Müller glia in both PR and MR, CD44 is only expressed by Müller glia apices in PR. Since the apices of Müller glia are in direct contact with the hyaluronan-rich IPM, the Müller glia-IPM interface in PR is likely a favourable region for supporting progenitor or stem cell-like signalling. These observations provide novel insights into potential stem-cell favouring microenvironments in mature human retina.

http://ift.tt/2jFfYB6

A peer review process as part of the implementation of clinical pathways in radiation oncology: Does it improve compliance?

Publication date: Available online 19 January 2017
Source:Practical Radiation Oncology
Author(s): Brian J. Gebhardt, Dwight E. Heron, Sushil Beriwal
PurposeClinical pathways are patient management plans that standardize evidence-based practices to ensure high quality and cost-effective medical care. Implementation of a pathway is a collaborative process in our network requiring the active involvement of physicians. This approach promotes acceptance of pathway recommendations, though a peer-review process is necessary to ensure compliance and to capture and approve off-pathway selections. We investigated the peer review process and factors associated with time to completion of peer-review.Methods & MaterialsThe cancer center implemented radiation oncology pathways for every disease site throughout a large, integrated network. Recommendations are written based upon national guidelines, published literature, and institutional experience with evidence evaluated hierarchically in order of efficacy, toxicity, and then cost. Physicians enter decisions into an online, menu-driven decision support tool that integrates with medical records. Data were collected from the support tool including the rate of on- and off-pathway selections, peer-review decisions performed by disease site directors, and time to complete peer-review.ResultsA total of 6965 treatment decisions were entered in 2015, and 605 (8.7%) were made off-pathway and were subject to peer-review. The median time to peer-review decision was 2days (interquartile range, 0.2–6.8). Factors associated with time to peer-review decision >48hours on univariate analysis include disease site (p<0.0001) with a trend toward significance (p=0.066) for radiation therapy (RT) modality. There was no difference between recurrent and non-recurrent disease (p=0.267). Multivariable analysis revealed disease site was associated with time to peer-review (p<0.001), with lymphoma and skin/sarcoma most strongly influencing decision time>48hours.ConclusionsClinical pathways are an integral tool for standardizing evidence-based care throughout our large, integrated network with 91.3% of all treatment decisions being made as per pathway. The peer-review process was feasible with <1% selections ultimately rejected suggesting that awareness of peer-review of treatment decisions encourages compliance with clinical pathway recommendations.

http://ift.tt/2jehSpu

Initial clinical outcomes of Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR)

Publication date: Available online 19 January 2017
Source:Practical Radiation Oncology
Author(s): Susan M. Hiniker, Karl Bush, Tyler Fowler, Evan C. White, Samuel Rodriguez, Peter G. Maxim, Sarah S. Donaldson, Billy W. Loo
PurposeRadiation therapy is an important component of treatment for many childhood cancers. Depending upon the age and maturity of the child, pediatric radiation therapy often requires general anesthesia for immobilization, position reproducibility, and daily treatment delivery. We designed and clinically implemented a radiation therapy compatible audio-visual system allowing children to watch streaming video during treatment with the goal of reducing the need for daily anesthesia through immersion in video.Materials/MethodsWe designed an Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) system using a digital media player with wireless streaming and pico projector, and a radiolucent display screen positioned within the patient's field of view to provide the child with sufficient entertainment and distraction for the duration of serial treatments without the need for daily anesthesia. We piloted this system in 25 pediatric patients between the ages of 3–12years. We calculated the number of fractions of radiation for which this system was used successfully and anesthesia avoided, and compared it to reported anesthesia rates in the literature for children of this age.ResultsTwenty-three of 25 patients (92%) were able to complete the prescribed course of radiation therapy without anesthesia using the AVATAR system, with a total of 441 fractions of treatment administered using AVATAR. The median age of patients successfully treated with this approach was 6years. Seven of the 23 patients were initially treated with daily anesthesia and were successfully transitioned to use of the AVATAR system. Patients and families reported an improved treatment experience with the use of the AVATAR system as compared to anesthesia.ConclusionThe AVATAR system enables a high proportion of children to undergo radiation therapy without anesthesia when compared to reported anesthesia rates, justifying continued development and clinical investigation of this technique.

http://ift.tt/2k9gIja

Interplay between the endocrine and circadian systems in fishes

The circadian system is responsible for the temporal organisation of physiological functions which, in part, involves daily cycles of hormonal activity. In this review, we analyse the interplay between the circadian and endocrine systems in fishes. We first describe the current model of fish circadian system organisation and the basis of the molecular clockwork that enables different tissues to act as internal pacemakers. This system consists of a net of central and peripherally located oscillators and can be synchronised by the light–darkness and feeding–fasting cycles. We then focus on two central neuroendocrine transducers (melatonin and orexin) and three peripheral hormones (leptin, ghrelin and cortisol), which are involved in the synchronisation of the circadian system in mammals and/or energy status signalling. We review the role of each of these as overt rhythms (i.e. outputs of the circadian system) and, for the first time, as key internal temporal messengers that act as inputs for other endogenous oscillators. Based on acute changes in clock gene expression, we describe the currently accepted model of endogenous oscillator entrainment by the light–darkness cycle and propose a new model for non-photic (endocrine) entrainment, highlighting the importance of the bidirectional cross-talking between the endocrine and circadian systems in fishes. The flexibility of the fish circadian system combined with the absence of a master clock makes these vertebrates a very attractive model for studying communication among oscillators to drive functionally coordinated outputs.

http://ift.tt/2iZwr2f

Longitudinal multiple sclerosis lesion segmentation: Resource and challenge

Publication date: 1 March 2017
Source:NeuroImage, Volume 148
Author(s): Aaron Carass, Snehashis Roy, Amod Jog, Jennifer L. Cuzzocreo, Elizabeth Magrath, Adrian Gherman, Julia Button, James Nguyen, Ferran Prados, Carole H. Sudre, Manuel Jorge Cardoso, Niamh Cawley, Olga Ciccarelli, Claudia A.M. Wheeler-Kingshott, Sébastien Ourselin, Laurence Catanese, Hrishikesh Deshpande, Pierre Maurel, Olivier Commowick, Christian Barillot, Xavier Tomas-Fernandez, Simon K. Warfield, Suthirth Vaidya, Abhijith Chunduru, Ramanathan Muthuganapathy, Ganapathy Krishnamurthi, Andrew Jesson, Tal Arbel, Oskar Maier, Heinz Handels, Leonardo O. Iheme, Devrim Unay, Saurabh Jain, Diana M. Sima, Dirk Smeets, Mohsen Ghafoorian, Bram Platel, Ariel Birenbaum, Hayit Greenspan, Pierre-Louis Bazin, Peter A. Calabresi, Ciprian M. Crainiceanu, Lotta M. Ellingsen, Daniel S. Reich, Jerry L. Prince, Dzung L. Pham
In conjunction with the ISBI 2015 conference, we organized a longitudinal lesion segmentation challenge providing training and test data to registered participants. The training data consisted of five subjects with a mean of 4.4 time-points, and test data of fourteen subjects with a mean of 4.4 time-points. All 82 data sets had the white matter lesions associated with multiple sclerosis delineated by two human expert raters. Eleven teams submitted results using state-of-the-art lesion segmentation algorithms to the challenge, with ten teams presenting their results at the conference. We present a quantitative evaluation comparing the consistency of the two raters as well as exploring the performance of the eleven submitted results in addition to three other lesion segmentation algorithms. The challenge presented three unique opportunities: (1) the sharing of a rich data set; (2) collaboration and comparison of the various avenues of research being pursued in the community; and (3) a review and refinement of the evaluation metrics currently in use. We report on the performance of the challenge participants, as well as the construction and evaluation of a consensus delineation. The image data and manual delineations will continue to be available for download, through an evaluation website²2 The Challenge Evaluation Website is: http://ift.tt/2k6vIu7 as a resource for future researchers in the area. This data resource provides a platform to compare existing methods in a fair and consistent manner to each other and multiple manual raters.

http://ift.tt/2iHSmMV

Functional connectivity decreases in autism in emotion, self, and face circuits identified by Knowledge-based Enrichment Analysis

Publication date: 1 March 2017
Source:NeuroImage, Volume 148
Author(s): Wei Cheng, Edmund T. Rolls, Jie Zhang, Wenbo Sheng, Liang Ma, Lin Wan, Qiang Luo, Jianfeng Feng
A powerful new method is described called Knowledge based functional connectivity Enrichment Analysis (KEA) for interpreting resting state functional connectivity, using circuits that are functionally identified using search terms with the Neurosynth database. The method derives its power by focusing on neural circuits, sets of brain regions that share a common biological function, instead of trying to interpret single functional connectivity links. This provides a novel way of investigating how task- or function-related networks have resting state functional connectivity differences in different psychiatric states, provides a new way to bridge the gap between task and resting-state functional networks, and potentially helps to identify brain networks that might be treated. The method was applied to interpreting functional connectivity differences in autism. Functional connectivity decreases at the network circuit level in 394 patients with autism compared with 473 controls were found in networks involving the orbitofrontal cortex, anterior cingulate cortex, middle temporal gyrus cortex, and the precuneus, in networks that are implicated in the sense of self, face processing, and theory of mind. The decreases were correlated with symptom severity.

http://ift.tt/2k6EkAE

Microbubble-Assisted Ultrasound-Induced Transient Phosphatidylserine Translocation

Publication date: Available online 19 January 2017
Source:Ultrasound in Medicine & Biology
Author(s): Jean-Michel Escoffre, Marc Derieppe, Bart Lammertink, Clemens Bos, Chrit Moonen
Microbubble-assisted ultrasound (sonopermeabilization) results in reversible permeabilization of the plasma membrane of cells. This method is increasingly used in vivo because of its potential to deliver therapeutic molecules with limited cell damage. Nevertheless, the effects of sonopermeabilization on the plasma membrane remain not fully understood. We investigated the influence of sonopermeabilization on the transverse mobility of phospholipids, especially on phosphatidylserine (PS) externalization. We performed studies using optical imaging with Annexin V and FM1-43 probes to monitor PS externalization of rat glioma C6 cells. Sonopermeabilization induced transient membrane permeabilization, which is positively correlated with reversible PS externalization. This membrane disorganization was temporary and not associated with loss of cell viability. Sonopermeabilization did not induce PS externalization via activation of the scramblase. We hypothesize that acoustically induced membrane pores may provide a new pathway for PS migration between both membrane leaflets. During the membrane-resealing phase, PS asymmetry may be re-established by amino-phospholipid flippase activity and/or endocytosis, along with exocytosis processes.

http://ift.tt/2iZkBFw

Assessing Work-Related Musculoskeletal Symptoms Among Otolaryngology Residents

Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits, however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents.

http://ift.tt/2jEkBf3

Nasal Septal Perforation Secondary to Systemic Bevacizumab

A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature.

http://ift.tt/2k67NdV

Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease

To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.

http://ift.tt/2jEfvzm

Cochlear implantation for single-sided deafness and tinnitus suppression

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.

http://ift.tt/2k6h8mb

Cochlear implantation in an NPC patient post-irradiation presenting with electrode array extrusion through the posterior canal wall

Cochlear implant is a viable rehabilitation option for sensorineural hearing loss in post-irradiated patients [1,2]. The retro-cochlear auditory pathways appear to remain functionally intact in the long term in patients who have had irradiation for nasopharyngeal carcinoma, [3] and the overall hearing outcomes post-cochlear implant were similar in post-irradiated patients and patients who had no prior irradiation [4].

http://ift.tt/2jEfwmU

Isolated sphenoid sinus opacification: A systematic review

Unilateral sphenoid sinus opacification (SSO) on imaging is a common incidental radiologic finding. Inflammatory sinus disease is rarely isolated to one sinus cavity therefore SSO raises the potential for neoplastic etiology. The clinical significance of SSO was evaluated and compared to maxillary sinus opacification (MSO).

http://ift.tt/2k67NKX

Extended use of perioperative antibiotics in head and neck microvascular reconstruction

Many head and neck surgical procedures are considered clean-contaminated wounds and antibiotic prophylaxis is recommended. Despite prophylaxis, the incidence of surgical site infections remains significant – especially in the setting of free tissue transfer. The antibiotic course is often of a longer duration after free tissue transfer than the recommended 24 hours post-operatively. Currently, there is no consensus on appropriate antibiotic regimen or duration at this time. This study investigates the outcomes of a 7-day perioperative antibiotic regimen after microvascular reconstruction of the head and neck at our institution.

http://ift.tt/2jEkKiN

Surgical timing for facial paralysis after temporal bone trauma

To explore surgical timing of facial paralysis after temporal bone trauma.

http://ift.tt/2k6j4uK

Corrigendum to ‘Relational victimization and depressive symptoms: The role of autonomic nervous system reactivity in emerging adults’ [Int. J. Psychophysiol. 110C (2016) 119–127]

Publication date: Available online 19 January 2017
Source:International Journal of Psychophysiology
Author(s): Leigh Ann Holterman, Dianna K. Murray-Close, Nicole L. Breslend

http://ift.tt/2juw52a

Assessing Work-Related Musculoskeletal Symptoms Among Otolaryngology Residents

The effect of task demand and incentive on neurophysiological and cardiovascular markers of effort

Publication date: Available online 19 January 2017
Source:International Journal of Psychophysiology
Author(s): Stephen H Fairclough, Kate Ewing
According to motivational intensity theory, effort is proportional to the level of task demand provided that success is possible and successful performance is deemed worthwhile. The current study represents a simultaneous manipulation of demand (working memory load) and success importance (financial incentive) to investigate neurophysiological (EEG) and cardiovascular measures of effort. A 2×2 repeated-measures study was conducted where 18 participants performed a n-back task under three conditions of demand: easy (1-back), hard (4-back) and very hard (7-back). In addition, participants performed these tasks in the presence of performance-contingent financial incentive or in a no-incentive (pilot trial) condition. Three bands of EEG activity were quantified: theta (4-7Hz), lower-alpha (7.5-10Hz) and upper-alpha (10.5-13Hz). Fronto-medial activity in the theta band and activity in the upper-alpha band at frontal, central and parietal sites were sensitive to demand and indicated greatest effort when the task was challenging and success was possible. Mean systolic blood pressure and activity in the lower-alpha band at parietal sites were also sensitive to demand but also increased in the incentive condition across all levels of task demand. The results of the study largely support the predictions of motivational intensity using neurophysiological markers of effort.

http://ift.tt/2jELWOn

Nasal Septal Perforation Secondary to Systemic Bevacizumab

Attentional bias toward infant faces – Review of the adaptive and clinical relevance

Publication date: Available online 19 January 2017
Source:International Journal of Psychophysiology
Author(s): Marta Knijnik Lucion, Vanessa Oliveira, Lisiane Bizarro, Adrianne Rahde Bischoff, Patricia Pelufo Silveira, Marcia Kauer-Sant'Anna
Human survival depends on care received early in life. Infants need to capture adults' attention to have their basic needs met. Therefore, infant stimuli are prioritized by the attention system in adults, resulting in an attentional bias toward infant faces. We conducted a systematic review of the literature on behavioral measures of attentional bias toward infant faces. PubMed, PsycINFO, and ISI Web of Knowledge databases were used. The review suggests the existence of a measurable attentional bias toward infant faces and a positive correlation between attentional bias toward infant distress and the quality of mother-infant relationship. Depressive symptoms and breastfeeding modulate this behavior in women. Parental status and sex also influence the attentional prioritization of infant faces. Evidence indicates that differences in attentional bias are associated with clinical symptoms and variations in maternal behavior, reinforcing the potential use of attentional bias as a behavioral marker of clinical outcomes.

Graphical abstract

http://ift.tt/2jEUzs3

Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease

To evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.

http://ift.tt/2jEfvzm

Cochlear implantation for single-sided deafness and tinnitus suppression

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.

http://ift.tt/2k6h8mb

Cochlear implantation in an NPC patient post-irradiation presenting with electrode array extrusion through the posterior canal wall

Isolated sphenoid sinus opacification: A systematic review

Extended use of perioperative antibiotics in head and neck microvascular reconstruction

Surgical timing for facial paralysis after temporal bone trauma

To explore surgical timing of facial paralysis after temporal bone trauma.

http://ift.tt/2k6j4uK

Tensegrity-inspired polymer nanocomposites

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Ji Hoon Lee, Meisha L. Shofner
Investigating the design space available in nanofilled polymers is expected to produce materials with unique structure-property relationships. In this work, the concept of tensegrity is used as inspiration for microstructural design. Tensegrity is an elegant and efficient structural design, relying upon interactions between elements, specifically elements in compression which are connected through a tensioned web. In this embodiment, the nanoparticles are considered the compressive elements, and the polymer matrix, when suitably processed, is considered the tensioned web. Nanocomposite materials containing polymer-decorated hydroxyapatite nanoparticles were used to evaluate the tensegrity-inspired approach. Nanocomposite systems with a semi-crystalline matrix (polyethylene oxide) and an amorphous matrix (polymethyl methacrylate) were prepared and characterized with compatible polymer-decorated nanoparticles. The results showed that the nanocomposite with a semi-crystalline matrix was more promising as a candidate for producing the tensegrity-inspired microstructure and that the concept could produce improved thermomechanical properties in the glassy temperature regime.

Graphical abstract

http://ift.tt/2jEDuPf

Tuning nanophase separation behavior in segmented polyhydroxyurethane via judicious choice of soft segment

Publication date: 10 February 2017
Source:Polymer, Volume 110
Author(s): Goliath Beniah, Brice E. Uno, Tian Lan, Junho Jeon, William H. Heath, Karl A. Scheidt, John M. Torkelson
Polyhydroxyurethane (PHU) is of major research interest because it is a non-isocyanate polyurethane-like (NIPU) polymer. Here, we demonstrate the ability to tune nanophase separation in linear, segmented PHU copolymers via the soft segment. PHUs were synthesized from polytetramethylene oxide (PTMO)- and polybutadiene-co-acrylonitrile (PBN)-based soft segments, with divinyl benzene dicyclocarbonate and Dytek-A as hard segment and chain extender, respectively. These NIPU polymers were characterized by small-angle X-ray scattering (SAXS), atomic force microscopy (AFM), dynamic mechanical analysis (DMA), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and tensile testing. SAXS reveals that the NIPUs with 30–40 wt% hard segment are nanophase separated with interdomain spacings of 9–16 nm. DMA reveals that PTMO-based PHUs have broad interphases with a range of local compositions and glass transition temperatures (Tgs), with tan δ ≥ 0.3 over temperature ranges exceeding 70 °C in breadth. In contrast, PBN-based PHUs have sharper interphases, evidenced by narrow tan δ peaks near soft-segment and hard-segment Tgs as well as by DSC and AFM data. FTIR shows that the ratio of hydrogen-bonded carbonyl to free carbonyl is higher in PBN-based PHU than in PTMO-based PHU, consistent with the absence and presence of intersegment hydrogen bonding in PBN-based PHU and PTMO-based PHU, respectively.

Graphical abstract

http://ift.tt/2jEAmCM

Orientation and interfacial stress transfer of cellulose nanocrystal nanocomposite fibers

Publication date: 10 February 2017
Source:Polymer, Volume 110
Author(s): Huibin Chang, Jeffrey Luo, H. Clive Liu, Amir A. Bakhtiary Davijani, Po-Hsiang Wang, Satish Kumar
Orientation and interfacial stress transfer in cellulose nanocrystals (CNC) reinforced polyacrylonitrile (PAN) nanocomposite fibers were determined by Raman spectroscopy. The 1095 cm⁻¹ Raman band was used to quantify the orientation of CNC in composite fiber. Under VV (vertical/vertical) mode, polar plots of all composite fibers showed a two-fold symmetry. Under VH (vertical/horizontal) mode, it showed a four-fold symmetry. The CNCs are highly oriented in the composite fiber, which is confirmed by second and fourth order orientation parameters:〈P2(cosθ)〉 and〈P4(cosθ)〉. The 1095 cm⁻¹ Raman band shift under uniaxial deformation was used to characterize the interfacial shear stress transfer between PAN matrix and CNCs.

Graphical abstract

http://ift.tt/2jekSlq

Multi-responsive core-crosslinked poly (thiolether ester) micelles for smart drug delivery

Publication date: 10 February 2017
Source:Polymer, Volume 110
Author(s): Yanfang Hu, Ming Deng, Huailin Yang, Li Chen, Chunsheng Xiao, Xiuli Zhuang, Xuesi Chen
Herein, a kind of multi-responsive core-crosslinked poly (thiolether ester) micelles was facilely prepared for reactive oxygen species (ROS), acid and reduction sensitive drug delivery. Firstly, a hydroxyl-rich poly (thiolether ester) (PTE) was synthesized by the thiol-ene/thiol-expoxy polymerization using ethanedithiol (EDT) and glycidylmethacrylate (GMA) as monomers. The resultant PTE was then coupled with carboxyl terminated poly (ethylene glycol) (PEG) and lipoic acid (LA) to give the graft copolymer PTE-g-PEG-LA. The obtained PTE-g-PEG-LA could self-assemble into micelles in the aqueous media and turn into core-crosslinked nanoparticles in the presence of dithiothreitol (DTT) at pH ∼8.3.The core-crosslinked PTE-g-PEG-LA micelles showed more compact structure and higher drug loading efficiency towards the model drug doxorubicin (DOX) as compared with non-crosslinked PTE-g-PEG micelles. In vitro drug release profiles demonstrated that the release of drug from DOX-loaded core-crosslinked PTE-g-PEG-LA micelles (CNP/DOX) could be accelerated in the ROS-abundant, acidic or reductive environment. The triggered release of loading drug from CNP/DOX in A549 and HeLa cells were also verified by laser scanning confocal microscopy, flow cytometry and cell proliferation inhibition assessments. These results indicate that the cross-linked PTE-g-PEG-LA micelles may provide huge potential for smart drug delivery in cancer therapy.

Graphical abstract

http://ift.tt/2jec5Ad

Editorial Board and Contents

Publication date: February 2017
Source:Trends in Cell Biology, Volume 27, Issue 2

http://ift.tt/2iQlQDL

Assessing sleepiness and cataplexy in children and adolescents with narcolepsy: a review of current patient-reported measures

The objective of this study was to review patient-reported outcome measures assessing excessive daytime sleepiness (EDS) or cataplexy in children or adolescents to determine their usefulness and limitations in pediatric narcolepsy assessment.

http://ift.tt/2k6dDvU

Age and sex differences in bedroom habits and bedroom preferences

The objective of this study was to estimate the prevalence of different bedroom habits/preferences, and to assess whether these habits/preferences differ with age and sex.

http://ift.tt/2iHBxSa

Obstructive sleep apnea and polycystic ovary syndrome: Cause or association?

Polycystic ovary syndrome (PCOS) is among the most common endocrinopathies in reproductive-age women, with a reported prevalence between 6 and 10%. Although there are modest variations between specific diagnostic criteria (1, 2), it is clear that PCOS (however defined), carries with it a significant risk for metabolic disturbances that include both prediabetes as well as frank type 2 diabetes; individual components of the metabolic syndrome are also seen with greater frequency in PCOS women compared to controls (1-3).

http://ift.tt/2k6cVij

A patient with idiopathic angioedema presenting with superior vena cava syndrome and lymphedema

A 40-year-old woman with a history of 2 episodes of corticosteroid-responsive angioedema without urticaria presented to the allergy clinic for evaluation of recurrent angioedema after a third episode. Her medical history was significant for papillary thyroid carcinoma that required anterior neck dissection and radiation as well as epithelioid hemangioendothelioma of the right internal jugular vein that required resection and graft placement. Her first episode of laryngeal edema occurred while she was completing radiation treatment 10 months earlier and was accompanied by 1 day of shortness of breath and stridor that required admission to the intensive care unit.

http://ift.tt/2iQ83wR

Intrauterine uterine contraception and chronic urticaria: a case series

Chronic urticaria and angioedema are skin diseases marked by the daily or almost daily occurrence of urticaria and/or angioedema for longer than 6 weeks. Although drug, food, aeroallergen, contact allergen, thyroid autoimmunity, and vitamin D associations and autoantibodies to the high affinity immunoglobulin E (IgE) receptor or free IgE might be discovered, in most cases the etiology remains idiopathic.1,2 Women represent most cases of chronic urticaria.

http://ift.tt/2iZ1ivW

Smartphone-based vs paper-based asthma action plans for adolescents

Adolescents with asthma are at risk of poor outcomes and are traditionally difficult to reach.

http://ift.tt/2iQcpnB

Intrauterine uterine contraception and chronic urticaria: a case series

A patient with idiopathic angioedema presenting with superior vena cava syndrome and lymphedema

Smartphone-based vs paper-based asthma action plans for adolescents

Adolescents with asthma are at risk of poor outcomes and are traditionally difficult to reach.

http://ift.tt/2iQcpnB

Host–microbiota interactions: epigenomic regulation

Vivienne Woo | Theresa Alenghat

http://ift.tt/2jEXEbo

Is exercise a viable therapeutic intervention to mitigate mitochondrial dysfunction and insulin resistance induced by sleep loss?

Sleep loss has emerged as a risk factor comparable to that of physical inactivity for the development of insulin resistance, impaired glucose tolerance and Type 2 Diabetes Mellitus. This is a concern as it was estimated in 2012 that approximately 70 million adults in the United States are sleeping less than 6 hours each night, and the average nightly sleep duration of a representative sample of the U.S adult population is reported to be significantly less than in previous decades. The underlying mechanisms responsible for chronic sleep loss induced insulin resistance include modifications in the regulation of hormone secretion, peripheral clock gene regulation, and the cellular signaling processes associated with regulating mitochondrial respiratory function.

http://ift.tt/2jEeW8Q

Niacin intake and incident adult-onset atopic dermatitis in women

Supplemental nicotinamide, a derivative of niacin, has been reported to decrease transepidermal water loss. However, in this analysis including 67,643 women from the Nurses' Health Study 2, niacin intake was not protective for atopic dermatitis.

http://ift.tt/2iQd8Fd

Notch signaling in T cells is essential for allergic airway inflammation, but expression of Notch ligands Jagged1 and Jagged2 on dendritic cells is dispensable

Although Notch signaling in T cells is critical for development of T helper2 cell-driven house-dust mite mediated allergic airway inflammation in mice, expression of the Notch ligands Jagged1 and Jagged2 on dendritic cells is dispensable.

http://ift.tt/2jEL4sz

Allergen-dependent oxidant formation requires purinoceptor activation of ADAM 10 and prothrombin

http://ift.tt/2iQ1dYb

JAK1 gain-of-function causes an autosomal dominant immune dysregulatory and hypereosinophilic syndrome

Germline JAK1 gain-of-function mutations cause autosomal dominant immune dysregulation and hypereosinophilia with eosinophilic infiltration of the gastrointestinal tract, massive hepatosplenomegaly and severe atopic dermatitis that can be successfully treated with ruxolitinib, an oral JAK1/2 inhibitor.

http://ift.tt/2jEaQxJ

Zika Virus—What the Otolaryngologist Should Know

This review summarizes information on the Zika virus, its clinical courses, and diagnosis to educate otolaryngologists about relevant diagnostic, therapeutic, and preventive measures.

http://ift.tt/2gqli9D

Endoscopic Repair of Tympanic Membrane Perforations

This Viewpoint discusses the advantage of the transcanal endoscopic approach for tympanoplasty.

http://ift.tt/2gqgYH7

EMR Implementation and Otolaryngologist Productivity

This observational study examines the association between transitioning to an electronic medical record system and physician productivity in otolaryngology.

http://ift.tt/2jEiDeH

Characteristics of Low Gestational Age Newborns Undergoing Tracheotomy

This cohort analysis of extremely low gestational age newborns in the Trial of Late Surfactant evaluates the use of mean airway pressure as an indicator of the need for tracheotomy.

http://ift.tt/2jEddk1

Unusual Cause of Anemia and Positive Fecal Occult Blood Test

A man presented with edema of the lower leg and suspected venous thrombosis; computed tomography revealed an esophageal intraluminal tubular mass of soft-tissue density originating just below the pyriform recessus and extending through the esophagus in the stomach lumen. What is your diagnosis?

http://ift.tt/2k6b3pK

Incorrect Numbers at Risk in Figure

In the Original Investigation titled "Cetuximab and Radiotherapy in Laryngeal Preservation for Cancers of the Larynx and Hypopharynx: A Secondary Analysis of a Randomized Clinical Trial," published in the September issue of JAMA Otolaryngology–Head & Neck Surgery,¹ incorrect values for the numbers of patients at risk appeared in Figure 2A. At day 30, the numbers of patients at risk should be 34 for CRT (cetuximab plus radiotherapy) and 25 for radiotherapy alone (not 3 and 2). This article was corrected online.

http://ift.tt/2hz0RIS

Zika Virus—What the Otolaryngologist Should Know

Endoscopic Repair of Tympanic Membrane Perforations

This Viewpoint discusses the advantage of the transcanal endoscopic approach for tympanoplasty.

http://ift.tt/2gqgYH7

Prosthetic Voice Rehabilitation Following Laryngectomy

Total laryngectomy (TL) as an operation has evolved since it was first performed by Billroth in 1873, and has declined in use as the primary treatment for advanced laryngeal cancer. This decline in use has been arguably associated with a decline in survival rates. Less controversial is the critical requirement to provide alaryngeal patients with acceptable forms of voice restoration, which include electrolarynx, esophageal speech, and indwelling tracheoesophageal prostheses (TEP). Of these, the use of TEP has been shown to significantly improve patient quality of life, self-esteem, and sexual function with concomitant decrease in symptoms of depression and anxiety. Objective assessments of voice restoration outcomes, including TEP device life, are necessary to properly counsel patients and engage in shared decision making about voice restoration after laryngectomy.

http://ift.tt/2k6800W

Chronic Sinusitis and Risk of Head and Neck Cancer in US Elderly

This study uses SEER-Medicare data to evaluate the associations of chronic sinusitis with subsequent head and neck cancers, including nasopharyngeal cancer, human papillomavirus–related oropharyngeal cancer, and nasal cavity and paranasal sinus cancer.

http://ift.tt/2jE7nPw

Voice Change, Odynophagia, and Neck Pain Following a Sneeze

A man experienced sudden voice change, odynophagia, and neck pain following a single sneeze; laryngoscopy showed hematoma of the true vocal fold and laryngeal surface of the epiglottis with normal vocal fold movement and complete glottic closure. What is your diagnosis?

http://ift.tt/2k6dkRX

Survival and Surgical Outcomes for Pediatric Head and Neck Melanoma

This cohort study uses information from the National Cancer Data Base to examine the survival, demographic, tumor, and treatment characteristics of pediatric head and neck melanoma.

http://ift.tt/2ghPiG0

Incorrect Numbers at Risk in Figure

Surgical treatment For T4 Oropharyngeal Cancer

To the Editor The article by Zenga et al on the role of surgery for T4 oropharyngeal cancer was interesting, but I believe it had several omissions that add to the limitations. The most problematic issue with the analysis was the inherent bias in a comparison between 2 groups, 1 that undergoes the therapy (surgery) and 1 that does not, when the latter group has patients who either medically or technically cannot receive the therapy.

http://ift.tt/2jEcSO5

Characteristics of Low Gestational Age Newborns Undergoing Tracheotomy

Increases in the Rate of Age-Related Hearing Loss in the Older Old

This medical record review uses audiometric evaluations at an academic medical center to determine if the rate of age-related hearing loss is constant in the older old.

http://ift.tt/2k6b3WM

Unusual Cause of Anemia and Positive Fecal Occult Blood Test

January 2017 Issue Highlights

http://ift.tt/2jEiyrp

EMR Implementation and Otolaryngologist Productivity

This observational study examines the association between transitioning to an electronic medical record system and physician productivity in otolaryngology.

http://ift.tt/2jEiDeH

Parental Knowledge of Obstructive Sleep-Disordered Breathing

This study develops a questionnaire to measure parents' understanding of adenotonsillectomy for obstructive sleep-disordered breathing as an aid in decision making and outcomes research.

http://ift.tt/2k6b25a

Prosthetic Voice Rehabilitation Following Laryngectomy

Otolaryngologist—Beware of Zika

The recent introduction of the Zika virus into the Western hemisphere and its unprecedented and rapid spread represent a great challenge to the otolaryngologist. The article by Arnaoutakis and Padhya discusses the issues confronting otolaryngologists in dealing with this phenomenon.

http://ift.tt/2jE6pD0

Chronic Sinusitis and Risk of Head and Neck Cancer in US Elderly

Office-Based vs OR Management of Recurrent Respiratory Papillomatosis

This medical record review of adult patients with recurrent respiratory papillomatosis investigates whether demographic or disease characteristics differ between patients undergoing office-based vs traditional operating room surgical treatment approaches.

http://ift.tt/2k5Zq22

January 2017 Issue Highlights

http://ift.tt/2jEiyrp

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

This observational study examined voice prosthesis device life across 390 patients in a large cancer hospital in the United States.

http://ift.tt/2k67Wy5

Voice Change, Odynophagia, and Neck Pain Following a Sneeze

A Tracheal Mass

A woman had a cervical tracheal mass on magnetic resonance imaging for cervical spine pain; flexible fiber-optic nasolaryngoscopy demonstrated a smooth hypervascular mass arising from the posterior membranous trachea. What is your diagnosis?

http://ift.tt/2jE6FSv

Survival and Surgical Outcomes for Pediatric Head and Neck Melanoma

Effect of Insurance Status on Children With Cochlear Implantation

This study reviews the achievement of fundamental auditory recognition and sound imitation in children with cochlear implants and investigates whether underinsured patients would achieve these goals in a delayed manner.

http://ift.tt/2k6eCfH

Surgical treatment For T4 Oropharyngeal Cancer

A Man With Objective Tinnitus

A man had recurrent episodes of unilateral high-pitched "clicking" in his right ear followed by vertigo that lasted 3 to 4 seconds but no hearing loss, aural fullness, autophony, or headache. What is your diagnosis?

http://ift.tt/2jE6ExV

Increases in the Rate of Age-Related Hearing Loss in the Older Old

This medical record review uses audiometric evaluations at an academic medical center to determine if the rate of age-related hearing loss is constant in the older old.

http://ift.tt/2k6b3WM

Parental Knowledge of Obstructive Sleep-Disordered Breathing

Otolaryngologist—Beware of Zika

Office-Based vs OR Management of Recurrent Respiratory Papillomatosis

A Tracheal Mass

Effect of Insurance Status on Children With Cochlear Implantation

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

This observational study examined voice prosthesis device life across 390 patients in a large cancer hospital in the United States.

http://ift.tt/2k67Wy5

A Man With Objective Tinnitus

Title page/Editorial Board

Publication date: February 2017
Source:Medical Hypotheses, Volume 99

http://ift.tt/2ju34Uu

Sleep and cargo reorganization: a hypothesis

Publication date: Available online 19 January 2017
Source:Medical Hypotheses
Author(s): Richard J. McCloskey
Several molecules that act in the nervous system to regulate sleep and wake were first identified based on their transport effects in pigmented cells. I compiled a list of such molecules like melatonin, melanin-concentrating hormone, and pigment dispersing factor, etc. Molecules that induce pigment aggregation promote sleep whereas molecules that induce pigment dispersal promote wake. I call these Sleep and PIgment Regulating Factors SPIRFs. SPIRFs regulate organelle trafficking in both pigmentary models and neurons. I propose that cargo transport fulfills necessary sleep functions such as remodeling synapses and restoring homeostasis in the distribution of cell components. I put forth the hypothesis that sleep-promoting SPIRFs induce states of increased cargo movement towards the cell body, and propose that this function is a critical neuron maintenance task for which animals must sleep.

http://ift.tt/2jE73Ah

Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile–based classification

A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described.

http://ift.tt/2iYTHO5

Eat Well, or Get Roommates Who Do

Publication date: Available online 19 January 2017
Source:Cell Host & Microbe
Author(s): Lee M. Kaplan, Joseph Brancale
In the January issue of Cell Host & Microbe, Griffin et al. (2017) report that the intestinal microbiome adapts to dietary practices. Restricted diversity induced by a typical American diet reflects a durable loss of taxa that is replenished only when dietary manipulation is accompanied by exposure to a healthier microbiota.

Teaser

In the January issue of Cell Host & Microbe, Griffin et al. (2017) report that the intestinal microbiome adapts to dietary practices. Restricted diversity induced by a typical American diet reflects a durable loss of taxa that is replenished only when dietary manipulation is accompanied by exposure to a healthier microbiota.

http://ift.tt/2iPYz4t

The Bactericidal Lectin RegIIIβ Prolongs Gut Colonization and Enteropathy in the Streptomycin Mouse Model for Salmonella Diarrhea

Publication date: Available online 19 January 2017
Source:Cell Host & Microbe
Author(s): Tsuyoshi Miki, Ryosuke Goto, Mayuka Fujimoto, Nobuhiko Okada, Wolf-Dietrich Hardt
The bactericidal lectin RegIIIβ is inducibly produced by intestinal epithelial cells as a defense against infection by enteropathogens. In the gut lumen, RegIIIβ kills not only certain enteropathogens, but also some commensal bacteria; thus, RegIIIβ is also thought to be an innate immune effector shaping microbiota composition and establishing intestinal homeostasis. Using the streptomycin mouse model for Salmonella colitis, we show that RegIIIβ can promote sustained gut colonization of Salmonella Typhimurium and prolong enteropathy. RegIIIβ expression was associated with suppression of Bacteroides spp. in the gut lumen, prolonged disease-associated alterations in colonic metabolism, and reduced luminal vitamin B6 levels. Supplementation with Bacteroides spp. or vitamin B6 accelerated pathogen clearance from the gut and remission of enteropathy. Our findings indicate that interventions at the level of RegIIIβ and supplementation with Bacteroides spp. or vitamin B6 might open new avenues for therapeutic intervention in the context of Salmonella colitis.

Graphical abstract

Teaser

Gut infection with enteropathogens elicits expression of the antimicrobial RegIIIβ lectin. Miki et al. find that RegIIIβ prolongs the duration of Salmonella diarrhea by suppressing Bacteroides spp. and reducing vitamin B6 levels in the gut. Controlling the RegIIIβ-dependent effects might be a promising avenue for treating Salmonella-induced diarrhea.

http://ift.tt/2jEBXbl

Systematic Characterization and Analysis of the Taxonomic Drivers of Functional Shifts in the Human Microbiome

Publication date: Available online 19 January 2017
Source:Cell Host & Microbe
Author(s): Ohad Manor, Elhanan Borenstein
Comparative analyses of the human microbiome have identified both taxonomic and functional shifts that are associated with numerous diseases. To date, however, microbiome taxonomy and function have mostly been studied independently and the taxonomic drivers of functional imbalances have not been systematically identified. Here, we present FishTaco, an analytical and computational framework that integrates taxonomic and functional comparative analyses to accurately quantify taxon-level contributions to disease-associated functional shifts. Applying FishTaco to several large-scale metagenomic cohorts, we show that shifts in the microbiome's functional capacity can be traced back to specific taxa. Furthermore, the set of taxa driving functional shifts and their contribution levels vary markedly between functions. We additionally find that similar functional imbalances in different diseases are driven by both disease-specific and shared taxa. Such integrated analysis of microbiome ecological and functional dynamics can inform future microbiome-based therapy, pinpointing putative intervention targets for manipulating the microbiome's functional capacity.

Graphical abstract

Teaser

Comparative human microbiome analyses have identified both taxonomic and functional shifts associated with diseases. Manor and Borenstein present an integrative multi-omic framework that identifies the microbial drivers of functional shifts. Its application reveals that shifts in the microbiome's functional capacity can be traced back to function-, site-, and disease-specific taxa.

http://ift.tt/2jEM6VB

Response to Therapy Status Is an Excellent Predictor of Pregnancy-Associated Structural Disease Progression in Patients Previously Treated for Differentiated Thyroid Cancer

Thyroid , Vol. 0, No. 0.

http://ift.tt/2iPS4Pt

Kongenitaler Nävus, atypischer Nävus Spitz oder spitzoides Melanom?

http://ift.tt/2jROnKK

Endothelial dysfunction in the early postoperative period after major colon cancer surgery

Background. Evidence suggests that endothelial dysfunction in the early postoperative period promotes myocardial injury after non-cardiac surgery. The aim of this study was to investigate the impact of colon cancer surgery on endothelial function and the association with the l-arginine-nitric oxide pathway postoperatively.Methods. Patients undergoing elective colon cancer surgery (n = 31) were included in this prospective observational cohort study. Endothelial function, as measured using the reactive hyperaemia index (RHI), was assessed non-invasively using digital pulse tonometry. RHI and plasma concentrations of L-arginine, asymmetric dimethylarginine (ADMA), dihydrobiopterin and biopterin metabolites, tetrahydrobiopterin (BH4) and total biopterin were measured before surgery, at four h after surgery and at postoperative day one and two. Cardiac troponin I was measured before surgery and once daily on postoperative days one to four.Results. Preoperative RHI was 1.86 (1.64 – 2.11) and decreased significantly during the observation period (linear mixed effects model of serial measurements, P = 0.015). Both L-arginine (P < 0.001) and ADMA (P = 0.024) decreased during the postoperative period. All biopterin metabolites were significantly decreased after surgery. A significant positive correlation was found between logAUC(l-arginine/ADMA) and logAUC(RHI) (P = 0.015) and between logAUC(L-arginine/ADMA) and logAUC(BH4) (P = 0.015). None of the patients had cardiac troponin I elevations.Conclusions. RHI was attenuated in the first days after colon cancer surgery indicating acute endothelial dysfunction. Endothelial dysfunction correlated with disturbances in the L-arginine – nitric oxide pathway. Our findings provide a rationale for investigating the hypothesized association between acute endothelial dysfunction and cardiovascular complications after non-cardiac surgery.Clinical trial registration. NCT02344771.

http://ift.tt/2jEOhIz

Advances in Anesthesia . TM McLoughlin, FV Salinas and L Torsher (editors)

Advances in Anesthesia. McLoughlinTM, SalinasFV and TorsherL (editors). Published by Elsevier. Pp. 213. Price $175. ISBN 978-0-323-35605-3

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American Thyroid Association Experts Debate Benefits and Challenges of New ATA Guidelines for Managing Hyperthyroidism and Thyrotoxicosis

In a stimulating new Roundtable Discussion, a distinguished panel of leading physicians and clinical researchers highlight the key changes, new topics, and areas of ongoing controversy in the "2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis." The Roundtable Discussion and the American Thyroid Association (ATA) guidelines are available free on the website of Thyroid, the official peer-reviewed journal of the ATA, published by Mary Ann Liebert, Inc., publishers.

Led by Moderator Douglas S. Ross, MD, Harvard Medical School and Massachusetts General Hospital, Boston, the Roundtable features panelists Victor J. Bernet, MD, Mayo Clinic and Mayo Clinic College of Medicine, Jacksonville, FL; David S. Cooper, MD, The Johns Hopkins University School of Medicine, Baltimore, MD; Gilbert Daniels, MD, Harvard Medical School and Massachusetts General Hospital; Jacqueline Jonklaas, MD, PhD, Georgetown University, Washington, DC; John C. Morris, MD, Mayo Clinic, Rochester, MN; Elizabeth N. Pearce, MD, Boston University School of Medicine; Mary Samuels, MD, Oregon Health & Science University, Portland; and Julie Ann Sosa, MD, MA, Duke Cancer Institute and Duke Clinical Research Institute, Duke University, Durham, NC.

The panelists, all members of the American Thyroid Association and some of whom were on the task force that developed the previous management guidelines in 2011, highlighted the major changes in the 2016 guidelines, which included an increase in the number of recommendations from 100 to 124 and an expanded focus on more unusual cases of thyrotoxicosis. The spirited and informative discussion also focused on important changes in the new guidelines, including new paradigms for determining the etiology of thyrotoxicosis, new approaches to monitor response to anti-thyroid drugs such as measures of thyrotropin receptor antibodies, new data supporting the safety of long-term use of anti-thyroid drugs, and new approaches to manage hyperthyroidism in women who want to become pregnant.

"These guidelines provide a significant update compared to the previous version published in 2011 because they integrate recent studies and developments in practice trends. They form a detailed and balanced framework for the diagnosis and management of patients with different etiologies of thyrotoxicosis that is based on the currently available evidence," says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago.

"The updated guidelines have refined several important aspects of diagnosis and management of patients with hyperthyroidism based upon new knowledge and technology. The panel's discussion focused upon several of the more common issues regarding application of new recommendations. I found it to be both simulating and informative." says John C. Morris, MD, President of the American Thyroid Association, Professor of Medicine, Mayo Clinic, Rochester, Minnesota.

The Roundtable was supported by Quidel.

About the Journal
Thyroid, the official journal of the American Thyroid Association, is an authoritative peer-reviewed journal published monthly online with open access options and in print. The Journal publishes original articles and timely reviews that reflect the rapidly advancing changes in our understanding of thyroid physiology and pathology, from the molecular biology of the cell to clinical management of thyroid disorders. Complete tables of content and a sample issue may be viewed on the Thyroid website. The complete Thyroid Journal Program includes the highly valued abstract and commentary publication Clinical Thyroidology, led by Editor-in-Chief Jerome M. Hershman, MD and published monthly, and the groundbreaking videojournal companion VideoEndocrinology, led by Editor Gerard Doherty, MD and published quarterly. Complete tables of content and sample issues may be viewed on the Thyroid website.

About the Society
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA delivers its mission — of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health — through several key endeavors: the publication of highly regarded professional journals, Thyroid, Clinical Thyroidology, and VideoEndocrinology; annual scientific meetings; research grant programs for young investigators, biennial clinical and research symposia; support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease and thyroid cancer. The ATA promotes thyroid awareness and information through its online Clinical Thyroidology for the Public (distributed free of charge to over 11,000 patients and public subscribers) and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet.

About the Publisher
Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Diabetes Technology & Therapeutics, Journal of Women's Health, and Metabolic Syndrome and Related Disorders. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's more than 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

The post American Thyroid Association Experts Debate Benefits and Challenges of New ATA Guidelines for Managing Hyperthyroidism and Thyrotoxicosis appeared first on American Thyroid Association.

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Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies , S Narang, A Weisheipl and EL Ross (editors)

Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies, NarangS, WeisheiplA and RossEL (editors). Published by Oxford University Press. Pp. 408. Price $115. ISBN 978-0-19-937737-4

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Paravertebral block in paediatric abdominal surgery—a systematic review and meta-analysis of randomized trials

The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus been recommended for open cholecystectomy and other less painful surgeries such as inguinal herniorraphy and appendectomy. We performed a systematic review of PVB in paediatric abdominal conditions to assess its clinical efficacy and side effects compared with other analgesic therapies.A search of Medline, Embase, and Web of Science and hand-searching references from inception date to May 2016 was done. Relevant studies were randomized clinical trials in patients 0–18 years old comparing PVB (single shot or continuous catheter) with any comparator and analgesic medication. Pain scores, rescue analgesia and adverse events were compared.The systematic reviews identified six trials enrolling 358 paediatric patients. PVB medications included bupivacaine, ropivacaine, lidocaine, and fentanyl. Surgical procedures included inguinal herniorraphy, cholecystectomy, and appendectomy. The standardized mean difference in early pain scores favoured PVB: 0.85 [95% confidence interval (CI) 0.12–1.58] at 4–6 h and 0.64 (95% CI 0.28–1.00) at 24 h. One study reported a reduced length of stay. Parental [odds ratio (OR) 5.12 (95% CI 2.59–10.1)] and surgeon [OR 6.05 (95% CI 2.25–16.3)] satisfaction were higher in those receiving a PVB. No major complications occurred with a PVB.PVB resulted in minimally improved pain scores for up to 24 h after surgery, reduced rescue analgesia requirements, and increased surgeon and parental satisfaction. PVB is a good alternative to caudal and ilioinguinal block in paediatric abdominal surgery.

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Preoperative α-blockade in catecholamine-secreting tumours: fight for it or take flight?

Dating back at least to the early report of Charles Mayo in 1927, phaeochromocytoma, a catecholamine-secreting tumour of adrenal chromaffin cells, has been considered a surgically curable cause of hypertension.<a href="#aew414-B1" class="reflinks">1</a> In the first half of the 20th century, however, the provision of anaesthesia for a laparotomy and resection of adrenal phaeochromocytoma and the related paraganglionoma (a tumour of extra-adrenal chromaffin tissue) was one of the greatest challenges faced by members of the fledgling specialty.<a href="#aew414-B2" class="reflinks">2–4</a> Thirty years ago in the British Journal of Anaesthesia, Hull<a href="#aew414-B5" class="reflinks">5</a> reflected further back to the early days of phaeochromocytoma surgery when perioperative mortality was as high as 30–45%.

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Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial †

Background. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was introduced to adult anaesthesia to improve the safety of airway management during apnoea before intubation. The objective of our study was to determine whether THRIVE safely prolongs apnoeic oxygenation in children.Methods. This was a randomized controlled trial in 48 healthy children, with normal airways and cardiorespiratory function, in age groups 0–6 and 7–24 months, 2–5 and 6–10 yr old, presenting for elective surgery or imaging under general anaesthesia. All children were induced with sevoflurane, O2, and N2O, followed by muscle relaxation with rocuronium, and standardized preoxygenation with bag-and-mask ventilation. The control arm received jaw support during apnoea, whereas the THRIVE arm received jaw support during apnoea and age-specific flow rates. The primary outcome was to demonstrate that children allocated to THRIVE maintain transcutaneous haemoglobin saturation at least twice as long as the expected age-dependent apnoea time in the control group.Results. Both study arms (each n=24) were similar in age and weight. The apnoea time was significantly shorter in the control arm: average 109.2 (95% CI 28.8) s in the control arm and 192 s in the THRIVE arm (0–6 months), 147.3 (95% CI 18.9) and 237 s (7–24 months), 190.5 (95% CI 15.3) and 320 s (2–5 yr), and 260.8 (95% CI 37.5) and 430 s (6–10 yr), respectively. Average transcutaneous haemoglobin saturation remained at 99.6% (95% CI 0.2) during THRIVE. Transcutaneous CO2 increased to a similar extent in both arms, with 2.4 (95% CI 0.5) mm Hg min−1 for the control arm and 2.4 (95% CI 0.4) mm Hg min−1 for the THRIVE arm.Conclusion. Transnasal humidified rapid-insufflation ventilatory exchange prolongs the safe apnoea time in healthy children but has no effect to improve CO2 clearance.Clinical trial registration. ACTRN12615001319561.

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Quest to determine the ideal position of the central venous catheter tip

Central venous cannulation is a standard practice for any major surgery and intensive care unit admission entailing major haemodynamic effects, blood loss, administration of fluids and vasoactive drugs, and central venous pressure monitoring.<a href="#aew443-B1" class="reflinks">1</a> The internal jugular vein (IJV) or subclavian vein is the preferred route for this purpose. Hitherto, the practice regarding the length of insertion of the central venous catheter (CVC) has not conformed to any fixed guidelines.<a href="#aew443-B2" class="reflinks">2</a> One of the dreaded complications of CVC placement is cardiac tamponade as a result of perforation of the vessel or the cardiac chamber, which carries a high mortality.<a href="#aew443-B3" class="reflinks">3</a><a href="#aew443-B4" class="reflinks">4</a> The US Food and Drug Administration recommends that the CVC tip should not be located in or allowed to migrate into the heart to avert this catastrophic complication.<a href="#aew443-B5" class="reflinks">5</a> Owing to this, it is believed that the tip of the catheter should be placed in the middle superior vena cava (SVC), outside the pericardial reflection enveloping the lower SVC. This corresponds to the level of the carina, ∼2 cm above the junction of the SVC and the right atrium (RA).<a href="#aew443-B2" class="reflinks">2</a><a href="#aew443-B4" class="reflinks">4</a><a href="#aew443-B6" class="reflinks">6</a>

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Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a step forward in apnoeic oxygenation, paradigm-shift in ventilation, or both?

In this issue of the BJA, Humphreys and colleagues<a href="#aew432-B1" class="reflinks">1</a> present their data on the use of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) (Fisher and Paykel Healthcare, Auckland, New Zealand) in children. THRIVE is a technique that uses rapidly insufflated, heated, humidified gases administered via high flow nasal cannula (HFNC) to achieve apnoeic oxygenation and ventilation. This is the first study to demonstrate that THRIVE is effective in prolonging the safe apnoeic time in children during airway management. The purpose of this editorial is to explore the processes contributing to oxygenation and ventilation achieved through THRIVE, and to discuss future applications for this potentially promising ventilatory technique.

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Indirect admission to intensive care after surgery: what should be considered?

A number of countries have developed, at national or state level, quality registries that contain individualised data on patient characteristics, health status, medical interventions and outcomes after treatment.<a href="#aew433-B1" class="reflinks">1</a><a href="#aew433-B2" class="reflinks">2</a> These registries offer new opportunities to perform large-scale population-based studies in the field of perioperative medicine.

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Reply

Editor—We thank Dr Molokhia for his interest in our editorial<a href="#aew454-B1" class="reflinks">1</a>. We too had acknowledged the limitation of waist circumference (WC) in not being able to differentiate between visceral and subcutaneous fat. Indeed, all anthropometric indices of abdominal adiposity are subject to inaccuracies. This applies to both WC and sagittal abdominal diameter (SAD) owing to the different anatomical locations adopted for measurements<a href="#aew454-B1" class="reflinks">1</a> and lack of evidence on optimal cut-offs. The intention of our editorial was to highlight some of the drawbacks of BMI and to suggest a suitable alternative that can be of similar practical utility to BMI in the perioperative setting. Waist circumference can be measured with a simple measuring tape rather than needing specialized abdominal callipers or any expensive methods, such as computed tomography or magnetic resonance imaging. In fact, both WC and SAD have been found to be correlated strongly with visceral adipose tissue at the abdominal level<a href="#aew454-B3" class="reflinks">3</a> and cardiometabolic risk factors.<a href="#aew454-B2" class="reflinks">2</a> Moreover, another study found no advantage of SAD over other simpler measures, such as WC.<a href="#aew454-B4" class="reflinks">4</a> Hence, until further large-scale robust research provides conclusive evidence of the superiority of SAD, WC is just as good and simpler than SAD to incorporate in routine perioperative evaluation.

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Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series †

Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.

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Πέμπτη 19 Ιανουαρίου 2017

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