Covalent Growth Factor Tethering to Direct Neural Stem Cell Differentiation and Self-Organization

Publication date: Available online 2 February 2017
Source:Acta Biomaterialia
Author(s): Trevor R. Ham, Mahmoud Farrag, Nic D. Leipzig
Tethered growth factors offer exciting new possibilities for guiding stem cell behavior. However, many of the current methods present substantial drawbacks which can limit their application and confound results. In this work, we developed a new method for the site-specific covalent immobilization of azide-tagged growth factors and investigated its utility in a model system for guiding neural stem cell (NSC) behavior. An engineered interferon-γ (IFN-γ) fusion protein was tagged with an N-terminal azide group, and immobilized to two different dibenzocyclooctyne-functionalized biomimetic polysaccharides (chitosan and hyaluronan). We successfully immobilized azide-tagged IFN-γ under a wide variety of reaction conditions, both in solution and to bulk hydrogels. To understand the interplay between surface chemistry and protein immobilization, we cultured primary rat NSCs on both materials and showed pronounced biological effects. Expectedly, immobilized IFN-γ increased neuronal differentiation on both materials. Expression of other lineage markers varied depending on the material, suggesting that the interplay of surface chemistry and protein immobilization plays a large role in nuanced cell behavior. We also investigated the bioactivity of immobilized IFN-γ in a 3D environment in vivo and found that it sparked the robust formation of neural tube-like structures from encapsulated NSCs. These findings support a wide range of potential uses for this approach and provide further evidence that adult NSCs are capable of self-organization when exposed to the proper microenvironment.Statement of SignificanceFor stem cells to be used effectively in regenerative medicine applications, they must be provided with the appropriate cues and microenvironment so that they integrate with existing tissue. This study explores a new method for guiding stem cell behavior: covalent growth factor tethering. We found that adding an N-terminal azide-tag to interferon-γ enabled stable and robust Cu-free 'click' immobilization under a variety of physiologic conditions. We showed that the tagged growth factors retained their bioactivity when immobilized and were able to guide neural stem cell lineage commitment in vitro. We also showed self-organization and neurulation from neural stem cells in vivo. This approach will provide another tool for the orchestration of the complex signaling events required to guide stem cell integration.

Graphical abstract

http://ift.tt/2k1ZVwY

Study of efficacy of esthetic High-Intensity Focused Ultrasound system on Iranian skin for reducing the laxity and wrinkles of aging

Summary

Background

Ultrasound is a mechanical wave that transmitted in a straight line and it can be focused at frequencies of 1-7 MHz with a high degree of precision. An important aspect of HIFU is that damaging focal point is located several millimeters below the surface of the skin and tissue above and below the focal point remains unaffected. Due to absorption of this energy, temperature of tissue rises to more than 60°C and this stimulates the cells for collagen production and tissue rejuvenation.

Objective

To evaluate the clinical efficacy and safety of High-Intensity Focused Ultrasound on Skin Laxity and wrinkles.

Material and Method

The study involved 22 women aged 35-62 with skin type II-IV. HIFU device with three transducers was employed. Various focal depths with different energies were used in accordance with skin thickness. Improvement for seven regions of face and whole face were evaluated by two dermatologists and patients 3 months after treatment.

Results

All of the patients completed the study. Three months after treatment, there was a highly statistical improvement in skin laxity for all of the patients. Also, the average percentage of improvement by doctor's opinion and patients was 58% and 60%, respectively.

Conclusion

The experimental data obtained from dermatologists and patients showed that HIFU appears to be a safe and effective modality for skin laxity treatment.

http://ift.tt/2kYLl7d

The efficacy study of the combination of tripeptide-10-citrulline and acetyl hexapeptide-3. A prospective, randomized controlled study

Summary

Background

Bioactive peptides have beneficial effects on the skin.

Objective

We investigated to evaluate the effect of acetyl hexapeptide-3 and tripeptide-10 citrulline and the possible synergism between these two peptides.

Methods

Twenty-four healthy volunteers were randomized to receive combination of acetyl hexapeptide-3 with tripeptide-10 citrulline (Group G1), tripeptide-10 citrulline (Group, G2), acetyl hexapeptide-3 (Group G3), or neither peptide (Group G4) for 60 days. Skin properties evaluated included skin microtopography, parameters cR2 and cR3, and transepidermal water loss (TEWL) using a skin visioscan and a tewameter, respectively.

Results

After 20 days, the measurements between G1 and G2 groups (cR2 P=.045, cR3 P=.044), G2 and G3 groups (cR2 P=.017, cR3 P=.017), G3 and G4 groups (CR2 P=.022), and G2 and G4 groups (cR3 P=.028) from baseline were significant. After 60 days, measurements between groups G1 and G3 (cR2 P=.016, cR3 P=.025), groups G2 and G3 (cR2 P=.044, cR3= P=.044), and groups G1 and G4 (cR2 P=.025) were significant. After 20 days, changes in TEWL between groups G1 and G3 (P=.03), groups G2 and G3 (P=.045), and groups G3 and G4 (P=.025) were significant. After 40 days, changes between groups G2 and G3 (P=.028) and groups G3 and G4 (P=.01) from baseline were significant.

Conclusion

Our results confirm the antiwrinkle activity of acetyl hexapeptide-3. A significant decrease in TEWL with acetyl hexapeptide-3 treatment is observed. We provided clinical evidence for the antiwrinkle efficacy of tripeptide-10 citrulline and possibly TEWL. The underlying mechanism by which these two peptides can act synergistically was not clear in this study.

http://ift.tt/2ksSAYe

Chemotherapy-induced alopecia management: Clinical experience and practical advice

Summary

Background

Chemotherapy-induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment-related aspects such as drug dose, administration regimen, and exposure to X-rays, but also patient-related characteristics. To the best of our knowledge, no guidelines are available about CIA management.

Aims and methods

With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, during, and after drug administration and to create a sort of practical guide for dermatologists and oncologists.

Results and conclusion

There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence-based management strategies.

http://ift.tt/2kYT0Cs

Study of efficacy of esthetic High-Intensity Focused Ultrasound system on Iranian skin for reducing the laxity and wrinkles of aging

Summary

Background

Ultrasound is a mechanical wave that transmitted in a straight line and it can be focused at frequencies of 1-7 MHz with a high degree of precision. An important aspect of HIFU is that damaging focal point is located several millimeters below the surface of the skin and tissue above and below the focal point remains unaffected. Due to absorption of this energy, temperature of tissue rises to more than 60°C and this stimulates the cells for collagen production and tissue rejuvenation.

Objective

To evaluate the clinical efficacy and safety of High-Intensity Focused Ultrasound on Skin Laxity and wrinkles.

Material and Method

The study involved 22 women aged 35-62 with skin type II-IV. HIFU device with three transducers was employed. Various focal depths with different energies were used in accordance with skin thickness. Improvement for seven regions of face and whole face were evaluated by two dermatologists and patients 3 months after treatment.

Results

All of the patients completed the study. Three months after treatment, there was a highly statistical improvement in skin laxity for all of the patients. Also, the average percentage of improvement by doctor's opinion and patients was 58% and 60%, respectively.

Conclusion

The experimental data obtained from dermatologists and patients showed that HIFU appears to be a safe and effective modality for skin laxity treatment.

http://ift.tt/2kYLl7d

The efficacy study of the combination of tripeptide-10-citrulline and acetyl hexapeptide-3. A prospective, randomized controlled study

Summary

Background

Bioactive peptides have beneficial effects on the skin.

Objective

We investigated to evaluate the effect of acetyl hexapeptide-3 and tripeptide-10 citrulline and the possible synergism between these two peptides.

Methods

Twenty-four healthy volunteers were randomized to receive combination of acetyl hexapeptide-3 with tripeptide-10 citrulline (Group G1), tripeptide-10 citrulline (Group, G2), acetyl hexapeptide-3 (Group G3), or neither peptide (Group G4) for 60 days. Skin properties evaluated included skin microtopography, parameters cR2 and cR3, and transepidermal water loss (TEWL) using a skin visioscan and a tewameter, respectively.

Results

After 20 days, the measurements between G1 and G2 groups (cR2 P=.045, cR3 P=.044), G2 and G3 groups (cR2 P=.017, cR3 P=.017), G3 and G4 groups (CR2 P=.022), and G2 and G4 groups (cR3 P=.028) from baseline were significant. After 60 days, measurements between groups G1 and G3 (cR2 P=.016, cR3 P=.025), groups G2 and G3 (cR2 P=.044, cR3= P=.044), and groups G1 and G4 (cR2 P=.025) were significant. After 20 days, changes in TEWL between groups G1 and G3 (P=.03), groups G2 and G3 (P=.045), and groups G3 and G4 (P=.025) were significant. After 40 days, changes between groups G2 and G3 (P=.028) and groups G3 and G4 (P=.01) from baseline were significant.

Conclusion

Our results confirm the antiwrinkle activity of acetyl hexapeptide-3. A significant decrease in TEWL with acetyl hexapeptide-3 treatment is observed. We provided clinical evidence for the antiwrinkle efficacy of tripeptide-10 citrulline and possibly TEWL. The underlying mechanism by which these two peptides can act synergistically was not clear in this study.

http://ift.tt/2ksSAYe

Chemotherapy-induced alopecia management: Clinical experience and practical advice

Summary

Background

Chemotherapy-induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment-related aspects such as drug dose, administration regimen, and exposure to X-rays, but also patient-related characteristics. To the best of our knowledge, no guidelines are available about CIA management.

Aims and methods

With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, during, and after drug administration and to create a sort of practical guide for dermatologists and oncologists.

Results and conclusion

There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence-based management strategies.

http://ift.tt/2kYT0Cs

Characterizing the detectability of emission signals from a North Korean nuclear detonation

Publication date: April 2017
Source:Journal of Environmental Radioactivity, Volumes 169–170
Author(s): David Werth, Robert Buckley
The detectability of emission sources, defined by a low-level of mixing with other sources, was estimated for various locations surrounding the Sea of Japan, including a site within North Korea. A high-resolution meteorological model coupled to a dispersion model was used to simulate plume dynamics for four periods, and two metrics of airborne plume mixing were calculated for each source. While emissions from several known sources in this area tended to blend with others while dispersing downwind, the North Korean plume often remained relatively distinct, thereby making it potentially easier to unambiguously 'backtrack' it to its source.



http://ift.tt/2ksYzwi

Public member dose assessment of Bushehr Nuclear Power Plant under normal operation by modeling the fallout from stack using the HYSPLIT atmospheric dispersion model

Publication date: May 2017
Source:Journal of Environmental Radioactivity, Volume 171
Author(s): A. Zali, M. Shamsaei Zafarghandi, S.A. Feghhi, A.M. Taherian
In this work, public dose resulting from fission products released from Bushehr Nuclear Power Plant (BNPP) under normal operation is assessed. Due to the long range transport of radionuclides in this work (80 km) and considering terrain and meteorological data, HYbrid Single-Particle Lagrangian Integrated Trajectory (HYsplit) model, which uses three dimensional long-range numerical models, has been employed to calculate atmospheric dispersion. Annual effective dose calculation is carried out for inhalation, ingestion, and external exposure pathways in 16directions and within 80 km around the site for representative person. The results showed the maximum dose of inhalation and external exposure for adults is 3.8 × 10⁻⁸Sv/y in the SE direction and distance of 600 m from the BNPP site which is less than ICRP 103 recommended dose limit (1 mSv). Children and infants' doses are higher in comparison with adults, although they are less than 1 mSv. Ingestion dose percentage in the total dose is less than 0.1%. The results of this study underestimate the Final Safety Analysis Report ofBNPP-1 (FSAR)data.



http://ift.tt/2kt7bTL

Radioactivity levels in the mostly local foodstuff consumed by residents of the high level natural radiation areas of Ramsar, Iran

Publication date: April 2017
Source:Journal of Environmental Radioactivity, Volumes 169–170
Author(s): Nasrin Fathabadi, Ali Akbar Salehi, Kazem Naddafi, Mohammad Reza Kardan, Masud Yunesian, Ramin Nabizadeh Nodehi, Mohammad Reza Deevband, Molood Gooniband Shooshtari, Saeedeh Sadat Hosseini, Mahtab Karimi
Among High Level Natural Radiation Areas (HLNRAs) all over the world, the northern coastal city of Ramsar has been considered enormously important. Many studies have measured environmental radioactivity in Ramsar, however, no survey has been undertaken to measure concentrations in the diets of residents. This study determined the ²²⁶Ra activity concentration in the daily diet of people of Ramsar. The samples were chosen from both normal and high level natural radiation areas and based on the daily consumption patterns of residents. About 150 different samples, which all are local and have the highest consumption, were collected during the four seasons. In these samples, after washing and drying and pretreatment, the radionuclide was determined by α-spectrometry. The mean radioactivity concentration of ²²⁶Ra ranged between 5 ± 1 mBq kg⁻¹ wet weight (chino and meat) to 725 ± 480 mBq kg⁻¹ for tea dry leaves. The ²²⁶Ra activity concentrations compared with the reference values of UNSCEAR appear to be higher in leafy vegetables, milk and meat product. Of the total daily dietary ²²⁶Ra exposure for adults in Ramsar, the largest percentage was from eggs. The residents consuming eggs from household chickens may receive an elevated dose in the diet.



http://ift.tt/2jFU39m

Duplication Anomalies of the Internal Auditory Canal: Varied Spectrum

Abstract

Duplication anomalies of the internal auditory canal are rare, with only twenty-one cases reported in literature. These range from incomplete partition and complete partition to true duplication. We present three cases showing this entire spectrum of duplication abnormalities and discuss the role of imaging in the preoperative work up of such patients planned for cochlear implant.

http://ift.tt/2kYypOv

Duplication Anomalies of the Internal Auditory Canal: Varied Spectrum

Abstract

Duplication anomalies of the internal auditory canal are rare, with only twenty-one cases reported in literature. These range from incomplete partition and complete partition to true duplication. We present three cases showing this entire spectrum of duplication abnormalities and discuss the role of imaging in the preoperative work up of such patients planned for cochlear implant.

http://ift.tt/2kYypOv

Coercive Control, Physical Violence, and Masculinity

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2k1IigR

Treatment pattern and frequency of serum TSH measurement in users of different levothyroxine formulations: a population-based study during the years 2009–2015

Abstract

Background

Several conditions can modify the intestinal absorption of levothyroxine tablets, with potential consequences on their therapeutic effect. Pre-dosed ampoules and oral drops have been recently made available to overcome this limitation.

Aims

To describe the pattern of use of different formulations of levothyroxine in a general population of Southern Italy and to perform an exploratory analysis investigating the effect of switching from levothyroxine tablets to oral liquid formulations.

Methods

Data were extracted from the Caserta Local Health Unit database. All patients receiving at least one levothyroxine prescription during the years 2009–2015 were identified. 1-year incidence of use of formulation-specific levothyroxine was calculated. Switchers between levothyroxine tablets and oral liquid formulations were identified and the frequency of thyroid-stimulating hormone measurement within 2 years prior and after the switch date was explored.

Results

Overall, 56,354 levothyroxine users were included in the study. Of these, 55,147 patients received at least one prescription for tablets (97.9%), 1867 pre-dosed ampoules (3.3%) and 1550 oral drops (2.8%). The proportion of levothyroxine users receiving oral liquid formulations slightly increased over time. Patients switching from tablets to oral liquid formulations showed a statistically significant reduction in the number of thyroid-stimulating hormone measurements after switching from tablets, especially in presence of drugs interacting with levothyroxine potentially altering its absorption.

Conclusions

Use of levothyroxine oral liquid formulations is increasing over time even though their use is still limited in a general population of Southern Italy. Our exploratory analysis showed that the frequency of thyroid-stimulating hormone measurement was reduced in patients switching from levothyroxine tablet to new formulations.

http://ift.tt/2ksSGiM

Primary Thyroid Carcinoma with Low-Risk Histology and Distant Metastases: Clinicopathologic and Molecular Characteristics

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kU2ZNn

Effects of Adequate Iodine Supply on the Incidence of Iodine-Induced Thyroid Disorders in Slovenia

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kjIQwU

Acknowledgment of Reviewers

Thyroid Feb 2017, Vol. 27, No. 2: 302-305.


http://ift.tt/2kU31EZ

Shigenobu Nagataki (January 18, 1932–November 12, 2016)

Thyroid Feb 2017, Vol. 27, No. 2: 135-136.


http://ift.tt/2kU21kn

Future Meetings

Thyroid Feb 2017, Vol. 27, No. 2: 306-307.


http://ift.tt/2kjN3ku

Primary Thyroid Carcinoma with Low-Risk Histology and Distant Metastases: Clinicopathologic and Molecular Characteristics

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kU2ZNn

Effects of Adequate Iodine Supply on the Incidence of Iodine-Induced Thyroid Disorders in Slovenia

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kjIQwU

Acknowledgment of Reviewers

Thyroid Feb 2017, Vol. 27, No. 2: 302-305.


http://ift.tt/2kU31EZ

Shigenobu Nagataki (January 18, 1932–November 12, 2016)

Thyroid Feb 2017, Vol. 27, No. 2: 135-136.


http://ift.tt/2kU21kn

Future Meetings

Thyroid Feb 2017, Vol. 27, No. 2: 306-307.


http://ift.tt/2kjN3ku

Blockage of androgen and administration of estrogen induce transdifferentiation of testis into ovary

Induction of sex reversal of XY fish has been restricted to the sex undifferentiated period. In the present study, differentiated XY tilapia were treated with Trilostane (TR), Metopirone (MN) and Glycyrrhetinic acid (GA) (inhibitor of 3β-HSD, Cyp11b2 and 11β-HSD respectively) alone, or in combination with 17β-estrodiol (E2) from 30 to 90 dah (days after hatching). At 180 dah, E2 alone resulted in 8.3%, and TR, MN and GA alone resulted in no secondary sex reversal (SSR), while TR+E2, MN+E2 and GA+E2 resulted in 88.3%, 60.0% and 46.7% of SSR, respectively. This sex reversal could be rescued by simultaneous administration of 11-ketotestosterone (11-KT). Compared with the control XY fish, decreased serum 11-KT and increased E2 level were detected in SSR fish. Immunohistochemistry analyses revealed that Cyp19a1a, Cyp11b2 and Dmrt1 were expressed in the gonads of GA+E2, MN+E2 and TR+E2 SSR XY fish at 90 dah, but only Cyp19a1a was expressed at 180 dah. When the treatment was applied from 60 to 120 dah, TR+E2 resulted in 3.3% of SSR, MN+E2 and GA+E2 resulted in no SSR. These results demonstrated that once 11-KT was synthesized, it could antagonize E2 induced male-to-female SSR, which could be abolished by simultaneous treatment with inhibitor of steroidogenic enzymes. The upper the enzyme was located in the steroidogenic pathway, the higher SSR rate was achieved when it was inhibited as some of the precursors, such as androstenedione, testosterone, 5a-dihydrotestosterone, could act as androgens. These results highlight the key role of androgen in male sex maintenance.

http://ift.tt/2kjQ3xc

Quantifying 125I placement accuracy in prostate brachytherapy using postimplant transrectal ultrasound images

Publication date: Available online 1 February 2017
Source:Brachytherapy
Author(s): Muhammad F. Jamaluddin, Sunita Ghosh, Michael P. Waine, Ronald S. Sloboda, Mahdi Tavakoli, John Amanie, Albert D. Murtha, Don Yee, Nawaid Usmani
PurposeThe quality of a prostate brachytherapy implant depends on the accurate placement of sources. This study quantifies the misplacement of ¹²⁵I sources from the intended location using intraoperative ultrasound images.Methods and Materials¹²⁵I sources were manually identified in the postimplant ultrasound images and compared to the preoperative plan. Due to the subjective nature of the identifying sources, only sources identified with high confidence were included in the analysis. Misplacements from the original intended coordinate were measured along the X, Y, and Z axes and were stratified between overall misplacements and regions of the prostate gland.ResultsA total of 1619 ¹²⁵I sources using 357 strands were implanted in 15 patients' prostate glands, with 1197 (74%) confidently identified for misplacement analysis. The overall mean displacement was 0.49 cm and in the X, Y, and Z direction was 0.13, 0.15, and 0.38 cm, respectively. Greater source misplacement occurred in the anterior part of the prostate gland than the posterior part of the prostate gland by a factor 1.33 (p < 0.0001). Comparing sources in the lateral vs. medial regions of the prostate, no statistically significant differences on source misplacement were observed. Comparing misplacement in the base vs. midgland vs. apex identified the greatest difference between the base and midgland by a factor of 1.29 (p < 0.0001).ConclusionsThis study has identified significant misplacement of ¹²⁵I sources from their intended locations with the greatest error misplacement occurring in the Z direction. Source misplacement tends to occur more commonly in the anterior gland and in the base of the prostate.



http://ift.tt/2kVqZg2

MRI in prostate brachytherapy: Evidence, clinical end points to data, and direction forward

Publication date: Available online 1 February 2017
Source:Brachytherapy
Author(s): Thomas J. Pugh, Sajal S. Pokharel
The integration of multiparametric MRI into prostate brachytherapy has become a subject of interest over the past 2 decades. MRI directed high-dose-rate and low-dose-rate prostate brachytherapy offers the potential to improve treatment accuracy and standardize postprocedure quality. This article reviews the evidence to date on MRI utilization in prostate brachytherapy and postulates future pathways for MRI integration.



http://ift.tt/2jyPrqb

Dosimetric and radiobiologic comparison of 103Pd COMS plaque brachytherapy and Gamma Knife radiosurgery for choroidal melanoma

Publication date: Available online 1 February 2017
Source:Brachytherapy
Author(s): Daniel Gorovets, Nolan L. Gagne, Christopher S. Melhus
PurposePlaque brachytherapy (BT) and Gamma Knife radiosurgery (GKRS) are highly conformal treatment options for choroidal melanoma. This study objectively compares physical dose and biologically effective dose (BED) distributions for these two modalities.Methods and MaterialsTumor and organ-at-risk (OAR) dose distributions from a CT-defined reference right eye were compared between ¹⁰³Pd COMS (Collaborative Ocular Melanoma Study Group) plaques delivering 70 Gy (plaque heterogeneity corrected) over 120 h to the tumor apex and GKRS plans delivering 22 Gy to the 40% isodose line for a representative sample of clinically relevant choroidal melanoma locations and sizes. Tumor and OAR biologically effective dose-volume histograms were generated using consensus radiobiologic parameters and modality-specific BED equations.ResultsPublished institutional prescriptive practices generally lead to larger tumor and OAR physical doses from COMS BT vs. GKRS. Radiobiologic dose conversions, however, revealed variable BEDs. Medium and large tumors receive >1.3 times higher BEDs with COMS BT vs. GKRS. OAR BEDs have even greater dependence on tumor size, location, and treatment modality. For example, COMS BT maximum BEDs to the optic nerve are lower than from GKRS for large anterior and all posterior tumors but are higher for anterior small and medium tumors.ConclusionsBT and GKRS for choroidal melanoma have different physical dose and BED distributions with potentially unique clinical consequences. Using published institutional prescriptive practices, neither modality is uniformly favored, although COMS BT delivers higher physical doses and BEDs to tumors. These results suggest that lowering the physical prescription dose for COMS BT to more closely match the BED of GKRS might maintain equivalent tumor control with less potential morbidity.



http://ift.tt/2kVqPoN

Deformable image registration for cervical cancer brachytherapy dose accumulation: Organ at risk dose–volume histogram parameter reproducibility and anatomic position stability

Publication date: Available online 1 February 2017
Source:Brachytherapy
Author(s): E. Flower, V. Do, J. Sykes, C. Dempsey, L. Holloway, K. Summerhayes, D.I. Thwaites
PurposeThe purpose of this study was to determine the effect of deformable image registration (DIR) on cumulative organ at risk dose–volume histogram (DVH) parameter summation for more than three brachytherapy fractions. The reproducibility of different methods of DIR was tested. DIR was then used to assess the stability of the anatomic position of the DVH parameters within the bladder and rectum.Methods and MaterialsDIR was completed for 39 consecutive cervical cancer brachytherapy patients' planning CTs. Accumulated DVH parameters (D2cc and D0.1cc) for bladder and rectum were compared with dose summation without DIR. Reproducibility of DIR results was assessed for different methods of implementation based on adding contour biases added to the DIR algorithm. VolD2cc and VolD0.1cc structures were created from the overlap of the D2cc and D0.1cc isodose and the bladder or rectum, respectively. The overlap of VolD2cc and VolD0.1cc structures was calculated using the Dice similarity coefficient.ResultsDIR accumulated D2cc and D0.1cc decreased by an average of 2.9% and 4.2% for bladder and 5.08% and 2.8% for rectum compared with no DIR. DIR was most reproducible when the bladder or rectum contour was masked. The average Dice similarity coefficient was 0.78 and 0.61 for the bladder D2cc and D0.1cc as well as 0.83 and 0.62 for rectal D2cc and D0.1cc, respectively.ConclusionsDose decreases were observed for accumulated DVH parameters using DIR. Adding contour-based biases to the algorithm increases the reproducibility of D2cc and D0.1cc accumulation. The anatomic position of VolD2cc was more stable than VolD0.1cc.



http://ift.tt/2jyWYFI

Brachytherapy boost for prostate cancer: Trends in care and survival outcomes

Publication date: Available online 1 February 2017
Source:Brachytherapy
Author(s): S.M. Glaser, M.J. Dohopolski, G.K. Balasubramani, R.M. Benoit, R.P. Smith, S. Beriwal
PurposeAndrogen suppression combined with elective nodal and dose-escalated radiation therapy recently demonstrated an improved biochemical failure–free survival in men who received external beam radiation therapy (EBRT) plus a brachytherapy boost (BB) compared with dose-escalated external beam radiotherapy (DE-EBRT). We sought to analyze the factors predictive for use of EBRT + BB as compared with DE-EBRT and report resulting survival outcomes on a national level using a hospital-based registry.Methods and MaterialsWe identified 113,719 men from the National Cancer Database from 2004 to 2013 with intermediate- or high-risk prostate cancer who were treated with EBRT + BB or DE-EBRT. We performed univariate and multivariate analyses of all available factors potentially predictive of receipt of treatment selection. Survival was evaluated in a multivariable model with propensity adjustment.ResultsFor intermediate-risk patients, utilization of BB decreased from 33.1% (n = 1742) in 2004 to 12.5% (n = 766) in 2013 and for high-risk patients, utilization dropped from 27.6% (n = 879) to 10.8% (n = 479). Numerous factors predictive for use of BB were identified. Cox proportional hazards analysis was performed—adjusting for age, Charlson–Deyo comorbidity score, T stage, prostate-specific antigen, Gleason score, and sociodemographic factors—and demonstrated BB use was associated with a hazard ratio of 0.71 (95% confidence interval, 0.67–0.75; p < 0.0005) and 0.73 (95% confidence interval, 0.68–0.78; p < 0.0005) for intermediate- and high-risk patients, respectively.ConclusionsThere has been a concerning decline in the utilization of BB for intermediate- and high-risk prostate cancer patients despite an association with improved on overall survival. Numerous factors predictive for use of BB have been identified.



http://ift.tt/2kVDsQz

New application of three-dimensional printing biomaterial in nasal reconstruction

Objectives

Polycaprolactone (PCL) is an U.S. Food and Drug Administration-approved synthetic biodegradable polymer and is easily fabricated into three-dimensional (3D) structures. In this study, the 3D-printed PCL implant for nasal augmentation was further evaluated for its suitability for nasal surgeries such as septoplasty and rhinoplasty.

Methods

Ten New Zealand White rabbits were included and divided into study and sham groups (7 and 3, respectively). A lateral incision was made on the nasal dorsum and a pocket formed in the subperichondrial plane between the upper lateral cartilage and nasal septum. Polycaprolactone was fabricated based on 3D printing technology into a 0.8 × 0.8-cm rectangular shape for use as a nasal implant. The material was inserted as a septal extension graft and sutured with alar cartilage for nasal reshaping. The implants were harvested 4, 8, and 12 weeks after implantation and evaluated by gross morphological assessment and histological examination.

Results

The initial shape of the implant was unchanged in all cases, and no definitive postoperative complications were seen over the 3-month period. Gross morphological evaluation confirmed that implants remained in their initial location without migration or extrusion. Histologic evaluations showed that the implant architectures were maintained with excellent fibrovascular ingrowth and minimal inflammatory reactions.

Conclusion

Polycaprolactone can be used for nasal reconstruction such as nasal augmentation. Polycaprolactone is easy to work with and will avoid the increased operative time and morbidity associated with autograft harvesting. Therefore, PCL implants designed by 3D printing can serve as clinically biocompatible materials in craniofacial reconstruction in the future.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2jXTbxB

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Objective

To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity.

Study Design

Cross-sectional population analysis.

Methods

Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT.

Results

A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC.

Conclusion

Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence.

Level of Evidence

2C. Laryngoscope, 2017

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Target volume and artifact evaluation of a new data driven 4D CT

Publication date: Available online 2 February 2017
Source:Practical Radiation Oncology
Author(s): Rachael Martin, Tinsu Pan
Purpose4D CT is often used to define the internal gross target volume (IGTV) for radiation therapy of lung cancer. Traditionally, this technique requires the use of an external motion surrogate, however, a new image data driven 4D CT has become available. This study aims to describe this data driven 4D CT and compare target contours created with it to those created using standard 4D CT.MethodsCine CT data of 35 patients undergoing SBRT were collected and sorted into phases using standard and data driven 4D CT. IGTV contours were drawn using a semi-automated method on maximum intensity projection (MIP) images of both 4D CT methods. Errors due to reproducibility of the method were characterized. A comparison of phase image artifacts was made using a normalized cross correlation method which assigned a score from +1 (data driven "better") to −1 (standard "better").ResultsThe volume difference between the data driven and standard IGTVs was not significant (data driven was 2.1±1.0% smaller, p=0.08). The Dice similarity coefficient (DSC) showed good similarity between the contours (0.949±0.006). The mean surface separation was 0.4±0.1mm and the Hausdorff distance was 3.1±0.4mm. An average artifact score of +0.37 indicated the data driven method had significantly fewer and/or less severe artifacts than the standard method (p=1.5e-5 for difference from 0).ConclusionOn average, the difference between IGTVs derived from data driven and standard was not clinically relevant or statistically significant, suggesting data driven 4D CT can be used in place of standard 4D CT without adjustments to IGTVs. The relatively large differences in some patients were usually attributed to limitations in automatic contouring or differences in artifacts. Artifact reduction and setup simplicity suggest a clinical advantage to data driven 4D CT.



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Improving patient safety and workflow efficiency with standardized pre-treatment radiation therapist chart reviews

Publication date: Available online 2 February 2017
Source:Practical Radiation Oncology
Author(s): Kelly Cooper Younge, Katherine Woch Naheedy, Joel Wilkinson, Joumana Dekmak, Elizabeth Covington, Bonnie Durbin, Eric Nelson, Stephanie Filpansick, Jean M Moran
PurposeTherapists play a critical role in ensuring patient safety, however, they are sometimes given insufficient time to perform quality assurance of a patient's treatment chart and documentation prior to the start of treatment. In this work, we show the benefits of introducing a formal therapist pre-start QA checklist, completed in a quiet space well in advance of treatment, into our workflow.Materials and MethodsA therapist pre-start QA checklist was created by analyzing in-house variance reports and treatment unit delays over a period of six months. Therapists were then given dedicated time and a workspace to perform their checks within the dosimetry office of our department. The effectiveness of the checklist was quantified by recording the percentage of charts QA'ed prior to treatment, the percentage of charts with errors needing intervention, and treatment unit delays over a nearly two year time period. The frequency and types of errors found by the pre-start QA were also recorded.ResultsThrough the use of therapist pre-start QA, instances of treatment unit delays were reduced by up to a factor of nine over the first year of the program. At the outset of this new initiative, nearly 40% of charts had errors requiring intervention, with the majority being scheduling-related. With upstream workflow changes and automation, this was reduced over the period of a year to about 10%.ConclusionThe number of treatment unit delays was dramatically reduced through the use of a formal therapist pre-start QA checklist completed well in advance of treatment. The data collected via the checklist continues to be used for further quality improvement efforts.



http://ift.tt/2jFEcHG

New application of three-dimensional printing biomaterial in nasal reconstruction

Objectives

Polycaprolactone (PCL) is an U.S. Food and Drug Administration-approved synthetic biodegradable polymer and is easily fabricated into three-dimensional (3D) structures. In this study, the 3D-printed PCL implant for nasal augmentation was further evaluated for its suitability for nasal surgeries such as septoplasty and rhinoplasty.

Methods

Ten New Zealand White rabbits were included and divided into study and sham groups (7 and 3, respectively). A lateral incision was made on the nasal dorsum and a pocket formed in the subperichondrial plane between the upper lateral cartilage and nasal septum. Polycaprolactone was fabricated based on 3D printing technology into a 0.8 × 0.8-cm rectangular shape for use as a nasal implant. The material was inserted as a septal extension graft and sutured with alar cartilage for nasal reshaping. The implants were harvested 4, 8, and 12 weeks after implantation and evaluated by gross morphological assessment and histological examination.

Results

The initial shape of the implant was unchanged in all cases, and no definitive postoperative complications were seen over the 3-month period. Gross morphological evaluation confirmed that implants remained in their initial location without migration or extrusion. Histologic evaluations showed that the implant architectures were maintained with excellent fibrovascular ingrowth and minimal inflammatory reactions.

Conclusion

Polycaprolactone can be used for nasal reconstruction such as nasal augmentation. Polycaprolactone is easy to work with and will avoid the increased operative time and morbidity associated with autograft harvesting. Therefore, PCL implants designed by 3D printing can serve as clinically biocompatible materials in craniofacial reconstruction in the future.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2jXTbxB

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Objective

To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity.

Study Design

Cross-sectional population analysis.

Methods

Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT.

Results

A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC.

Conclusion

Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence.

Level of Evidence

2C. Laryngoscope, 2017

http://ift.tt/2k1uMtq

[Current position of new fixed-dose combination of tiotropium and olodaterol - its role in the treatment of chronic obstructive pulmonary disease in the Czech Republic].

[Current position of new fixed-dose combination of tiotropium and olodaterol - its role in the treatment of chronic obstructive pulmonary disease in the Czech Republic].

Vnitr Lek. 2016;62(12):1011-1020

Authors: Koblížek V, Svoboda M

Abstract
COPD is a serious pulmonary disease with rising global socioeconomic impact. From the perspective of the Czech Republic COPD was responsible for 21 000 acute hospitalizations and 3 500 deaths, mortality reaches 33/100 000 in 2015. Early stages of disease may be associated with a significant reduction of exercise capacity and the reduction of activities of daily living. Moreover early stages of bronchial obstruction are associated with the fastest lung function decline. Finally, early elimination of the risk of inhalation exposure is able to influence the course of the disease and to reduce its mortality. Most current treatment strategies and national recommendations attributed central role to bronchodilator drugs. Long-acting bronchodilators (LAMA and LABA) creates an essential component of the treatment of symptomatic individuals in the Czech COPD guidelines as well. Actual version of this document constitutes as standard therapy: long-lasting inhaled bronchodilators, targeted efforts to eliminate inhalation risk, vaccination, regular exercise, repeated inhalation technique training, identification, and treatment of relevant comorbidities. All other drugs (inhaled-corticosteroids, mucoactive medication, roflumilast, antibiotics), and non-pharmacological (lung volume reductions, nutrition support, long-term oxygen, home non-invasive ventilation, lung transplantation, palliative care) procedures are intended for a specific subgroups of patients only. The newest type of bronchodilator therapy is represented by a fixed dual bronchodilation. Currently we can use four original drug combinations: titropium + olodaterol, glycopyrronium + indacaterol, umeklidinium + vilanterol and aclidinium + formoterol in the Czech Republic. This area is an enterprising research. For example comprehensive scientific program covering eight studies on 15 000 COPD patients (TOviTO) assess the therapeutic benefits of tiotropium + olodaterolu in terms of lung function, quality of life, exercise tolerance, daily physical activity and the incidence of acute exacerbations. Meanwhile the published results of analyzed studies TONADO, OTEMTO, VIVACITO, and the first results of the study DYNAGITO have showed that fixed dual bronchodilation should be a mandatory treatment to all the symptomatic COPD patients. Unfortunately "face to face" comparison of different drug combinations is still missing. However, the treatment with tiotropium + olodaterol combination has been demonstrated to significantly (35 %) reduce the occurrence of clinically significant deterioration, which may lead to the stabilization of this multicomponent disease.Key words: COPD - hospitalizations - inhaled bronchodilators - mortality - treatment.

PMID: 28139131 [PubMed - in process]

http://ift.tt/2kYqD7x

Validation of a new snoring detection device based on a hysteresis extraction algorithm

Publication date: Available online 1 February 2017
Source:Auris Nasus Larynx
Author(s): Hirotaka Hara, Masakazu Tsutsumi, Syunsuke Tarumoto, Toshikazu Shiga, Hiroshi Yamashita
ObjectiveThis paper aims to introduce and validate our newly developed snoring detection device to automatically identify the incidence and amplitude of snores using the hysteresis extraction method.MethodsThirty patients (16 males and 14 females) with a history of snoring were included in this study. Each patient underwent a conventional polysomnography (PSG). Natural overnight snoring was recorded from each subject using our original snore detection device and an integrated circuit (IC) recorder while the patient slept during PSG. A new algorithm based on hysteresis extraction was used to detect snores and qualify the level of each event at 30-s intervals (one epoch). The automated and subjective assessment concordance was evaluated by comparing a total of 27,295 epochs, and sensitivity, specificity, and accuracy were calculated.ResultsStudy population analysis revealed a mean rate of snore time against the total sleep time of 14.1±7.9%. Further, validation of the automatic snore detection revealed the following: sensitivity, 71.2%; specificity, 93.1%; positive predictive value, 77.7%; negative predictive value, 94.6%; and accuracy, 90.7%.ConclusionsThis study revealed the efficacy of our newly developed snoring detection device and indicated that it may serve as a useful method in further snoring analysis via objective medical assessment. However, the sample size of 30 subjects was relatively small; therefore, further research is needed to evaluate this device.



http://ift.tt/2kuiKtr

Facial nerve paralysis associated with temporal bone masses

Publication date: Available online 1 February 2017
Source:Auris Nasus Larynx
Author(s): Hironobu Nishijima, Kenji Kondo, Ryoji Kagoya, Hitoshi Iwamura, Kazuo Yasuhara, Tatsuya Yamasoba
ObjectiveTo investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy.MethodsFNP assessed by the House–Brackmann (HB) grading system and by electroneurography (ENoG) were compared retrospectively.ResultsWe reviewed 914 patient records and identified 31 patients with FNP due to benign TBMs. Moderate FNP (HB Grades II–IV) was dominant for facial nerve schwannoma (FNS) (n=15), whereas severe FNP (Grades V and VI) was dominant for cholesteatomas (n=8) and hemangiomas (n=3). The average ENoG value was 19.8% for FNS, 15.6% for cholesteatoma, and 0% for hemangioma. Analysis of the correlation between HB grade and ENoG value for FNP due to TBMs and Bell's palsy revealed that given the same ENoG value, the corresponding HB grade was better for FNS, followed by cholesteatoma, and worst in Bell's palsy.ConclusionsFacial nerve damage caused by benign TBMs could depend on the underlying pathology. Facial movement and ENoG values did not correlate when comparing TBMs and Bell's palsy. When the HB grade is found to be unexpectedly better than the ENoG value, TBMs should be included in the differential diagnosis.



http://ift.tt/2kuuo7C

MEG and EEG demonstrate similar test-retest reliability of the 40Hz auditory steady-state response

Publication date: Available online 1 February 2017
Source:International Journal of Psychophysiology
Author(s): Kristina T. Legget, Allison K. Hild, Sarah E. Steinmetz, Steven T. Simon, Donald C. Rojas
The auditory steady-state response (ASSR) is increasingly being used as a biomarker in neuropsychiatric disorders, but research investigating the test-retest reliability of this measure is needed. We previously reported ASSR reliability, measured by electroencephalography (EEG), to 40Hz amplitude-modulated white noise and click train stimuli. The purpose of the current study was to (a) assess the reliability of the MEG-measured ASSR to 40Hz amplitude-modulated white noise and click train stimuli, and (b) compare test-retest reliability between MEG and EEG measures of ASSR, which has not previously been investigated. Additionally, impact of stimulus parameter choice on reliability was assessed, by comparing responses to white noise and click train stimuli. Test-retest reliability, across sessions approximately one week apart, was assessed in 17 healthy adults. On each study day, participants completed two passive listening tasks (white noise and click train stimuli) during separate MEG and EEG recordings. Between-session correlations for evoked power and inter-trial phase coherence (ITPC) were assessed following source-space projection. Overall, the MEG-measured ASSR was significantly correlated between sessions (p<0.05, FDR corrected), suggesting acceptable test-retest reliability. Results suggest greater response reproducibility for ITPC compared to evoked responses and for click train compared to white noise stimuli, although further study is warranted. No significant differences in reliability were observed between MEG and EEG measures, suggesting they are similarly reliable. This work supports use of the ASSR as a biomarker in clinical interventions with repeated measures.



http://ift.tt/2jFgWts

Vemurafenib-induced toxic epidermal necrolysis: is it an emerging side effect of the drug?

Abstract

Vemurafenib, a selective inhibitor of the BRAF-kinase used in treatment of metastatic melanoma alone or in combinations,¹ is known to cause various adverse skin reactions such as maculopapular rash, photosensitivity and hyperkeratotic lesions, affecting more than 90% of patients.^1-2 Severe adverse reactions were observed in less than 1% of the patients in clinical trials.³ However, the increasing number of reported cases of vemurafenib-induced toxic epidermal necrolysis (TEN), a life-threatening severe cutaneous adverse reaction, is striking. ^4-8 We herein present another patient with vemurafenib-induced TEN.

This article is protected by copyright. All rights reserved.

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Diagnostic Agreement and Interobserver Concordance with Teledermoscopy Referrals

Abstract

Background

Malignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between Primary Health Care and Dermatology clinics, the management of these patients could be made more efficient.

Objective

To evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images.

Methods

The referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision.

Results

Teledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to Primary Health Care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent 5 times. The interobserver concordance was moderate with both methods.

Conclusion

By adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jyx0Ce

Use of Topical Glucocorticoids: a Population-Based Cohort Study

Abstract

Background

Little is known about the prescriptions of topical glucocorticoids in the general population.

Objectives

To report an overall picture of topical glucocorticoid prescriptions in France.

Methods

This study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1/97^th random sampling of the French population covered by the main national healthcare insurance system (approximately 90% of the whole population). All patients prescribed topical glucocorticoids over a 5-year period (January 1, 2011 to December 31, 2015) were identified using a specific codes list for topical glucocorticoids.

Results

Over the 5-year study period, 662,531 individuals were recorded for at least one day in the EGB. Among them, 220,345 (33.3%) were prescribed at least once topical glucocorticoid. The prevalence of topical glucocorticoid prescription increased regularly from 2011 (11.7%) to 2015 (12.5%). A total of 922,026 tubes of topical glucocorticoids were dispensed, mainly high potency glucocorticoids, and were mainly prescribed by general practitioners (73.1%). A total of 1,713 (0.8%) patients were prescribed at least 24 tubes over a calendar year. These patients were more frequently men (p<0.001) and older (p<0.001) than the overall population of patients prescribed topical glucocorticoids. The 124,844 tubes prescribed to these patients had stronger potency than those prescribed to the overall population (p<0.001) and were mostly prescribed by general practitioners (68.1%). The reasons for prescription were available for only 371 patients (21.7%) and were mainly psoriasis, auto-immune bullous dermatoses and eczema.

Conclusion

About 12% of the French general population is prescribed topical glucocorticoids at least once each year. Most prescriptions are issued by general practitioners, dermatologists being the prescribers in less than one quarter of cases.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jFnsAC

A Case of Eosinophilic Fasciitis Associated with Pyoderma Gangrenosum

Abstract

Eosinophilic fasciitis (EF) is a rare, systemic inflammatory disease that is characterized by symmetrical swelling and scleroderma-like indurations of the distal extremities and trunk, often accompanied by pain and eosinophilia. Rarely, muscle degeneration may occur. Histologically, EF is marked by thickened, fibrotic fascia and fascial inflammation with lymphocytes and eosinophils.^1,2 Herein, we present a previously unreported case of concurrent pyoderma gangrenosum (PG) and biopsy-proven EF successfully treated with rituximab.

This article is protected by copyright. All rights reserved.

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Thermoplastic polyurethanes from β-methyl-δ-valerolactone-derived amidodiol chain extenders

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): David M. Guptill, Jacob P. Brutman, Thomas R. Hoye
Here we describe the synthesis of thermoplastic polyurethanes (TPUs) from polyols and amidodiol chain extenders, each of which is prepared from glucose-derived β-methyl-δ-valerolactone (MVL). Utilizing these novel chain extenders, we prepared TPUs with ca. 42–44 wt% hard segment content, comprising 72–75 wt% MVL-derived atoms. This compares favorably with an analogous sample prepared using 1,4-butanediol as the chain extender having 57 wt%. These TPUs are ductile (600–900% strain at break) and have high tensile strength (14–33 MPa stress at break). By virtue of the nature of the diamidodiol used as chain extenders, the hard segments contain a greater density of hydrogen bonding –NHC(=O)– functional groups relative to those prepared using traditional short chain 1,n-alkanediols.

Graphical abstract

http://ift.tt/2kUWqXM

A processing method with high efficiency for low density polyethylene nanofibers reinforced by aligned carbon nanotubes via nanolayer coextrusion

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Junfeng Cheng, Hongting Pu, Jiang Du
A method for large-scale processing of low density polyethylene (LDPE) nanofibers reinforced by aligned multi-walled carbon nanotubes (MWCNTs) is achieved via nanolayer coextrusion. The morphology and nano-sized diameter of the nanofibers are observed on scanning electron microscope. The prioritized alignment and dispersion of MWCNTs along the fiber axis are determined by transmission electron microscopy, polarized Raman spectra, and high resolution optical microscopy. The dispersion of MWCNTs in nanofibers is better than that in homologous micron-fibers. In addition, MWCNTs can promote the crystallization of LDPE in varying degrees which depend on the fiber diameter and MWCNTs content. As a result of the alignment of MWCNTs, the nanofibers exhibit enhanced mechanical properties. The tensile strength of LDPE(1 wt% MWCNTs) nanofibers is more than twice of pure nanofibers (without MWCNTs). The volume resistivity of the LDPE(MWCNTs) nanofiber mats containing 9 wt% MWCNTs can be reduced to 100 Ω cm.

Graphical abstract

http://ift.tt/2kUGR26

Size control of aromatic polyamide hollow spheres prepared by reaction-induced phase separation

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Hirofumi Nakayama, Naoto Adachi, Hironori Atarashi, Tetsuya Uchida, Shinichi Yamazaki, Kunio Kimura
Size control of the poly (1,4-phenylene-5-hydroxyisophthalamide) hollow spheres was examined by tuning the polymerization condition, focusing on concentration, temperature and solvent. Higher concentration lowered the diameter owing to the higher degree of super-saturation for nucleation. Temperature drop during the polymerization just before the nucleation was so effective to make the diameter smaller. Moreover, the diameter was susceptive to the solubility of oligomers in the solvent, and higher content of liquid paraffin in the aromatic solvent lowered the solubility, resulting in the decrease in the diameter. Based on these results, the combination of the temperature drop and the solvent effect was the most desirable to prepare the smallest hollow spheres, and the diameter of hollow spheres could be controlled from 4.4 to 0.7 μm.

Graphical abstract

http://ift.tt/2kUS3vD

Modeling the formation of layered, amphiphilic gels

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Santidan Biswas, Awaneesh Singh, Antoine Beziau, Tomasz Kowalewski, Krzysztof Matyjaszewski, Anna C. Balazs
The efficient formulation of layered gels that encompass both hydrophilic and hydrophobic domains could lead to novel materials with a range of vital functionalities. To facilitate the fabrication of these materials, we perform dissipative particle dynamics (DPD) simulations to model the formation of two-layered stackable gels where the gels are incompatible and their respective solvents are immiscible. The bottom layer of the gel is created first and then a solution of new initiators, monomers and cross-linkers is introduced on top of this first layer. These components then undergo living copolymerization to form the second gel layer. We investigate all possible combinations using free radical polymerization (FRP) and controlled/living atom transfer radical polymerization (ATRP) to form the two-layered material. When the lower gel is formed via ATRP, the system forms connected, stacked gel layers. If, however, the lower gel is formed via FRP, the gels do not form interconnected layers. The presence of active radical chain ends in the lower gel grown by ATRP enables the formation of covalent bonds with the upper gel layer. On the other hand, the lack of active radicals in the lower FRP gel leads to a sharp interfacial region, with negligible inter-gel bonds connecting the two layers. Our simulations provide insight into the nanoscale nature of the interface between the gel layers and yield guidelines for forming mechanically robust, "stackable" amphiphilic gels.

Graphical abstract

http://ift.tt/2kUXMSf

Microspheres of polyurethanes functionalized with push-pull type azo chromophores and their photoinduced deformation behavior

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Yuqi Zhou, Bingyang Liu, Xiaogong Wang
A series of azo polyurethanes bearing push-pull type azo chromophores was synthesized by post-polymerization azo-coupling reactions between a polyurethane precursor and diazonium salts of different aniline derivatives, respectively. Colloidal spheres with narrow size distributions were obtained by aggregation of these azo polyurethanes in DMF-H2O mixed solvents, which were induced by slowly increasing the water content. The self-assembling processes and formed structures were investigated by laser light scattering and transmission electron microscopy. When irradiated with linearly polarized light from Ar⁺ laser (488 nm) and diode solid state laser (532 nm), the azo polyurethane microspheres showed significant deformations elongated in the light polarization direction. The electron-withdrawing groups on the azo chromophores show a significant effect on the photoinduced deformation degree. These microspheres composed of the azo polyurethanes bearing carboxylic acid and trifluoromethyl groups as the electron-withdrawing substituents shows the largest deformation degrees when irradiated with 488 and 532 nm light, respectively.

Graphical abstract

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Facile preparation of hydrogen-bonded supramolecular polyvinyl alcohol-glycerol gels with excellent thermoplasticity and mechanical properties

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Shengjie Shi, Xin Peng, Tianqi Liu, Ya-Nan Chen, Changcheng He, Huiliang Wang
Facile preparation of tough hydrogels with excellent processability is of great practical importance, but it remains a great challenge. A novel type of hydrogen-bonded supramolecular PVA-glycerol gels is prepared with a very simple physical mixing method, in which glycerol molecules connect PVA chains into bundles by forming many H-bonds. The PVA-glycerol gels show much higher transparency than common PVA gels, due to their lower crystallinities and nanosized microstructures. The physical crosslinking nature and easy gelation at room temperature endow the gels with excellent moldability and thermoplasticity. The easy breaking of the H-bonding provides an effective energy-dissipating mechanism, leading to the high tensile strengths (up to more than 2 MPa), moduli, toughness and fracture energies of the gels. The PVA-glycerol gels also exhibit weaker temperature-dependent mechanical behaviors and excellent cold-resistance. The easy preparation and excellent properties of these gels should facilitate the practical applications of tough gels in many fields.

Graphical abstract

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An abnormal melting behavior of isotactic polypropylene spherulites grown at low temperatures

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Zhenzhen Zhou, Le Ma, Weiwei Zhen, Xiaoli Sun, Zhongjie Ren, Huihui Li, Shouke Yan
In this work, an abnormal melting behavior of isotactic polypropylene (iPP) was investigated by polarized optical microscopy (POM), temperature-modulated differential scanning calorimetry (TMDSC), scanning electron microscopy (SEM), wide-angle X-ray diffraction (WAXD) and small-angle X-ray scattering (SAXS). It can be found by POM that the melting of α-iPP spherulites isothermally crystallized at 135 °C could occur prior to that of α-iPP spherulites crystallized at 125 °C when heated by 2 °C min⁻¹, but the case is opposite if the heating rates are 10, 20 or 50 °C min⁻¹. Meanwhile, the occurrence of lamellar thickening could be revealed by in-situ synchrotron SAXS, it can be revealed that the initial lamellar thickness of α-iPP spherulites grown at 135 °C is over that of spherulites grown at 125 °C, whereas the latter exceeds the former by means of lamellar thickening after heating. After a series of experiments, the lamellar thickening mechanism could be described as the following, i.e., the tangential lamellae in the spherulite melt and recrystallize on the radial lamellae during heating process, yielding much thicker radial lamellae with higher perfection.

Graphical abstract

http://ift.tt/2kUV7Ij

Investigation of the biocompatibility and cytotoxicity associated with ROP initiator and its role in bulk polymerization of l-lactide

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Sharad P. Parwe, Shrikant D. Warkad, Manoj V. Mane, Pranita S. Shedage, Baijayantimala Garnaik
Poly (l-lactide) (PLLA) is one of the most attractive polymers for use in biomedical applications. In such applications it is necessary to reduce the use of toxic chemicals and catalysts used in PLLA synthesis, to minimize any adverse effects. In view of this, we have performed ring opening polymerization (ROP) of l-lactide (LA) using biocompatible initiator, namely, Zinc l-Proline (ZnP) in bulk. High molecular weight PLLA (Mw up to 1.45 × 10⁵ Da) was obtained using the ZnP complex. The ZnP complex is safe, easy to prepare, store and handle. ¹H and ¹³C NMR spectra of PLLA were used to determine the extent of monomer conversion and stereo sequence respectively. Differential Scanning Calorimetry (DSC) and Size Exclusion Chromatography (SEC) were used to determine thermal properties, Mn, Mw and polydispersity index respectively. The mechanism of ROP of LA in the presence of ZnP was studied using Density Functional Theory (DFT) which was in good agreement with results from ¹H NMR and Matrix-Assisted Laser Desorption/Ionization Spectrometry (MALDI-TOF). Biocompatibility/non toxicity of PLLA prepared using ZnP was studied in-vitro using MTT assay by examining the proliferation rate of mouse myoblast C2C12 cell line. Escherichia coli and Staphylococcus aureus were used for the study of antibacterial activity of PLLA.

Graphical abstract

http://ift.tt/2kUSoyD

Preparation and properties of positively charged mesoglobules based on poly(2-isopropyl-2-oxazoline) and evaluation of their potential as carriers of polynucleotides

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Natalia Toncheva-Moncheva, Emilia Veleva-Kostadinova, Christo Tsvetanov, Denitsa Momekova, Stanislav Rangelov
A series of random copolymers of 2-isopropyl-2-oxazoline and ethylenimine (PiPOX-ran-PEI) with PEI contents 5–84% were prepared by partial acidic hydrolysis of poly(2-isopropyl-2-oxazoline) (PiPOX). Dynamic and electrophoretic light scattering were utilized to investigate aqueous solution properties of the copolymers. Above the phase transition temperature of PiPOX, well-defined nanoparticles (mesoglobules) typically ranging in size 200–500 nm, depending on the heating protocol, and surface potential reaching +35 mV, were formed. The mesoglobules consisted of a core dominated by PiPOX and a thin positively charged shell from PEI moieties which mediated formation of polyplexes with DNA. Upon complexation with DNA, performed at 65 °C and at varying N/P (amine-to-phosphate groups) ratios, well-defined polyplex particles with dimensions ranging between 110 and 250 nm and typically negative ζ potential were formed. Cooling down to the physiologically relevant temperature of 37 °C resulted in a slight-to-moderate increase of the size due to swelling of the polyplex particles and reduction of the negative ζ potential. The copolymers with PEI contents ≥15% can be considered perspective for delivery of polynucleotides.

Graphical abstract

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Rheological behavior of polyacrylonitrile and polyacrylonitrile/lignin blends

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): H. Clive Liu, Chia-Chi Tuan, Amir A. Bakhtiary Davijani, Po-Hsiang Wang, Huibin Chang, Ching-Ping Wong, Satish Kumar
Dynamic shear rheology study is conducted on the polyacrylonitirile (PAN) solution and composite solutions of PAN with up to 37.5 wt% annual plant lignin (APL) to address current barriers of PAN/lignin blend development as carbon fiber precursor. PAN/APL blends exhibit lower yield stresses, lower relaxation times, and lower viscosities than to PAN solution according to the dynamic frequency sweep measurements from −7 °C to 56 °C. Yet an increase of solution activation energy of flow is observed with the increasing lignin content in solution. This is attributed to the potential interactions of PAN and lignin. Solution loss tangents obtained from dynamic frequency sweeps between −7 °C and 56 °C at an oscillatory frequency of 100 rad/s is used to envision the effect of lignin on solution structure during fiber processing.

Graphical abstract

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Dynamic, ultra-pH-sensitive graft copolymer micelles mediated rapid, complete destruction of 3-D tumor spheroids in vitro

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Guoqing Yan, Qian Zha, Jun Wang, Xin Wang, Xu Cheng, Weijing Yao, Rupei Tang
PEGylated poly(ortho ester amides) copolymer micelles (POEAd-g-MPEG micelles) with ultra-pH-sensitivity, which exhibited a dynamic change in size under mildly acidic conditions, were constructed by facile method, therefore achieving: (i) remaining stealthy and long-circulating in the blood; (ii) small NPs once in the tumor extracellular space for enhancing penetration; (iii) bigger NPs after penetration into the core of tumor for improving retention; (iv) rapid and complete dissolution to release drug at intracellular pH for improving toxicity to tumor cells upon being internalized by tumor cells. The enhanced tumor penetration and inhibition are closely related to these dynamic characteristics, resulting in unprecedentedly rapid, complete destruction of 3-D tumor spheroids in vitro.

Graphical abstract

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Impact of carbon nanotube prelocalization on the ultra-low electrical percolation threshold and on the mechanical behavior of sintered UHMWPE-based nanocomposites

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Tiana Deplancke, Olivier Lame, Sophie Barrau, Kesavan Ravi, Florent Dalmas
Nascent powder particles of Ultra High Molecular Weight Polyethylene have been covered by multi-walled carbon nanotubes and then processed by means of sintering. The prelocalization of carbon nanotubes in the interfacial region between powder particles of UHMWPE allowed reaching an electrical percolation threshold as low as 0.04 wt%. It is also a possible way to reinforce specifically the interfacial regions with a very small amount of fillers. Indeed, the nucleation effect of the nanotubes is very strong on the strain-induced crystallization in the melting state of the composite. The tensile experiments above the melting point allowed by the extremely broad rubbery plateau of the UHMWPE show a significant increase in strain-hardening due to the addition of CNTs from 0.02 wt%. In the solid state the elastic properties, such as yield stress, and the crystallinity can also be increased for higher CNT concentrations despite the presence of aggregates which reduce the elongation at break.

Graphical abstract

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A Characterization of Cancer Patients in Inpatient Rehabilitation Facilities: A Retrospective Cohort Study

Publication date: Available online 1 February 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jacqueline M. Mix, Carl V. Granger, Michael J. LaMonte, Paulette Niewczyk, Margaret DiVita, Richard Goldstein, Jerome Yates, Jo L. Freudenheim
ObjectiveTo identify the types of cancer patients admitted to inpatient medical rehabilitation and to describe their rehabilitation outcomes.DesignRetrospective cohort study;SettingU.S. inpatient rehabilitation facilities (IRFs)ParticipantsAdult patients diagnosed with malignant cancer for a cancer related impairment admitted to an IRF between October 2010 and September 2012 were identified from the Uniform Data System for Medical Rehabilitation (UDSMR) database (n = 27,952).InterventionsnoneMain Outcome Measure(s)Demographic, medical and rehabilitation characteristics for patients with various cancer tumor types were summarized using data collected from the Inpatient Rehabilitation Patient Assessment Instrument (IRF-PAI). Rehabilitation outcomes included the percentage of patients discharged to community and acute care settings and functional change from admission to discharge. Functional status was measured using the FIM® instrument.ResultsCancer patients constituted about 2.4% of the total IRF patient population. Cancer types included brain and nervous system (52.9%), digestive (12.0%), bone and joint (8.7%), blood and lymphatic (7.6%), respiratory (7.1%) and other (11.7%). Overall, 72% were discharged to a community setting and 16.5% were discharged back to acute care. Patients with blood and lymphatic cancers had the highest frequency of discharge back to acute care (28%). On average, all cancer patient groups made significant functional gain during their IRF stay (FIM total change: 23.5 ± 16.2).ConclusionsIn a database representing approximately 70% of all US patients in IRFs, we found that a variety of cancer types are admitted to inpatient rehabilitation. The majority of cancer patients admitted to IRFs were discharged to a community setting and on average, improved their function. Future research is warranted to understand the referral patterns of admission to post-acute care rehabilitation and to identify factors that are associated with rehabilitation benefit in order to inform the establishment of appropriate care protocols.



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Letter from the Guest Editor: Pelvic MR Imaging

Publication date: Available online 31 January 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Tarun Pandey




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Speech-Language Pathologists' Use of Hearing Screening for Clients With Aphasia: Challenges, Potential Solutions, and Future Directions

Purpose

The co-occurrence of aphasia and hearing loss can lead to compounded receptive communication impairment that is significantly worse than in either disorder alone. Therefore, identifying potential hearing loss is a critical part of communication assessment for clients with neurogenic communication disorders, many of whom have aphasia. This clinical focus article explores speech language pathologists' (SLPs') hearing-screening practices with this population, identifies patterns of concern, and presents potential solutions and future research needs.

Method

SLPs completed an online survey. Data were obtained from 102 SLPs who work with adults with aphasia.

Results

Most respondents indicated that they do some form of hearing screening, although few do them in a reliable, valid manner. Awareness of American Speech-Language-Hearing Association hearing-screening guidelines was low. The most common reasons given for not conducting screenings included cost and lack of proper equipment and time.

Conclusions

SLPs are an important resource for identifying potential hearing loss in individuals with aphasia. These data suggest that hearing screenings are being conducted only inconsistently with this population, often using nonstandardized methods. The results demonstrate a need to develop hearing-screening tools that are affordable, easily accessible, and validated for aphasia, and to raise awareness of currently available hearing-screening protocols and tools.

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Methylphenidate effects on P300 responses from children and adolescents.

The attention deficit hyperactivity disorder (ADHD) is characterized by a lack of attention, by hyperactivity and impulsivity, by flawed academic performance, by problematic family and social relationships and by a need for psychosocial adjustment (1). Neuropsychological studies have suggested an association between ADHD and neural alterations in the prefrontal cortex and its projections in various subcortical structures (2, 3). Methylphenidate (MPH) is the most commonly prescribed central nervous system stimulant used to treat ADHD.

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Fully-covered metallic stenting in an infant with tracheoesophageal fistula due to button battery ingestion

Previously, the main treatment options for tracheoesophageal fistula included surgery and conservative treatment. Herein, we report a child suffering from severe tracheoesophageal fistula due to button battery ingestion. The child relapsed soon after a repair surgery. Then, he was endotracheally implanted with a fully-covered metallic stent combined with a jejunal tube feeding. He recovered soon and the stent was removed five months later. The fistula was healed with no relapse during a 25-month follow-up.

http://ift.tt/2kjbsGS

Upper Eyelid Reconstruction Using a Blepharoplasty Flap.

Purpose: The blepharoplasty flap is a relatively simple but under-recognized surgical technique for repairing defects that result from excision of broad-based lesions on the upper eyelid that lie between the eyelid crease and the eyelashes. As this has not been previously published in the literature, the authors aim to increase the awareness of this technique. Methods: The eyelid crease is marked. A line is drawn perpendicular to the crease line along the aspect of the lesion closest to the centre of the eyelid, dividing the eyelid into 4 quarters. The lesion is excised along with the area lying diagonally. An advancement flap is then fashioned from excess skin of the upper eyelid and moved inferiorly to close the defect. Results: The resulting cosmetic results seen postoperatively have been excellent. Conclusions: The blepharoplasty flap is a style of surgical advancement flap that utilizes the tissue that would normally be excised during blepharoplasty. This straightforward technique can prove useful in the surgical repertoire due to its potential to be widely adopted in surgical practice. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis

To evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.

http://ift.tt/2ku3eOl

Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis

To evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.

http://ift.tt/2ku3eOl

Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?.

Objective: To report the case of a 42-year-old woman with a nasal bone fracture that was easily treated using a surgical navigation system. Methods: In this clinical report, the authors suggest that intraoperative surgical navigation systems are useful diagnostically and for localizing sites of nasal bone fractures exactly. Results: The patient underwent successful closed reduction of the nasal bone fracture. Conclusions: Surgical navigation is a useful tool for identifying nasal bone fracture locations and for guiding closed reduction. Surgical navigation is recommended when nasal bone fractures are complicated or not well reduced using the ordinary method. (C) 2017 by Mutaz B. Habal, MD.

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Relations of Facial Nerve With Retromandibular Vein in Human Fetuses.

The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 +/- 4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood. (C) 2017 by Mutaz B. Habal, MD.

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Characteristics of Pediatric Cheek Mass.

Purpose: Patients with cheek mass are often referred to our medical center's department of plastic surgery. Most patients with deep cheek mass have the characteristic of a slowly growing, painless mass. We reviewed the lesion's pathology of this complex anatomic area in the pediatric population, focusing on differential diagnosis and the recent surgical strategies. Methods: We retrospectively reviewed 56 patients visiting our department from 2009 to 2016. Data analysis included the patients' lesion characteristics, clinical presentation, presumptive diagnosis, results of preoperative investigations, pathological diagnosis, and treatment details. Results: Patient age ranged from 1 day to 19 years (mean 7.81 years). The most common presentation was an asymptomatic, slowly enlarging mass. Preoperative diagnoses were made after clinical examination, and then the imaging study was performed. Surgical intervention was performed in 31 patients. The most common histopathological types were vascular anomalies. The next order of prevalence, from most prevalent to least, was lipomatosis, neurofibroma, and teratoma cases. Conclusion: As for our patients, various histopathological types of pediatric cheek mass were presented. Being suspicious of a rare disease and having a prudent diagnostic skill were important for a successful diagnosis. The primary treatment of these lesions is surgical excision with a meticulous surgical approach. In our patients, the prognosis of such treatment was good. This study provides a differential diagnosis of cheek mass in the pediatric population and signifies that the prevalence and types of cheek mass in pediatrics are different from those of the adult population. (C) 2017 by Mutaz B. Habal, MD.

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Anatomical Study of the Infraorbital Nerve and Surrounding Structures for the Surgery of Orbital Floor Fractures.

The infraorbital nerve (ION) can easily be damaged by orbital trauma and periorbital surgical manipulations, due to its abutment to the orbital floor. Anatomic variability of the ION and surrounding structures has infrequently been documented. The aim of this study is to give precise anatomical knowledge about the ION with surrounding structures, to avoid iatrogenic injury of the ION during periorbital procedures. Forty orbits of 40 skull subjects (20 males and 20 females) were studied to analyze structures around the ION. The authors located the ION, infraorbital canal/groove (IOC/G), and infraorbital foramen (IOF), using several reference points. The various distances were also measured between those structures, and statistically analyzed. The authors compared the left and right sides, and analyzed the differences between both sexes. The IOF was also investigated regarding the shape and presence of the accessory IOF. Three different types of orbital floor osseous anatomy were made based on macroscopic analysis. Type 1 shows no groove, and the ION enters the canal covered by the roof (5 patients, 12.5%). Type 2 revealed a pseudocanal, which has a very thin, almost transparent roof (26 patients, 65.0%). Type 3 consists of the ION traveling in a true groove, before entering an IOC (9 patients, 22.5%). IOG/C complexes took the upward lateral course, until exiting via the IOF. The mean +/- SD length of the IOC was 12.86 +/- 3.79 mm, and of the IOG was 16.15 +/- 2.88 mm. The calculated combined mean length of the IOC/G complex was found to be 29.01 +/- 3.17 mm. An accessory IOF was found in 35% of the skulls (50% in male and 20% in female skulls), with a higher frequency on the left side in both male and female skulls. These results can increase the authors' knowledge of the anatomic variability of the infraorbital region, and help facial plastic surgeons during their surgical manipulations prevent any possible iatrogenic injury of the ION. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2kugBxY

Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap.

Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles, and bone substance surrounding the eye. Such patients require orbital exenteration, which may involve extraocular skeletal structures (even exposing paranasal sinuses), resulting in 3-dimensional defects requiring reconstruction. This study presents our experience with anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps for the reconstruction of extensive orbital exenteration defects involving various paranasal sinuses. Between 2012 and 2016, 4 patients with extensive 3-dimensional orbital defects with sinus involvement were treated using the ALT/VL chimeric flap. The ALT component (117-170 cm2) was used to resurface the cutaneous defect while the VL component (105-243 cm3) was used to obliterate the cavitary defect. The flaps were all based on the common descending pedicle, and branches to separate components were individually dissected. Recipient vessels were in the neck region, to which the donor pedicles were passed through a tunnel for anastomosis. All cavitary and surface defects were simultaneously reconstructed via the ALT/VL chimeric flap. Within an average of 17 months, no complications associated with flap surgery were observed. One patient received postoperative adjuvant radiotherapy with no complications. With its separate components supplied by a common vascular pedicle, the ALT/VL chimeric free flap allows the surgeon to conveniently reconstruct separate spatial and volumetric defects resulting from extensive orbital exenteration. (C) 2017 by Mutaz B. Habal, MD.

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Open Reduction in Pediatric Condylar Fracture.

Facial fractures in children are rare. Lack of pneumatization, fat pockets, mixed dentition, contribute to the elasticity and bone stability. When mandibular fractures occur in children, most often involve the condyle by indirect trauma. Such fractures are the center of discussion on the form of treatment if this should be performed conservatively, or held the reduction and fixation of the fracture with surgical exposure of the fragments. In condylar fractures in children, in most patients, the proposed treatment is closed reduction. Treatment with open reduction and fixation has its specific indications. In this case, the authors report a patient cycling accident victim, with cut-contusion injury in ment with limited mouth opening and left condylar fracture with medial rotation. The treatment was the reduction and fixation of fragments by open process. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jXvCVL

Is Presence of Vascular Loop in Magnetic Resonance Imaging Always Related to Tinnitus?.

Introduction: One of the most common otological complaints is tinnitus in adults. When there is a complaint of unilateral tinnitus and retrocochlear pathology is suspected, imaging methods are applied. However, the imaging findings obtained may not always be compatible with the severity and localization of the tinnitus. Aim: The aim of the present study was to determine whether or not there was a significant correlation between the findings on magnetic resonance imaging (MRI) and the presence and severity of tinnitus in patients with the complaint of unilateral tinnitus. Method: The study included 44 patients with no loss of hearing who presented with the complaint of unilateral tinnitus. The relationship between tinnitus severity and vascular loop presence was investigated. Results: Various types of vascular loop were determined in 14 patients. No statistically significant relationship was determined between the presence of vascular loop and the Tinnitus Handicap Inventory scores. Conclusion: The results of this study showed no significant difference in respect of the presence of vascular loop on the MRI findings of symptomatic and healthy ears. The presence of vascular loop on MRI is not always a pathological event and should be considered only as an examination finding that could be an anatomic variation. (C) 2017 by Mutaz B. Habal, MD.

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Combined Endoscopic and Trans Palpebral Orbital Reconstruction for Silent Sinus Syndrome.

Silent Sinus Syndrome is defined as a painless spontaneous and progressive enophthalmos and hypoglobus with maxillary sinus hypoplasia and orbital floor resorption. It is caused by maxillary sinus atelectasis in a setting of ipsilateral chronic maxillary sinus hypoventilation. The syndrome was first described in 1964 by Montgomery, but the term "Silent Sinus Syndrome" was not coined until 1994 by Soparkar. The aetiology is still controversial: some authors postulate a basal hypoplastic sinus, other suggest an acquired process due to an obstruction of the ostium in the medium meatus. Silent Sinus Syndrome presents in the third to fifth decades of life, very rarely in childhood with no gender predilection and it is usually a unilateral disorder. The symptoms are not shown to be related to chronic sinuses disease. The clinical signs are: enophthalmos, hypoglobus, upper lid retraction secondary to dystopia of the globe, sinking of the eye and orbital asymmetry, deepened upper lid sulcus, disappearance of the palpebral fold line, lagophthalmos, vertical diplopia, malar depression, and facial asymmetry. Extraocular muscle function is generally preserved and usually there is no visual impairment. The diagnosis is confirmed by computed tomography scan of the orbits and paranasal sinuses. The treatment consists of orbital reconstruction and functional rehabilitation of the maxillary sinuses. (C) 2017 by Mutaz B. Habal, MD.

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An Economic Analysis of Bromocriptine Versus Trans-Sphenoidal Surgery for the Treatment of Prolactinoma.

Prolactinomas account for ~40% of all pituitary adenomas and are important causes of infertility and gonadal dysfunction. In general, most prolactinomas are treated medically with dopaminergic agonists, while surgery is reserved for patients intolerant or nonresponsive to these medications. The aim of this study was to carry out a comparative analysis of the cost-effectiveness of medical therapy with bromocriptine and surgical therapy with trans-sphenoidal surgery. A Markov model was developed based on retrospective data from 126 patients with prolactinoma treated in our hospital between October 2008 and May 2009, and from data published previously. For patients with microadenoma, the cost of medical treatment was estimated to be [yen]20,555, while the cost of surgery was calculated to be [yen]22,527. For patients with macroadenoma, the cost of therapy with bromocriptine was [yen]31,461 in males and [yen]27,178 in females, while the cost of surgery was [yen]42,357 in males and [yen]44,094 in females. Sensitivity analyses (carried our using variations in patient age, bromocriptine therapeutic dose, bromocriptine maintenance dose, and the success rate of bromocriptine withdrawal) indicated that our model showed good stability, although our results were most heavily influenced by variations in the bromocriptine maintenance dose. It is concluded that, from an economic viewpoint, medical therapy with bromocriptine should be the first-line treatment option for patients with prolactinoma, irrespective of whether this is a microadenoma or macroadenoma. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jXvAND

Endoscopic Endonasal Transsphenoidal Approach From the Otolaryngologist Point of View.

Objective: In February 2009, the authors' center formed a team of neurosurgeons, otolaryngologists, endocrinologists, and radiologists to perform pituitary surgery using the endoscopic endonasal transsphenoidal approach (EETSA). This paper reviews the authors' experience with the technique, pathological outcomes, hormone profiles, and postoperative complications. Methods: Between February 2009 and December 2015, 535 patients underwent the EETSA with 2-nostrils/4-hands surgery. All of the patients had preoperative neurophthalmological and endocrinological assessments and neuroimaging. Patients were followed for at least 6 months with otolaryngological evaluations. Results: The most common pathology treated was pituitary adenomas, with 390 (72.9%) patients. Of these, 287 (73.6%) were nonfunctioning adenomas. As the surgical method, the conventional 2-nostrils/4-hands technique was performed in 77 patients (14.4%), a right conventional nasoseptal flap and left modified nasoseptal rescue flap technique was used in 135 patients (25.2%), and bilateral modified nasoseptal rescue flaps were used in 323 patients (60.4%). Postoperative complications occurred in 46 patients (8.6%). The most common complications were vascular injury or hematoma (10 patients, 1.9%), and the most common postoperative sinonasal complaints were hyposmia or anosmia. Olfactory function was significantly decreased according to the Connecticut Chemosensory Clinical Research Center test (P

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A Surgical Technique for Management of the Metopic Suture in Syndromic Craniosynostosis.

Objectives: The objective is to describe a new surgical procedure developed in the San Jose Pediatric University Hospital for the management of syndromic synostosis of the metopic suture in a patient clinically diagnosed with Saethre-Chotzen syndrome. Methods: The diagnosis of Saethre-Chotzen syndrome, bilateral coronal sutures, and metopic suture synostoses was made through photographic, anthropometric, exophthalmometric, and computed tomography analysis. The keel-like frontal bone deformity was corrected following resection using a fusiform osteotomy, remodelling was obtained by milling the edges, and the bony fragments were repositioned and fixed on the posterior wall of the frontal bone. Additionally, a fronto-orbital advancement with a self-stabilizing bar was performed. Results: The 1-year postoperative results showed improvement in the position of the fronto-orbital bar, adequate cranial expansion, satisfactory correction of the upper facial third alteration, and correction of the keel-like deformity. Conclusions: The surgical approach has not previously been described in the literature and offers an alternative management for syndromic craniosyntostosis of the metopic suture, avoiding skull irregularities. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ku0osk

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1: Anophthalmic Patients' Aetiology, Opinions, and Attitudes.

Purpose: Ocular prostheses are constructed to aid cosmetic, functional, and psychological rehabilitation of anophthalmic patients. Part-1 of this study aimed to evaluate anophthalmic patients' opinions, attitudes, and experience about aspects related to their postfit ocular prostheses. Methods: One hundred sixty questionnaires were delivered to anophthalmic patients inquiring about different information such as age, gender, occupation, eye-loss cause, prosthesis type, prosthesis-wearing frequency, prosthesis-cleaning frequency, and problems encountered. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software (P 0.05). Conclusions: Trauma is the most common cause of anophthalmic patients in the North-West of England. Anophthalmic patients are likely to experience problems with their prosthetic eye if they have lost their natural eye due to disease; it is their first prosthesis; or if they clean it once every 6 months. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ku90zw

Efficacy and Safety of Willis Covered Stent for Treatment of Internal Carotid Artery Aneurysms.

Objective: The purpose of this study was to evaluate the clinical and short-term outcome of patients who underwent covered stent treatment for internal carotid artery aneurysms. Methods: Twelve cases patients with internal carotid artery aneurysms were treated with Willis covered stents during the period from December 2010 to January 2016. The guiding catheter was placed as high as possible to facilitate the delivery of the covered stent system. Results: Covered stent placement was successful in 11 of 12 case patients (91.6%), embolization was successful in 11 of 12 patients (91.6%), the treatment in 1 patient of 12 cavernous aneurysms patients was performed covered stents +ONYX + plastic coil embolization, and the other was used Willis covered stents. The results indicated that only 1 of 12 patients underwent postoperative massive cerebral infarction, but was successfully rescued. The angiographic following-up of patients using covered stent suggested that 12 cases patients were complete occlusion and the parent artery patency. Clinical follow-up results also demonstrated that clinical neurologic symptoms fully recovered in 11 of 12 cases patients, another case improved and were not aggravated in any patient before discharge and had aggravated symptoms. Conclusion: Willis covered stents are effective for treatment of internal carotid artery aneurysms with good safety and short-term outcomes. (C) 2017 by Mutaz B. Habal, MD.

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