Assessing asthma in the otolaryngologist's office.

Purpose of review: To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. Recent findings: Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. Summary: Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2lFWxJ5

Biologics for asthma and allergy.

Purpose of review: The development of monoclonal antibody-based biologics targeted at inhibition of the Th2 cytokines interleukin-4, interleukin-5 and interleukin-13 represent potentially effective treatments for asthma and allergic diseases. This short review is based on English-language original articles in PubMed or MedLine that reported significant clinical findings on the evidence demonstrating the effectiveness or otherwise of the targeting of interleukin-4, interleukin-5 or interleukin-13 in asthma or allergic disease. Recent findings: Asthma exhibits marked heterogeneity both clinically and at the molecular phenotypic level requiring specifically targeted treatments to block the key pathways of the disease. It is becoming apparent that significant clinical effects with anticytokine-based biologic therapies are more likely in carefully selected patient populations that take asthma phenotypes into account. Biologics aimed at interleukin-4/13, interleukin-5 or immunoglobulin E are potentially effective treatments for patients with difficult to treat allergic disease. The development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these expensive interventions. Summary: Overall these biologics-based therapies are effective treatments for difficult to treat asthma and allergic disease with a safety profile comparable with placebo in the majority of published studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2lFL3W1

Assessing asthma in the otolaryngologist's office.

Purpose of review: To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. Recent findings: Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. Summary: Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2lFWxJ5

Biologics for asthma and allergy.

Purpose of review: The development of monoclonal antibody-based biologics targeted at inhibition of the Th2 cytokines interleukin-4, interleukin-5 and interleukin-13 represent potentially effective treatments for asthma and allergic diseases. This short review is based on English-language original articles in PubMed or MedLine that reported significant clinical findings on the evidence demonstrating the effectiveness or otherwise of the targeting of interleukin-4, interleukin-5 or interleukin-13 in asthma or allergic disease. Recent findings: Asthma exhibits marked heterogeneity both clinically and at the molecular phenotypic level requiring specifically targeted treatments to block the key pathways of the disease. It is becoming apparent that significant clinical effects with anticytokine-based biologic therapies are more likely in carefully selected patient populations that take asthma phenotypes into account. Biologics aimed at interleukin-4/13, interleukin-5 or immunoglobulin E are potentially effective treatments for patients with difficult to treat allergic disease. The development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these expensive interventions. Summary: Overall these biologics-based therapies are effective treatments for difficult to treat asthma and allergic disease with a safety profile comparable with placebo in the majority of published studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2lFL3W1

Integration of high-risk human papillomavirus into cellular cancer-related genes in head and neck cancer cell lines

ABSTRACT

Background

Human papillomavirus (HPV)-positive oropharyngeal cancer is generally associated with excellent response to therapy, but some HPV-positive tumors progress despite aggressive therapy. The purpose of this study was to evaluate viral oncogene expression and viral integration sites in HPV16- and HPV18-positive squamous cell carcinoma lines.

Methods

E6/E7 alternate transcripts were assessed by reverse transcriptase-polymerase chain reaction (RT-PCR). Detection of integrated papillomavirus sequences (DIPS-PCR) and sequencing identified viral insertion sites and affected host genes. Cellular gene expression was assessed across viral integration sites.

Results

All HPV-positive cell lines expressed alternate HPVE6/E7 splicing indicative of active viral oncogenesis. HPV integration occurred within cancer-related genes TP63, DCC, JAK1, TERT, ATR, ETV6, PGR, PTPRN2, and TMEM237 in 8 head and neck squamous cell carcinoma (HNSCC) lines but UM-SCC-105 and UM-GCC-1 had only intergenic integration.

Conclusion

HPV integration into cancer-related genes occurred in 7 of 9 HPV-positive cell lines and of these 6 were from tumors that progressed. HPV integration into cancer-related genes may be a secondary carcinogenic driver in HPV-driven tumors. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mhjrbd

Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer

ABSTRACT

Background

The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy.

Methods

Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed.

Results

Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%).

Conclusion

PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mvsCRn

Treatment-related determinants of survival in early-stage (T1–2N0M0) oral cavity cancer: A population-based study

ABSTRACT

Background

National guidelines support both surgical and radiotherapy (RT) as initial treatment options for early-stage oral cavity squamous cell carcinoma (SCC). There remains limited data evaluating the survival outcomes of RT and the current practice patterns for these lesions.

Methods

We conducted a retrospective review of 8274 patients in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2008 with T1 to T2N0M0 oral cavity SCC. Primary outcomes were 5-year overall survival (OS) and disease-specific survival (DSS).

Results

Surgical therapy had significantly improved OS (140 months; p < .001) and DSS (217 months; p < .001) compared to surgery with adjuvant RT (104 and 163 months, respectively) and definitive RT (68 and 136 months, respectively). The use of radiation alone was associated with an increased T classification, hard palate, retromolar trigone primary site lesions, and advanced patient age.

Conclusion

Primary radiation without surgery continues to be used in a subset of early-stage oral cavity SCCs, in which it is associated with decreased OS and DSS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mheLC7

Treatment delays in oral cavity squamous cell carcinoma and association with survival

Abstract

Background

Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear.

Methods

The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)_start, RT duration, total treatment package (surgery-to-RT_end), and diagnosis-to-RT_end were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model.

Results

Medians for diagnosis-to-surgery, surgery-to-RT_start, RT duration, total treatment package, and diagnosis-to-RT_end were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02).

Conclusion

Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mvfDPN

Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma

ABSTRACT

Background

The purpose of this study was to investigate the critical primary tumor depth of invasion in oral squamous cell carcinoma that would lead to a 20% or greater risk of nodal metastasis.

Methods

An institutional review board approved retrospective review of our head and neck database was performed from 2009 to 2014 and the data were statistically analyzed.

Results

Two hundred eighty-six patients with a diagnosis of oral squamous cell carcinoma who met our inclusion criteria underwent primary excision and neck dissection. For a depth of invasion of 1 mm or less, there were no patients with a positive node. From 1.1 mm to 2 mm of depth of invasion, there was 1 of 11 patients (9%) who had at least 1 positive node. At 2.1 mm to 3 mm, 5 of 25 patients (20%) had at least 1 positive node.

Conclusion

Depth of invasion and the location of the tumor are 2 important variables to consider when making treatment recommendations to patients with clinical N0 disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mhgO9t

Integration of high-risk human papillomavirus into cellular cancer-related genes in head and neck cancer cell lines

ABSTRACT

Background

Human papillomavirus (HPV)-positive oropharyngeal cancer is generally associated with excellent response to therapy, but some HPV-positive tumors progress despite aggressive therapy. The purpose of this study was to evaluate viral oncogene expression and viral integration sites in HPV16- and HPV18-positive squamous cell carcinoma lines.

Methods

E6/E7 alternate transcripts were assessed by reverse transcriptase-polymerase chain reaction (RT-PCR). Detection of integrated papillomavirus sequences (DIPS-PCR) and sequencing identified viral insertion sites and affected host genes. Cellular gene expression was assessed across viral integration sites.

Results

All HPV-positive cell lines expressed alternate HPVE6/E7 splicing indicative of active viral oncogenesis. HPV integration occurred within cancer-related genes TP63, DCC, JAK1, TERT, ATR, ETV6, PGR, PTPRN2, and TMEM237 in 8 head and neck squamous cell carcinoma (HNSCC) lines but UM-SCC-105 and UM-GCC-1 had only intergenic integration.

Conclusion

HPV integration into cancer-related genes occurred in 7 of 9 HPV-positive cell lines and of these 6 were from tumors that progressed. HPV integration into cancer-related genes may be a secondary carcinogenic driver in HPV-driven tumors. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mhjrbd

Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer

ABSTRACT

Background

The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy.

Methods

Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed.

Results

Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%).

Conclusion

PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mvsCRn

Treatment-related determinants of survival in early-stage (T1–2N0M0) oral cavity cancer: A population-based study

ABSTRACT

Background

National guidelines support both surgical and radiotherapy (RT) as initial treatment options for early-stage oral cavity squamous cell carcinoma (SCC). There remains limited data evaluating the survival outcomes of RT and the current practice patterns for these lesions.

Methods

We conducted a retrospective review of 8274 patients in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2008 with T1 to T2N0M0 oral cavity SCC. Primary outcomes were 5-year overall survival (OS) and disease-specific survival (DSS).

Results

Surgical therapy had significantly improved OS (140 months; p < .001) and DSS (217 months; p < .001) compared to surgery with adjuvant RT (104 and 163 months, respectively) and definitive RT (68 and 136 months, respectively). The use of radiation alone was associated with an increased T classification, hard palate, retromolar trigone primary site lesions, and advanced patient age.

Conclusion

Primary radiation without surgery continues to be used in a subset of early-stage oral cavity SCCs, in which it is associated with decreased OS and DSS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mheLC7

Treatment delays in oral cavity squamous cell carcinoma and association with survival

Abstract

Background

Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear.

Methods

The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)_start, RT duration, total treatment package (surgery-to-RT_end), and diagnosis-to-RT_end were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model.

Results

Medians for diagnosis-to-surgery, surgery-to-RT_start, RT duration, total treatment package, and diagnosis-to-RT_end were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02).

Conclusion

Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mvfDPN

Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma

ABSTRACT

Background

The purpose of this study was to investigate the critical primary tumor depth of invasion in oral squamous cell carcinoma that would lead to a 20% or greater risk of nodal metastasis.

Methods

An institutional review board approved retrospective review of our head and neck database was performed from 2009 to 2014 and the data were statistically analyzed.

Results

Two hundred eighty-six patients with a diagnosis of oral squamous cell carcinoma who met our inclusion criteria underwent primary excision and neck dissection. For a depth of invasion of 1 mm or less, there were no patients with a positive node. From 1.1 mm to 2 mm of depth of invasion, there was 1 of 11 patients (9%) who had at least 1 positive node. At 2.1 mm to 3 mm, 5 of 25 patients (20%) had at least 1 positive node.

Conclusion

Depth of invasion and the location of the tumor are 2 important variables to consider when making treatment recommendations to patients with clinical N0 disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2mhgO9t

Laryngoscopy during swimming: A novel diagnostic technique to characterize swimming- induced laryngeal obstruction

Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for respiratory symptoms in athletes and is particularly prevalent in aquatic athletes. A definitive diagnosis of EILO is dependent on laryngoscopy, performed continuously, while an athlete engages in the sport that precipitates their symptoms. This report provides the first description of the feasibility of performing continuous laryngoscopy during exercise in a swimming environment. The report describes the methodology and safety of the use of continuous laryngoscopy while swimming. Laryngoscope, 2017

http://ift.tt/2mhsqt9

Laryngoscopy during swimming: A novel diagnostic technique to characterize swimming- induced laryngeal obstruction

Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for respiratory symptoms in athletes and is particularly prevalent in aquatic athletes. A definitive diagnosis of EILO is dependent on laryngoscopy, performed continuously, while an athlete engages in the sport that precipitates their symptoms. This report provides the first description of the feasibility of performing continuous laryngoscopy during exercise in a swimming environment. The report describes the methodology and safety of the use of continuous laryngoscopy while swimming. Laryngoscope, 2017

http://ift.tt/2mhsqt9

Exendin-4 inhibits structural remodeling and improves Ca2+ homeostasis in rats with heart failure via the GLP-1 receptor through the eNOS/cGMP/PKG pathway

Publication date: Available online 24 February 2017
Source:Peptides
Author(s): Jingjing Chen, Dandan Wang, Fangai Wang, Shaobo Shi, Yuting Chen, Bo Yang, Yanhong Tang, Congxin Huang
The glucagon-like peptide-1 receptor (GLP-1R) agonist exendin-4 is a long-acting analogue of GLP-1, which stimulates insulin secretion and is clinically used in the treatment of type 2 diabetes. Previous studies have demonstrated that GLP-1 agonists and analogues serve as cardioprotective factors in various conditions. Disturbances in calcium cycling are characteristic of heart failure (HF); therefore the aim of this study was to investigate the effect of exendin-4 (a GLP-1 mimetic) on the regulation of calcium handling and identify the underlying mechanisms in a heart failure (HF) rat model after myocardial infarction (MI). Rats underwent surgical ligation of the left anterior descending coronary artery or sham surgery prior to infusion with vehicle, exendin-4, or exendin-4 and exendin9-39 for four weeks. Exendin-4 treatment decreased MI size, suppressed chamber dilation, myocyte hypertrophy and fibrosis, and improved in vivo heart function in the rats subjected to MI. Exendin-4 resulted in an increase in circulating GLP-1, and GLP-1R in ventricular tissues. Additionally, exendin-4 activated the eNOS/cGMP/PKG signaling pathway and inhibited the Ca²⁺/calmodulin-dependent kinase II (CaMKII) pathways. Myocytes isolated from exendin-4-treated hearts displayed higher Ca²⁺ transients, higher sarcoplasmic reticulum Ca²⁺ content and higher L-type Ca²⁺ current densities than MI hearts. Exendin-4 treatment restored the protein expression of sarcoplasmic reticulum Ca²⁺ uptake ATPase (SERCA2a), phosphorylated phospholamban (PLB) and Cav1.2 and decreased the levels of phosphorylated ryanodine receptor (RyR). Moreover, the favorable effects of exendin-4 were significant inhibited by exendin9-39 (a GLP-1 receptor antagonist). Exendin-4 treatment of a HF rat model after MI inhibited cardiac and cardiomyocytes progressive remodeling. In addition, Ca²⁺ handling and its molecular modulation were also improved by exendin-4 treatment. The beneficial effects of exendin-4 on cardiac remodeling may be mediated through activation of the eNOS/cGMP/PKG pathway.



http://ift.tt/2mv8jUn

Gastric bypass in the pig increases GIP levels and decreases active GLP-1 levels

Publication date: Available online 24 February 2017
Source:Peptides
Author(s): Andreas Lindqvist, Mikael Ekelund, Stefan Pierzynowski, Leif Groop, Jan Hedenbro, Nils Wierup
Gastric bypass surgery results in remission of type 2 diabetes in the majority of patients. The incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) have been implicated in the observed remission. Most knowledge so far has been generated in obese subjects. To isolate the surgical effects of gastric bypass on metabolism and hormone responses from the confounding influence of obesity, T2D or food intake, we performed gastric bypass in lean pigs, using sham-operated and pair-fed pigs as controls. Thus, pigs were subjected to Roux-en-Y gastric bypass (RYGB) or sham-surgery and oral glucose tolerance tests (OGTT). RYGB- and sham-pigs exhibited similar basal and 120-minute glucose levels in response to the OGTT. However, RYGB-pigs had approximately 1.6-fold higher 30-min glucose (p<0.01). Early insulin release (EIR) was enhanced approximately 3.5-fold in the RYGB-pigs (p<0.01). Furthermore, GIP release, both the acute and sustained release (p<0.001 and p<0.01, respectively) were increased approximately 2.5-fold and 1.4-fold, respectively, in RYGB-pigs. While total GLP-1 release increased approximately 2.1-fold after RYGB (p<0.001), active GLP-1 was 33% lower (p<0.01). Interestingly basal DPP4-activity was approximately 3.2-fold higher in RYGB-pigs (p<0.001).In conclusion, RYGB in lean pigs increases the response of GIP, total GLP-1 and insulin, but reduces levels of active GLP-1 in response to an oral glucose load. These data challenge the role of active GLP-1 as a contributor to remission from diabetes after RYGB.



http://ift.tt/2lPuRSw

Letter From the Guest Editors

Publication date: February 2017
Source:Seminars in Ultrasound, CT and MRI, Volume 38, Issue 1
Author(s): Olivier Helenon, Nicolas Grenier




http://ift.tt/2lFux8c

Ghrelin and Cancer Progression

Publication date: Available online 24 February 2017
Source:Biochimica et Biophysica Acta (BBA) - Reviews on Cancer
Author(s): Tsung-Chieh Lin, Michael Hsiao
Ghrelin is a small peptide with 28 amino acids, and has been characterized as the ligand of the growth hormone secretagogue receptor (GHSR). In addition to its original function in stimulating pituitary growth hormone release, ghrelin is multifunctional which plays role in the regulation of energy balance, gastric acid release, appetite, insulin secretion, gastric motility and the turnover of gastric and intestinal mucosa. The discovery of ghrelin and GHSR expression beyond normal tissues suggests its role other than physiological function. Emerging evidences has reveal ghrelin's function in regulating several processes related to cancer progression, especially in metastasis and proliferation. We further show the relative GHRL and GHSR expression in pan-cancers from The Cancer Genome Atlas (TCGA), suggesting the potential pathological role of the axis in cancers. This review focuses on ghrelin's biological function in cancer progression, and reveals its clinical significance especially the impact on cancer patient outcome.



http://ift.tt/2lFqusF

Autophagy as a potential target for sarcoma treatment

Publication date: Available online 24 February 2017
Source:Biochimica et Biophysica Acta (BBA) - Reviews on Cancer
Author(s): Li Min, Edwin Choy, Raphael E. Pollock, Chongqi Tu, Francis Hornicek, Zhenfeng Duan
Autophagy is a constitutively active, evolutionary conserved, catabolic process for maintaining homeostasis in cellular stress responses and cell survival. Although its mechanism has not been fully illustrated, recent work on autophagy in various types of sarcomas has demonstrated that autophagy exerts an important role in sarcoma cell growth and proliferation, in pro-survival response to therapies and stresses, and in therapeutic resistance of sarcoma. Thus, the autophagic process is being seen as a possibly novel therapeutic target of sarcoma. Additionally, some co-regulators of autophagy have also been investigated as promising biomarkers for the diagnosis and prognosis of sarcoma. In this review, we summarize contemporary advances in the role of autophagy in sarcoma and discuss the potential of autophagy as a new target for sarcoma treatment.



http://ift.tt/2lk2rwW

Cerebrospinal Fluid Fistula for the Craniofacial Surgeon: A Review and Management Paradigm.

Craniofacial surgeons perform operations that involve exposure of the dura. Typical procedures include cranial vault remodeling (CVR), fronto-orbital advancement (FOA), Le Fort III, monobloc, bipartition advancement, or distraction. Cerebrospinal fluid (CSF) fistulas remain one of the most common complications encountered, occurring in up to 30% of patients. Cerebrospinal fluid fistulas can be encountered intraoperatively, acutely, or in the late postoperative period. Traditional management has been well described in the neurosurgical literature. While several studies of complications exist, there is a relative lack of adequate information for craniofacial surgeons. The authors review current literature and provide 3 patients to illustrate our management paradigm. The authors review 30 years of experience at our institution and the pertinent literature. The mean rate of CSF fistula was 11.2%; rates were lowest for FOA/CVR, 5.5%. Patients with fistulas persisting after 2 days of conservative therapy or whom were symptomatic prompted placement of a lumbar subarachnoid catheter. Failure of the leak to resolve with CSF diversion prompted exploration and therapy which could include a patch, pericranial flap, and/or endonasal repair with septal flaps. Three patients are used to illustrate the paradigm, all of which have had no recurrence thus far. Cerebrospinal fluid fistula remains one of most common complications craniofacial surgeons encounter. Although neurosurgeons are often part of the clinical team, the craniofacial surgeon should be familiar with all aspects of treatment. Prompt diagnosis and appropriate knowledgeable management may avoid morbidity and mortality. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2mvb33Z

Microsurgical Replantation of Total Avulsed Scalp: Extending the Limits.

Background: Avulsion of the scalp is a rare but severe trauma and challenging to the reconstructive surgeon. It poses not only physical concussion but also significant persisting psychological distress to the patients. Methods: Medical records from 5 patients who suffered scalp avulsion were reviewed retrospectively. The following data and methods were assessed: age, number of vessels repaired, method of replantation, vein grafts required, blood transfusion, ischemia time, total operating time, and percentage of scalp survival. Results: In 4 patients, the replantation was performed at the anatomic site. Two arteries and 2 veins were anastomosed in 2 patients; a single artery and a single vein were anastomosed in 2 patients. The middle temporal vein was chosen for anastomosis as a recipient vessel in 2 patients. In the fifth patient with simultaneous cervical fracture that makes primarily replantation technically not possible, the scalp was implanted ectopically in the forearm for the purpose of secondary replantation at the anatomic site. After a mean follow-up of 22.6 months (range 13-29 months), 4 of 5 patients exhibited successful survival of the replanted scalp. Conclusions: The success of scalp replantation is determined by a comprehensive management of the trauma and well-trained microsurgical technique. The middle temporal vein can be used as a reliable alternative recipient vessel for microvascular anastomosis when replanting the avulsed scalp. In patients in whom primary replantation is not possible, temporary ectopic implantation of the avulsed scalp and anatomic replantation at a second stage is considerable. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2lPiVAb

Early Surgical Correction of the Nasal Deformity in Laurin-Sandrow Syndrome.

Laurin-Sandrow syndrome (LSS) is a rare autosomal disorder characterized by polysyndactyly of the hands and feet in a mirror fashion, absence of the radius and tibia with duplicated ulna and fibula, and nasal anomalies. Nasal defects are varied, and range from hypoplastic nasal skeleton to redundant nasal tissue, along with abnormalities of nasal subunits. Only 14 patients of LSS have been described in the literature. The authors present a unique case of a newborn with LSS and anterior nasal stenosis, resulting in respiratory failure. Early surgical intervention to relieve the bony and soft tissue overgrowth of the anterior nasal vault was required to allow for successful extubation. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2mvnk8i

Editorial Lp(a) – the underestimated cardiovascular risk factor

http://ift.tt/2mh26iv

Orbital apex syndrome as a complication of herpes zoster ophthalmicus

Orbital apex syndrome is a rare neuro-ophthalmic manifestation of herpes zoster virus infection. We report one such case with favourable outcome in an immunocompetent patient. A 60-year-old woman presented with rash in the dermatome of the left ophthalmic nerve (V1), followed by sudden loss of vision with complete left-sided external and internal ophthalmoplegia. MRI of brain and orbits with contrast revealed optic perineuritis and myositis without intracranial involvement confirming the diagnosis of orbital apex syndrome. Functional visual recovery was achieved after a course of intravenous and oral steroids under antiviral cover over a follow-up period of 3 months.

http://ift.tt/2lTRIgl

Lattice-like paraproteinemic keratopathy (PPK) of monoclonal gammopathy of undetermined significance (MGUS)

Description

A male patient aged 71 years presented with a history of progressive visual loss in the past 3 years. Ophthalmological evaluation showed a best-corrected visual acuity of 20/200 bilaterally and the presence of bilateral linear lattice-like corneal opacities similar to lattice dystrophy (LD) and dense nuclear cataracts at slit lamp examination (figure 1). There was no family history of ocular diseases. Serum protein electrophoresis included in the systemic investigation showed a band in the -globulin fraction (figure 2). Nephelometry detected an increased level of light chains—75.6 mg/dL (normal: 3.3–19.4 mg/dL) and a normal level of light chains—14.4 mg/dL (normal: 5.7–26.3 mg/dL) and an increased / ratio of 5.25 (normal: 0.26–1.65). Immunoelectrophoresis also confirmed the IgG- gammopathy. Myelogram showed 2% of plasma cells. No lytic bone lesions were present on plain X-ray. No mutations were found on transforming growth factor β-induced gene (TGFBI) nor on gelsolin gene...

http://ift.tt/2lFDtZY

Rare association of congenital penile urethrocutaneous fistula with Y-type urethral duplication

A 24-year-old man presented with symptoms of difficulty in passage of urine, mixed with gas and stool from penoscrotal junction since birth. He had a history of surgery (posterior sagittal anorectoplasty) for imperforate anus in first week of his life. On physical examination, external meatus was adequate with small 5x5 mm fistulous opening noted at penoscrotal junction with normal anal tone and opening. On evaluation with retrograde urethrography, voiding cystourethrogram, cystoscopy and barium enema, he was found to have penile urethrocutaneous fistula of 0.5x0.5 cm with Y-type incomplete urethral duplication. Urethroanal fistula (Y-type urethral duplication) was of small size (<5 mm), so closed primarily through perineal route with interposition of ischiorectal fat. Penile urethrocutaneous fistula (4 mm) too was closed primarily and covered with tunica vaginalis flap in single sitting. It has been 6 months since surgery and the patient is fully continent and voiding well with no urinary or faecal leak.

http://ift.tt/2lTWSbR

Hypercalcaemia caused by active pulmonary tuberculosis in an elderly person without fever or pulmonary symptoms

Many diseases can cause hypercalcaemia, including primary hyperparathyroidism, cancer, drugs and granulomatous diseases. A nursing home resident aged 81 years was admitted because of altered mental status. The patient did not have fever, cough, sputum or night sweat. Hypercalcaemia was identified as a cause of the consciousness disturbance. Chest radiograph showed no acute process. Laboratory workups revealed elevated serum levels of 1,25-(OH)2 vitamin D₃ and positive T-spot test. Microscopic examination of the suctioned sputum identified acid-fast bacilli, which was confirmed as Mycobactrium tuberculsosis. Tuberculosis should be considered as the important cause of hypercalcaemia since early diagnosis and treatment is recommended for preventing its outbreak among people with close contacts with patients.

http://ift.tt/2lFJlCs

Over 10 years MRI observation of a patient with neuronal intranuclear inclusion disease

We present a sporadic neuronal intranuclear inclusion disease (NIID) patient with neuropathy followed by cognitive dysfunction along with brain MRIs findings of leucoencephalopathy. Her cognitive impairment gradually progressed along with abnormal intensity lesions in diffusion-weighted images. This pathological and clinical deterioration resemble pathological process in prion diseases.

http://ift.tt/2lTEOP3

Emergency cricothyroidotomy following tracheobronchial stenting

A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO₂ narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.

http://ift.tt/2lFwEYg

Subretinal abscess

Description

A 32-year-old man with a history of intravenous drug use was admitted to the hospital for evaluation of intermittent fever and chills over the course of several weeks. On examination, the temperature was 39.0°C and pulse rate 110 bpm. A grade 2/6 holosystolic murmur was appreciated at the left lower sternal border. Transthoracic echocardiography with agitated saline contrast demonstrated an echodensity on the septal leaflet of the tricuspid valve associated with mild tricuspid regurgitation and a right-to-left shunt. Blood cultures grew methicillin-resistant Staphylococcus aureus. On the third day of hospitalisation, mild conjunctival erythema of the right eye was observed, which was associated with discomfort and a subjective decrease in vision. Visual fields on confrontation revealed a large inferior scotoma. Bedside indirect ophthalmoscopy established the presence of a yellow, elevated subretinal mass ~10 times the diameter of the optic disc, adjacent to the superior-temporal vascular arcade, with associated intraretinal...

http://ift.tt/2lTSyJR

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function.

http://ift.tt/2lFJ1Uh

A comprehensive in vitro biological investigation of metal complexes of tolfenamic acid

Publication date: Available online 24 February 2017
Source:Alexandria Journal of Medicine
Author(s): Md. Mahabob Ullah Mazumder, Abhijit Sukul, Sajal Kumar Saha, Asif Alam Chowdhury, Yasir Mamun
ObjectiveThe inquisitive objective of the study was to observe the antimicrobial, cytotoxicity, and antioxidant activities of some newly synthesized metal complexes of tolfenamic acid.MethodsWhile antimicrobial activity was studied by disk diffusion method, cytotoxicity was studied by performing brine shrimp lethality bioassay. Moreover, DPPH radical scavenging potential was observed to determine the antioxidant property of the complexes.ResultsFrom the disk diffusion antimicrobial screening of tolfenamic acid and its metal complexes, it was found out that considerable antimicrobial activity in terms of zone of inhibition against the tested organisms had been demonstrated by Cu and Zn complex of tolfenamic acid. In addition, the brine shrimp lethality bioassay corroborated that tolfenamic acid and Cu, Co, Zn complexes of the parent NSAID exhibited cytotoxicity with LC50 values 1.23±0.91μg/ml, 1.12±0.12μg/ml, 1.17±0.56μg/ml, 1.35±0.24μg/ml respectively, compared to the vincristine sulfate had LC50 value of 0.82±0.09μg/ml. Furthermore, 1,1-diphenyl-2-picrylhydrazyl assay revealed that in comparison with standard BHT had IC50 of 11.84±0.65, Cu and Co complex of tolfenamic acid exhibited significant antioxidant or radical-scavenging properties with IC50 values 13.61±0.58μg/ml and 15.38±0.09μg/ml, respectively.ConclusionIt can be postulated that metal complexes of tolfenamic acid have auspicious pharmacological effects: antimicrobial, cytotoxicity, and antioxidant potency. Hence, these complexes might have better therapeutic responses in future; notwithstanding, it needs further detailed analysis in other pharmacological perspectives.



http://ift.tt/2lFAAbf

Self-esteem as an important factor in quality of life and depressive symptoms in anosmia: A pilot study

Abstract

Objectives

Previous research has reported a negative impact of olfactory dysfunction on quality of life and depressive symptoms. As self-esteem was identified as a contributing factor to depression, the present study aimed to investigate quality of life (QoL), depressive symptoms, and self-esteem in patients with smell loss.

Design

Prospective controlled study.

Setting

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, in cooperation with the Department of Ear, Nose and Throat Diseases, Medical University of Vienna, Austria.

Participants

Twenty-two anosmic patients (12 female, 10 male) and 25 healthy controls (15 female, 10 male) participated in this study.

Main outcome measures

Olfactory performance was assessed using the Sniffin' Sticks battery. In addition, psychological questionnaires that covered the topics quality of life (WHOQOL-BREF), depressive symptoms (BDI-II), and self-esteem (MSWS) were conducted.

Results

The results of this study revealed a decrease in quality of life and reduced body-related self-esteem in anosmic patients. Furthermore, quality of life and self-esteem were correlated with depressive symptoms.

Conclusion

As self-esteem, quality of life, and depressive symptoms in anosmia interact with each other, we suggest that self-esteem should be considered in the medical history, in order to provide a personalized intervention, adapted to the patient's needs.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lkaERH

Influence of surface roughness on silicone rubber voice prostheses on in vitro biofilm formation and clinical lifetime in laryngectomized patients

Abstract

Objectives

Evaluation of the influence of a smooth surface moulding technique of silicone rubber indwelling voice prostheses on in vitro biofilm formation and analysis of the clinical in situ lifetime.

Design

Biofilm formation on smooth and Groningen ultra-low resistance (URL) prostheses was studied in an artificial throat model. The clinical lifetime of smooth voice prostheses were compared to the previous lifetime of URL by counting the number of replacements in a consecutive 6 months period in the same patient. Participants: Eleven laryngectomized patients in follow up who required frequent replacement of their voice prostheses.

Settings

Tertiary University Medical Center.

Results

Use of a smoother mould and less viscous silicone rubber yielded a decrease in surface roughness from 46 nm to 8 nm, and was accompanied by a 40% reduction in the prevalence of bacteria and yeast in in vitro formed biofilms. Clinically, the lifetime was significantly (p < 0.005) increased by a factor of 2.1.

Conclusions

This combined in vitro and clinical study suggests that the choice of material and in particular its surface finishing, may be determining factors with respect to the clinical lifetime of silicone rubber implants and devices failing due to biofilm formation.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lPfolm

Self-esteem as an important factor in quality of life and depressive symptoms in anosmia: A pilot study

Abstract

Objectives

Previous research has reported a negative impact of olfactory dysfunction on quality of life and depressive symptoms. As self-esteem was identified as a contributing factor to depression, the present study aimed to investigate quality of life (QoL), depressive symptoms, and self-esteem in patients with smell loss.

Design

Prospective controlled study.

Setting

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, in cooperation with the Department of Ear, Nose and Throat Diseases, Medical University of Vienna, Austria.

Participants

Twenty-two anosmic patients (12 female, 10 male) and 25 healthy controls (15 female, 10 male) participated in this study.

Main outcome measures

Olfactory performance was assessed using the Sniffin' Sticks battery. In addition, psychological questionnaires that covered the topics quality of life (WHOQOL-BREF), depressive symptoms (BDI-II), and self-esteem (MSWS) were conducted.

Results

The results of this study revealed a decrease in quality of life and reduced body-related self-esteem in anosmic patients. Furthermore, quality of life and self-esteem were correlated with depressive symptoms.

Conclusion

As self-esteem, quality of life, and depressive symptoms in anosmia interact with each other, we suggest that self-esteem should be considered in the medical history, in order to provide a personalized intervention, adapted to the patient's needs.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lkaERH

Influence of surface roughness on silicone rubber voice prostheses on in vitro biofilm formation and clinical lifetime in laryngectomized patients

Abstract

Objectives

Evaluation of the influence of a smooth surface moulding technique of silicone rubber indwelling voice prostheses on in vitro biofilm formation and analysis of the clinical in situ lifetime.

Design

Biofilm formation on smooth and Groningen ultra-low resistance (URL) prostheses was studied in an artificial throat model. The clinical lifetime of smooth voice prostheses were compared to the previous lifetime of URL by counting the number of replacements in a consecutive 6 months period in the same patient. Participants: Eleven laryngectomized patients in follow up who required frequent replacement of their voice prostheses.

Settings

Tertiary University Medical Center.

Results

Use of a smoother mould and less viscous silicone rubber yielded a decrease in surface roughness from 46 nm to 8 nm, and was accompanied by a 40% reduction in the prevalence of bacteria and yeast in in vitro formed biofilms. Clinically, the lifetime was significantly (p < 0.005) increased by a factor of 2.1.

Conclusions

This combined in vitro and clinical study suggests that the choice of material and in particular its surface finishing, may be determining factors with respect to the clinical lifetime of silicone rubber implants and devices failing due to biofilm formation.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lPfolm

Longitudinal segmentation of age-related white matter hyperintensities

Publication date: Available online 24 February 2017
Source:Medical Image Analysis
Author(s): Carole H. Sudre, M.Jorge Cardoso, Sebastien Ourselin
Although white matter hyperintensities evolve in the course of ageing, few solutions exist to consider the lesion segmentation problem longitudinally. Based on an existing automatic lesion segmentation algorithm, a longitudinal extension is proposed. For evaluation purposes, a longitudinal lesion simulator is created allowing for the comparison between the longitudinal and the cross-sectional version in various situations of lesion load progression. Finally, applied to clinical data, the proposed framework demonstrates an increased robustness compared to available cross-sectional methods and findings are aligned with previously reported clinical patterns.

Graphical abstract

http://ift.tt/2lkcVwn

Foreign Body Aspiration in Adults (Two Unusual Foreign Bodies; Knife and Tube Tracheostomy).

Related Articles

Foreign Body Aspiration in Adults (Two Unusual Foreign Bodies; Knife and Tube Tracheostomy).

Iran J Otorhinolaryngol. 2017 Jan;29(90):59-61

Authors: Hashemi SM, Kolahdouzan M, Shahabi S, Talebzadeh H, Rezaei MT

Abstract
INTRODUCTION: Foreign body aspiration is usually a serious condition that is most common among the pediatric population, and rare in adults. In adults, aspiration may be tolerated for a long time.
CASE REPORTS: Our first case is a 38-year-old man who presented with a 2-day history of swallowing a foreign body. He was completely asymptomatic. Chest X-ray revealed the presence of 5-cm foreign object in the right main bronchus. Rigid bronchoscopy was performed and a knife was removed from the right main bronchus. Second, a 57-year old man with a known case of laryngeal cancer from 15 years previously was admitted for respiratory distress. He had previously undergone a permanent tracheostomy and had received radiotherapy for his cancer. At the first visit, the patient had prominent distress and was transferred to the operating room as an emergency. A tube was seen on chest X-ray. On bronchoscopy, we found the tracheostomy situated in the carina. The cleaved tracheostomy was removed using the grasper, by grasping the cuff line.
CONCLUSION: We conclude that foreign body aspiration might be completely asymptomatic, especially in an adult. A good history and imaging findings can help us to diagnose and treat the condition carefully.

PMID: 28229065 [PubMed - in process]

http://ift.tt/2kVE0JP

Abnormal Auditory Brainstem Response (ABR) Findings in a Near-Normal Hearing Child with Noonan Syndrome.

Related Articles

Abnormal Auditory Brainstem Response (ABR) Findings in a Near-Normal Hearing Child with Noonan Syndrome.

Iran J Otorhinolaryngol. 2017 Jan;29(90):53-57

Authors: Jalaei B, Zakaria MN, Sidek D

Abstract
INTRODUCTION: Noonan syndrome (NS) is a heterogeneous genetic disease that affects many parts of the body. It was named after Dr. Jacqueline Anne Noonan, a paediatric cardiologist.
CASE REPORT: We report audiological tests and auditory brainstem response (ABR) findings in a 5-year old Malay boy with NS. Despite showing the marked signs of NS, the child could only produce a few meaningful words. Audiological tests found him to have bilateral mild conductive hearing loss at low frequencies. In ABR testing, despite having good waveform morphology, the results were atypical. Absolute latency of wave V was normal but interpeak latencies of wave's I-V, I-II, II-III were prolonged. Interestingly, interpeak latency of waves III-V was abnormally shorter.
CONCLUSION: Abnormal ABR results are possibly due to abnormal anatomical condition of brainstem and might contribute to speech delay.

PMID: 28229064 [PubMed - in process]

http://ift.tt/2kVJBQw

Childhood Laryngeal Dystonia Following Bilateral Globus Pallidus Abnormality: A Case Study and Review of Literature.

Related Articles

Childhood Laryngeal Dystonia Following Bilateral Globus Pallidus Abnormality: A Case Study and Review of Literature.

Iran J Otorhinolaryngol. 2017 Jan;29(90):47-52

Authors: Saeedi Borujeni MJ, Esfandiary E, Almasi-Dooghaee M

Abstract
INTRODUCTION: Dystonia is a disorder of movement caused by various etiologies. Laryngeal dystonia is caused by the spasm of laryngeal muscles. It is a disorder caused by vocal fold movement in which excessive adduction or abduction of the vocal folds occurs during speech. The pathophysiology of this type of dystonia is not fully known. Some researchers have suggested that basal ganglia structures and their connections with cortical areas have been involved in the pathogenesis of dystonia.
CASE REPORT: In this paper a 7.5-year-old boy suffering from laryngeal dystonia with bilateral lesions in Globus Pallidus is presented. The patient also suffered from swallowing problems, monotone voice, vocal tremor, hypersensitivity of gag reflex, and stuttering. Drug treatment failed to cure him; therefore, he was referred to rehabilitation therapy.
CONCLUSION: In conclusion, special attention should be brought upon laryngeal dystonia, especially in patients showing Extra-pyramidal symptoms and/or abnormalities of the basal ganglia. In children, laryngeal dystonia may be potentially fatal. Lack of consideration for this condition during rehabilitation therapy can lead to serious consequences for a child.

PMID: 28229063 [PubMed - in process]

http://ift.tt/2kTPxts

Two Techniques of Tonsillectomy Performed in Identical Twins: A Case Report.

Related Articles

Two Techniques of Tonsillectomy Performed in Identical Twins: A Case Report.

Iran J Otorhinolaryngol. 2017 Jan;29(90):43-46

Authors: Bagherihagh A, Sadr Hossein SM

Abstract
INTRODUCTION: Cold dissection (CD) and bipolar cautery dissection (BCD) techniques are two common surgical tonsillectomy procedures used in the clinic. Obstruction has become more prevalent as the major surgical indication and is most prominently observed in younger children.
CASE REPORT: In this report, we aimed to explain the abovementioned surgical techniques in detail and compare the results in identical twins (monozygote twins). Using low energy electrocautery, irrigating the operation site continuously during cauterization, avoiding unnecessary sutures, and direct cautery to the tonsil bed are all effective measures that have diminished post-op pain in bipolar electrocautery dissection, compared to cold dissection tonsillectomy.
CONCLUSION: Bipolar cautery dissection with some modification is very good alternative for tonsillar surgery.

PMID: 28229062 [PubMed - in process]

http://ift.tt/2kVHs7D

Central Myxoma / Myxofibroma of the Jaws: A Clinico-Epidemiologic Review.

Related Articles

Central Myxoma / Myxofibroma of the Jaws: A Clinico-Epidemiologic Review.

Iran J Otorhinolaryngol. 2017 Jan;29(90):35-42

Authors: Rowland A, Benjamin F, Athanasius-Chukwudi O, Uchenna-Kevin O, Modupeola-Omotara S

Abstract
INTRODUCTION: Myxomas are a group of benign rare tumors of connective-tissue origin that occur in both hard (central) and soft tissues of the body. The aim of this study is to highlight our experience in the management of central myxoma of the jaw, with emphasis on its clinic-epidemiologic features as seen in our environment.
MATERIALS AND METHODS: All patients who were managed for central myxoma of the jaw at the Oral and Maxillofacial Surgery department of a regional University Teaching Hospital between September 1997 and October 2015 were retrospectively studied. Details sourced included age, sex, site of tumor, duration, signs/symptoms, treatment given, and complications. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results from descriptive statistics were represented in the form of tables and charts, with a test for significance (ρ) using Pearson Chi-square (χ(2)) set at 0.05.
RESULTS: A total of 16 patients were managed within the period reviewed, consisting of 10 (62.5%) females and six (37.5%) males, giving a male-to-female ratio of 1:1.7. The ages of patients ranged from 5 to 70 years, with a mean of 27.06±15.45 years. The mandible accounted for nine (56.3%) cases and the maxilla for six (37.5%) cases, while a combination of the maxilla and the zygoma were involved in one (6.3%) case. Bucco-lingual or bucco-palatal expansion were the most common presentation (six [46.2%] cases each). Histological assessment of tissue specimens showed that fibromyxoma accounted for seven (43.8%) cases, while the remaining nine (56.3%) cases were diagnosed as myxoma. All patients had jaw resections, and these consisted of mandibulectomies in nine (60.0%) patients and maxillectomies in six (40.0%) patients. The duration of hospital stay ranged from 5 to 29 days, with a mean of 17.86±7.68 days. Complications were noted in three patients, and all were surgical wound infections.
CONCLUSION: Most patients in our environment present late with large tumors and are usually not compliant with follow-up review. Thus, a radical approach is favored in most patients.

PMID: 28229061 [PubMed - in process]

http://ift.tt/2kVOLfp

Comparison of Fluoroplastic Causse Loop Piston and Titanium Soft-Clip in Stapedotomy.

Related Articles

Comparison of Fluoroplastic Causse Loop Piston and Titanium Soft-Clip in Stapedotomy.

Iran J Otorhinolaryngol. 2017 Jan;29(90):23-28

Authors: Faramarzi M, Gilanifar N, Roosta S

Abstract
INTRODUCTION: Different types of prosthesis are available for stapes replacement. Because there has been no published report on the efficacy of the titanium soft-clip vs the fluoroplastic Causse loop Teflon piston, we compared short-term hearing results of both types of prosthesis in patients who underwent stapedotomy due to otosclerosis.
MATERIALS AND METHODS: A total of 57 ears were included in the soft-clip group and 63 ears were included in the Teflon-piston group. Pre-operative and post-operative air conduction, bone conduction, air-bone gaps, speech discrimination score, and speech reception thresholds were analyzed.
RESULTS: Post-operative speech reception threshold gains did not differ significantly between the two groups (P=0.919). However, better post-operative air-bone gap improvement at low frequencies was observed in the Teflon-piston group over the short-term follow-up (at frequencies of 0.25 and 0.50 kHz; P=0.007 and P=0.001, respectively).
CONCLUSION: Similar post-operative hearing results were observed in the two groups in the short-term.

PMID: 28229059 [PubMed - in process]

http://ift.tt/2kVS0DJ

Opium Addiction and Risk of Laryngeal and Esophageal Carcinoma.

Related Articles

Opium Addiction and Risk of Laryngeal and Esophageal Carcinoma.

Iran J Otorhinolaryngol. 2017 Jan;29(90):19-22

Authors: Bakhshaee M, Raziee HR, Afshari R, Amali A, Roopoosh M, Lotfizadeh A

Abstract
INTRODUCTION: Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus.
MATERIALS AND METHODS: Fifty eight patients with laryngeal cancer, ninety eight patients with upper esophageal cancer and twenty seven healthy individuals with no evidence of head and neck or esophageal malignancies were selected from Otolaryngology and Radiation Oncology Department of Mashhad University of Medical Sciences. Duration and amount of cigarette smoking and opium consumption were recorded through comprehensive interviews.
RESULTS: The crude odds ratio for laryngeal cancer was 5.58 (95% CI 2.05-15.15, P=0.000) in cigarette smokers relative to non-smokers and 9.09 (95% CI 3.21-25.64, P=0.000) in opium users relative to non-users. The crude odds ratio for esophageal cancer was 0.44 (95% CI 0.18-1.09, P=0.07) in cigarette smokers relative to non-smokers and 1.44 (95% CI 0.57-3.62, P=0.43) in opium users relative to non-users. After adjusting for smoking, the odds ratio for laryngeal cancer in opium users relative to non-users was 6.06 (95% CI 1.10-33.23, P=0.05). Laryngeal cancer was detected at a significantly lower age in opium users (54.54±10.93 vs 62.92±10.10 years, P=0.02) than in smokers. This effect was not observed in esophageal cancer. Although the duration (year 17.50±14.84 vs 21.91±14.03; P=0.34) and amount (pack/day 0.625 vs 0.978; P=0.06) of smoking were higher among those who were opium dependent, these differences were not statistically significant (P=0.34 and P=0.06, respectively).
CONCLUSION: Opium addiction by snuffing is an independent risk factor for the development laryngeal cancer but not esophageal cancer. Cigarette smoking increases this risk. Opium dependency increases the likelihood of developing laryngeal cancer at a younger age.

PMID: 28229058 [PubMed - in process]

http://ift.tt/2lgCONe

Meatoplasty in Canal wall down Surgery: Our Experience and Literature Review.

Related Articles

Meatoplasty in Canal wall down Surgery: Our Experience and Literature Review.

Iran J Otorhinolaryngol. 2017 Jan;29(90):11-17

Authors: Memari F, Maleki Delarestaghi M, Mir P, GolMohammadi M, Shams Koushki E

Abstract
INTRODUCTION: Meatoplasty is the final and essential step in performing effective canal wall down surgery for chronic otitis media. In this article we review some previous techniques and discuss our preferred method.
MATERIALS AND METHODS: In this observational case series study, we used this technique in 53 patients (28 male and 25 female) between January 2005 and January 2008. Our survey was completed in 31 patients.
RESULTS: Twenty-six patients (83.9%) said their ear appeared normal after the procedure, but five patients (16.1%) complained of some minor change in the shape of their ear. Twenty-nine patients (93.5%) had a completely wide ear canal. The ear canal had some degree of stenosis in two patients (6.5%) post-operatively.
CONCLUSION: This technique offers good functional and cosmetic results with minimal manipulation and minimal anatomic disruption.

PMID: 28229057 [PubMed - in process]

http://ift.tt/2meIX0J

Experimental Visualization of Labyrinthine Structure with Optical Coherence Tomography.

Related Articles

Experimental Visualization of Labyrinthine Structure with Optical Coherence Tomography.

Iran J Otorhinolaryngol. 2017 Jan;29(90):5-9

Authors: Mohebbi S, Mirsalehi M, Kahrs LA, Ortmaier T, Lenarz T, Majdani O

Abstract
INTRODUCTION: Visualization of inner ear structures is a valuable strategy for researchers and clinicians working on hearing pathologies. Optical coherence tomography (OCT) is a high-resolution imaging technology which may be used for the visualization of tissues. In this experimental study we aimed to evaluate inner ear anatomy in well-prepared human labyrinthine bones.
MATERIALS AND METHODS: Three fresh human explanted temporal bones were trimmed, chemically decalcified with ethylenediaminetetraacetic acid (EDTA), and mechanically drilled under visual control using OCT in order to reveal the remaining bone shell. After confirming decalcification with a computed tomography (CT) scan, the samples were scanned with OCT in different views. The oval window, round window, and remnant part of internal auditory canal and cochlear turn were investigated.
RESULTS: Preparation of the labyrinthine bone and visualization under OCT guidance was successfully performed to a remaining bony layer of 300µm thickness. OCT images of the specimen allowed a detailed view of the intra-cochlear anatomy.
CONCLUSION: OCT is applicable in the well-prepared human inner ear and allows visualization of soft tissue parts.

PMID: 28229056 [PubMed - in process]

http://ift.tt/2kVS2vl

Emphasis on the early diagnosis of antithyroid drug-induced agranulocytosis: retrospective analysis over 16 years at one Chinese center

Abstract

Purpose

Antithyroid drug (ATD)-induced agranulocytosis is a rare but life-threatening adverse drug reaction that occurs in patients during the treatment of Graves' disease. We aimed to comprehensively examine data for patients with this rare complication and to improve the clinical safety of ATDs.

Methods

We retrospectively reviewed the medical records of 64 hospitalized patients diagnosed with ATD-induced agranulocytosis between 2000 and 2015.

Results

Agranulocytosis occurred in 52 (81.3%) patients within the first 3 months after initiation of ATD therapy. Fever (84.4%) and sore throat (82.8%) were the most common symptoms. Although they experienced symptoms, 30 (46.9%) patients did not seek treatment immediately and delayed their diagnosis of agranulocytosis. The minimum granulocyte count was lower in the patients diagnosed after the appearance of symptoms than in those diagnosed before the appearance of symptoms (0.01 × 10⁹/L (0 × 10⁹/L − 0.06 × 10⁹/L) versus 0.26 × 10⁹/L (0.05 × 10⁹/L − 0.40 × 10⁹/L), P < 0.001). The interval days from the appearance of symptoms to the diagnosis of agranulocytosis were negatively correlated with the minimum granulocyte count (r = −0.348, P = 0.005). In addition, a lower minimum granulocyte count was associated with a longer recovery time (β = −11.899, 95% CI −15.304 to −8.496).

Conclusions

Our findings have demonstrated that delayed diagnosis of ATD-induced agranulocytosis is common in our population. Delayed diagnosis is associated with severe agranulocytosis and may prolong the recovery time from agranulocytosis. Monitoring of the white blood cell and granulocyte counts may be an effective way to establish an early diagnosis and prevent progression to severe agranulocytosis.

http://ift.tt/2kV3fMq

Generation and Characterization of Inhibitory Antibodies Specific to Guinea Pig CXCR1 and CXCR2

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2lFgijS

Monoclonal Antibody TfR Monoclonal Antibody

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 35-35.


http://ift.tt/2l9W4v4

Antiglycopeptide Mouse Monoclonal Antibody LpMab-21 Exerts Antitumor Activity Against Human Podoplanin Through Antibody-Dependent Cellular Cytotoxicity and Complement-Dependent Cytotoxicity

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 20-24.


http://ift.tt/2lFcmzK

Monoclonal Antibody 4E3-2F7 Antimouse Dermokine-β/α

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 36-36.


http://ift.tt/2lFshfz

PAPA, PASH and PAPASH Syndromes: Pathophysiology, Presentation and Treatment

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis usually manifesting as skin ulcers with undermined erythematous-violaceous borders. It may be isolated, associated with systemic conditions or occurring in the context of autoinflammatory syndromes such as PAPA (pyogenic arthritis, PG and acne), PASH (PG, acne and suppurative hidradenitis) or PAPASH (pyogenic arthritis, acne, PG and suppurative hidradenitis). From a physiopathological point of view, all these conditions share common mechanisms consisting of over-activation of the innate immune system leading to increased production of the interleukin (IL)-1 family and 'sterile' neutrophil-rich cutaneous inflammation. From a genetic point of view, a number of mutations affecting the proteins of the inflammasome complex (the molecular platform responsible for triggering autoinflammation) or the proteins that regulate inflammasome function have been described in these disorders. As these debilitating entities are all associated with the over-expression of IL-1 and tumour necrosis factor (TNF)-α, biological drugs specifically targeting these cytokines are currently the most effective treatments but, given the emerging role of IL-17 in the pathogenesis of these syndromes, IL-17 antagonists may represent the future management of these conditions.

http://ift.tt/2mvf20l

Resilience, work engagement and stress reactivity in a middle-aged manual worker population

Publication date: Available online 24 February 2017
Source:International Journal of Psychophysiology
Author(s): Julie K. Black, George M. Balanos, Anna C. Whittaker (previously Phillips)
Work stress is a growing problem in Europe. Together, the negative physiological effect of stress on health, and increasing age increases the risk of developing cardiovascular disease in those aged over 50years. Therefore, identifying older workers who may be at risk of work-related stress, and its physiological effects, is key to promoting their health and wellbeing in the workforce. The present study examined the relationship between perceived psychological resilience and work-related factors (work engagement and presenteeism) and the physiological response to acute psychological stress in older manual workers in the UK. Thirty-one participants, mean (SD) age 54.9 (3.78)years reported perceived levels of resilience, work engagement, and presenteeism using standardized questionnaires. Cardiovascular measurements (heart rate (HR) and blood pressure (BP) and salivary cortisol were used to assess their physiological response to an acute psychological stress task. Resilience was not associated with work-related factors or reactivity. However, workers with higher work engagement showed lower SBP (p=0.02) and HR (p=0.001) reactivity than those with lower work engagement. Further, those with higher sickness presenteeism also had higher HR reactivity (p=0.03). This suggests a potential pathway by which higher work stress might contribute to the risk of future cardiovascular disease.



http://ift.tt/2lF7BWU

The relationship between maternal responsivity, socioeconomic status, and resting autonomic nervous system functioning in Mexican American children

Publication date: Available online 24 February 2017
Source:International Journal of Psychophysiology
Author(s): Megan Johnson, Julianna Deardorff, Elizabeth L. Davis, William Martinez, Brenda Eskenazi, Abbey Alkon
Adversity, such as living in poor socioeconomic conditions during early childhood, can become embedded in children's physiology and deleteriously affect their health later in life. On the other hand, maternal responsivity may have adaptive effects on physiology during early childhood development. The current study tested both the additive and interactive effects of socioeconomic status (SES) and maternal responsivity measured at 1year of age on resting autonomic nervous system (ANS) function and trajectory during the first 5years of life. Participants came from a birth cohort comprised of Mexican-origin families living in California. Children's resting ANS functioning (respiratory sinus arrhythmia; RSA; pre-ejection period; PEP; and heart rate; HR) was collected at 1, 3.5, and 5years of age (N=336) and modeled across time using Hierarchical Linear Modeling. Consistent with hypotheses, results showed that low SES predicted flatter trajectories of resting HR and PEP over early childhood (i.e., patterns of consistently higher heart rate; shorter PEP), whereas children who experienced positive maternal responsivity had steeper trajectories in RSA and PEP over time (i.e., increasing parasympathetic activation; decreasing sympathetic activation). The interaction between SES and maternal responsivity significantly predicted RSA intercept at age 5, such that among children living in low SES environments, high maternal responsivity mitigated the negative effect of poverty and predicted higher resting RSA at 5years of age. Results are consistent with the early life programming theory that suggests that environmental influences become biologically embedded in the physiology of children living in socially disadvantaged contexts, and identify increased maternal responsivity as a developmental mechanism that could offset the deleterious effects of low SES.



http://ift.tt/2lFmAOI

Imaging prevalence of nasal septal perforation in an urban population

Publication date: May–June 2017
Source:Clinical Imaging, Volume 43
Author(s): Menachem Gold, Issac Boyack, Nicholas Caputo, Aaron Pearlman
ObjectiveTo determine the prevalence of nasal septal perforation (NSP) on CT imaging in an urban hospital setting.MethodsFacial bone CT scans from 3708 consecutive patients were reviewed for the presence of NSP. Size of the perforation was measured in two dimensions. Medical records were reviewed for possible risk factors.ResultsThe prevalence of NSP was 2.05%. The most common risk factor was a history of drug abuse. Cocaine was the most prevalent drug used.ConclusionThe prevalence of NSP was more than double of that previously published, likely related to intranasal drug use in our urban population.



http://ift.tt/2lFmGWM

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Accounts for More Than Half of “Carcinomas” Harboring RAS Mutations

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kVG5ps

Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

Thyroid , Vol. 0, No. 0.


http://ift.tt/2lFiupO

Channel of viral DNA packaging motor for real time kinetic analysis of peptide oxidation states

Publication date: May 2017
Source:Biomaterials, Volume 126
Author(s): Shaoying Wang, Zhi Zhou, Zhengyi Zhao, Hui Zhang, Farzin Haque, Peixuan Guo
Nanopore technology has become a powerful tool in single molecule sensing, and protein nanopores appear to be more advantageous than synthetic counterparts with regards to channel amenability, structure homogeneity, and production reproducibility. However, the diameter of most of the well-studied protein nanopores is too small to allow the passage of protein or peptides that are typically in multiple nanometers scale. The portal channel from bacteriophage SPP1 has a large channel size that allows the translocation of peptides with higher ordered structures. Utilizing single channel conductance assay and optical single molecule imaging, we observed translocation of peptides and quantitatively analyzed the dynamics of peptide oligomeric states in real-time at single molecule level. The oxidative and the reduced states of peptides were clearly differentiated based on their characteristic electronic signatures. A similar Gibbs free energy (ΔG⁰) was obtained when different concentrations of substrates were applied, suggesting that the use of SPP1 nanopore for real-time quantification of peptide oligomeric states is feasible. With the intrinsic nature of size and conjugation amenability, the SPP1 nanopore has the potential for development into a tool for the quantification of peptide and protein structures in real time.



http://ift.tt/2lAb5d8

Pathology-targeted cell delivery via injectable micro-scaffold capsule mediated by endogenous TGase

Publication date: May 2017
Source:Biomaterials, Volume 126
Author(s): Chunxiao Qi, Yaqian Li, Patrick Badger, Hongsheng Yu, Zhifeng You, Xiaojun Yan, Wei Liu, Yan Shi, Tie Xia, Jiahong Dong, Chenyu Huang, Yanan Du
Targeted cell delivery to lesion sites via minimally invasive approach remains an unmet need in regenerative medicine to endow satisfactory therapeutic efficacy and minimized side-effects. Here, we rationally designed a pathology-targeted cell delivery strategy leveraging injectable micro-scaffolds as cell-loading capsule and endogenous tissue transglutaminase (TGase) at lesion site as adhesive. Up-regulated TGase post-liver injury catalyzed chemical bonding between the glutamine and lysine residues on liver surface and micro-scaffolds both ex vivo and in vivo, facilitating sufficient adhesion on the pathological liver. Upon intraperitoneal injection, Mesenchymal Stem Cell-loaded capsules, exhibiting cell protection from shear-induced damage and post-transplantation anoikis, adhered to the CCl4-treated liver with a hundred-fold improvement in targeting efficiency (70.72%) compared to free-cell injection, which dramatically improved mice survival (33.3% vs. 0% for free-cell therapy) even with low-dosage treatment. This unique and widely-applicable cell delivery mechanism and strategy hold great promise for transforming cell therapy for refractory diseases.



http://ift.tt/2lAhrcn

Summary of mutations underlying autosomal recessive congenital ichthyoses (ARCI) in Arabs with four novel mutations in ARCI-related genes from the United Arab Emirates

Abstract

Background

Clinical and molecular heterogeneity is a prominent characteristic of congenital ichthyoses, with the involvement of numerous causative loci. Mutations in these loci feature in autosomal recessive congenital ichthyoses (ARCIs) quite variably, with certain genes/mutations being more frequently uncovered in particular populations.

Methods

In this study, we used whole exome sequencing as well as direct Sanger sequencing to uncover four novel mutations in ARCI-related genes, which were found in families from the United Arab Emirates. In silico tools such as CADD and SIFT Indel were used to predict the functional consequences of these mutations.

Results

The here-presented mutations occurred in three genes (ALOX12B, TGM1, ABCA12), and these are a mixture of missense and indel variants with damaging functional consequences on their encoded proteins.

Conclusions

This study presents an overview of the mutations that were found in ARCI-related genes in Arabs and discusses molecular and clinical details pertaining to the above-mentioned Emirati cases and their novel mutations with special emphasis on the resulting protein changes.

http://ift.tt/2muPbWe

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Accounts for More Than Half of “Carcinomas” Harboring RAS Mutations

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kVG5ps

Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

Thyroid , Vol. 0, No. 0.


http://ift.tt/2lFiupO

Epidemiological and survival analysis of triple-negative breast cancer cases in a retrospective multicenter study

R Sarin, L Khandrika, RNM Hanitha, A Avula, M Batra, S Kaul, H Raj, S Shivkumar, S Gupta, E Khan, TPS Bhandari, SVSS Prasad, VA Reddy, G Swarnalata, M Bakre, S Chatterjee, J Jain

Indian Journal of Cancer 2016 53(3):353-359

INTRODUCTION: This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options. MATERIALS AND METHODS: Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers. RESULTS: About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with <4% of the cases of metastatic cancer. Data on follow-up were somewhat sporadic as a good number of cases were lost to follow-up, but from the available data, recurrence rate was about 11%. Death, when it occurred, was mostly in the early periods of treatment with 35% of the events occurring before 3 years. The overall survival rates beyond 3 years were more than 86%. CONCLUSIONS: Data and sample collection are an ongoing process, so we expect this data set to be enriched with more cases and longer duration of follow-up in a year. Preliminary analysis sheds light on the potential of such a collection both for understanding the epidemiology of the disease and also for conducting future studies with an eye toward improving treatment outcomes.

http://ift.tt/2lCf3QQ

Does magnetic resonance imaging accurately predict residual disease after unplanned excision of soft-tissue sarcomas?

S Patkar, A Gulia, S Juvekar, B Rekhi, A Puri

Indian Journal of Cancer 2016 53(3):408-411

BACKGROUND: Often, it is difficult to assess the presence of residual disease after an unplanned excision in soft-tissue sarcomas. Inadequate excision leads to disease recurrence and inferior oncological outcomes while unnecessary excision may lead to additional surgical procedures with inherent morbidity and increased cost of treatment. There is a paucity of literature comparing the preoperative imaging findings with the final histopathology report to accurately assess the presence of residual disease. MATERIALS AND METHODS: The clinical details of 55 patients who had oncological scar excision after unplanned prior excision were retrieved. Histopathological evaluation of scar was compared with presurgery magnetic resonance imaging (MRI) for the presence of residual disease. Sensitivity, specificity, and positive and negative predictive value (NPV) of MRI for detection of residual disease were calculated. RESULTS: On MRI, residual disease was seen in 28 cases, no disease in 24 cases whereas findings of three patients were indeterminate. On final histopathology, residual disease was present in 30 (55%) patients whereas no residual tumor was seen in 25 (45%) patients. Two patients in whom MRI suggested the presence of residual disease had no tumor on final histopathology. No evidence of residual disease was reported in MRI of 24 patients. Of these, twenty patients were confirmed to have no tumor on final histopathology, whereas four patients had a residual tumor. Sensitivity: 86.66%, specificity: 90.90%, positive predictive value (PPV): 92.85%, NPV: 83.33%. CONCLUSION: MRI can aid in preoperative planning by identifying the site and extent of the previous surgery. It has a high PPV (92%) for detection of residual disease. However, a negative scan (NPV 83%) does not reliably exclude the presence of residual disease.

http://ift.tt/2lC8bTt

Weekly cisplatin (30–40 mg/m2) as radiosensitizer: Is it high or moderate emetic agent?

A Karpe, VM Patil, A Joshi, V Noronha, S Gupta, A Ramaswamy, A Sahu, V Doshi, T Gupta, S Rath, S Banavali, K Prabhash

Indian Journal of Cancer 2016 53(3):454-456

PURPOSE: The American Society of Clinical Oncology (ASCO) guideline recommends a high antiemetic prophylaxis for any dose of cisplatin. This hypothesis was tested by us in this analysis of solid tumor patients who received weekly cisplatin as a radiosensitizer in a dose range of 30–40 mg/m2. METHODS: This was a retrospective analysis of 181 solid tumor patients who received weekly cisplatin (in the dose range of 30–40 mg/m2) as a radiosensitizer between July 2015 and August 2015. The antiemetic prophylaxis schedule provided was classified as optimal (if a high antiemetic prophylaxis was provided) or suboptimal (if a nonhigh antiemetic prophylaxis was provided). The incidence of acute, delayed and breakthrough vomiting after chemotherapy was noted. SPSS version 20 was used for analysis. Fisher's exact test was used to determine the association between antiemetic schedule (suboptimal vs. optimal) and postchemotherapy emesis. RESULTS: In the present study, of 181 patients, only 25 patients (13.8%) received optimal antiemetic prophylaxis while the remaining 156 (86.2%) received suboptimal prophylaxis. In the cohort of patients with suboptimal prophylaxis, dexamethasone was omitted in all patients (100%) while NK receptor antagonist was omitted in 76 patients (48.7%). The rate of vomiting was lower in patients receiving optimal prophylaxis as compared to that in patients receiving suboptimal prophylaxis (12% vs. 39.75%; P - 0.005). CONCLUSION: Omission of dexamethasone followed by aprepitant was the main reason for suboptimal prophylaxis. High antiemetic prophylaxis in accordance with ASCO guidelines overall decreased the risk of emesis in patients receiving CTRT with weekly cisplatin in the dose range of 30–40 mg/m2.

http://ift.tt/2lEY9D2

Everolimus in heavily pretreated metastatic breast cancer: Is real world experience different?

J Bajpai, A Ramaswamy, S Gupta, J Ghosh, S Gulia

Indian Journal of Cancer 2016 53(3):464-467

BACKGROUND: Drugs targeting mammalian target of rapamycin signaling pathway have been recently approved for treatment of hormone receptor (HR) positive metastatic breast cancer (MBC). However, there is lack of real world data from India on the use of this therapeutic strategy. MATERIALS AND METHODS: A retrospective analysis of MBC patients who had recurrence or progression while receiving aromatase inhibitors (AI's) and further treated with everolimus and either tamoxifen/AI/fulvestrant between March 2012 and June 2014, was undertaken. RESULTS: There were 41 patients with median age 55 years, 73% with visceral metastasis, and 73% with ≥2 sites of metastases. Thirty (73%) patients had received 3 prior lines of therapy including AI (100%), tamoxifen (94%), fulvestrant (39%), and chemotherapy (100%) while the remaining had received <3 lines of prior therapy. The commonest Grade 3/4 adverse events were stomatitis (19%), hyperglycemia (new/worsening, 17%), fatigue (14.5%), nonneutropenic infections (14%), anemia (12%) and pneumonitis (7%). Everolimus dose reductions were required in 31% patients. There were 30% partial responses, 38% prolonged disease stabilizations and 32% disease progression as best responses to everolimus. The median progression-free survival was 22 weeks (5 months). CONCLUSIONS: Everolimus based treatment has meaningful activity in heavily pretreated patients with HR-positive MBC but is associated with considerable toxicity and requirement for dose adjustment.

http://ift.tt/2mn8X6Q

Role of laminin 332 in lymph node metastasis of papillary thyroid carcinoma

Publication date: Available online 24 February 2017
Source:Auris Nasus Larynx
Author(s): Kyoung Ho Oh, June Choi, Jeong-Soo Woo, Seung Kuk Baek, Kwang Yoon Jung, Min Ji Koh, Young-Sik Kim, Soon Young Kwon
ObjectiveThe invasiveness of papillary thyroid carcinoma (PTC), including the occurrence of cervical lymph node metastasis, is the main determining factors contributing to recurrence and poor prognosis. Laminin 332 is a glycoprotein involved in cell migration and cancer cell invasion into surrounding tissues and is therefore related to poor prognosis in many cancers. Here, we investigated the expression and role of laminin 332 in PTC and examine the possibility that laminin 332 could be involved in the invasiveness of PTC.MethodsLaminin 332 expression was determined by immunohistochemical staining in all 40 patients. The correlations between laminin 332 expression and clinical factors were investigated. We examined the expression of the laminin 332 γ2 chain using reverse transcription polymerase chain reaction and western blotting in PTC cells and determined the relationship between the expression of laminin 332 and the invasiveness of these cell lines using cell invasion assays.ResultsLaminin 332 was expressed specifically within tumor tissue. The frequency of laminin 332 γ2 chain expression was significantly correlated with cervical lymph node metastasis (​p=0.003). Invasiveness increased as the expression of laminin 332 γ2 increased in the tested PTC cell lines.ConclusionLaminin 332 expression may be a useful marker for predicting lymph node metastasis in papillary thyroid carcinoma, and could increase the ability of cancer cells to invade, which would influence the prognosis of patients with PTC.



http://ift.tt/2muMC6S

The effects of unilateral cochlear ablation on the expression of vesicular glutamate transporter 1 in the lower auditory pathway of neonatal rats

Publication date: Available online 24 February 2017
Source:Auris Nasus Larynx
Author(s): Hiroki Hasegawa, Miyako Hatano, Hisashi Sugimoto, Makoto Ito, Hiroshi Kawasaki, Tomokazu Yoshizaki
ObjectivesUnilateral cochlear damage has profound effects on the central auditory pathways in the brain.MethodsWe examined the effects of unilateral cochlear ablation on VGLUT1 expression in the cochlear nucleus (CN) and the superior olivary complex (SOC) in neonatal rats.ResultsVGLUT1 expression in the CN subdivisions (the AVCN, the PVCN and the DCN-deep layers) and the SOC (the MnTB, the LSO and the MSO) ipsilateral to the ablated side was significantly suppressed by unilateral cochlear ablation. Interestingly, VGLUT1 expression in the PVCN and the DCN-deep layers contralateral to the ablated side was also reduced.ConclusionOur findings indicate that unilateral cochlear ablation affects VGLUT1 expression in the central auditory pathways not only ipsilateral but also contralateral to the ablated side.



http://ift.tt/2lPoU7Z

Efficacy and safety of sorafenib in advanced renal cell cancer and validation of Heng criteria

A Joshi, A Ramaswamy, V Noronha, VM Patil, A Chandrasekharan, A Goel, A Sahu, N Sable, A Agrawal, S Menon, K Prabhash

Indian Journal of Cancer 2016 53(3):423-428

INTRODUCTION: Sorafenib is an established upfront treatment option for metastatic RCC (mRCC). There is no published literature regarding its performance in Indian Patients. We present an analysis of Sorafenib use in our institute and attempt to validate the Heng criteria as a prognostic score in these patients. MATERIALS AND METHODS: Patients who received Sorafenib as first line treatment for advanced RCC from June 2012 to December 2015 were prognosticated by Heng criteria and retrospectively analysed for baseline demographics, toxicity, response and outcomes. RESULTS: 82 patients (65 males, 17 females) with a median age of 57 years were included for final analysis. Median ECOG PS was 1, 95.2 % of the patients had Stage IV disease and clear cell was the predominant histology (79.4%). 23.2%, 42.7% and 34.1% of patients were classified as low, intermediate and high risk by Heng's criteria, respectively. Dose reduction was required in 24.4% of patients, while 14.6% required permanent cessation of Sorafenib due to intolerable or recurrent side effects. Common adverse events included HFS (68.2%), mucositis (35.3%), fatigue (35.3%), rash (32.9%) and hypertension (25.6%). Response rate observed was 18.2%, while clinical benefit rate was 57.2% in the 57 patients where response was evaluable. Median progression free survival was 7.75 months (5.45-10.05) and median overall survival (OS) was 12.18 months (9.61 – 14.76). Median OS was 19.6, 16.1 and 10.3 months respectively for low, intermediate and high risk patients by Heng criteria and the criteria was statistically discriminatory for the 3 groups for OS (p=0.045, chi-square test). CONCLUSION: Sorafenib is a viable upfront treatment option for metastatic RCC in Indian patients with acceptable PFS, although a high incidence of HFS, mucositis and rash is observed. The Heng score has discriminatory value in mRCC with Sorafenib and can be considered for routine use in the clinic.

http://ift.tt/2lR1xLU

Applicability of a single 5 color cytoplasmic markers tube as primary panel for immunophenotyping of acute leukemia: A Gujarat Cancer and Research Institute experience

BP Parikh, SP Patel, BN Raiya, HH Vora, DH Jetly

Indian Journal of Cancer 2016 53(3):349-352

INTRODUCTION: Flow cytometry is highly sensitive for detection and quantitative analysis of surface and intracellular antigens in malignant hemopoietic cells. Immunophenotyping is a routine practice for classification and lineage assignment of acute leukemia. In the present study, our aim is to identify the role of a single 5 color, CD45, myeloperoxidase (MPO), cCD79a, cCD3, and Tdt, cytoplasmic markers combination as a primary tube. We compared with final diagnosis on the basis of morphology, cytochemistry, and primary and secondary panels of immunophenotyping and also with other study. MATERIALS AND METHODS: We have included 455 new cases of acute leukemias with applied primary and secondary panels of markers for immunophenotyping. We analyzed sensitivity and specificity of different subsets with combination of positive and negative markers. RESULTS: MPO was positive in 61.4% of acute myeloid leukemia (AML) cases. All 184 (100%) cases of the AML were negative for cCD3 and cCD79a co-expression. cCD79a expression was highly sensitive as 98.5% B-acute lymphoblastic leukemia (B-ALL) expressed it. cCD3 expression was detected in 100% cases of T-ALL, and its co-expression was not seen in B-ALL and AML. CONCLUSION: Our study indicates that there was very good correlation of 5-color cytoplasmic tube-based diagnosis versus final diagnosis based on morphology, cytochemistry, and flow cytometry. We can use this 5-color cytoplasmic tube method to make immunophenotyping cost-effective.

http://ift.tt/2lR3FD6

Cancer and cure: A critical analysis

PS Roy, BJ Saikia

Indian Journal of Cancer 2016 53(3):441-442

Cancer is one of the most dreaded diseases of the 20th century and spreading further with continuance and increasing incidence in the 21st century. The situation is so alarming that every fourth person is having a lifetime risk of cancer. India registers more than 11 lakh new cases of cancer every year, whereas, this figure is above 14 million worldwide. Is cancer curable? The short answer to this question is "Yes." In fact, all cancers are curable if they are caught early enough. Cancer cells continue to grow unless one of four things occur: (1) The cancerous mass is removed surgically; (2) using chemotherapy or another type of cancer-specific medication, such as hormonal therapy; (3) using radiation therapy; or (4) the cancer cells shrink and disappear on their own.

http://ift.tt/2lQRxSU

The male breast cancer: Epidemiological data from the North of Peru

G Flores-Trujillo, E Serrano-LaBarrera

Indian Journal of Cancer 2016 53(3):359-359



http://ift.tt/2lR15x0

The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan

AH Baloch, AN Khosa, N Bangulzai, H Sadia, M Ahmed, F Khan, M Jan, M Tareen, MH Kakar, J Shuja, HK Naseeb, J Ahmad

Indian Journal of Cancer 2016 53(3):363-365

Introduction: Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5%–15% of all the breast cancer cases. The present study was performed on 171 breast cancer patients from Balochistan registered in CENAR (Center for Nuclear Medicine and Radiotherapy), Quetta. Materials and Methods: Written consent was obtained from the patients. The history of the disease was taken from the patients, and the patients' enrollment files were retrieved. Results: Of the 171 patients, 5 (2.96%) were diagnosed with ILC with tumor Grade II, and stage of the cancer reported was Grade III in all the 5 patients affected with ILC. Conclusion: ILC is the second most common type of breast cancer diagnosed with comparatively lower grade but almost reported infiltrating.

http://ift.tt/2lR1AHA

Incidence and pattern of bone metastases at presentation in Indian carcinoma breast patients

SM Doddala, A Suryadevara, SK Chinta, AL Madisetty

Indian Journal of Cancer 2016 53(3):360-362

BACKGROUND: Breast cancer (BC) is the most common female cancer and frequently metastases to the bones. Breast cancer among Indian women occurs a decade earlier and more aggressive than the western population. Screening guidelines are based on western studies. The aim of our study is to assess the role of Technitium99m bone scan (TBS) in screening Indian EBC patients at presentation. We also looked at the pattern of BM in all stages of BC. METHODS: Patients with BC who had TBS at presentation from January 2012 to September 2015 were included in the study. RESULTS: Bone metastases were seen in 23.42% (241/1029). Of these, 10.06% (31/308) EBC, 25.60% (169/660) locally advanced BC (LABC) and 63.93% (39/61) of metastatic BC (MBC) patients had BM. Most common sites of BM were spine and pelvis. In long bone and sternum, proximal part was commonly involved. CONCLUSION: The incidence of BM in Indian BC patients at presentation is higher than western population. The incidence of BM per stage is similar to west. So TBS should be done in LABC and symptomatic EBC. There is high incidence of BM to spine and pelvis. In pelvis, SI joints and ilium and in long bones and sternum, proximal parts were commonly involved.

http://ift.tt/2lCfSJj

Pattern of care in operable endometrial cancer treated at a rural-based tertiary care cancer center

SB Dessai, D Adrash, M Geetha, S Arvind, J Bipin, S Nayanar, K Sachin, MS Biji, S Balasubramanian

Indian Journal of Cancer 2016 53(3):416-419

PURPOSE: An audit was planned to study the demographics, staging, treatment details, and outcomes of operable endometrial cancers. METHODOLOGY: All operable endometrial cancers treated between January 2009 and October 2014 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. Descriptive statistics was performed. The time-to-event analysis was done by Kaplan–Meier method. Univariate and multivariate analyses were done for disease-free survival (DFS) and overall survival (OS). RESULTS: There were 55 patients with a median age of 59 years (35–73 years). The Eastern Cooperative Oncology Group performance status was 1 in 52 patients (94.5%) and 2 in 3 patients (5.5%). Forty-nine patients (89.1%) had disease restricted to endometrium while 6 patients (10.9%) had cervical involvement. The surgery done was Type I hysterectomy in 49 patients (89.1%), Type II in 5 patients (9.1%), and Type III in 1 patient (1.8%). Pelvic lymph node dissection was done in all patients while para-aortic (infrahilar) dissection was done in 48 patients (87.3%). The pathological stages were Stage IA in 19 patients, Stage IB in 15 patients, Stage II in 4 patients, Stage IIIA in 3 patients, Stage IIIB in 2 patients, Stage IIIC1 in 5 patients, Stage IIIC2 in 4 patients, and Stage IV in 3 patients. Grade 1 tumors were seen in 23 patients, Grade 2 in 13 patients, and Grade 3 in 19 patients. The histology was endometrioid in 44 patients, serous in 6 patients, clear cell in 3 patients, and others in 2 patients. Adjuvant treatment was received by 40 patients. With a median follow-up of 2.5 years, the 3-year DFS and OS were 78% and 82%, respectively. Age >59 years, Stage III or greater, and Grade 3 tumors were independent prognostic factors adversely affecting both DFS and OS. CONCLUSION: The outcomes in our study are comparable to that seen in Western literature. Elderly status, higher stage, and a poorly differentiated tumor are associated with poor outcomes.

http://ift.tt/2lCnlIr