Head and Neck Diseases by Alexandros G.Sfakianakis: 03/04/17

Σάββατο 4 Μαρτίου 2017

The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy

Fast staging procedures and treatment are crucial for the prognosis of head and neck squamous cell carcinomas (HNSCC). HNSCC have shown rapid tumor growth, with a doubling of tumor volume in approximately 90 days [1], resulting in poor outcomes in patients with delayed treatment initiation [2–4]. In the last decades, however, time to treatment initiation (TTI) has increased in several countries [5–8], as a consequence of rising use of high-definition diagnostic techniques and treatment personalization [4].

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Subcutaneous immunoglobulins for the treatment of a patient with antisynthetase syndrome and secondary chronic immunodeficiency after anti-CD20 treatment: a case report

Antisynthetase syndrome is a rare and debilitating multiorgan disease characterized by inflammatory myopathy, interstitial lung disease, cutaneous involvement, and frequent chronic inflammation of the joints. ...

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Anesthetic Management of a Patient with Cowden Syndrome and Review of Anesthetic Concerns

Cowden syndrome (CS) is a rare autosomal dominant disorder demonstrating variable penetrance and an incidence of 1:200 000. The syndrome is characterized by gastrointestinal polyposis, mucocutaneous hamartomas of face and oral papillomatosis. Eighty percent of patients with CS have mutation in phosphatase and tensin homolog tumor-suppressor gene making them prone for developing malignancies of breast, thyroid and genitourinary system. Arteriovenous malformations (AVM) in brain, vertebral column and skin are also common features [1].

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Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma

Asthma and obesity are public health problems that disproportionately affect underserved children. Urban children with asthma may be limited in their participation in physical activity, further increasing their risk for overweight.

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Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma

Subcutaneous immunoglobulins for the treatment of a patient with antisynthetase syndrome and secondary chronic immunodeficiency after anti-CD20 treatment: a case report

Omalizumab anaphylaxis occurring outside the recommended observation times

In a case-control study in the September 2016 issue of the Journal, Lieberman et al1 describe a series of 30 patients who had anaphylactic reactions associated with omalizumab administration, comparing them with 88 patients who received omalizumab without such reactions. Among their important findings is an increased risk for anaphylaxis to omalizumab in patients who have a history of anaphylaxis to food, medication, or other causes. Such a history would raise the overall 0.2% risk to 0.62%, but in those without such a history would lower the risk to 0.08%.

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Reply

We thank Kelso1 for his comments on our case-control study,2 and his questions regarding the proportion of reactions that occurred outside of the observation period recommended by the Omalizumab-Associated Anaphylaxis Joint Task Force.3

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Diffuse heterotopic calcification of fibula flap: a previously unreported case

We describe what is, to the best of our knowledge, a new phenomenon, in which small multiple foci of heterotopic calcification developed in a fibular free flap that had been used to reconstruct a maxillary defect.

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Curbing—The Metallic Mode In-between

This study aims to study the categorization Curbing from the pedagogical method Complete Vocal Technique as a reduced metallic mode compared with the full metallic modes Overdrive and Edge by means of audio perception, laryngostroboscopic imaging, acoustics, long-term average spectrum (LTAS), and electroglottography (EGG).

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Responses of Middle-Frequency Modulations in Vocal Fundamental Frequency to Different Vocal Intensities and Auditory Feedback

Auditory feedback can make reflexive responses on sustained vocalizations. Among them, the middle-frequency power of F0 (MFP) may provide a sensitive index to access the subtle changes in different auditory feedback conditions.

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Vocal Fold Vibration Following Surgical Intervention in Three Vocal Pathologies: A Preliminary Study

High-speed videoendoscopy captures the cycle-to-cycle vibratory motion of each individual vocal fold in normal and severely disordered phonation. Therefore, it provides a direct method to examine the specific vibratory changes following vocal fold surgery. The purpose of this study was to examine the vocal fold vibratory pattern changes in the surgically treated pathologic vocal fold and the contralateral vocal fold in three vocal pathologies: vocal polyp (n = 3), paresis or paralysis (n = 3), and scar (n = 3).

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Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches

J reconstr Microsurg
DOI: 10.1055/s-0037-1599130

Background This study describes outcomes from a new surgical approach to treat "anterior" pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN). Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS). Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms. Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes

J reconstr Microsurg
DOI: 10.1055/s-0037-1599099

Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53–3.21) and 1.50 (95% CI: 0.85–2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32–3.35) and 1.04 (95% CI: 0.72–1.48), respectively. Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Surgeon-Based 3D Printing for Microvascular Bone Flaps

J reconstr Microsurg
DOI: 10.1055/s-0037-1600133

Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence Level IV.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Radiocaesium contamination and dose rate estimation of terrestrial and freshwater wildlife in the exclusion zone of the Fukushima Dai-ichi Nuclear Power Plant accident

Publication date: May 2017
Source:Journal of Environmental Radioactivity, Volume 171
Author(s): Shoichi Fuma, Sadao Ihara, Hiroyuki Takahashi, Osamu Inaba, Youji Sato, Yoshihisa Kubota, Yoshito Watanabe, Isao Kawaguchi, Tatsuo Aono, Haruhi Soeda, Satoshi Yoshida
To characterise the radioactive contamination of terrestrial and freshwater wildlife caused by the Fukushima Dai-ichi Nuclear Power Plant accident, biological samples, namely, fungi, mosses, plants, amphibians, reptiles, insects, molluscs, and earthworms, were collected mainly from the forests of the exclusion zone in the Fukushima Prefecture from 2011 to 2012. Caesium-134 and ¹³⁷Cs were detected by gamma spectrometry in almost all the samples. Fungi, ferns, and mosses accumulated high amounts of radiocaesium, as they did in Chernobyl, with ¹³⁴Cs + ¹³⁷Cs activity concentrations of 10⁴–10⁶ Bq kg⁻¹ fresh mass (FM). Earthworms, amphibians, and the soft tissue of the garden snail Acusta despecta sieboldiana, also had levels as high as 10⁴–10⁵ Bq kg⁻¹ FM of ¹³⁴Cs + ¹³⁷Cs. Most of the estimated total (internal + external) dose rates to herbaceous plants, amphibians, insects, and earthworms were below the corresponding derived consideration reference levels (DCRLs) recommended by the ICRP. This suggests that, in most cases, there was little chance of deleterious effects of ionising radiation on these organisms in the exclusion zone for the first year after the accident, though the dose rates were underestimated mainly due to the lack of consideration of short-lived radionuclides.

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Meeting report: Metastasis Research Society–Chinese Tumor Metastasis Society joint conference on metastasis

Abstract

During September 16th–20th 2016, metastasis experts from around the world convened for the 16th Biennial Congress of the Metastasis Research Society and 12th National Congress of the Chinese Tumor Metastasis Society in Chengdu, China to share most current data covering basic, translational, and clinical metastasis research. Presentations of the more than 40 invited speakers of the main congress and presentations from the associated Young Investigator Satellite Meeting are summarized in this report by session topic. The congress program also included three concurrent short talk sessions, an advocacy forum with Chinese and American metastatic patient advocates, a 'Meet the Professors Roundtable' session for young investigators, and a 'Meet the Editors' session with editors from Cancer Cell and Nature Cell Biology. The goal of integrating expertise and exchanging the latest findings, ideas, and practices in cancer metastasis research was achieved magnificently, thanks to the excellent contributions of many leaders in the field.

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A reflection and a look forward with Dr. Sue Eccles, retired Editor-in-Chief of Clinical and Experimental Metastasis

Abstract

After a lifetime's work devoted to metastasis research, Dr. Sue Eccles recently retired. She was a founding member the Metastasis Research Society in 1984, and has served as Editor-In-Chief of Clinical and Experimental Metastasis from its inception until her retirement, an amazing 32 years of service. Dr. Kate Bakaitis recently talked with Dr. Eccles about her experiences, memories and advice for young investigators.

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Get Buy-In from the Whole Team – Bring Them to the ASBA Conference

If you want to get into sleep medicine, or improve the oral appliance section of your dental practice, it takes buy-in from the entire practice. Sure, you can go to the American Sleep and Breathing Academy (ASBA) annual meeting by yourself, but will you be able to transmit the enthusiasm and knowledge that you gain?

I call it the "seminar high" and attaining those heights is better when at least one team member from the clinical or administrative side is along for the trip. Conference tuition and travel expenses for this year's Sleep and Wellness Conference has been made affordable with the goal being for at least one staff member to attend.

Visit Conference website for more information http://ift.tt/2l5Uf2D

In my work as executive director at Gergen's Sleep Lab, I have seen all that enthusiasm go to waste because dentists feel overwhelmed at the prospect of adding oral appliances to their practice. It is definitely not the same as traditional restorative dentistry.

Dentists may successfully relay some of what they learn, but they will inevitably forget something. Even if they could describe everything they learned, it's difficult to communicate the sheer inspiration that happens after a two-day educational event.

Remember, if staff members don't come to the presentations, they will simply have one thing on their minds; How much extra work is this new oral appliance commitment going to generate? If you can't explain the tools (software, proper insurance protocols, and treatment), it may only lead to frustration.

Don't leave staff to scramble and figure out what they need to do. Invite your team members to the ASBA show. Again, we understand that cost can be an issue, and you may hesitate to spend more dollars on tuition and travel expenses. However, if you go to a seminar and pay the tuition, then come back and fail to properly begin the oral appliance business, you will end up losing what you pay in tuition anyway.

The most successful doctors I see are the ones who bring their team members. Once they get home, they are the ones compiling ideas and determining how oral appliances can be implemented. You want everyone on board. If staff members are too busy to go, they are probably too busy to seriously pursue sleep medicine.

Visit Conference website for more information http://ift.tt/2l5Uf2D

Office managers, assistants, and hygienists will be talking to patients about oral appliances and giving those patients the basics. They will be talking about insurance, billing, and treatment and they answer phones and answer questions. Give them the tools they need to succeed. It will be worth the investment.

Angela Kowaleski is executive director of Gergen's Sleep Lab, with locations in Arizona and Illinois.

She has more than 20 years experience in the field of dental sleep medicine.

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Cabergoline for hyperprolactinemia: getting to the heart of it

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Follicle stimulating hormone, its novel association with sex hormone binding globulin in men and postmenopausal women

Abstract

Purpose

Follicle stimulating hormone plays direct roles in a variety of nongonadal tissues and sex hormone binding globulin is becoming the convergence of the crosstalk among metabolic diseases. However, no studies have explored the association between follicle stimulating hormone and sex hormone binding globulin. We aimed to study this association among men and women.

Methods

SPECT-China is a population-based study conducted since 2014. This study included 4206 men and 2842 postmenopausal women. Collected serum was assayed for gonadotropins, sex hormone binding globulin, sex hormones etc. Regression analyses were performed to assess the relationship between sex hormone binding globulin and follicle stimulating hormone and other variables including metabolic factors, thyroid function and sex hormones. Treatment with follicle stimulating hormone at different concentrations of 0, 5, 50 and 100 IU/L for 24 h was performed in HepG2 cells.

Results

In Spearman correlation, sex hormone binding globulin was significantly correlated with FSH, triglycerides, thyroxins, body mass index and blood pressure in men and postmenopausal women (all P < 0.05). In regression analyses, follicle stimulating hormone was a significant predictor of sex hormone binding globulin in men and postmenopausal women (P < 0.05), independent of above variables. Follicle stimulating hormone induced sex hormone binding globulin expression in a dose-dependent fashion in HepG2 cells.

Conclusion

Serum follicle stimulating hormone levels were positively associated with circulating sex hormone binding globulin levels in men and postmenopausal women. This association is independent of age, insulin resistance, hepatic function, lipid profile, thyroid function, adiposity, blood pressure, and endogenous sex hormones.

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Biochemical assessment of disease control in acromegaly: reappraisal of the glucose suppression test in somatostatin analogue (SA) treated patients

Abstract

Background

It is recommended not to measure growth hormone during oral glucose suppression (oral glucose tolerance test) during somatostatin analog treatment in acromegaly. However, we have observed that failure to suppress growth hormone in response to oral glucose tolerance test during somatostatin analog unmasks insufficient disease control and hypothesize that somatostatin analog also induces insufficient growth hormone suppression to mixed meals.

Methods

We therefore compared serum growth hormone levels during two mixed meals in patients with controlled insulin-like growth factor-I levels after either surgery alone (n = 9) or somatostatin analog treatment (n = 9). The patients were unbiasedly matched for gender and insulin-like growth factor-I and studied twice in the following order: (1) during a 6 h growth hormone day curve including two mixed meals and (2) during a 3 h growth hormone profile including 60 min fasting followed by a 2-h oral glucose tolerance test.

Results

During the day curve growth hormone levels were elevated in the somatostatin analog group (P = 0.008) and growth hormone levels 1 h after each meal declined significantly only in the surgery group (P = 0.02). During the oral glucose tolerance test the two groups had similar growth hormone levels prior to the glucose load (P = 0.6), whereas a significant 66% suppression was observed after glucose only in the surgery group (P = 0.001).

Conclusions

(1) Patients controlled by somatostatin analog fail to suppress growth hormone in response to both mixed meals and oral glucose tolerance test (2) This phenomenon is likely to result in elevated serum growth hormone levels during everyday life in somatostatin analog-treated patients, (3) We postulate that measuring growth hormone levels during oral glucose tolerance test is useful to unmask potential somatostatin analog under-treatment in the presence of 'safe' insulin-like growth factor-I levels.

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Cabergoline for hyperprolactinemia: getting to the heart of it

http://ift.tt/2lqzSlp

Follicle stimulating hormone, its novel association with sex hormone binding globulin in men and postmenopausal women

Abstract

Purpose

Methods

Results

Conclusion

http://ift.tt/2mR0YPR

Biochemical assessment of disease control in acromegaly: reappraisal of the glucose suppression test in somatostatin analogue (SA) treated patients

Abstract

Background

Methods

Results

Conclusions

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CO 2 laser for the treatment of diabetic foot ulcers with exposed bone. A consecutive series of type 2 diabetic patients

Abstract

Aim

The treatment of foot ulcers with exposed bone is challenging, because of the risk of infection and of difficulties in the development of granulation tissue. A CO₂ laser beam could be used to produce discontinuities in periosteum, allowing the exposure of blood containing multipotent stem cells, capable of initiating the healing process. The local application of platelet-rich plasma (PRP) has been proposed as a therapeutic tool for accelerating healing in foot ulcers, including those in patients with diabetes. Aim of the present pilot, proof-of-concept study is the assessment of the therapeutic potential of CO₂ laser treatment, either alone or combined with PRP, in the treatment of diabetic foot ulcers with exposed bone.

Methods

We performed a pilot, uncontrolled 3-month observation study on a consecutive series of 9 type two diabetic patients and foot ulcers with exposed bone. A CO₂-laser was used for producing nine discontinuities on periosteum for each cm², by directing the focused laser beam on the bone until bleeding. The procedure was repeated up to 6 times, at a distance of 1 week and ulcers assessed weekly until the end of the study (3 months). In the last 5 of the 14 patients, the treatment described above was associated with PRP.

Results

Of the nine patients treated, four healed, and one more patient developed granulation tissue covering entirely bone surface. Out of the four patients who did not heal, one underwent minor amputation. Among the five patients treated with a combination of CO₂ laser and PRP, two healed within 3 months, and two more patients developed granulation tissue covering entirely bone surface; the fifth patient did not show any improvement and underwent amputation.

Conclusions

The present pilot experience represents a novelty in this field showing a possible use of CO₂-laser in the treatment of diabetic foot ulcers.

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Immunotherapy for type 1 diabetes

Abstract

Introduction

Although many approaches have been tested to overcome the insulin dependence caused by the pancreatic β-cells destruction observed in individuals affected by type 1 diabetes (T1D), medical research has largely failed to halt the onset or to reverse T1D.

Methods

In this work, the state of the art of immunotherapy will be examined, and the most important achievement in the field will be critically discussed. Particularly, we will focus on the clinical aspect, thus avoiding the tedious preclinical work done in NOD mice, which has been so poorly translated to the bedside.

Conclusions

Stem cell therapies achieved thus this far the most promising results, while immune ablation and standard immunosuppressants did not maintain the premises of preclinical results. The next step will be to generate a feasible and safe clinical approach in order to cure the thousands of patients affected by T1D.

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Assessment of in vivo mast cell reactivity in patients with systemic mastocytosis

Abstract

Background

Patients with systemic mastocytosis (SM) have clinical signs of mast cell (MC) activation and increased levels of MC mediators. It is unclear whether the increased mediator levels are caused by increased numbers of tissue MCs, or whether these cells in affected individuals have a hyperactive phenotype.

Objective

To determine reactivity of the skin and the airways to directly acting mediators and indirectly acting mast cell secretagogues in subjects with SM.

Methods

Skin reactivity to morphine and histamine, and airway responsiveness to mannitol and methacholine was assessed in 15 patients with SM, 11 patients with allergic asthma (A) and 13 healthy controls (HC). Serum tryptase and urinary metabolites of the MC mediators histamine and prostaglandin D₂ were measured, as well as ex vivo basophil histamine release.

Results

Mast cell mediators in the blood and urine were significantly higher in patients with SM than in HC and A controls. Responsiveness to local activation of skin MCs (by morphine) and airway MCs (by mannitol) was similar in SM and HC groups. Likewise, end-organ responsiveness in the skin to histamine, and in the airways to methacholine, was similar in all three subject groups. There was no evidence of increased basophil reactivity in SM patients.

Conclusions & Clinical Relevance

Mast cells in the skin and airways of subjects with SM do not exhibit hyper-reactivity towards the MC-activating stimuli morphine and mannitol, respectively. Therefore, the highly elevated baseline levels of MC mediators in SM are most likely due to increased MC numbers, rather than altered MC responsiveness. The underlying mechanisms could involve leakage of MC mediators, or dysfunctions in mediator synthesis, storage and release. One clinical implication of our study is that there is no contraindication to perform skin tests using morphine in subjects with mastocytosis

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Assessment of in vivo mast cell reactivity in patients with systemic mastocytosis

Abstract

Background

Objective

To determine reactivity of the skin and the airways to directly acting mediators and indirectly acting mast cell secretagogues in subjects with SM.

Methods

Results

Conclusions & Clinical Relevance

http://ift.tt/2lKdGyU

Interferon-γ induced insufficient autophagy contributes to p62-dependent apoptosis of epithelial cells in chronic rhinosinusitis with nasal polyps

Abstract

Background

Autophagy is a lysosomal degradation pathway that is essential for cell survival, differentiation, and homeostasis. This study aimed to investigate the contribution of autophagy to the pathogenesis of CRS with nasal polyps (CRSwNP).

Methods

The expression of autophagic proteins [microtubule-associated protein 1 light chain 3B (LC3B)-II, autophagy-related proteins (Atg), and Beclin 1], substrate proteins (p62 and ubiquitinated proteins), and apoptotic signaling molecules [cysteine-aspartic protease-3 and 8, and poly-ADP-ribose polymerase] in the sinonasal mucosa and nasal epithelial cells (NECs) was detected by immunohistochemistry and Western blotting. Autophagic vacuoles were observed with transmission electron microscopy. BEAS-2B cells and NECs were treated with rapamycin, bafilomycin A1, or various cytokines. In some experiments, cultured NECs were transfected with small interfering RNA targeting p62 (sip62) or Atg5 (siAtg5). Cultured cells were analyzed with Western blotting and flow cytometry.

Results

Although autophagic protein expression and autophagic vacuole formation were increased in both eosinophilic and non-eosinophilic CRSwNP, particularly in NECs, there was also an up-regulation of substrate proteins and apoptotic signaling molecules. IFN-γ, but not IL-4, IL-13, or IL-17A, simultaneously enhanced LC3B-II and p62 levels as well as cell apoptosis in BEAS-2B cells and/or normal NECs. Bafilomycin A1 up-regulated the levels of LC3B-II and p62 in polyp NECs and IFN-γ treated normal NECs. IFN-γ-induced apoptosis of normal NECs was exaggerated by bafilomycin A1 and siAtg5. Sip62 suppressed apoptosis of polyp NECs and IFN-γ treated NECs. IFN-γ protein levels were increased in both eosinophilic and non-eosinophilic CRSwNP.

Conclusions

IFN-γ induces activated but insufficient autophagy and thus contributes to a degree to p62-dependent apoptosis of NECs in CRSwNP.

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Interferon-γ induced insufficient autophagy contributes to p62-dependent apoptosis of epithelial cells in chronic rhinosinusitis with nasal polyps

Abstract

Background

Methods

Results

Conclusions

IFN-γ induces activated but insufficient autophagy and thus contributes to a degree to p62-dependent apoptosis of NECs in CRSwNP.

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Serum cotinine levels should optimally be measured when evaluating the outcomes of cartilage tympanoplasty in smokers

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Reply to the letter concerning article: ‘Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center’

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Serum cotinine levels should optimally be measured when evaluating the outcomes of cartilage tympanoplasty in smokers

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Reply to the letter concerning article: ‘Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center’

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Pharyngitis in the Wake of an Invasive Dental Procedure

Publication date: Available online 3 March 2017
Source:The Journal of Emergency Medicine
Author(s): Erica Simon, Brit Long, Craig Pedersen

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The Role of Early Focused Cardiac Ultrasound in a Not-So-Typical Presentation of Takotsubo Cardiomyopathy: A Case Report

Publication date: Available online 3 March 2017
Source:The Journal of Emergency Medicine
Author(s): Jithin G. Varghese, Qurat-ul-ain Jelani, Stuart Zarich, Brooks Walsh
BackgroundFocused cardiac ultrasound (FoCUS) can be extremely helpful in identifying unexpected diagnoses that can significantly alter treatment options. The diagnosis of Takotsubo cardiomyopathy (TCM) may be difficult to identify.Case ReportWe describe a 47-year-old woman who presented to the emergency department (ED) with atypical features of TCM. Her clinical features included being a premenopausal woman with mild chest pain with a lack of identifiable emotional or physical stressors or significant electrocardiographic changes. Initial findings on FoCUS were consistent with TCM, with these findings replicated on repeat bedside echo performed in the ED by the cardiology fellow. A subsequent comprehensive echo showed marked improvement of the TCM pattern within 24 hours.Why Should an Emergency Physician Be Aware of This?TCM may present in younger women or men, without obvious preceding physical or emotional stressors and with nonspecific ECG findings. FoCUS performed in the ED may suggest a diagnosis of TCM in patients with chest pain or dyspnea of uncertain etiology. The performance of FoCUS, as highlighted by this case report, can lead to timely intervention and follow-up of a variety of cardiac conditions.

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Spontaneous Hemothorax, A Rare Face of Vertebral Osteochondroma

Publication date: Available online 3 March 2017
Source:The Journal of Emergency Medicine
Author(s): Sarah Sainte, Herbert Decaluwé, Peter Vanbrabant
BackgroundOsteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically.Case ReportWe report the unusual occurrence of a large hemothorax and lacerated right diaphragm in a 41-year-old woman caused by vertebral osteochondroma affecting the eleventh thoracic vertebra. Thoracoscopic exploration with resection of the osteochondroma and repair of the diaphragm was performed.Why Should an Emergency Physician Be Aware of This?Spontaneous hemothorax is a potential life-threatening condition when the initial diagnosis is postponed and hemodynamic instability and hypovolemic shock occurs. Osteochondroma as a cause of spontaneous hemothorax is uncommon but may require urgent surgical intervention with video-assisted thoracoscopic surgery of thoracotomy to control the hemorrhage and prevent recurrence.

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Effects of Student-Performed Point-of-Care Ultrasound on Physician Diagnosis and Management of Patients in the Emergency Department

Publication date: Available online 3 March 2017
Source:The Journal of Emergency Medicine
Author(s): Daniel S. Udrea, Andrew Sumnicht, Deanna Lo, Logan Villarreal, Stephanie Gondra, Richard Chyan, Audra Wisham, Vi Am Dinh
BackgroundDespite the increasing integration of ultrasound training into medical education, there is an inadequate body of research demonstrating the benefits and practicality of medical student–performed point-of-care ultrasound (SP-POCUS) in the clinical setting.ObjectivesThe primary purpose of this study was to evaluate the effects that SP-POCUS can have on physician diagnosis and management of patients in the emergency department, with a secondary purpose of evaluating the diagnostic accuracy of SP-POCUS.MethodsSP-POCUS examinations were performed in the emergency department by medical students who completed year one of a 4-year medical school curriculum with integrated ultrasound training. Scans were evaluated by an emergency physician who then completed a survey to record any changes in diagnosis and management.ResultsA total of 641 scans were performed on the 482 patients enrolled in this study. SP-POCUS resulted in a change in management in 17.3% of scans performed. For 12.4% of scans, SP-POCUS discovered a new diagnosis. SP-POCUS reduced time to disposition 33.5% of the time. Because of SP-POCUS, physicians avoided ordering an additional imaging study for 53.0% of the scans performed. There was 94.7% physician agreement with SP-POCUS diagnosis.ConclusionsThis study showed that SP-POCUS is feasible and may potentially have a meaningful impact on physician diagnosis and management of patients in the emergency department. In addition, the implementation of SP-POCUS could serve as an ideal method of developing ultrasound skills in medical school while positively impacting patient care.

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Impact of low-level laser therapy on hyposalivation, salivary pH, and quality of life in head and neck cancer patients post-radiotherapy

Abstract

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm², 30 mW, illuminated area 0.04 cm², 7.5 J/cm², 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p < 0.0001), mean pH values (p = 0.0002 and p = 0.0004), and mean score from the quality of life questionnaire (p < 0.0001). Low-level laser therapy seems to be effective to mitigate salivary hypofunction and increase salivary pH of patients submitted to radiotherapy for head and neck cancer, thereby leading to an improvement in quality of life.

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Pain Control by Novel Route of Gifted Choice Against Peroral Route

Abstract

Introduction

Pain after surgical extraction of third molars has been a nemesis for oral surgeons with clinicians, thus striving for an analgesic modality. NSAIDs are among the most widely used therapeutic classes of analgesics. Transbuccal diclofenac sodium patches have been developed as an innovative drug delivery system using buccal mucosa as a gifted choice, hence overcoming first pass metabolism and offering the advantage of sustained drug delivery with reduced incidence of systemic adverse effects.

Aim

A comparative study was conducted to evaluate the efficacy of diclofenac sodium for pain control, administered via the far-fetched and gifted novel route through the transbuccal patch and by ever popular per oral route and also to assess the adverse effects vis-à-vis for transbuccal diclofenac patch and oral diclofenac following extraction of bilaterally symmetrical impacted mandibular third molars under local anaesthesia.

Methodology

Thirty healthy subjects of both the sexes in the age of 12 to 50 years with asymptomatic bilaterally symmetrical mandibular third molars underwent extraction under LA. It is a split-mouth study, i.e. after the extraction of tooth on one side, diclofenac sodium (50 mg) via oral route was given and then in another visit, when the same patient is comfortable and asymptomatic, extraction on contralateral side was executed and transbuccal patched diclofenac sodium (20 mg) was applied. Pain was measured on visual analog scale and verbal rating scale by the patient for 3 days and adverse effects if any were noted.

Result

Statistical analysis showed that transbuccal diclofenac sodium was significantly efficacious when compared to the drug administered orally. Also, statistically significant results were obtained in percentage reduction in pain from 1st to 3rd postoperative day in transbuccal group. No significant difference is seen for adverse reactions.

Conclusion

Transbuccal diclofenac sodium patch is more efficacious and can be used for pain control.

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Response Inhibition and Internet Gaming Disorder: A Meta-analysis

Publication date: August 2017
Source:Addictive Behaviors, Volume 71
Author(s): Evangelia Argyriou, Christopher B. Davison, Tayla T.C. Lee
Previous research has demonstrated that Internet Gaming Disorder (IGD) has multiple negative effects in psychological functioning and health. This makes the identification of its underpinnings, such as response inhibition, essential for the development of relevant interventions that target these core features of the disorder resulting in more effective treatment. Several empirical studies have evaluated the relationship between response inhibition deficits and IGD using neurocognitive tasks, but provided mixed results. In this study, we conducted a meta-analysis of studies using three neurocognitive tasks, the Go/No Go, the Stroop, and the Stop-Signal tasks, to integrate existing research and estimate the magnitude of this relationship. We found a medium overall effect size (d=0.56, 95% CI [0.32, 0.80]) indicating that compared with healthy individuals, individuals with IGD are more likely to exhibit impaired response inhibition. This finding is in alignment with literature on inhibition and addictive and impulsive behaviors, as well as with neuroimaging research. Theoretical implications regarding the conceptualization of IGD as a clinical disorder, shared commonalities with externalizing psychopathology, and clinical implications for treatment are discussed.

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Development and validation of a model to predict blood alcohol concentrations: Updating the NHTSA equation

Publication date: August 2017
Source:Addictive Behaviors, Volume 71
Author(s): Yiqi Zhang, Changxu Wu, Jingyan Wan
ObjectsTo date, multiple models have been developed to estimate blood or breath alcohol concentration (BAC/BrAC). Several factors have been identified that affect the discrepancy between BACs/BrACs and retrospective estimation (eBAC) with existing equations. To the best of our knowledge, a model to quantify the effects of factors on the discrepancy between BAC/BrAC and eBAC is still nonexistent. The goal of this work was to develop a model to provide a more accurate retrospective estimation of breath alcohol concentration (eBAC).MethodA laboratory study with alcohol consumption and a driving task was conducted with 30 participants (17 male and 13 female) to explore the factors that may contribute to the discrepancy between BrAC and eBAC obtained with existing models. A new eBAC model was developed to improve the estimation of BrAC by modeling effects of gender, weight, and the delay of BrAC measurement on the discrepancy. The validity of the model was tested and established with the data from the experiment conducted in this study and two published research studies, and compared with existing eBAC models.ResultsResults of the model validity examination indicated that the developed model had higher R squares and lower root-mean-squared errors (RMSE) in estimating BrAC in three experiments compared with the existing eBAC models, including the NHTSA equation, the Matthew equation, the Lewis equation, the Watson equation, and the Forrest equation.ConclusionThe developed eBAC model had a better performance of BrAC estimation compared with existing eBAC models. The validation of the model with the data from three empirical studies indicated a high level of generalizability in estimating BrAC.

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Label and label-free based surface-enhanced Raman scattering for pathogen bacteria detection: A review

Publication date: 15 August 2017
Source:Biosensors and Bioelectronics, Volume 94
Author(s): Yu Liu, Haibo Zhou, Ziwei Hu, Guangxia Yu, Danting Yang, Jinshun Zhao
Rapid, accurate detection of pathogen bacteria is a highly topical research area for the sake of food safety and public health. Surface-enhanced Raman scattering (SERS) is being considered as a powerful and attractive technique for pathogen bacteria detection, due to its sensitivity, high speed, comparatively low cost, multiplexing ability and portability. This contribution aims to give a comprehensive overview of SERS as a technique for rapid detection of pathogen bacteria based on label and label-free strategies. A brief tutorial on SERS is given first of all. Then we summarize the recent trends and developments of label and label-free based SERS applied to detection of pathogen bacteria, including the relatively complete interpretation of SERS spectra. In addition, multifunctional SERS platforms for pathogen bacteria in matrix are discussed as well. Furthermore, an outlook of the work done and a perspective on the future directions of SERS as a reliable tool for real-time pathogen bacteria detection are given.

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How to Perform and Interpret Functional Magnetic Resonance Imaging Studies in Functional Gastrointestinal Disorders.

How to Perform and Interpret Functional Magnetic Resonance Imaging Studies in Functional Gastrointestinal Disorders.

J Neurogastroenterol Motil. 2017 Mar 02;:

Authors: Lee IS, Preissl H, Enck P

Abstract
Functional neuroimaging studies have revealed the importance of the role of cognitive and psychological factors and the dysregulation of the brain-gut axis in functional gastrointestinal disorder patients. Although only a small number of neuroimaging studies have been conducted in functional gastrointestinal disorder patients, and despite the fact that the neuroimaging technique requires a high level of knowledge, the technique still has a great deal of potential. The application of functional magnetic resonance imaging (fMRI) technique in functional gastrointestinal disorders should provide novel methods of diagnosing and treating patients. In this review, basic knowledge and technical/practical issues of fMRI will be introduced to clinicians.

PMID: 28256119 [PubMed - as supplied by publisher]

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Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy.

Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy.

Nucl Med Commun. 2017 Mar 02;:

Authors: Taywade SK, Ramaiah VL, Basavaraja H, Venkatasubramaniam PR, Selvakumar J

Abstract
OBJECTIVE: Myocardial perfusion scintigraphy (MPS) is a valuable, noninvasive imaging modality in the evaluation of patients with coronary artery disease. Adenosine stress may occasionally be associated with ECG changes. This study evaluated the strength of association between adenosine stress-related ECG changes and perfusion defects on Tc-MPS.
PATIENTS AND METHODS: 117 (mean age: 61.25±9.27 years; sex: men 87, women 30) patients with known/suspected coronary artery disease underwent adenosine stress MPS. ECG was monitored continuously during adenosine stress for ST-depression. On the basis of the summed difference score, reversible perfusion defects were categorized as follows: normal: less than 4, mild: 4-8, moderate: 9-13, and severe: more than 13.
RESULTS: ST-depression was observed in 27/117 (23.1%) and reversible perfusion defects were observed in 18/27 (66.66%) patients. 2/27, 6/27, and 10/27 patients had mild, moderate, and severe ischemia, respectively. 9/27 patients had normal perfusion. ECG changes and perfusion defects showed a moderate strength of association (correlation coefficient r=0.35, P=0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of ECG findings for prediction of ischemia were 35.29, 86.36, 67.67, and 63.33%, respectively.
CONCLUSION: ECG changes during adenosine stress are not uncommon. It shows a moderate strength of association with reversible perfusion defects. ECG changes during adenosine merit critical evaluation of MPS findings.

PMID: 28257311 [PubMed - as supplied by publisher]

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Management of brain metastasized non-small cell lung cancer (NSCLC) - From local treatment to new systemic therapies.

Management of brain metastasized non-small cell lung cancer (NSCLC) - From local treatment to new systemic therapies.

Cancer Treat Rev. 2017 Feb 17;54:122-131

Authors: Tsakonas G, De Petris L, Ekman S

Abstract
Lung cancer has the highest frequency of brain dissemination compared to all other solid tumours. Classical treatment options such as brain irradiation have started to be questioned due to lack of survival benefit and risk for severe side effects. Oncogenic driven tumours have the highest frequency of brain dissemination among NSCLC patients and available targeted therapies have shown activity both intra-and extracranially, with an acceptable toxicity profile. The recent approval of immune checkpoint inhibitors for the treatment of NSCLC has complicated treatment selection even more. Data regarding efficacy of immune therapy in the CNS are limited, though promising, and data from larger cohorts are eagerly expected. The purpose of this review is to summarize all available treatment options for brain metastatic NSCLC with an emphasis on oncogenic driven tumours. Treatment selection for brain metastasized NSCLC patients is challenging because of the detrimental effect of potential treatment related CNS side effects in patients' quality of life. Clinical decision making should be done in an individualised way, taking both clinical and molecular factors into consideration.

PMID: 28254730 [PubMed - as supplied by publisher]

http://ift.tt/2mYnLID

A survey on IVIVC/IVIVR development in the pharmaceutical industry – Past experience and current perspectives

Publication date: 1 May 2017
Source:European Journal of Pharmaceutical Sciences, Volume 102
Author(s): M.A. Nguyen, T. Flanagan, M. Brewster, F. Kesisoglou, S. Beato, J. Biewenga, J. Crison, R. Holm, R. Li, E. Mannaert, M. McAllister, M. Mueller-Zsigmondy, U. Muenster, K. Ojala, S. Page, A. Parr, S. Rossenu, P. Timmins, A. Van Peer, A. Vermeulen, P. Langguth
The present work aimed to describe the current status of IVIVC/IVIVR development in the pharmaceutical industry, focusing on the use and perception of specific approaches as well as successful and failed case studies. Two questionnaires have been distributed to 13 EFPIA partners of the Oral Biopharmaceutics Tools Initiative and to the Pharmacokinetics Working Party of the European Medicines Agency in order to capture the perspectives and experiences of industry scientists and agency members, respectively. Responses from ten companies and three European Agencies were received between May 21st 2014 and January 19th 2016. The majority of the companies acknowledged the importance of IVIVC/IVIVR throughout the drug development stages and a well-balanced rate of return on investment. However, the IVIVC/IVIVR approach seemed to be underutilized in regulatory submissions. Four of the ten companies stated to have an internal guidance related to IVIVC/IVIVR modelling, whereas three felt that an overall strategy is not necessary. Successful models mainly served to support formulation development and to provide a better mechanistic understanding. There was not yet much experience with safe-space IVIVRs as well as the use of physiologically based modelling in the field of IVIVC. At the same time, the responses from both industry and agencies indicated that there might be a need for a regulatory framework to guide the application of these novel approaches. The relevance of IVIVC/IVIVR for oral IR drug products was recognized by most of the companies. For IR formulations, relationships other than Level A correlation were more common outcomes among the provided case studies, such as multiple Level C correlation or safe-space IVIVR, which could be successfully used for requesting regulatory flexibility. Compared to the responses from industry scientists, there was a trend towards a higher appreciation of the BCS among the regulators, but a less positive attitude towards the utility of non-compendial dissolution methods for establishing a successful IVIVC/IVIVR. The lack of appropriate in vivo data and regulatory uncertainty were considered the major difficulties in IVIVC/IVIVR development. The results of this survey provide unique insights into current IVIVC/IVIVR practices in the pharmaceutical industry. Pursuing an IVIVC/IVIVR should be generally encouraged, considering its high value from both industry and regulators' perspective.

Graphical abstract

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Evaluation of CT vascularization patterns for survival prognosis in patients with hepatocellular carcinoma treated by conventional TACE.

Evaluation of CT vascularization patterns for survival prognosis in patients with hepatocellular carcinoma treated by conventional TACE.

Diagn Interv Radiol. 2017 Mar 03;:

Authors: Hasdemir DB, Dávila LA, Schweitzer N, Meyer BC, Koch A, Vogel A, Wacker F, Rodt T

Abstract
PURPOSE: Transarterial chemoembolization (TACE) is an established treatment for intermediate stage hepatocellular carcinoma (HCC). The aim of this retrospective study was to evaluate the power of lesion vascularization criteria based on computed tomography for prognosis of overall survival before initiation of treatment.
METHODS: A total of 59 patients with intermediate stage HCC treated with TACE as first-line treatment were retrospectively evaluated. TACE procedures were performed using doxorubicin, cisplatin, and lipiodol. Response evaluation criteria in solid tumors version 1.1 (RECIST 1.1) were used to determine the initial tumor response. Four vascularization patterns (VP) of the largest target lesion (homogeneous vascularization [VP1], homogeneous vascularization with additional arterial hypervascularization [VP2], heterogeneous vascularization with [VP3] and without zones of hypervascularization [VP4]) were assessed prior to the first TACE and correlated to survival.
RESULTS: Kaplan-Meier analysis yielded a median overall survival of 608 days (standard error [SE], 120.5 days). Survival analysis showed significant differences depending on the vascularization patterns (P = 0.012; hazard ratio, 0.327): patients with homogeneously vascularized lesions (VP1, VP2) had a median overall survival of 1091 days (SE, 235.5 days). Patients with heterogeneous vascularization of the lesion (VP3 and VP4) showed a median overall survival of 508 days (SE, 113.9 days).
CONCLUSION: The vascularization pattern of the largest HCC lesion is helpful for survival prognosis under TACE treatment and therefore has the potential to be used as an additional parameter for treatment stratification.

PMID: 28256449 [PubMed - as supplied by publisher]

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MRI-Based Texture Analysis to Differentiate Sinonasal Squamous Cell Carcinoma from Inverted Papilloma.

MRI-Based Texture Analysis to Differentiate Sinonasal Squamous Cell Carcinoma from Inverted Papilloma.

AJNR Am J Neuroradiol. 2017 Mar 02;:

Authors: Ramkumar S, Ranjbar S, Ning S, Lal D, Zwart CM, Wood CP, Weindling SM, Wu T, Mitchell JR, Li J, Hoxworth JM

Abstract
BACKGROUND AND PURPOSE: Because sinonasal inverted papilloma can harbor squamous cell carcinoma, differentiating these tumors is relevant. The objectives of this study were to determine whether MR imaging-based texture analysis can accurately classify cases of noncoexistent squamous cell carcinoma and inverted papilloma and to compare this classification performance with neuroradiologists' review.
MATERIALS AND METHODS: Adult patients who had inverted papilloma or squamous cell carcinoma resected were eligible (coexistent inverted papilloma and squamous cell carcinoma were excluded). Inclusion required tumor size of >1.5 cm and preoperative MR imaging with axial T1, axial T2, and axial T1 postcontrast sequences. Five well-established texture analysis algorithms were applied to an ROI from the largest tumor cross-section. For a training dataset, machine-learning algorithms were used to identify the most accurate model, and performance was also evaluated in a validation dataset. On the basis of 3 separate blinded reviews of the ROI, isolated tumor, and entire images, 2 neuroradiologists predicted tumor type in consensus.
RESULTS: The inverted papilloma (n = 24) and squamous cell carcinoma (n = 22) cohorts were matched for age and sex, while squamous cell carcinoma tumor volume was larger (P = .001). The best classification model achieved similar accuracies for training (17 squamous cell carcinomas, 16 inverted papillomas) and validation (7 squamous cell carcinomas, 6 inverted papillomas) datasets of 90.9% and 84.6%, respectively (P = .537). For the combined training and validation cohorts, the machine-learning accuracy (89.1%) was better than that of the neuroradiologists' ROI review (56.5%, P = .0004) but not significantly different from the neuroradiologists' review of the tumors (73.9%, P = .060) or entire images (87.0%, P = .748).
CONCLUSIONS: MR imaging-based texture analysis has the potential to differentiate squamous cell carcinoma from inverted papilloma and may, in the future, provide incremental information to the neuroradiologist.

PMID: 28255033 [PubMed - as supplied by publisher]

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Clinical and Imaging Characteristics of Diffuse Intracranial Dolichoectasia.

Clinical and Imaging Characteristics of Diffuse Intracranial Dolichoectasia.

AJNR Am J Neuroradiol. 2017 Mar 02;:

Authors: Brinjikji W, Nasr DM, Flemming KD, Rouchaud A, Cloft HJ, Lanzino G, Kallmes DF

Abstract
BACKGROUND AND PURPOSE: Among patients with vertebrobasilar dolichoectasia is a subset of patients with disease affecting the anterior circulation as well. We hypothesized that multivessel intracranial dolichoectasia may represent a distinct phenotype from single-territory vertebrobasilar dolichoectasia. The purpose of this study was to characterize clinical characteristics and angiographic features of this proposed distinct phenotype termed "diffuse intracranial dolichoectasia" and compare them with those in patients with isolated vertebrobasilar dolichoectasia.
MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of patients with diffuse intracranial dolichoectasia and compared their demographics, vascular risk factors, additional aneurysm prevalence, and clinical outcomes with a group of patients with vertebrobasilar dolichoectasia. "Diffuse intracranial dolichoectasia" was defined as aneurysmal dilation of entire vascular segments involving ≥2 intracranial vascular beds. Categoric and continuous variables were compared by using χ(2) and Student t tests, respectively.
RESULTS: Twenty-five patients had diffuse intracranial dolichoectasia, and 139 had vertebrobasilar dolichoectasia. Patients with diffuse intracranial dolichoectasia were older than those with vertebrobasilar dolichoectasia (70.9 ± 14.2 years versus 60.4 ± 12.5 years, P = .0002) and had a higher prevalence of abdominal aortic aneurysms (62.5% versus 14.3%, P = .01), other visceral aneurysms (25.0% versus 0%, P < .0001), and smoking (68.0% versus 15.9%, P < .0001). Patients with diffuse intracranial dolichoectasia were more likely to have aneurysm growth (46.2% versus 21.5%, P = .09) and rupture (20% versus 3.5%, P = .007) at follow-up. Patients with diffuse intracranial dolichoectasia were less likely to have good neurologic function at follow-up (24.0% versus 57.6%, P = .004) and were more likely to have aneurysm-related death (24.0% versus 7.2%, P = .02).
CONCLUSIONS: The natural history of patients with diffuse intracranial dolichoectasia is significantly worse than that in those with isolated vertebrobasilar dolichoectasia. Many patients with diffuse intracranial dolichoectasia had additional saccular and abdominal aortic aneurysms. These findings suggest that diffuse intracranial dolichoectasia may be a distinct vascular phenotype secondary to a systemic arteriopathy affecting multiple vascular beds.

PMID: 28255032 [PubMed - as supplied by publisher]

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Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion.

Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion.

AJNR Am J Neuroradiol. 2017 Mar 02;:

Authors: Yamauchi H, Kagawa S, Kishibe Y, Takahashi M, Higashi T

Abstract
BACKGROUND AND PURPOSE: Misery perfusion may cause selective neuronal damage in atherosclerotic ICA or MCA disease. Bypass surgery can improve misery perfusion and may prevent neuronal damage. On the other hand, surgery conveys a risk for neuronal damage. The purpose of this retrospective study was to determine whether progression of cortical neuronal damage in surgically treated patients with misery perfusion is larger than that in surgically treated patients without misery perfusion or medically treated patients with misery perfusion.
MATERIALS AND METHODS: We evaluated the distribution of benzodiazepine receptors twice by using PET and (11)C-labeled flumazenil in 18 surgically treated patients with atherosclerotic ICA or MCA disease (9 with misery perfusion and 9 without) and no perioperative stroke before and after bypass surgery; in 8 medically treated patients with misery perfusion and no intervening ischemic event; and in 7 healthy controls. We quantified abnormal decreases in the benzodiazepine receptors of the cerebral cortex within the MCA distribution and compared changes in the benzodiazepine receptor index among the 3 groups.
RESULTS: The change in the benzodiazepine receptor index in surgically treated patients with misery perfusion (27.5 ± 15.6) during 7 ± 5 months was significantly larger than that in surgically treated patients without misery perfusion (-5.2 ± 9.4) during 6 ± 4 months (P < .001) and in medically treated patients with misery perfusion (3.2 ± 15.4) during 16 ± 6 months (P < .01).
CONCLUSIONS: Progression of cortical neuronal damage in surgically treated patients with misery perfusion and no perioperative stroke may occur and may be larger than that in medically treated patients with misery perfusion and no intervening ischemic event.

PMID: 28255031 [PubMed - as supplied by publisher]

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A Multiparametric Model for Mapping Cellularity in Glioblastoma Using Radiographically Localized Biopsies.

A Multiparametric Model for Mapping Cellularity in Glioblastoma Using Radiographically Localized Biopsies.

AJNR Am J Neuroradiol. 2017 Mar 02;:

Authors: Chang PD, Malone HR, Bowden SG, Chow DS, Gill BJ, Ung TH, Samanamud J, Englander ZK, Sonabend AM, Sheth SA, McKhann GM, Sisti MB, Schwartz LH, Lignelli A, Grinband J, Bruce JN, Canoll P

Abstract
BACKGROUND AND PURPOSE: The complex MR imaging appearance of glioblastoma is a function of underlying histopathologic heterogeneity. A better understanding of these correlations, particularly the influence of infiltrating glioma cells and vasogenic edema on T2 and diffusivity signal in nonenhancing areas, has important implications in the management of these patients. With localized biopsies, the objective of this study was to generate a model capable of predicting cellularity at each voxel within an entire tumor volume as a function of signal intensity, thus providing a means of quantifying tumor infiltration into surrounding brain tissue.
MATERIALS AND METHODS: Ninety-one localized biopsies were obtained from 36 patients with glioblastoma. Signal intensities corresponding to these samples were derived from T1-postcontrast subtraction, T2-FLAIR, and ADC sequences by using an automated coregistration algorithm. Cell density was calculated for each specimen by using an automated cell-counting algorithm. Signal intensity was plotted against cell density for each MR image.
RESULTS: T2-FLAIR (r = -0.61) and ADC (r = -0.63) sequences were inversely correlated with cell density. T1-postcontrast (r = 0.69) subtraction was directly correlated with cell density. Combining these relationships yielded a multiparametric model with improved correlation (r = 0.74), suggesting that each sequence offers different and complementary information.
CONCLUSIONS: Using localized biopsies, we have generated a model that illustrates a quantitative and significant relationship between MR signal and cell density. Projecting this relationship over the entire tumor volume allows mapping of the intratumoral heterogeneity in both the contrast-enhancing tumor core and nonenhancing margins of glioblastoma and may be used to guide extended surgical resection, localized biopsies, and radiation field mapping.

PMID: 28255030 [PubMed - as supplied by publisher]

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Neonatal Diabetes and the KATP Channel: From Mutation to Therapy

Publication date: Available online 3 March 2017
Source:Trends in Endocrinology & Metabolism
Author(s): Frances M. Ashcroft, Michael C. Puljung, Natascia Vedovato
Activating mutations in one of the two subunits of the ATP-sensitive potassium (KATP) channel cause neonatal diabetes (ND). This may be either transient or permanent and, in approximately 20% of patients, is associated with neurodevelopmental delay. In most patients, switching from insulin to oral sulfonylurea therapy improves glycemic control and ameliorates some of the neurological disabilities. Here, we review how KATP channel mutations lead to the varied clinical phenotype, how sulfonylureas exert their therapeutic effects, and why their efficacy varies with individual mutations.

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The Current Status of Research on Chronic Traumatic Encephalopathy.

The Current Status of Research on Chronic Traumatic Encephalopathy.

World Neurosurg. 2017 Feb 27;:

Authors: Perrine K, Helcer J, Tsiouris AJ, Pisapia DJ, Stieg P

Abstract
Chronic Traumatic Encephalopathy (CTE) evolved from the term "dementia pugilistica" describing the dementia found in many boxers to its current use in describing the dementia and depression sometimes found in athletes subjected to multiple concussions or sub-concussive blows to the head. Concurrently, the neuropathology evolved to specify a unique type of tauopathy found in perivascular spaces at the depth of sulci and other features not typically seen in neurodegenerative tauopathies. Four stages of CTE have been proposed, with four corresponding clinical syndromes of Traumatic Encephalopathy Syndrome. However, it remains unclear whether this is a syndrome unique to repetitive head trauma, especially in contact sports, as the epidemiology has been difficult to establish. In particular, research to date suffers from a "denominator" problem in not establishing the total number of potential cases at risk for developing CTE. The current review examines the evidence to date for these syndromes, and contributing or complicating factors affecting the neuropathology, neuroimaging, and clinical presentations associated with them.

PMID: 28254594 [PubMed - as supplied by publisher]

http://ift.tt/2m7d0pU

Medial temporal lobe epilepsy associated with hippocampal sclerosis is a distinctive syndrome.

Medial temporal lobe epilepsy associated with hippocampal sclerosis is a distinctive syndrome.

J Neurol. 2017 Mar 02;:

Authors: No YJ, Zavanone C, Bielle F, Nguyen-Michel VH, Samson Y, Adam C, Navarro V, Dupont S

Abstract
Epileptic syndromes are distinctive disorders with specific features, which when taken together, permit a specific diagnosis. There is actually a debate on that medial temporal lobe epilepsy with hippocampal sclerosis is an epileptic syndrome. To address this issue, we searched for discriminative semiological features between temporal lobe epilepsy patients with hippocampal sclerosis (TLE-HS patients or group 1), TLE patients with medial structural lesion other than hippocampal sclerosis or in MRI-negative cases with medial onset on further investigations (group 2) and lateral TLE patients (LTLE or group 3). We retrospectively collected data from medical and EEG-video records of 523 TLE patients, referred for surgery to the Pitié-Salpêtrière Epileptology Unit between 1991 and 2014. We identified 389 patients belonging to group 1, 61 patients belonging to group 2, and 73 patients belonging to group 3 and performed a comparative analysis of their clinical data and surgical outcomes. TLE-HS patients (group 1): (1) began epilepsy earlier (11 ± 9 vs. 20 ± 10 vs. 15 ± 9 years); (2) exhibited more frequently early febrile convulsions (FC) (59 vs 7 vs 5%); (3) presented more: ictal gestural automatisms (90 vs 54 vs 67%), dystonic posturing (47 vs 20 vs 23%), and secondary generalized tonic-clonic seizures (GTCS) (70 vs 44% vs 48%) as compared to both groups 2 and 3 patients (all p < 0.001). With respect to auras, abdominal visceral auras were more reported by TLE-HS than by LTLE patients (49 vs 16%). Three cardinal criteria correctly classified 94% of patients into TLE-HS group: history of FC, dystonic posturing, and secondary GTCS. Postoperative outcome was significantly better in TLE-HS group than in the two other groups (p = 0.03 and 0.003). Our study demonstrates that cardinal criteria are reliably helpful to distinguish patients with TLE-HS from those with other TLE and may allow considering TLE-HS as a distinctive syndrome.

PMID: 28255730 [PubMed - as supplied by publisher]

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Nerve Blocks Under General Anesthesia: Time to Liberalize Indications?

Nerve Blocks Under General Anesthesia: Time to Liberalize Indications?

Reg Anesth Pain Med. 2017 Mar 02;:

Authors: Masaracchia MM, Herrick MD, Seiffert EA, Sites BD

PMID: 28257389 [PubMed - as supplied by publisher]

http://ift.tt/2m7o0U1

Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial.

Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial.

Reg Anesth Pain Med. 2017 Mar 02;:

Authors: Wiegel M, Moriggl B, Schwarzkopf P, Petroff D, Reske AW

Abstract
BACKGROUND AND OBJECTIVES: The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial.
METHODS: Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0.75%) before general anesthesia for arthroscopic shoulder surgery. Pain (Numerical Rating Scale, 0-10), grip strength, degree of satisfaction, and strength of recommendation were assessed.
RESULTS: We randomized 168 patients to each group and analyzed 164 in the SSNB group and 165 in the ISB group. Nerve blocks were successful in 98% of the patients from each group. Both procedures provided good postoperative analgesia, and the mean pain level for SSNB was slightly but significantly lower by 0.32 units (95% confidence interval, 0.18-0.46; P < 0.001) and noninferior given a margin of 1.1 units; P < 0.001. Within the first 24 hours, 162 (99%) of SSNB patients had unimpaired grip strength compared to 81 (49%) of ISB patients (P < 0.001). The multiple primary outcome, superior unimpaired grip strength, and noninferior pain control was significant; P < 0.001. Compared to ISB patients (n = 130 [79%]), significantly more SSNB patients (n = 150 [91%]) were satisfied/highly satisfied. Patients in the SSNB group were more likely to recommend the procedure highly.
CONCLUSIONS: For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB.

PMID: 28257388 [PubMed - as supplied by publisher]

http://ift.tt/2lJZTIA

Current trends of balloon laryngoplasty in Thailand.

Current trends of balloon laryngoplasty in Thailand.

Eur Arch Otorhinolaryngol. 2017 Mar 02;:

Authors: Moungthong G, Bunbanjerdsuk S, Wright N, Sathavornmanee T, Setabutr D

Abstract
OBJECTIVE: To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand.
STUDY DESIGN: Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices.
SUBJECTS AND METHODS: Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions.
RESULTS: Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%).
CONCLUSIONS: Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

PMID: 28255926 [PubMed - as supplied by publisher]

http://ift.tt/2mY7tQ9

Comments on: "The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty."

Comments on: "The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty."

Eur Arch Otorhinolaryngol. 2017 Mar 02;:

Authors: Cagici CA

PMID: 28255925 [PubMed - as supplied by publisher]

http://ift.tt/2mQdEpV

Evaluation of moderate and severe blepharoptosis correction using the interdigitated part of the frontalis muscle and orbicularis oculi muscle suspension technique: A cohort study of 235 cases.

Evaluation of moderate and severe blepharoptosis correction using the interdigitated part of the frontalis muscle and orbicularis oculi muscle suspension technique: A cohort study of 235 cases.

J Plast Reconstr Aesthet Surg. 2016 Nov 16;:

Authors: Wang T, Li X, Wang X, Wang Q, Li W, Zhou L, Song W, Wang J

Abstract
BACKGROUND: Blepharoptosis is defined as an abnormally low-lying upper eyelid margin in the primary gaze, causing vertical narrowing of the palpebral fissure. It is difficult to achieve consistently satisfactory results in moderate or severe cases despite many surgical methods being available to correct them.
METHODS: Between January 2001 and December 2014, a retrospective cohort study was conducted using medical records and perioperative photographs of 235 patients. All the patients, having presented with moderate or severe bilateral or unilateral blepharoptosis, underwent blepharoptosis correction with the interdigitated orbicularis oculi-frontalis muscle flap suspension technique and contemporaneous double-eyelid surgery. The results, including complications, were followed up and evaluated.
RESULTS: The mean age of the patients was 17.4 years (range 3-50 years). The follow-up period ranged from 6 months to 8 years, with a mean follow-up of 13 months. Long-term postoperative complications included undercorrection (3.0%), overcorrection (0.7%) and eyelid fold deformity (4.0%). No ectropion, entropion, fornix conjunctival prolapse or exposure keratitis was noted.
CONCLUSIONS: Blepharoptosis correction with interdigitated orbicularis oculi-frontalis muscle flap suspension is an effective technique for the management of moderate or severe blepharoptosis. The results demonstrated very low complication rates and substantial cosmetic and functional improvement using simple manipulation.

PMID: 28254497 [PubMed - as supplied by publisher]

http://ift.tt/2lpFTPs

Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting.

Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting.

Lancet. 2017 Feb 27;:

Authors: Breitenstein C, Grewe T, Flöel A, Ziegler W, Springer L, Martus P, Huber W, Willmes K, Ringelstein EB, Haeusler KG, Abel S, Glindemann R, Domahs F, Regenbrecht F, Schlenck KJ, Thomas M, Obrig H, de Langen E, Rocker R, Wigbers F, Rühmkorf C, Hempen I, List J, Baumgaertner A, FCET2EC study group

Abstract
BACKGROUND: Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke.
METHODS: In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383.
RESULTS: We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation.
INTERPRETATION: 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods.
FUNDING: German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

PMID: 28256356 [PubMed - as supplied by publisher]

http://ift.tt/2mmJwoB

Upper airway in infants-a computed tomography-based analysis.

Upper airway in infants-a computed tomography-based analysis.

Paediatr Anaesth. 2017 Mar 02;:

Authors: Wani TM, Rafiq M, Akhter N, AlGhamdi FS, Tobias JD

Abstract
BACKGROUND: Recent studies suggest that the pediatric airway is elliptical with the subglottis rather than the cricoid as the narrowest part contrary to the old belief of a funnel-shaped airway. The shape of the airway in neonates and infants has not been studied separately. This study seeks to define the shape of the upper airway in neonates and infants, and determine if there are differences in airway shape between infants and older children.
METHODS: We studied 40 computed tomographic scans of children from birth to 12 months of age undergoing radiological evaluation unrelated to airway symptomatology. The computed tomographic scans were obtained during either natural sleep or with sedation and spontaneous ventilation without airway devices in place. Transverse and anteroposterior diameters were measured at the subglottic level and at the cricoid ring.
RESULTS: The mean age was 5.9 ± 3.4 months. The mean transverse and anteroposterior diameters were 5.3 ± 0.83 mm and 7.2 ± 0.89 mm at the subglottic region and 6.1 ± 0.86 mm and 6.7 ± 0.79 mm at the cricoid level. An increase in the transverse dimension of the airway was observed from the subglottic region to the cricoid ring. Although the anteroposterior dimension decreased from the subglottis to the cricoid ring, the airway remained wider in the anteroposterior dimension compared to the transverse dimension from the subglottis to the cricoid ring.
CONCLUSION: The present study demonstrates that the airway in neonates and infants between the subglottic area and the cricoid remains elliptical. The cricoid is not round as has been observed in older children. The airway is wider anteroposteriorly and narrows in the transverse dimension from the subglottis to the cricoid in infants.

PMID: 28256046 [PubMed - as supplied by publisher]

http://ift.tt/2mQko7e

Immobile cerebral veins in the context of positional brain shift: an undescribed risk factor for acute subdural hemorrhage.

Immobile cerebral veins in the context of positional brain shift: an undescribed risk factor for acute subdural hemorrhage.

Surg Radiol Anat. 2017 Mar 03;:

Authors: Tsutsumi S, Ono H, Yasumoto Y

Abstract
BACKGROUND: Changes in head position are thought to cause a degree of brain shift in the intracranial cavity. However, little is known on the concurrent shift of the cerebral veins. The present study aimed to investigate the positional shift of the cerebral veins that accompanies brain shift.
METHODS: Sagittal T2-weighted magnetic resonance imaging was performed on 21 consecutive patients lying in the supine and prone positions, using the same sequence. For each patient, imaging data were obtained for the two positions as a pair of images with morphologically best-matched cerebral contours.
RESULTS: The subarachnoid spaces in the parasagittal frontal convexity showed variable reductions related to a postural change from a supine to a prone position, with a mean percent reduction (%Δ) of 17.8 ± 11.7%. Additionally, cerebral cisterns ventral to the brainstem and upper cervical cord were reduced in most patients when lying in a prone position, with a mean %Δ of 16.6 ± 8.7%. In contrast, none of these 130 pairs of identical venous segments located in the parasagittal cerebral convexity showed positional shift. Cadaveric dissections found that the major cortical veins were superficially upheld by the arachnoid membranes.
CONCLUSIONS: The parasagittal major cortical and bridging veins do not seem to show positional shifts. Positional change in the posterior-anterior direction causes a shearing between the frontal cortices and the distributing veins and can be a risk factor for acute subdural hemorrhage, in case of severe head trauma.

PMID: 28255617 [PubMed - as supplied by publisher]

http://ift.tt/2mQfp6M

Imaging of the endolymphatic space in patients with Ménière's disease.

Imaging of the endolymphatic space in patients with Ménière's disease.

Auris Nasus Larynx. 2017 Feb 27;:

Authors: Yoshida T, Sugimoto S, Teranishi M, Otake H, Yamazaki M, Naganawa S, Nakashima T, Sone M

Abstract
OBJECTIVE: To examine endolymphatic hydrops (EH) using magnetic resonance imaging (MRI) in patients with definite Ménière's disease (MD) and those with nonotological diseases.
METHODS: We studied 32 patients with unilateral MD, 10 patients with bilateral MD and 21 patients with control ears who had other benign diseases not associated with hearing or vestibular dysfunction. The mean age of the subjects was 54.0 years (range 27-74) in the MD group and 56.1 years (range 24-79) in the control group. Using MRI, the degree of EH was classified as none, mild and significant in the cochlea and vestibule separately. The ratio of the area of endolymphatic space to the vestibular fluid space was calculated for the vestibule. The duration of MD was defined as the months between the first attack of MD and the MRI study.
RESULTS: EH was present in the cochlea of 45/52 affected ears of patients with MD (87%) and in 16/42 control ears (38%). Significant cochlear hydrops was present in 37/52 affected ears (71%) and in 4/42 control ears (10%). EH in the vestibule was present in 49/52 affected ears (94%) and in 3/42 control ears (7%). Significant vestibular hydrops was present in 40/52 affected ears (77%) and in none of the 42 control ears. There was no relationship between the degree of EH and its duration. Using a cut off value for the relative size of EH in the vestibule of 41.9%, the test had a sensitivity of 88.5% and a specificity of 100% to diagnose definite MD.
CONCLUSION: Cochlear EH was occasionally observed in control ears on MRI, as in normal temporal bone specimens. The presence or absence and degree of vestibular EH were significantly different between ears with MD and control ears. EH in the vestibule might be a specific predictor of definite MD.

PMID: 28256285 [PubMed - as supplied by publisher]

http://ift.tt/2lpvPWB

Microbiologic Methods in the Diagnostics of Upper Respiratory Tract Pathogens.

Microbiologic Methods in the Diagnostics of Upper Respiratory Tract Pathogens.

Adv Exp Med Biol. 2017 Mar 03;:

Authors: Kompanikova J, Zumdick A, Neuschlova M, Sadlonova V, Novakova E

Abstract
Upper respiratory tract infection (URI) is a nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx, and larynx above the vocal cords. The aim of this study was to provide a summary of the most common pathogens of URI and to compare advantages and disadvantages of traditional and new rapid microbiological tests used to identify them. Blood samples were simultaneously examined by the enzyme-linked immunosorbent assay (ELISA) and by the FilmArray Respiratory Panel for eight different pathogens in a total of 15 tests performed in nasopharyngeal swabs. The ELISA method is unable to identify the pathologic agent until the host's immune system elicits a response. The method is readily available in many laboratories at a low cost, which puts less strain on economic resources. The FilmArray(®) Panel, on the other hand, is more expensive, but it is fast and exact in the identification of a broad spectrum etiologic agents. Nonetheless, since most repiratory tract infections are viral in origin and there is no treatment available, the diagnosis provided by the FilmArray Panel does not provide any additional clinical benefit and thus should be used only whenever necessary on the individual basis.

PMID: 28255915 [PubMed - as supplied by publisher]

http://ift.tt/2mQkkEE

Technical description of a modified jet ventilation injector for airway laser surgery in neonates and infants: retrospective analysis of 20 cases.

http:--linkinghub.elsevier.com-ihub-imag

Technical description of a modified jet ventilation injector for airway laser surgery in neonates and infants: retrospective analysis of 20 cases.

J Clin Anesth. 2016 Aug;32:142-7

Authors: Rosal Martins M, Van Boven M, Schmitz S, Hamoir M, Veyckemans F

Abstract
INTRODUCTION: The authors modified an adult jet ventilation injector (Hunsaker Mon-Jet Ventilation Tube(®)) to be able to provide transglottal high-frequency jet ventilation (HFJV) in small children undergoing laryngeal procedures with CO2 laser.
METHODS AND MATERIAL: Retrospective review of the anesthetic records of all children younger than 2years undergoing transglottal HFJV for CO2 laser laryngeal procedures using this modified adult injector between 2006 and 2013.
RESULTS: Nine children (5 boys, 4 girls) were identified who underwent a total of 20 procedures. Mean age was 7.4 ± 6.9months, and mean weight was 6 ± 2.8 kg. No complications were observed with the use of HFJV or this modified injector.
CONCLUSION: In experienced hands, this modified injector ensures excellent visibility and field access to the surgeon as well as adequate ventilation during laryngeal laser surgery in infants.

PMID: 27290963 [PubMed - indexed for MEDLINE]

http://ift.tt/2mQlQ9L

miR-125b inhibits goblet cell differentiation in allergic airway inflammation by targeting SPDEF.

miR-125b inhibits goblet cell differentiation in allergic airway inflammation by targeting SPDEF.

Eur J Pharmacol. 2016 Jul 05;782:14-20

Authors: Liu Z, Chen X, Wu Q, Song J, Wang L, Li G

Abstract
Asthma is a disease characterized by goblet cell differentiation, mucus hypersecretion, airway inflammation, and airway hyperresponsiveness. miR-125b was downregulated as normal human bronchial epithelial cells differentiation to pseudostratified epithelium. However, its role in asthma remains unknown especially in regulating goblet cell differentiation. miR-125b expression in the sputum of 50 asthmatic children and 50 age- and sex-matched healthy controls were assessed by quantitative RT-PCR (qRT-PCR). Meanwhile, expressions of miR-125b and SAM pointed domain-containing ETS transcription factor (SPDEF) in normal human tracheal epithelial (HTEpC) and A549 cells stimulated with lipopolysaccharide (LPS) for 2h were detected by qRT-PCR and western blot. Furthermore, the predicted miR-125b target was determined in silico and confirmed with dual-luciferase reporter assay. Additionally, intranasal delivery of miR-125b mimic in mice was performed to study its effects on house dust mite-induced allergic airway inflammation mouse models. We found that miR-125b expression was decreased in the sputum of the asthmatic patients especially in eosinophilic asthma. After stimulation with LPS, miR-125b expression was downregulated, accompanied by the upregulation of SPDEF in HTEpC and A549 cells. Moreover, SPDEF is a target of miR-125b, which regulates SPDEF at the posttranscriptional level. Additionally, intranasal delivery of miR-125b decreased SPDEF protein levels, goblet cell differentiation, mucus hypersecretion, and altered relevant gene expressions. Taken together, these results suggest that miR-125b inhibits SPDEF expression modulating goblet cell differentiation and mucus secretion in asthma.

PMID: 27112664 [PubMed - indexed for MEDLINE]

http://ift.tt/2lpvPG5

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Σάββατο 4 Μαρτίου 2017

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