Evolution of the hominin knee and ankle

Publication date: July 2017
Source:Journal of Human Evolution, Volume 108
Author(s): Mélanie A. Frelat, Colin N. Shaw, Simone Sukhdeo, Jean-Jacques Hublin, Stefano Benazzi, Timothy M. Ryan
The dispersal of the genus Homo out of Africa approximately 1.8 million years ago (Ma) has been understood within the context of changes in diet, behavior, and bipedal locomotor efficiency. While various morphological characteristics of the knee and ankle joints are considered part of a suite of traits indicative of, and functionally related to, habitual bipedal walking, the timing and phylogenetic details of these morphological changes remain unclear. To evaluate the timing of knee and ankle joint evolution, we apply geometric morphometric methods to three-dimensional digital models of the proximal and distal tibiae of fossil hominins, Holocene Homo sapiens, and extant great apes. Two sets of landmarks and curve semilandmarks were defined on each specimen. Because some fossils were incomplete, digital reconstructions were carried out independently to estimate missing landmarks and semilandmarks. Group shape variation was evaluated through shape–and form-space principal component analysis and fossil specimens were projected to assess variation in the morphological space computed from the extant comparative sample. We show that a derived proximal tibia (knee) similar to that seen in living H. sapiens evolved with early Homo at ∼2 Ma. In contrast, derived characteristics in the distal tibia appear later, probably with the arrival of Homo erectus. These results suggest a dissociation of the morphologies of the proximal and distal tibia, perhaps indicative of divergent functional demands and, consequently, selective pressures at these joints. It appears that longer distance dispersals that delivered the Dmanisi hominins to Georgia by 1.8 Ma and H. erectus to east–southeast Asia by 1.6 Ma were facilitated by the evolution of a morphologically derived knee complex comparable to that of recent humans and an ankle that was morphologically primitive. This research sets the foundation for additional paleontological, developmental, and functional research to better understand the mechanisms underlying the evolution of bipedalism.



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Dental development and age at death of the holotype of Anapithecus hernyaki (RUD 9) using synchrotron virtual histology

Publication date: July 2017
Source:Journal of Human Evolution, Volume 108
Author(s): Adeline Le Cabec, M. Christopher Dean, David R. Begun
The chronology of dental development and life history of primitive catarrhines provides a crucial comparative framework for understanding the evolution of hominoids and Old World monkeys. Among the extinct groups of catarrhines are the pliopithecoids, with no known descendants. Anapithecus hernyaki is a medium-size stem catarrhine known from Austria, Hungary and Germany around 10 Ma, and represents a terminal lineage of a clade predating the divergence of hominoids and cercopithecoids, probably more than 30 Ma. In a previous study, Anapithecus was characterized as having fast dental development. Here, we used non-destructive propagation phase contrast synchrotron micro-tomography to image several dental microstructural features in the mixed mandibular dentition of RUD 9, the holotype of A. hernyaki. We estimate its age at death to be 1.9 years and describe the pattern, sequence and timing of tooth mineralization. Our results do not support any simplistic correlation between body mass and striae periodicity, since RUD 9 has a 3-day periodicity, which was previously thought unlikely based on body mass estimates in Anapithecus. We demonstrate that the teeth in RUD 9 grew even faster and initiated even earlier in development than suggested previously. Permanent first molars and the canine initiated 49 and 38 days prenatally, respectively. These results contribute to a better understanding of dental development in Anapithecus and may provide a window into the dental development of the last common ancestor of hominoids and cercopithecoids.



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Catarrhine hallucal metatarsals from the early Miocene site of Songhor, Kenya

Publication date: July 2017
Source:Journal of Human Evolution, Volume 108
Author(s): Biren A. Patel, Gabriel S. Yapuncich, Cassandra Tran, Isaiah O. Nengo
Songhor is an early Miocene fossil locality in Kenya known for its diverse primate assemblage that includes catarrhine species belonging to the genera Kalepithecus, Limnopithecus, Dendropithecus, Rangwapithecus, and Proconsul. Expeditions to Songhor since the 1930s have recovered unassociated catarrhine postcranial remains from both the fore- and hindlimbs, including multiple elements from the feet. In this study, we describe KNM-SO 31233, a complete left hallucal metatarsal (Mt1), along with several other fragmentary Mt1 specimens (KNM-SO 1080, 5129, 5141, 22235). These fossils were compared to extant catarrhines and platyrrhines, as well as available fossil Miocene catarrhine Mt1s. Morphometric data were obtained from 3D surface renderings and subjected to a number of analyses to assess their phenetic affinity with the comparative sample, make predictions of body mass, and to infer their functional morphology. The size and shape of the Songhor Mt1s are diverse, exhibiting a large robust morph (KNM-SO 5141) similar in size but not in shape to extant African apes, medium-sized morphs (KNM-SO 1080, 5129 and 22235), and a smaller, slender one (KNM-SO 31233) that has a shape resembling arboreal quadrupedal leaping monkeys and suspensory atelines and hylobatids. KNM-SO 31233 is unlike other known fossil Mt1s, and in general, none of the Songhor Mt1s resembled any single extant anthropoid clade or species. The morpho-functional diversity of Songhor Mt1s is consistent with an extensive morphological and phylogenetic catarrhine diversity in the early part of the Miocene epoch.



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Global surgery: current evidence for improving surgical care.

Purpose of review: The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery. Recent findings: Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise. Summary: The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Knowledge and management of chronic spontaneous urticaria in Latin America: a cross-sectional study in Ecuador

The current EAACI/GA2LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored if physi...

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Relationship between various anthropometric measures and apnea-hypopnea index in Korean men

Body mass index (BMI) has been shown to be strongly correlated with severity of OSA. However, BMI has not been shown to be correlated with sleep apnea in all patients studied. The purpose of this study was to evaluate the relationship between various anthropometric measures and severity of OSA according to BMI in men.

http://ift.tt/2rNHZr7

Dexmedetomidine: a valuable sedative currently not widely available in the UK

British Journal of Anaesthesia, 2016; 117(2): 263–264, DOI 10.1093/bja/aew202

http://ift.tt/2q5Kc4O

Relationship between various anthropometric measures and apnea-hypopnea index in Korean men

Body mass index (BMI) has been shown to be strongly correlated with severity of OSA. However, BMI has not been shown to be correlated with sleep apnea in all patients studied. The purpose of this study was to evaluate the relationship between various anthropometric measures and severity of OSA according to BMI in men.

http://ift.tt/2rNHZr7

Dexmedetomidine: a valuable sedative currently not widely available in the UK

British Journal of Anaesthesia, 2016; 117(2): 263–264, DOI 10.1093/bja/aew202

http://ift.tt/2q5Kc4O

Scalp and Forehead Defects in the Post-Mohs Surgery Patient

Scalp and forehead reconstruction after Mohs micrographic surgery can encompass subcentimeter defects to entire scalp reconstruction. Knowledge of anatomy, flap design, and execution will prepare surgeons who operate in the head and neck area to confidently approach a variety of reconstructive challenges in this area.

http://ift.tt/2qPDOhb

Scalp and Forehead Defects in the Post-Mohs Surgery Patient

Scalp and forehead reconstruction after Mohs micrographic surgery can encompass subcentimeter defects to entire scalp reconstruction. Knowledge of anatomy, flap design, and execution will prepare surgeons who operate in the head and neck area to confidently approach a variety of reconstructive challenges in this area.

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An Innovative Risk-Reducing Approach to Postmastectomy Radiation Delivery after Autologous Breast Reconstruction

Introduction: Postmastectomy radiation therapy (PMRT) has known deleterious side effects in immediate autologous breast reconstruction. However, plastic surgeons are rarely involved in PMRT planning. Our institution has adopted a custom bolus approach for all patients receiving PMRT. This offers uniform distribution of standard radiation doses, thereby minimizing radiation-induced changes while maintaining oncologic safety. We present our 8-year experience with the custom bolus approach for PMRT delivery in immediate autologous breast reconstruction. Methods: All immediate autologous breast reconstruction patients requiring PMRT after 2006 were treated with the custom bolus approach. Retrospective chart review was performed to compare the postirradiation complications, reconstruction outcomes, and oncologic outcomes of these patients with those of previous patients at our institution who underwent standard bolus, and to historical controls from peer-reviewed literature. Results: Over the past 10 years, of the 29 patients who received PMRT, 10 were treated with custom bolus. Custom bolus resulted in fewer radiation-induced skin changes and less skin tethering/fibrosis than standard bolus (0% vs 10% and 20% vs 35%, respectively), and less volume loss and contour deformities compared with historical controls (10% vs 22.8% and 10% vs 30.7%, respectively). Conclusions: Custom bolus PMRT minimizes radiation delivery to the internal mammary vessels, anastomoses, and skin; uniformly doses the surgical incision; and provides the necessary radiation dose to prevent recurrence. Because custom bolus PMRT may reduce the deleterious effects of radiation on reconstructive outcomes while maintaining safe oncologic results, we encourage all plastic surgeons to collaborate with radiation oncologists to consider this technique.

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Distally Based Sural Artery Peroneus Flap (DBSPF) for Foot and Ankle Reconstruction

Background: Reconstruction of soft-tissue defects in lower third of leg, ankle, and foot has been a challenge and reconstructive surgeons have been trying to innovate different flaps. To solve this issue, we propose a distally based sural artery peroneus flap (DBSPF) in which we include superficial portion of the peroneus brevis muscle and its blood supply with the peroneal artery distally. The aim of this study was to evaluate the functional outcome and its usefulness over conventional distal sural artery flap or other local options available. Methods: This is a case series of 20 patients that include a DBSPF that was done for defects around ankle, distal leg, and foot caused by trauma or tumor ablation within the period of June 2013 to March 2015 in Kasralainy Hospital, Cairo. All cases were evaluated according to flap vascularity, distal reach of flap, aesthetic outcome, and donor-site morbidity. Results: All flaps survived. One flap developed venous congestion that subsided spontaneously with limb elevation. The flap dimension ranged from 42 cm to 442 cm2, and it reached the midfoot easily. The pivot point was kept as low as 2–6 cm from lateral malleolus according to location of perforators. The ankle stability was maintained, and the desired aesthetic outcome was achieved. Conclusions: The DBSPF is an addition to the armamentarium in plastic surgery for defects around ankle, distal leg, and foot. It is an easy and swift procedure as compared with complex microsurgical reconstruction.

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Coma blisters with deep soft tissue involvement after drug overdose

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Aims and Scope & Editorial Board

Publication date: April 2017
Source:Bioactive Carbohydrates and Dietary Fibre, Volume 10





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Necrotic cutaneous vasculitic skin lesions: a case of atypical Henoch-Schönlein purpura in a child with heterozygosity for factor V Leiden

Description

A Caucasian boy aged 5 years presented with acute onset of a non-tender, palpable purpuric rash to his lower limbs, preceded by a mild upper respiratory tract infection. Clinical findings were consistent with Henoch-Schönlein purpura (HSP) and he was discharged with community follow-up to monitor his lesions, blood pressure and urinalysis.

However, he clinically deteriorated over the following week with two further admissions due to evolving purpuric skin lesions (figure 1) and development of severe joint pain requiring opioid analgesia. There was no clinical evidence of renal or intestinal involvement.

Figure 1

Initial presentation of the purpuric Henoch Schonlein purpura rash.

Over a subsequent 6-week period, his purpuric lesions progressed to full thickness skin necrosis (figure 2). This was confirmed by a plastic surgery assessment and he was referred for a tertiary rheumatology review. He underwent a series...

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Surgery in late melanoma adrenal metastasis

Metastatic melanoma to adrenal gland are very infrequent, being generally associated with additional evidence of systemic disease and, consequently, with short-term survival. However, the prognosis and the therapeutic management vary depending on some important oncological features. Long-term survival rates have been described after complete resection of metastatic disease. Here, we report the case of a woman aged 41 years diagnosed with a cutaneous melanoma on the right side of her paravertebral region, level III of Clark, in 2002, who underwent surgical excision of the tumour with negative margins and a negative sentinel node. She posteriorly developed pulmonary metastasis in 2006 and 2009, both resected with curative intention and in 2013, she was diagnosed with an adrenal metastasis. Therefore, she was submitted to an uneventful right laparoscopic adrenalectomy. The pathology report described metastasis of a cutaneous melanoma, negative for BRAF mutation. The patient is actually disease-free after 30 months of follow-up.

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Unusual course of a haematoma of the thigh

Description

A Caucasian woman aged 56 years presented to emergency room (ER) department with leucorrhoea and fever since 48 hours. She was a smoker, had no diabetes history, no prosthetic material and denied use of injected drugs.

A month before, the patient had a closed inguinal trauma due to fall from height with a muscle strain of the anterior right thigh. Despite rest and analgesics, she went to ER several times because of progressive local pain and swelling. After 3 weeks, a local ultrasound scan showed a 3 cm size haematoma associated with probable rupture of obturator internus and rectus femoris muscles. On the following days, she developed fetid leucorrhoea associated with movements and compression of the anterior thigh. On physical examination and analyses, she had sepsis criteria and the abdomen/pelvic CT scan (figure1A, B) and MRI (figure1C, D) showed an abscess of 105x25mm size, complicated with...

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Bottom of an iceberg: undiagnosed aortic aneurysm masquerading as vocal cord palsy

Description

A previously healthy woman aged 60 years was referred to a tertiary referral cancer centre with change of voice for 1 week suspecting neoplastic aetiology on account of her tobacco chewing habit of more than 20 years. No history of voice abuse, fever or cough was there preceding the onset of the change of voice. She did not have any previous history of hospitalisation or diagnosed comorbidities. On clinical examination, her pulse rate was 82 bpm; blood pressure was 130/90 mm Hg and respiratory rate was 12/min.

Video laryngoscopy examination revealed left vocal cord palsy with no obvious lesion. A whole-body F18 FDG PET–CT scan revealed the presence of 6.6x4.8x6.7 cm lobulated sacullar aneurysm arising from the aortic arch between the origins of the left common carotid and subclavian arteries (figures 1 and 2). The likely mycotic aneurysm caused significant surrounding metabolically active inflammatory changes (figure 3). The...

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Effect of follicular dendritic cell secreted protein on gene expression of human periodontal ligament cells

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Lin Xiang, Na Xin, Ying Yuan, Xiaogang Hou, Junwei Chen, Na Wei, Ping Gong
ObjectiveThe objective of this study was to investigate the specific roles of follicular dendritic cell secreted protein (FDC-SP), a protein exists in saliva, in the inhibition of calcium precipitation during periodontal regeneration, as well as affect phenotype expression of human periodontal ligament cells (hPDLCs) during the differentiation process.DesignTo investigate this, we applied microarray technology to identify gene expression changes in hPDLCs transfected with FDC-SP and then clustered them according to their biological functions.ResultsOne hundred seventy-one genes were found differentially expressed by at least two-fold between FDC-SP -transfected and empty vector-transfected cells. Besides, genes encoding cell-cycle proteins, blood-related and cell differentiation-related proteins tended to be up-regulated after FDC-SP transfection, whereas cytokine/growth factors, signal transduction and metabolism-related genes tended to be down-regulated in hPDLCs overexpression FDC-SP.ConclusionsThe present study investigated FDC-SP's roles in hPDLCs' phenotype expression, via comparing the gene expression profiles between FDC-SP -transfected hPDLCs and empty vector-transfected cells upon microarray analysis. hPDLCs overexpression FDC-SP appear to display different gene expression patterns. In all, these observations showed a potential of FDC-SP in the maintenance of PDL homeostasis and its ultimate contribution to periodontal would-healing processes.



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Penicillium citrinum: opportunistic pathogen or idle bystander? A case analysis with demonstration of galactomannan cross-reactivity

Publication date: Available online 22 May 2017
Source:Medical Mycology Case Reports
Author(s): Shayla E. Hesse, Paul M. Luethy, John H. Beigel, Adrian M. Zelazny
We present a case of an immunocompromised woman with fever, pulmonary infiltrates and multiple bronchoalveolar lavage (BAL) cultures positive for Penicillium citrinum with a concomitant high BAL galactomannan level. We report the results of Aspergillus galactomannan testing performed on culture supernatants from her P. citrinum strain that confirmed the suspected cross-reactivity. Finally, we discuss the clinical significance and antifungal susceptibility of P. citrinum in our case and review the literature.



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Alteration of Nrf2 and Glutamate Cysteine Ligase expression contribute to lesions growth and fibrogenesis in ectopic endometriosis

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): L. Marcellin, P. Santulli, S. Chouzenoux, O. Cerles, C. Nicco, B. Dousset, M. Pallardy, S. Kerdine-Römer, PA. Just, C. Chapron, F. Batteux
The redox-sensitive nuclear factor erythroid-derived 2-like 2 (NRF2) controls endogenous antioxidant enzymes' transcription and protects against oxidative damage which is triggered by inflammation and known to favor progression of endometriosis. Glutamate Cysteine Ligase (GCL), a target gene of NRF2, is the first enzyme in the synthesis cascade of glutathione, an important endogenous antioxidant. Sixty-one patients, with thorough surgical examination of the abdominopelvic cavity, were recruited for the study: 31 with histologically-proven endometriosis and 30 disease-free women taken as controls. Expressions of NRF2 and GCL were investigated by quantitative RT-PCR and immunohistochemistry in eutopic and ectopic endometria from endometriosis-affected women and in endometrium of disease-free women. Ex vivo stromal and epithelial cells were extracted and purified from endometrial and endometriotic biopsies to explore expression of NRF2 and GCL in both stromal and epithelial compartments by western blot. Finally, in order to strengthen the role of NRF2 in endometriosis pathogenesis, we evaluated the drop of NRF2 expression in a mouse model of endometriosis using NRF2 knockout (NRF2^-/-) mice. The mRNA levels of NRF2 and GCL were significantly lower in ectopic endometria of endometriosis-affected women compared to eutopic endometria of disease-free women. The immunohistochemical analysis confirmed the decreased expression of both NRF2 and GCL in ectopic endometriotic tissues compared to eutopic endometria of endometriosis-affected and disease-free women. Immunoblotting revealed a significant decreased of NRF2 and GCL expression in epithelial and stroma cells from ectopic lesions of endometriosis-affected women compared to eutopic endometria from controls. Using a murine model of endometriosis, NRF2^-/- implants were more fibrotic compared to wild-type with an increased weight and volume. These findings indicate that expression of the transcription factor NRF2 and its effector GCL are both profoundly deregulated in endometriotic lesions towards increased growth and fibrogenetic processes.

Graphical abstract

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Influence of Transmitted Virus on the Host's Immune Response: A Case Study

Viral Immunology , Vol. 0, No. 0.


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Comparative approaches to understanding thyroid hormone regulation of neurogenesis

Publication date: Available online 22 May 2017
Source:Molecular and Cellular Endocrinology
Author(s): Jean-David Gothié, Barbara Demeneix, Sylvie Remaud
Thyroid hormone (TH) signalling, an evolutionary conserved pathway, is crucial for brain function and cognition throughout life, from early development to ageing. In humans, TH deficiency during pregnancy alters offspring brain development, increasing the risk of cognitive disorders. How TH regulates neurogenesis and subsequent behaviour and cognitive functions remains a major research challenge. Cellular and molecular mechanisms underlying TH signalling on proliferation, survival, determination, migration, differentiation and maturation have been studied in mammalian animal models for over a century. However, recent data show that THs also influence embryonic and adult neurogenesis throughout vertebrates (from mammals to teleosts). These latest observations raise the question of how TH availability is controlled during neurogenesis and particularly in specific neural stem cell populations. This review deals with the role of TH in regulating neurogenesis in the developing and the adult brain across different vertebrate species. Such evo-devo approaches can shed new light on (i) the evolution of the nervous system and (ii) the evolutionary control of neurogenesis by TH across animal phyla. We also discuss the role of thyroid disruptors on brain development in an evolutionary context.

Graphical abstract

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Severe medication-induced peripheral neuropathy treated with topical doxepin cream in a paediatric patient with leukaemia

A 17-year-old female with recently relapsed acute lymphoblastic leukaemia and a treatment course complicated by rhinocerebral mucormycosis infection developed severe peripheral neuropathy during the treatment for mucormycosis infection. This was felt to be a medication side effect. Her peripheral neuropathy was refractory to many well-established treatments, but ultimately responded dramatically and consistently to a novel therapy, topical doxepin cream (5%). This case report is the first published report of the application of topical doxepin cream for treatment of peripheral neuropathy in a paediatric patient.

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Traumatic phacocele: a rare but unique scenario

Description

The term phacocele is derived from a Greek word, where 'phaco' denotes lens and 'kele' meaning herniation. It is an unusual and very rare clinical condition.1

A 48-year-old male patient presented with sudden-onset diminution of vision, redness, pain in his left eye following blunt trauma 2 days ago. There was no significant ocular or systemic history. Visual acuity was perception of light positive with projection of rays accurate in left eye and 20/20 in right eye. On slit-lamp examination of the affected eye, there was a solid globular mass in the subconjunctival space located in the superonasal quadrant measuring 8x9 mm with smooth surface and rounded margins. There was an area of suspected scleral dehiscence, temporal to the mass lesion with uveal show (figure 1A). There was diffuse corneal oedema with descemet's folds. Anterior chamber detail was not clearly visible because of hyphaema (figure 1B). Intraocular pressure was 4 mm Hg....

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Angioscopy-guided selective aspiration thrombectomy for acute pulmonary thromboembolism

An 83-year-old woman with a history of pulmonary thromboembolism 10 years ago was referred for dyspnea. Anticoagulation therapy was terminated by her family doctor 3 years previously. On admission, D-dimer level was 16.6 µg/mL and arterial blood gas showed 88.1% on room air. Pulmonary arteriography (PAG) revealed some filling defects, mainly in the right interlobar artery (figure 1A). Non-obstructive angioscopy (NOA)1 showed two kinds of thrombi in the pulmonary arteries. At the translucent area, a massive, red, smooth thrombus was seen (figure 1B, video 1). Between the massive thrombus, floating, mobile, white-red, puff-like thrombi were demonstrated (figure 1C, video 2). As the thrombi entered the catheter spontaneously, aspiration was performed using a 20 mL syringe. Thrombi in the guiding catheter were collected by removing the guiding catheter. For the first trial, red thrombi were effectively aspirated (figure...

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Laryngocoele formation after ingestion of fish bone

Description

A 72-year-old man presented to the clinic with a 3-week history of anterior left neck pain. He described constant discomfort since eating fish a few weeks prior. He recalled pain at the time of eating, and felt he had ingested a fish bone.

There was no dysphagia, dyspnoea or haemoptysis on presentation. He had a medical history of type II diabetes mellitus, with no previous Ear, Nose and Throat issues.

Examination of the neck and oropharynx was normal. There were no palpable nodes or masses. Flexible nasendoscopy demonstrated a normal larynx. A lateral X-ray of the neck was arranged and showed no foreign body.

He was treated with simple analgesia and antacid, with a plan to review in 1 week.

He was reviewed and again examination and nasendoscopy were normal. CT scan revealed a traumatic laryngocoele at the left piriform sinus (figures 1 and 2).

...

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Systemic inflammatory response syndrome (SIRS) and a left bundle branch block (LBBB) due to nitrofurantoin

We present a case of a 74-year-old woman, who was on nitrofurantoin treatment for urinary tract infection (UTI), with fever and chills 7 hours after taking nitrofurantoin. She was hospitalised and evaluated for worsening UTI and sepsis. Initially, it appeared to be secondary to post-UTI sepsis because of possible resistant infection or conditions like pulmonary embolism or acute hepatitis. The patient also developed systemic inflammatory response syndrome, left bundle branch block (LBBB), thrombocytopaenia and transaminitis. Considering the side effects of nitrofurantoin, it was stopped. The patient showed improvement and recovered completely with symptomatic and supportive treatment. During follow-up visits with her primary care physician, thrombocytopaenia, transaminitisandLBBB were found to have been resolved.

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Non-surgical treatment of a relapsed cystic hygroma in an adult

Lymphatic malformations, also known as lymphangiomas or cystic hygromas, are benign masses that typically affect newborns and infants and involve the head and neck regions. They are, however, rare in adults and even rarer in the axillary region. Although surgery is considered to be the treatment of choice, we present a rare case of a recurrent cystic hygroma 32 years after the first surgical operation. Due to the cosmetic concerns and the risks of a surgical approach, non-surgical therapy with percutaneous sclerosants was performed, with a good outcome after a 2-year follow-up period.

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Actinomycosis presenting as an anterior abdominal mass after laparoscopic cholecystectomy

Abdominal actinomycosis is a rare disease caused by different anaerobic Actinomyces species. We report the case of a 55-year-old woman who presented with a painless, slow growing, left upper abdominal mass that developed after a laparoscopic cholecystectomy. A CT scan and MRI of the abdomen revealed a desmoid tumour of the left rectus abdominis muscle.

Surgical excision was performed with an uneventful postoperative course. The histological analysis of the specimen was inconsistent with a desmoid tumour and revealed an infection of Actinomyces israelii in the anterior abdominal wall that was confirmed with a microbiology culture. The surgical treatment was followed by a course of penicillin antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications. Although it is rare, the patient's history of laparoscopic cholecystectomy was identified as the likely source of infection.

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Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierres syndrome

We portray the case of a 16-year-old girl who was initially admitted to the paediatric emergency department with non-specific symptoms of a severe cold and was first treated symptomatically on an ambulatory basis. Within 6 days she developed the full clinical picture of Lemierre's syndrome with the extraordinary manifestation of involvement of her right hip. Despite an interdisciplinary coordinated treatment as well as surgical therapy, a full-blown sepsis evolved within a short time period and resulted in almost 2 months of intensive care. While the primary focus could be successfully controlled, a progressive avascular necrosis of the right proximal femur developed on the basis of a chronic osteomyelitis. This finally led to a pathological fracture of the femoral neck. After excluding the possibility of an enduring bacterial infection, the fracture was treated with a total hip replacement.

http://ift.tt/2rvijTw

Impella percutaneous left ventricular assist device for severe acute ischaemic mitral regurgitation as a bridge to surgery

Ischaemic papillary muscle rupture causing acute severe mitral regurgitation (MR) has a dramatic presentation and a very high mortality. Emergent surgical repair improves outcomes, which necessitates robust preoperative stabilisation. Here we discuss a patient with cardiogenic shock with an acute severe MR that was deemed very high risk for emergent valve replacement due to haemodynamic instability and respiratory failure. A percutaneous left ventricular assist device Impella 2.5 (Abiomed, Danvers, MA) drastically improved clinical status, and the patient underwent a successful surgical mitral valve replacement soon after placement of the temporary assist device. Our case highlights that percutaneous ventricular assist devices may help to stabilise patients with severe acute ischaemic MR, and it can serve as a bridge to surgery in high risk patients.

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Incidental discovery of a large complicated arteriovenous haemangioma

Arteriovenous haemangiomas within the chest are rare and uncommonly documented. After a 60-year-old woman with a history of smoking underwent a routine chest X-ray revealing a right apical mass, further investigations led to the discovery of a large extrapulmonary arteriovenous haemangioma in the superior mediastinum. Additionally, this case became complicated when the hemangioma was found to not only be compressing adjacent major arteries and veins, but also invading into the spinal canal and displacing the spinal cord. With multidisciplinary planning, the arteriovenous haemangioma was embolised and successfully resected. Thus, we present a case of an arteriovenous haemangioma in the superior mediastinum and discuss the importance of the case.

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Clostridium difficile extraintestinal abscess: a rare complication

Extraintestinal Clostridium difficile is rare. A 74-year-old man with a history of ulcerative colitis presented after a fall. Trauma work-up showed liver cirrhosis. Two days later he developed abdominal pain, distension, diarrhoea and leucocytosis. Stool tested positive for C. difficile. CT abdomen showed pancolitis with toxic megacolon. Total abdominal colectomy and ileostomy with a rectal stump was performed. He was discharged, but was readmitted with sepsis. CT abdomen showed a 10.4x7.2 cm fluid collection in the pelvis. C. difficile stool was negative. CT-guided abscess drainage grew C. difficile. Barium enema was negative for communication from the rectal stump to the abscess. The patient was treated with metronidazole for 2 weeks. In summary, extraintestinal C. difficile can develop from recent antibiotics use, gastrointestinal surgery and microperforations from toxic megacolon. We recommend abscess drainage, concomitant treatment with metronidazole and or vancomycin, and reimaging of abscess location 2–4 weeks after cessation of antibiotics.

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Native valve endocarditis caused by Lactococcus garvieae: an emerging human pathogen

A 57-year-old man presented with native mitral valve endocarditis caused by Lactococcus garvieae, a known animal pathogen that is increasingly being reported as a cause of human infections. The organism was cultured in four sets of blood cultures and identification was initially made by matrix-assisted laser desorption/ionisation—time of flight mass spectrometry and confirmed by 16S rDNA PCR of the blood culture isolate. He was successfully treated with 6 weeks of both amoxicillin and gentamicin and underwent valve replacement surgery after 4 weeks of antimicrobial treatment. The removed valve was sterile but L. garvieae DNA was detected on the valve using 16S rDNA PCR. The cause of the L. garvieae infection could not be ascertained but flexible sigmoidoscopy demonstrated colonic polyps, which have been linked to infection with this organism.

http://ift.tt/2qbxf5l

Safe administration of S-1 after 5-fluorouracil-induced cardiotoxicity in a patient with colorectal cancer

Cardiotoxicity is a rare but challenging complication of 5-fluorouracil (5-FU) therapy. Compared with 5-FU, after application of S-1 lower plasma levels of the cardiotoxic metabolite alpha-fluoro-beta-alanine have been reported. Evidence for safe administration of S-1 following 5-FU cardiotoxicity is limited to a case report in an Asian patient. Herein we report the first case of S-1 application after 5-FU cardiotoxicity in a Caucasian patient.

A 67-year-old man with right-sided metastatic colorectal cancer and history of 5-FU cardiotoxicity had a progressive disease after 8-month therapy with irinotecan and bevacizumab. In consideration of known 5-FU cardiotoxicity, he was referred to our department for therapy counselling. We started a combination therapy with S-1, oxaliplatin and bevacizumab. The treatment was well tolerated without any cardiac problems.

Our report confirms the safety of S-1 in cases of 5-FU cardiotoxicity also in a Caucasian patient.

http://ift.tt/2rvoF5n

Radiation-associated peritoneal angiosarcoma

Angiosarcomas account for only 1–2% of all soft tissue sarcomas, with the most common site of origin being in the head and neck region. Peritoneal angiosarcoma is an extremely rare tumour and few cases have been reported previously. Presentation of peritoneal angiosarcoma can be very variable, hence making diagnosis difficult. Herein, we review the current literature and describe a rare case of a patient who presented with haemorrhagic ascites, 17 years after radiotherapy for endometrial carcinoma and was subsequently diagnosed with peritoneal angiosarcoma. Due to extensive disease, surgery was not a viable option. She was started on palliative chemotherapy, but despite treatment, her condition deteriorated further and she eventually passed away. We highlight the diagnostic challenges and considerations in these patients as well as current treatment and management options available.

http://ift.tt/2qb7JNO

Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy

Sesamoid osteonecrosis is a disabling condition resulting in severe forefoot pain, for which there are limited treatment options. We present a 52-year-old man with 1-year history of pain, aggravated by walking and playing tennis. On examination, pain was localised to plantar aspect of the first metatarsophalangeal joint. Imaging revealed evolving end-stage avascular necrosis of lateral sesamoid with early secondary degenerative changes. Previous exhaustive conservative treatment had been unsuccessful in alleviating his pain. As an alternative to surgery, radial extracorporeal shock wave therapy (rESWT) was proposed. Treatment protocol was 2000 pulses at frequency of 5 Hz, and pressure was varied from 1.2 to 1.8 bar according to patient tolerance. A total of eight sessions were delivered. At completion of treatment, the patient reported minimal discomfort to no pain and was able to return to playing tennis with no recurrence. We propose rESWT to be an effective novel conservative treatment for sesamoid osteonecrosis.

http://ift.tt/2rvo7wv

Cardiac compression due to gastric volvulus: an unusual cause of chest pain

A 42-year-old man was admitted to coronary care for assessment with severe retrosternal chest pain. Echocardiography showed significant external compression of the left atrium. A subsequent CT scan revealed him to have a large hiatus hernia, with most of his stomach herniating into his thorax causing left atrial compression and gastric volvulus. He subsequently underwent successful emergency decompression of the gastric volvulus and repair of his hiatus hernia.

http://ift.tt/2qbF8HT

A Syrian man with abdominal pain

A 32-year-old man presented with progressive abdominal pain, nausea and vomiting after swallowing a packet of dollar bills, his entire money savings, during his journey to Europe as a refugee. Subsequent imaging confirmed the presence of a foreign body in his stomach, which required surgical intervention to be removed. This is one of many cases that illustrate the hopeless circumstances people in the Middle-Eastern warzone are currently facing.

http://ift.tt/2rvw9FD

'The dark pancreas: classic CT appearance of total pancreatic lipomatosis

Description

A 31-year-old male patient presented with a history of chronic abdominal pain and progressive loss of weight. Patient also had massive steatorrhea and had been a chronic alcoholic. There was no history of diabetes mellitus, tuberculosis or hypertension. Laboratory investigations revealed profound hypoproteinaemia. Patient underwent a contrast-enhanced CT of the abdomen. It demonstrated a striking 'dark' pancreas showing an attenuation of –88 Hounsfield units corresponding to fat (figure 1). No obvious enhancing solid component was seen. Careful review of the multiplanar CT reconstruction images confirmed the presence of dilated pancreatic duct with multiple intraductal calculi (figure 2). The CT findings were diagnostic of total pancreatic lipomatosis secondary to obstructed pancreatic ductal system by calculi/chronic calcific pancreatitis. Patient was managed conservatively using pancreatic enzyme replacement therapy.

Figure 1

Axial contrast-enhanced CT image shows the dark, hypoattenuating pancreatic parenchyma corresponding to fat. Note the...

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Caution advised with dapagliflozin in the setting of male urinary tract outlet obstruction

We describe an adverse outcome in a 70-year-old man with type 2 diabetes mellitus treated with sodium–glucose cotransporter type 2 (SGLT2) inhibitor dapagliflozin. SGLT2 inhibitors act in the proximal tubules to prevent glucose reabsorption and induce urinary glucose excretion, they have been associated with increased risk of urinary tract infection (UTI). Our patient presented to hospital with Escherichia coli septicaemia with positive urine and blood cultures on the background of two previous UTIs occurring post commencement of dapagliflozin in the community. Renal tract ultrasound in hospital revealed incomplete bladder emptying with evidence of urinary stasis, and a postvoid residual volume of 180 mL. His dapagliflozin was ceased, and he has had no further episodes of UTI. This case suggests there may be an increased risk of UTI in patients prescribed SGLT2 inhibitors who also have evidence of bladder outlet obstruction—caution is advised in the prescribing of SGLT2 inhibitors in this setting.

http://ift.tt/2rvuGin

Back pain and oedematous Schmorl node: a diagnostic dilemma

A 26-year-old female from India presented with progressive, unremitting low back pain for over 1 year. She had been treated unsuccessfully for left-sided sacroiliitis, pelvic floor dysfunction, ankylosing spondylitis and seronegative spondyloarthritis. MRI lumbar spine showed a Schmorl node with surrounding marrow oedema at L4, the relevance of which is not clear in literature. One year after initial presentation, a biopsy of this lesion revealed culture positive diagnosis of spinal tuberculosis. Despite advances in imaging, delayed diagnosis is not uncommon in spinal tuberculosis (TB). In our case, it was also attributed to an unknown early lesion: Schmorl node with surrounding oedema. Any association of this lesion with spinal TB has previously not been reported.

http://ift.tt/2qboXdI

OCT-based microangiography for reactive hyperaemia assessment within residual limb skin of people with lower limb loss

http://ift.tt/2qPn7CA

Efficacy and safety of non-invasive body tightening with high-intensity focused ultrasound (HIFU)

Abstract

Background

Noninvasive skin-tightening devices have become increasingly popular in response to increasing demand for improvements in skin laxity and tightening with minimal risk and recovery time.

Objective

We evaluated the efficacy and safety of HIFU for skin tightening in the face and body.

Methods

A total of 32 Korean subjects enrolled in this prospective clinical trial. The subjects were treated with HIFU to both cheeks, lower abdomen, and thigh. Skin elasticity was measured before and after treatment using a Cutometer (CT575, Courage and Khazaka^®, Cologne, Germany). Three blinded, experienced dermatologists evaluated paired pre- and post-treatment (week 4 and 12) photographs according to the Global Aesthetic Improvement Scale (GAIS). Participants also completed self-assessments using GAIS. Subjects rated their pain on a numeric rating scale (NRS) immediately, 7 days, 4 weeks, and 12 weeks after treatment.

Results

Skin elasticity measured via a Cutometer was significantly improved 12 weeks after treatment at all treated sites (P<.05). Both IGAIS and SGAIS showed significant improvements 12 weeks after treatment. Immediately after treatment the mean NRS score was 3.00±1.586, but no pain was reported at 4 and 12 weeks post-treatment. No serious adverse effects were observed during the follow-up period.

Conclusion

HIFU safely and effectively improves skin elasticity and clinical contouring of the face and body.

http://ift.tt/2rNv5Jz

Incidence and impact of Dihydropyrimidine dehydrogenase gene mutation on neoadjuvant chemotherapy in head and neck cancers

5 FU (5-Fluorouracil) is a common chemotherapeutic agent used in head and neck cancer in combination with docetaxel and cisplatin in the neoadjuvant setting [1,2]. Dihydropyrimidine dehydrogenase (DPD) is an enzyme essential for metabolism of 5FU [3]. The enzyme is coded by the gene DPYD [3]. Polymorphism and mutations leading to a decrease in production of this enzyme are known and these result in an increment in 5 FU related side effects [4–6]. The incidence of such polymorphisms or mutations is variable across different ethnic populations [7].

http://ift.tt/2qJLwJh

Metabolic Syndrome Among Leukemia Survivors: Still Delineating the Risk

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2rNyqIK

Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery Versus Active Surveillance, Without Using Genetic Testing: A Single Institute Experience, Prospective Analysis, and Recommendations

Thyroid , Vol. 0, No. 0.


http://ift.tt/2q55NKH

Postoperative Outcomes in Graves' Disease Patients: Results from the Nationwide Inpatient Sample Database

Thyroid , Vol. 0, No. 0.


http://ift.tt/2qQFHYW

Iodine Storage and Metabolism of Mild to Moderate Iodine-Deficient Pregnant Rats

Thyroid , Vol. 0, No. 0.


http://ift.tt/2q54200

Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery Versus Active Surveillance, Without Using Genetic Testing: A Single Institute Experience, Prospective Analysis, and Recommendations

Thyroid , Vol. 0, No. 0.


http://ift.tt/2q55NKH

Postoperative Outcomes in Graves' Disease Patients: Results from the Nationwide Inpatient Sample Database

Thyroid , Vol. 0, No. 0.


http://ift.tt/2qQFHYW

Iodine Storage and Metabolism of Mild to Moderate Iodine-Deficient Pregnant Rats

Thyroid , Vol. 0, No. 0.


http://ift.tt/2q54200

Risk factors for patient-reported errors during cancer follow-up: Results from a national survey in Denmark

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Anne Hjøllund Christiansen, Henriette Lipczak, Janne Lehmann Knudsen, Anne Mette Tranberg Kejs
Due to an increased cancer survival, more cancer patients are referred to follow-up after primary treatment. Knowledge of patient safety during follow-up is sparse.ObjectiveTo examine patient-reported errors during cancer follow-up and identify factors associated with errors.DesignA national survey on cancer patients' experiences of treatment and aftercare was conducted in 2012, about two years following cancer diagnosis (N=6914). Associations between patient-reported errors during follow-up and covariates were examined using multiple logistic regression. Qualitative responses were analysed using text analysis.ResultsThis study included 3731 patients, representing a response rate of 64%. Overall, 27.6% of patients reported at least one error during cancer follow-up. 11.7% reported that important information was missing at follow-up consultations; 9.8% were not called in for a follow-up as expected; 16.7% reported that the doctor/nurse handling the follow-up consultation were ill-prepared on their course of disease. Other errors were reported by 4.7%. Patients who reported errors in follow-up were more likely to report an error or complication during primary cancer treatment, not having one health professional with oversight and responsibility for their overall follow-up pathway, be younger, have a diagnosis of rare cancer, poorer self-rated health and high usage of healthcare services.ConclusionWorkflows related to handling of test results, referrals, bookings and medical records have to be improved. Introduction of one particular healthcare professional responsible for the patients' follow-up may result in fewer patient-reported errors however interventions are needed to examine this. Patients prone to errors should be subject to particular attention.



http://ift.tt/2q5nzNU

Neutrophil-Lymphocyte Ratio Is a Prognostic Marker in Patients with Locally Advanced (Stage IIIA and IIIB) Non-Small Cell Lung Cancer Treated with Combined Modality Therapy

Background.

Neutrophil-lymphocyte ratio (NLR) is a measure of systemic inflammation that appears prognostic in localized and advanced non-small cell lung cancer (NSCLC). Increased systemic inflammation portends a poorer prognosis in cancer patients. We hypothesized that low NLR at diagnosis is associated with improved overall survival (OS) in locally advanced NSCLC (LANSCLC) patients.

Patients and Methods.

Records from 276 patients with stage IIIA and IIIB NSCLC treated with definitive chemoradiation with or without surgery between 2000 and 2010 with adequate data were retrospectively reviewed. Baseline demographic data and pretreatment peripheral blood absolute neutrophil and lymphocyte counts were collected. Patients were grouped into quartiles based on NLR. OS was estimated using the Kaplan-Meier method. The log-rank test was used to compare mortality between groups. A linear test-for-trend was used for the NLR quartile groups. The Cox proportional hazards model was used for multivariable analysis.

Results.

The NLR was prognostic for OS (p < .0001). Median survival in months (95% confidence interval) for the first, second, third, and fourth quartile groups of the population distribution of NLR were 27 (19–36), 28 (22–34), 22 (12–31), and 10 (8–12), respectively. NLR remained prognostic for OS after adjusting for race, sex, stage, performance status, and chemoradiotherapy approach (p = .004).

Conclusion.

To our knowledge, our series is the largest to demonstrate that baseline NLR is a significant prognostic indicator in LANSCLC patients who received definitive chemoradiation with or without surgery. As an indicator of inflammatory response, it should be explored as a potential predictive marker in the context of immunotherapy and radiation therapy. The Oncologist 2017;22:1–6

Implications for Practice.

Neutrophil-lymphocyte ratio measured at the time of diagnosis was associated with improved overall survival in 276 patients with stage IIIA and IIIB non-small cell lung cancer (NSCLC) treated with definitive chemoradiation with or without surgery. To our knowledge, our series is the largest to demonstrate that baseline neutrophil-lymphocyte ratio is a significant prognostic indicator in locally advanced NSCLC patients who received definitive chemoradiation with or without surgery. Neutrophil-lymphocyte ratio is an inexpensive biomarker that may be easily utilized by clinicians at the time of locally advanced NSCLC diagnosis to help predict life expectancy.

http://ift.tt/2rbmIvb

Weekly Low-Dose Versus Three-Weekly High-Dose Cisplatin for Concurrent Chemoradiation in Locoregionally Advanced Non-Nasopharyngeal Head and Neck Cancer: A Systematic Review and Meta-Analysis of Aggregate Data

Background.

Three-weekly high-dose cisplatin (100 mg/m²) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, due to unsatisfactory patient tolerance, various weekly low-dose schedules have been increasingly used in clinical practice. The aim of this meta-analysis was to compare the efficacy, safety, and compliance between these two approaches.

Materials and Methods.

We systematically searched literature for prospective trials of patients with LA-SCCHN who received postoperative or definitive conventionally fractionated concurrent chemoradiation. Radiation doses were usually 60–66 gray (Gy) in the postoperative setting and 66–70 Gy in the definitive setting. Standard, three-weekly high-dose cisplatin (100 mg/m², 3 doses) was compared with the weekly low-dose protocol (≤50 mg/m², ≥6 doses). The primary endpoint was overall survival. Secondary outcomes comprised response rate, acute and late adverse events, and treatment compliance.

Results.

Fifty-two studies with 4,209 patients were included in two separate meta-analyses according to the two clinical settings. There was no difference in treatment efficacy as measured by overall survival or response rate between the chemoradiation settings with low-dose weekly and high-dose three-weekly cisplatin regimens. In the definitive treatment setting, the weekly regimen was more compliant and significantly less toxic with respect to severe (grade 3–4) myelosuppression (leukopenia p = .0083; neutropenia p = .0024), severe nausea and/or vomiting (p < .0001), and severe nephrotoxicity (p = .0099). Although in the postoperative setting the two approaches were more equal in compliance and with clearly less differences in the cisplatin-induced toxicities, the weekly approach induced more grade 3–4 dysphagia (p = .0026) and weight loss (p < .0001).

Conclusion.

In LA-SCCHN, current evidence is insufficient to demonstrate a meaningful survival difference between the two dosing regimens. Prior to its adoption into routine clinical practice, the low-dose weekly approach needs to be prospectively compared with the standard three-weekly high-dose schedule. The Oncologist 2017;22:1–11

Implications for Practice.

Given concurrently with conventional radiotherapy in locally advanced head and neck cancer, high-dose three-weekly cisplatin has often been replaced with weekly low-dose infusions to increase compliance and decrease toxicity. The present meta-analysis suggests that both approaches might be equal in efficacy, both in the definitive and postoperative settings, but differ in toxicity. However, some toxicity data can be influenced by unbalanced representation, and the conclusions are not based on adequately sized prospective randomized studies. Therefore, low-dose weekly cisplatin should not be used outside clinical trials but first prospectively studied in adequately sized phase III trials versus the high-dose three-weekly approach.

http://ift.tt/2rKxF41

U.S. Food and Drug Administration Approval Summary: Pembrolizumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma with Disease Progression on or After Platinum-Containing Chemotherapy

On August 5, 2016, the U.S. Food and Drug Administration granted accelerated approval to pembrolizumab (KEYTRUDA injection, Merck Sharp & Dohme Corp., Kenilworth, NJ) for treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum-containing chemotherapy. Approval was based on the objective response rate (ORR) and duration of response (DoR) in a cohort of patients in a nonrandomized multi-cohort trial (KEYNOTE-012) that included 174 patients with recurrent or metastatic HNSCC who had disease progression on or after platinum-containing chemotherapy. Patients received either intravenous pembrolizumab 10 mg/kg every 2 weeks or 200 mg every 3 weeks. ORR was determined by independent review according to Response Evaluation Criteria in Solid Tumors 1.1. ORR was 16% (95% confidence interval 11, 22) with a complete response rate of 5%. DoR ranged from 2.4+ months to 27.7+ months. Twenty-three of 28 responding patients (82%) had response durations of ≥6 months. Safety was evaluated in 192 patients with HNSCC receiving at least one dose of pembrolizumab. Frequent (≥2%) serious adverse reactions were pneumonia, dyspnea, confusional state, vomiting, pleural effusion, and respiratory failure. Clinically significant immune-mediated adverse reactions included pneumonitis, colitis, hepatitis, adrenal insufficiency, diabetes mellitus, skin toxicity, myositis, and thyroid disorders. The benefit-risk profile of pembrolizumab was considered acceptable in this patient population. As a condition of accelerated approval, Merck is required to conduct a confirmatory trial; this trial, KEYNOTE-040, is ongoing. The Oncologist 2017;22:1–6

Implications for Practice.

This accelerated approval expands the U.S. Food and Drug Administration-approved indications for pembrolizumab, providing health care providers with new information regarding pembrolizumab for the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum-containing chemotherapy. Pembrolizumab is the first drug to receive approval for treatment of patients with HNSCC since cetuximab was approved for this indication in 2006.

http://ift.tt/2rbrR6s

First-Line Palliative HER2-Targeted Therapy in HER2-Positive Metastatic Breast Cancer Is Less Effective After Previous Adjuvant Trastuzumab-Based Therapy

Background.

Survival of patients with human epidermal growth receptor 2 (HER2)-positive metastatic breast cancer (MBC) has improved dramatically since trastuzumab has become available, although the disease eventually progresses in most patients. This study investigates the outcome (overall survival [OS] and time to next treatment [TNT]) in MBC patients pretreated with trastuzumab in the adjuvant setting (TP-group) compared with trastuzumab-naïve patients (TN-group) in order to investigate the possibility of trastuzumab resistance.

Patients and Methods.

Patients treated with first-line HER2-targeted-containing chemotherapy were eligible for the study. A power analysis was performed to estimate the minimum size of the TP-group. OS and TNT were estimated using Kaplan-Meier curves and multivariable Cox proportional hazards models.

Results.

Between January 1, 2000, and June 1, 2014, 469 patients were included, of whom 82 were in the TP-group and 387 were in the TN-group. Median OS and TNT were significantly worse in the TP-group compared with the TN-group (17 vs. 30 months, adjusted hazard ratio [HR] 1.84 [1.15–2.96], p = .01 and 7 vs. 13 months, adjusted HR 1.65 [1.06–2.58], p = .03) after adjustment for age, year of diagnosis, disease-free interval, hormone receptor status, metastatic site, and cytotoxic regimens.

Conclusion.

First-line trastuzumab-containing treatment regimens are less effective in patients with failure of adjuvant trastuzumab compared with trastuzumab-naïve patients and might be due to trastuzumab resistance. The impact of trastuzumab resistance on the response on dual HER2 blockade with trastuzumab and pertuzumab and how resistance mechanisms can be used in the optimization of HER2-targeted treatment lines need further investigation. The Oncologist 2017;22:1–9

Implications for Practice.

Evidence on the efficacy of palliative trastuzumab-based therapy after failure of trastuzumab in the adjuvant setting is limited because of a minority of patients treated with adjuvant trastuzumab in clinical trials. In this study, less clinical benefit of palliative trastuzumab-based therapy was observed in patients relapsing after adjuvant trastuzumab compared with no adjuvant trastuzumab treatment. Subgroup analyses and multivariable analyses revealed that this was independent of possible confounding factors, including adjuvant taxane-treatment. This might suggest a clinically meaningful impaired efficacy of trastuzumab after previous, in this case adjuvant, trastuzumab therapy. These results could have implications for treatment decision-making after short progression-free intervals on trastuzumab-containing regimens in the palliative setting.

http://ift.tt/2rKGCtW

Prosthetics in Facial Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603459

Reconstruction of the head and neck can be a challenging undertaking owing to numerous considerations for successful rehabilitation. Although head and neck defects were once considered irretrievably morbid and associated with a poor quality of life, advances in surgical technique has immensely contributed to the well-being of these patients. However, all patients are not suitable surgical candidates and many have sought nonsurgical options for functional and cosmetic restoration. As such, the advent of prostheses has ameliorated those concerns and provided a viable alternative for select patient populations. Prosthetic reconstruction has evolved significantly over the past decade. Advances in biocompatible materials and imaging adjuncts have spurred further discovery and forward progress. A multidisciplinary approach to head and neck reconstruction focused on appropriate expectations and patient-centered goals is most successfully coordinated by a team of head and neck surgeons, maxillofacial surgeons, and prosthetic specialists. The aim of this article is to provide a comprehensive review of the current trends for prosthetic rehabilitation of head and neck defects, and further elaborate on the limitations and advancements in the field.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2rNhnGy

Tone perception in Mandarin-speaking children with cochlear implants

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http://ift.tt/2rKxENp

Processing of Ti-5553 with improved mechanical properties via an in-situ heat treatment combining selective laser melting and substrate plate heating

Publication date: 15 September 2017
Source:Materials & Design, Volume 130
Author(s): Holger Schwab, Matthias Bönisch, Lars Giebeler, Tobias Gustmann, Jürgen Eckert, Uta Kühn
In this study the Ti-based alloy Ti-5Al-5V-5Mo-3Cr (wt%) was processed using selective laser melting (SLM) while keeping the substrate plate at a constant temperature of 500°C. Cubic samples were successfully fabricated with a relative density of about 99%. Their microstructures were analysed and correlated with the mechanical properties and compared with the fabrication state of non-heated selective laser melted Ti-5553. Investigations by XRD, SEM and TEM revealed the formation of a microstructure composed of a β-phase matrix and finely dispersed α-phase plates when heating was conducted. The microstructure critically depends on the thermal history and was found to have a pronounced influence on the mechanical behaviour. The mechanical properties of the heated specimens showed an enhanced compressive strength of about 1600MPa while the deformability remained relatively high. These results demonstrate that selective laser melting is capable of creating bulk parts with improved mechanical by precipitation hardening realized by applying an additional substrate heating during the process.

Graphical abstract

http://ift.tt/2rN5h03

Social Fear Learning: from Animal Models to Human Function

Publication date: Available online 22 May 2017
Source:Trends in Cognitive Sciences
Author(s): Jacek Debiec, Andreas Olsson
Learning about potential threats is critical for survival. Learned fear responses are acquired either through direct experiences or indirectly through social transmission. Social fear learning (SFL), also known as vicarious fear learning, is a paradigm successfully used for studying the transmission of threat information between individuals. Animal and human studies have begun to elucidate the behavioral, neural and molecular mechanisms of SFL. Recent research suggests that social learning mechanisms underlie a wide range of adaptive and maladaptive phenomena, from supporting flexible avoidance in dynamic environments to intergenerational transmission of trauma and anxiety disorders. This review discusses recent advances in SFL studies and their implications for basic, social and clinical sciences.



http://ift.tt/2rbflno

Application of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2)

Publication date: Available online 22 May 2017
Source:Academic Radiology
Author(s): Frank Chen, Steven Cen, Suzanne Palmer
Rationale and ObjectivesTo evaluate interobserver agreement with the use of and the positive predictive value (PPV) of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) for the localization of intermediate- and high-grade prostate cancers on multiparametric magnetic resonance imaging (mpMRI).Materials and MethodsIn this retrospective, institutional review board-approved study, 131 consecutive patients who had mpMRI followed by transrectal ultrasound-MR imaging fusion-guided biopsy of the prostate were included. Two readers who were blinded to initial mpMRI reports, clinical data, and pathologic outcomes reviewed the MR images, identified all prostate lesions, and scored each lesion based on the PI-RADS v2. Interobserver agreement was assessed by intraclass correlation coefficient (ICC), and PPV was calculated for each PI-RADS category.ResultsPI-RADS v2 was found to have a moderate level of interobserver agreement between two readers of varying experience, with ICC of 0.74, 0.72, and 0.67 for all lesions, peripheral zone lesions, and transitional zone lesions, respectively. Despite only moderate interobserver agreement, the calculated PPV in the detection of intermediate- and high-grade prostate cancers for each PI-RADS category was very similar between the two readers, with approximate PPV of 0%, 12%, 64%, and 87% for PI-RADS categories 2, 3, 4, and 5, respectively.ConclusionsIn our study, PI-RADS v2 has only moderate interobserver agreement, a similar finding in studies of the original PI-RADS and in initial studies of PI-RADS v2. Despite this, PI-RADS v2 appears to be a useful system to predict significant prostate cancer, with PI-RADS scores correlating well with the likelihood of intermediate- and high-grade cancers.



http://ift.tt/2rbnSa6

Analysis of surgical results and of residual postoperative deformities in preaxial polydactyly of the hand

Polydactyly is the most common congenital anomaly of the hand. It may occur as a separate event or as part of a syndrome, with preaxial polydactyly of the hand (or thumb duplication) being the most common among Caucasians. The present study analyzed the surgical results and the residual postoperative deformities of patients with thumb duplication.

http://ift.tt/2rbbS8k

Platelet-Rich Fibrin Conduits as an Alternative to Nerve Autografts for Peripheral Nerve Repair

J reconstr Microsurg
DOI: 10.1055/s-0037-1603355

Background Peripheral nerves have limited regeneration capacity despite best efforts. Platelet-rich fibrin (PRF) contains growth factors that may stimulate peripheral nerve regeneration. This study verified whether nerve regeneration using autogenous vein conduits filled with PRF is comparable to autologous nerve graft, which is the standard treatment. Methods The sciatic nerve of the right paw of inbred rats was dissected, and a 10-mm segment was removed from rats randomized to receive autologous nerve graft (GRAFT) or vein conduit filled with PRF (PRF). A third group (SHAM) underwent surgery without nerve resection. The sciatic functional index (SFI) was measured 0, 30, 60, and 90 days postsurgery. Morphometry and morphology of the distal nerve injury were examined. Motor neurons in the anterior horn of spinal cord stained with FluoroGold and counted. Results No significant difference in SFI was observed between the GRAFT and PRF groups at any time point (all p > 0.05); however, SFI was lower in both groups compared with SHAM (p < 0.05). Morphometric and morphologic indexes were not significantly different between the GRAFT and PRF groups (p > 0.05); however, nerve fibers, axons, and myelin sheaths were thinner in both groups compared with SHAM (p = 0.0001). Average motor neurons' count was similar between the GRAFT and PRF groups (p = 0.91); the count was lower in both groups compared with SHAM (p = 0.002 and p = 0.001), respectively. Conclusion Autologous nerve GRAFT and PRF-filled autogenous vein conduits were associated with similar outcomes, and worse than those observed in SHAM controls. Vein conduits filled with PRF may be a favorable alternative treatment to nerve grafts.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2rJW61g

The Use of Antibiotic Beads to Salvage the Infected Breast Implant

When an implant becomes infected, implant salvage is often performed where the implant is removed, capsulectomy is performed, and a new implant is inserted. The patient is discharged with a PICC line and 6-8 weeks of IV antibiotics. This method has variable success and subjects the patient to long-term systemic antibiotics. In the 1960s, the use of antibiotic-impregnated beads for the treatment of chronic osteomyelitis was described. These beads deliver antibiotic directly to the site of the infection, thereby eliminating the complications of systemic IV antibiotics.

http://ift.tt/2qPZqYL

Does negative pressure wound therapy influence subjacent bacterial growth? A systematic review

Negative pressure wound therapy is a ubiquitous wound management resource. The influence of NPWT on the bacterial bioburden of the subjacent wound remains unclear. We sought to examine the evidence.

http://ift.tt/2q4Ywu8

An Analysis of the Operative Experience of Plastic Surgery Trainees in the United Kingdom Using eLogbook

We performed a comprehensive analysis of the operative experience of UK Plastic Surgery Trainees using the web-based eLogbook.

http://ift.tt/2rb0ysM

Studying the blood pressures of antegrade and retrograde internal mammary vessels: Do they really work as recipient vessels?

The proximal ends of the internal mammary (IM) vessels are now the most common recipient vessels for breast reconstruction. On the other hand, bilateral deep inferior epigastric artery perforator (DIEP) flaps are often needed according to the territory and the volume needed for reconstruction. The usefulness of retrograde IM vessels as second recipients has recently been reported, but there are very few quantitative studies on the hydrodynamics of the retrograde IM vessels. Since the flow is dependent on the pressure differential, the blood pressures of the antegrade IM artery (AIMA), antegrade IM vein (AIMV), retrograde IM artery (RIMA), retrograde IM vein (RIMV), and the recirculated intraflap vein (FV) were investigated to solve this question and confirm the reliability and usefulness of retrograde IM vessels.

http://ift.tt/2rKzH4a

Commentary: Cubital tunnel syndrome caused by intraneural or extraneural ganglion cysts-case report and review of the literature

Chang et al. describe 16 patients with extraneural ganglion cysts and 3 with intraneural ganglion cysts among their cohort of 184 consecutive patients with cubital tunnel syndrome. The authors do an admirable job of recognizing a connection to the elbow joint in each case. Despite the juxta-articular location of these cysts, many of these in the literature are still thought not to arise from the elbow joint. The finding that all patients with ganglion cysts had osteoarthritis of the elbow is reminiscent of the findings reported for peroneal extraneural and intraneural cysts arising from a degenerative superior tibiofibular joint (STFJ).

http://ift.tt/2rb0wRG

Composite breast reconstruction: implant-based breast reconstruction with adjunctive lipofilling

Options for breast reconstructions enclose autologous tissue transfers or implants. Fat grafting is gaining more interest in this specific field of breast surgery. This study concentrates on the technique and aesthetic results of breast reconstruction with fat grafts combined with implants, in women who have undergone total mastectomy.

http://ift.tt/2rKe2ZO

Re: Facial expression drawings and the full cup test: valid tools for the measurement of swelling after dental surgery

Al-Samman and Othman1 investigated the use of facial expression drawings and the "full cup test" to evaluate swelling postoperatively. As the corresponding author of one the studies they cited,2 and because their results differed from ours, I would like to add to the discussion.

http://ift.tt/2qeegGz

Re: re: Facial expression drawings and the full cup test: valid tools for the measurement of swelling after dental surgery

As the corresponding author of "Facial expression drawings and the full cup test: valid tools for the measurement of swelling after dental surgery"1 I would like reply to a letter from Isik et al.2

http://ift.tt/2qJl7eB

Myostatin-like proteins regulate synaptic function and neuronal morphology [RESEARCH ARTICLE]

Hrvoje Augustin, Kieran McGourty, Joern R. Steinert, Helena M. Cocheme, Jennifer Adcott, Melissa Cabecinha, Alec Vincent, Els F. Halff, Josef T. Kittler, Emmanuel Boucrot, and Linda Partridge

Growth factors of the TGF-β superfamily play key roles in regulating neuronal and muscle function. Myostatin (or GDF8) and GDF11 are potent negative regulators of skeletal muscle mass. However, expression of both Myostatin and its cognate receptors in other tissues, including brain and peripheral nerves, suggests a potential wider biological role. Here, we show that Myoglianin (MYO), the Drosophila homolog of Myostatin and GDF11, regulates not only body weight and muscle size, but also inhibits neuromuscular synapse strength and composition in a Smad2-dependent manner. Both Myostatin and GDF11 affected synapse formation in isolated rat cortical neuron cultures, suggesting an effect on synaptogenesis beyond neuromuscular junctions. We also show that Myoglianin acts in vivo to inhibit synaptic transmission between neurons in the escape response neural circuit of adult flies. Thus, these anti-myogenic proteins act as important inhibitors of synapse function and neuronal growth.

http://ift.tt/2qJzaAV

Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure.

Author: Uriel, Nir MD *; Colombo, Paolo C. MD; Cleveland, Joseph C. MD *; Long, James W. MD; Salerno, Christopher MD; Goldstein, Daniel J. MD *; Patel, Chetan B. MD; Ewald, Gregory A. MD; Tatooles, Antone J. MD; Silvestry, Scott C. MD; John, Ranjit MD; Caldeira, Christiano MD; Jeevanandam, Valluvan MD; Boyle, Andrew J. MD; Sundareswaran, Kartik S. PhD; Sood, Poornima MD; Mehra, Mandeep R. MD *

Page: 2003-2012

http://ift.tt/2rKw0vd

Plasma Ceramides, Mediterranean Diet, and Incident Cardiovascular Disease in the PREDIMED Trial (Prevencion con Dieta Mediterranea).

Author: Wang, Dong D. MD, ScD; Toledo, Estefania MD, PhD; Hruby, Adela PhD; Rosner, Bernard A. PhD; Willett, Walter C. MD, DrPH; Sun, Qi MD, ScD; Razquin, Cristina PhD; Zheng, Yan MD, PhD; Ruiz-Canela, Miguel PhD; Guasch-Ferre, Marta PhD; Corella, Dolores MD, PhD; Gomez-Gracia, Enrique MD, PhD; Fiol, Miquel MD, PhD; Estruch, Ramon MD, PhD; Ros, Emilio MD, PhD; Lapetra, Jose MD, PhD; Fito, Montserrat MD, PhD; Aros, Fernando MD, PhD; Serra-Majem, Luis MD, PhD; Lee, Chih-Hao PhD; Clish, Clary B. PhD; Liang, Liming PhD; Salas-Salvado, Jordi MD, PhD; Martinez-Gonzalez, Miguel A. MD, PhD; Hu, Frank B. MD, PhD

Page: 2028-2040

http://ift.tt/2rboEDV

Should a Reduction in All-Cause Mortality Be the Goal When Assessing Preventive Medical Therapies?.

Author: Sasieni, Peter D. PhD; Wald, Nicholas J. MB BS, DSc(Med), FRS

Page: 1985-1987

http://ift.tt/2rbpjVY

Insurance and Cardiovascular Health: Time for Evidence to Trump Politics.

Author: Wadhera, Rishi K. MD, MPhil; Joynt, Karen E. MD, MPH

Page: 1988-1990

http://ift.tt/2rKdtyV

Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use.

Author: Baggish, Aaron L. MD, MPH; Weiner, Rory B. MD; Kanayama, Gen MD, PhD; Hudson, James I. MD, ScD; Lu, Michael T. MD; Hoffmann, Udo MD, MPH; Pope, Harrison G. Jr MD, MPH

Page: 1991-2002

http://ift.tt/2rbkdJi

Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement.

Author: Shimura, Tetsuro MD; Yamamoto, Masanori MD; Kano, Seiji MD; Kagase, Ai MD; Kodama, Atsuko MD; Koyama, Yutaka MD; Tsuchikane, Etsuo MD; Suzuki, Takahiko MD; Otsuka, Toshiaki MD; Kohsaka, Shun MD; Tada, Norio MD; Yamanaka, Futoshi MD; Naganuma, Toru MD; Araki, Motoharu MD; Shirai, Shinichi MD; Watanabe, Yusuke MD; Hayashida, Kentaro MD; On behalf of the OCEAN-TAVI Investigators

Page: 2013-2024

http://ift.tt/2rbpukd

The Clinical Frailty Scale: Upgrade Your Eyeball Test.

Author: Afilalo, Jonathan MD, MSc

Page: 2025-2027

http://ift.tt/2rKdqmJ

Cardiac Fibroblast-Specific Activating Transcription Factor 3 Protects Against Heart Failure by Suppressing MAP2K3-p38 Signaling.

Author: Li, Yulin PhD; Li, Zhenya PhD; Zhang, Congcong PhD; Li, Ping MD; Wu, Yina PhD; Wang, Chunxiao PhD; Bond Lau, Wayne MD; Ma, Xin-liang MD, PhD; Du, Jie PhD

Page: 2041-2057

http://ift.tt/2rKwXnc

Putting the Brakes on Hypertensive Remodeling: An ATF3 Mechanism of Myofibroblast Restraint.

Author: Davis, Jennifer PhD

Page: 2058-2061

http://ift.tt/2rbk8W0

Evaluating the Cardiovascular Safety of Nonsteroidal Anti-Inflammatory Drugs.

Author: Antman, Elliott M. MD

Page: 2062-2072

http://ift.tt/2rKbUBl

Electrocardiogram Challenge Syncope in a Woman With Nausea and Diarrhea.

Author: De Puy, Federico MD; Kay, G. Neal MD

Page: 2073-2076

http://ift.tt/2rbbiHY

Scope of Sacubitril/Valsartan Eligibility After Heart Failure Hospitalization: Findings From the GWTG-HF Registry (Get With The Guidelines-Heart Failure).

Author: Parikh, Kishan S. MD; Lippmann, Steven J. PhD; Greiner, Melissa MS; Heidenreich, Paul A. MD, MS; Yancy, Clyde W. MD, MSc; Fonarow, Gregg C. MD; Hernandez, Adrian F. MD, MHS

Page: 2077-2080

http://ift.tt/2rKbScH

Slower Progress of Aortic Valve Calcification With Vitamin K Supplementation: Results From a Prospective Interventional Proof-of-Concept Study.

Author: Brandenburg, Vincent M. MD; Reinartz, Sebastian MD; Kaesler, Nadine PhD; Kruger, Thilo MD; Dirrichs, Tim MD; Kramann, Rafael MD, PhD; Peeters, Frederique MD; Floege, Jurgen MD; Keszei, Andras PhD; Marx, Nikolaus MD; Schurgers, Leon J. PhD *; Koos, Ralf MD *

Page: 2081-2083

http://ift.tt/2rbrWqB

Letter by Brophy Regarding Article, "ImPRECISION: Limitations to Interpretation of a Large Randomized Clinical Trial".

Author: Brophy, James M. MEng, MD, PhD

Page: e1052-e1053

http://ift.tt/2qPbTOu

A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation

The objective was to test the hypothesis of no difference in long-term (≥5 years) implant treatment outcomes after maxillary sinus floor augmentation (MSFA) with autogenous bone graft compared to a mixture of autogenous bone graft and bone substitutes or bone substitutes alone. A MEDLINE (PubMed), Embase, and Cochrane Library search in combination with a hand-search of relevant journals was conducted. Human studies published in English between January 1, 1990 and October 1, 2016 were included. Nine studies fulfilled the inclusion criteria.

http://ift.tt/2qP48rK

The accuracy of three-dimensional prediction of soft tissue changes following the surgical correction of facial asymmetry: An innovative concept

The accuracy of three-dimensional (3D) predictions of soft tissue changes in the surgical correction of facial asymmetry was evaluated in this study. Preoperative (T1) and 6–12-month postoperative (T2) cone beam computed tomography scans of 13 patients were studied. All patients underwent surgical correction of facial asymmetry as part of a multidisciplinary treatment protocol. The magnitude of the surgical movement was measured; virtual surgery was performed on the preoperative scans using Maxilim software.

http://ift.tt/2rN2nIE

Manipulation of visual information affects control strategy during a visuomotor tracking task

Publication date: 30 June 2017
Source:Behavioural Brain Research, Volume 329
Author(s): Paulina J.M. Bank, Lucas R.M. Dobbe, Carel G.M. Meskers, Jurriaan H. de Groot, Erwin de Vlugt
Proper understanding of motor control requires insight into the extent and manner in which task performance and control strategy are influenced by various aspects of visual information. We therefore systematically manipulated the visual presentation (i.e., scaling factor and optical flow density) of a visuomotor tracking task without changing the task itself, and investigated the effect on performance, effort, motor control strategy (i.e., anticipatory or corrective steering) and underlying neuromechanical parameters (i.e., intrinsic muscle stiffness and damping, and proprioceptive and visual feedback). Twenty healthy participants controlled the left-right position of a virtual car (by means of wrist rotations in a haptic robot) to track a slightly curved virtual road (presented on a 60" LED screen), while small torque perturbations were applied to the wrist (1.25–20Hz multisine) for quantification of the neuromechanical parameters. This visuomotor tracking task was performed in conditions with low/medium/high scaling factor and low/high optical flow density. Task performance was high in all conditions (tracking accuracy 96.6%–100%); a higher scaling factor was associated with slightly better performance. As expected, participants did adapt their control strategy and the use of proprioceptive and visual feedback in response to changes in the visual presentation. These findings indicate that effects of visual representation on motor behavior should be taken into consideration in designing, interpreting and comparing experiments on motor control in health and disease. In future studies, these insights might be exploited to assess the sensory-motor adaptability in various clinical conditions.



http://ift.tt/2rKu9qa

Editorial Board

Publication date: March 2017
Source:Artificial Intelligence in Medicine, Volume 77





http://ift.tt/2q535Vg

IGF1 stimulates greater muscle hypertrophy in the absence of myostatin in male mice

Insulin-like growth factors (IGFs) and myostatin have opposing roles in regulating the growth and size of skeletal muscle, with IGF1 stimulating, and myostatin inhibiting, growth. However, it remains unclear whether these proteins have mutually dependent, or independent, roles. To clarify this issue, we crossed myostatin null (Mstn-/-) mice with mice over-expressing Igf1 in skeletal muscle (Igf1+) to generate six genotypes of male mice; wild-type (Mstn+/+), Mstn+/-, Mstn-/-, Mstn+/+:Igf1+, Mstn+/-:Igf1+ and Mstn-/-:Igf1+. Over-expression of Igf1 increased the mass of mixed fiber type muscles (e.g. Quadriceps femoris) by 19% over Mstn+/+, 33% over Mstn+/- and 49% over Mstn-/- (P < 0.001). By contrast, the mass of the gonadal fat pad was correspondingly reduced with removal of Mstn and addition of Igf1. Myostatin regulated the number, while IGF1 regulated the size of myofibres, and deletion of Mstn and Igf1+ independently increased the proportion of fast type IIB myosin heavy chain isoforms in T. anterior (up to 10% each, P < 0.001). The abundance of Akt and rpS6 were increased in muscles of Mstn-/- mice, while phosphorylation of AktS473 was increased in Igf1+ mice (Mstn+/+:Igf1+, Mstn+/-:Igf1+ and Mstn-/-:Igf1+). Our results demonstrate that a greater than additive effect is observed on the growth of skeletal muscle and in the reduction of body fat when myostatin is absent and IGF1 is in excess. Finally, we show that myostatin and IGF1 regulate skeletal muscle size, myofibre type, and gonadal fat through distinct mechanisms that involve increasing the total abundance and phosphorylation status of Akt and rpS6.

http://ift.tt/2rKc2R9

Paternal hyperglycemia in rats exacerbates the development of obesity in offspring

Parental history with obesity or diabetes will increase the risk for developing metabolic diseases in offspring. However, literatures as to transgenerational inheritance of metabolic dysfunctions through male lineage are relatively scarce. In current study, we aimed to evaluate influences of paternal hyperglycemia on metabolic phenotypes in offspring. Male SD rats were ip injected with streptozotocin (STZ) or citrate buffer (CB, as control). STZ-injected rats with glucose levels higher than 16 mM were selected to breed with normal female rats. Offspring from STZ or CB treated fathers (STZ-O and CB-O) were maintained in the identical condition. We monitored body weight and food intake, and tests of glucose and insulin tolerance (GTTs and ITTs), fasting-refeeding and cold exposure were performed. Expression of factors involved in hypothalamic feeding and brown adipose tissue (BAT) thermogenic activity was performed by real-time PCR and Western blot. Adult STZ-O were heavier than CB-O. Impairment of GTTs was observed in STZ-O compared with CB-O at the 22- and 32-weeks of age; ITTs results showed decreased insulin sensitivity in STZ-O. Daily food intake and accumulated food intake during 12-hr refeeding after fasting were significantly higher in STZ-O. UCP1 levels were down-regulated in BAT from STZ-O at room temperature and cold exposure. Finally, STZ-O rats showed suppressed leptin signaling in the hypothalamus as evidenced by upregulated SOCS3, reduced phosphorylation of STAT3, impaired processing POMC and decreased α-MSH production. Our study revealed that paternal hyperglycemia predisposes offspring to developing obesity, which is possibly associated with impaired hypothalamic leptin signaling.

http://ift.tt/2rbGiY2

Mineralocorticoid receptor activation and specificity-conferring mechanisms: a short history

The mineralocorticoid receptor (henceforth MR) was first characterized 45 years ago (Funder 1972, Rousseau 1972), a decade and a half before its successful cloning (Arriza 1987) to which this issue of the Journal is dedicated. Aldosterone had been isolated and characterized 20 years before the MR: its initial name was electrocortin, reflecting its ability to promote electrolyte transport across epithelial membranes, rapidly changed to its familiar, current name aldosterone. What prompted the change was the finding of a unique aldehyde group at carbon18 of the steroid molecule, the physiological significance of which only became clear many years later (Funder 1988, Edwards 1988).

http://ift.tt/2rKJCX9

Airway stenting in a child with spondyloepiphyseal dysplasia congenita: 13-year survival

We describe the case of a boy with spondyloepiphyseal dysplasia congenita. At birth, he experienced severe respiratory distress necessitating tracheotomy. Endoscopy done because mechanical ventilation failed to resolve desaturations disclosed severe tracheo-bronchomalacia. A Polyflex silicone stent was placed in the trachea (replaced by Y-Dumon stent) and 2 Palmaz metallic stents in the mainstem bronchi (overlapped with 2 Jomed stents 5 years later). Airway stenting guaranteed a suitable respiratory status and allowed a child who was expected to die at birth, to reach 13.5 years old in good conditions.

http://ift.tt/2rbbIhi

Uncovering the pathogenesis of microtia using bioinformatics approach

Bioinformatics is widely used in the field of cancer research, but in the research of pathogenesis of congenital malformations the situation is different. The aim of this study was to explore the underlying mechanism using bioinformatics approach.

http://ift.tt/2rKfag0

Relationship between various anthropometric measures and apnea-hypopnea index in Korean men

Publication date: Available online 22 May 2017
Source:Auris Nasus Larynx
Author(s): Jeong-Hong Kim, Yong Cheol Koo, Hyung Ju Cho, Ju Wan Kang
ObjectiveBody mass index (BMI) has been shown to be strongly correlated with severity of OSA. However, BMI has not been shown to be correlated with sleep apnea in all patients studied. The purpose of this study was to evaluate the relationship between various anthropometric measures and severity of OSA according to BMI in men.MethodsWe conducted a retrospective analysis of the medical records of patients who visited for evaluation of OSA. Polysomnography results, height, weight, neck circumference, waist circumference, and hip circumference were obtained in all subjects. BMI, body adiposity index, waist to hip ratio, and waist to height ratio were also calculated.ResultsA total of 195 male participants were included in the final analysis. BMI showed the strongest correlation with AHI in all subjects. In 125 participants with a BMI of 25 or more, BMI was most strongly correlated with high AHI compared to other measurements. However, waist to hip ratio showed the strongest correlation with AHI in 70 participants with a BMI of less than 25 and, in this group, BMI did not show significant correlation with AHI.ConclusionConsiderations about anthropometric measurements in OSA patients should differ according to degree of obesity or BMI.



http://ift.tt/2qJeitt

Risk factors for lymph node metastases of facial cutaneous squamous cell carcinoma

Determining the risk factors for lymph node metastases of facial cutaneous squamous cell carcinoma and identifying their value for predicting nodal spread.

http://ift.tt/2qQ01cX

Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly

Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values.

http://ift.tt/2q4wDCN

mTOR signaling in the differentiation and function of regulatory and effector T cells

Hu Zeng | Hongbo Chi

http://ift.tt/2rKiwzz

Properties of the tapasin homologue TAPBPR

Andreas Neerincx | Louise H Boyle

http://ift.tt/2rb8Kt6

The ongoing saga of the mechanism(s) of MHC class I-restricted cross-presentation

Jeff E Grotzke | Debrup Sengupta | Qiao Lu | Peter Cresswell

http://ift.tt/2rKeSpv

Metabolic signatures of T-cells and macrophages in rheumatoid arthritis

Cornelia M Weyand | Markus Zeisbrich | Jörg J Goronzy

http://ift.tt/2rKeHu0

Traumapatienten: niedrigere Mortalität unter NOAKs als unter Warfarin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 319-320
DOI: 10.1055/s-0043-105635

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2ruQyKO

Pssst … AINS-Secrets: Heute aus der Traumatologie und Orthopädie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 382-386
DOI: 10.1055/s-0042-101659

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2qb9hHm

Immer wichtiger in Zeiten der Multiresistenz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 322-322
DOI: 10.1055/s-0042-122774

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2ruvww4

Wiederaufnahme auf die Intensivstation taugt nicht als Prognosekriterium

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 317-317
DOI: 10.1055/s-0043-109144

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Präoperative Vorbereitung: Optimierung pulmonaler Erkrankungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 356-366
DOI: 10.1055/s-0042-108926

Lungenerkrankungen wie COPD oder Asthma sind bedeutende Risikofaktoren perioperativer pulmonaler Komplikationen. Die Optimierung dieser Erkrankungen ist deshalb wichtiger Bestandteil des präoperativen Managements. Das Wissen um die Pathophysiologie und medikamentöse Therapie ist dabei essenziell.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2ruRT49

Vibrationstraining zur Verbesserung der Critical-Illness-Myopathie?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 317-318
DOI: 10.1055/s-0043-109145

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2ruRTkF

Präoperative Vorbereitung: Patient Blood Management – Was ist optimal?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 326-340
DOI: 10.1055/s-0042-108925

Patient Blood Management (PBM) fokussiert auf ein umfassendes Anämiemanagement, die Minimierung (unnötiger) iatrogener Blutverluste und die Ausschöpfung der natürlichen Anämietoleranz mit rationalem Einsatz von Erythrozytenkonzentrat-Transfusionen. Im Mittelpunkt des aktuellen Beitrags stehen die in der präoperativen Phase entscheidenden PBM-Komponenten: Management einer Anämie, prätransfusionelle Vorbereitungen und Management von Antikoagulanzien. Die präoperative Anämie ist ein unabhängiger Risikofaktor für eine erhöhte perioperative Morbidität und Sterblichkeit. Zum frühestmöglichen Zeitpunkt sollte daher vor elektiven Eingriffen die Ursachen der Anämie abgeklärt und bei behandelbaren Ursachen der Anämie eine spezifische Behandlung eingeleitet werden. Die präoperative prätransfusionelle Analytik sollte in Abhängigkeit von der Transfusionswahrscheinlichkeit (und dem Ausgangshämoglobinwert) einem Stufenkonzept folgen und aktuelle hausinterne Daten berücksichtigen. Im Umgang mit (oralen) Antikoagulanzien sollte bereits in der präoperativen Phase eine individuelle Risikostratifizierung erfolgen. Anhand des individuellen Blutungs- und Thromboembolierisikos wird sodann entschieden, ob die Medikation fortgeführt, pausiert oder überbrückt werden muss. Ohne klar definierte Verantwortlichkeiten im präoperativen PBM-Team, Kommunikation und Schulung aller Beteiligten ist langfristig kein Erfolg des präoperativen PBM-Programms zu erwarten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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ECMO-Therapie: Langzeitüberleben bei respiratorischem Versagen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 318-319
DOI: 10.1055/s-0043-109143

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2rv4lkJ

Kasuistik: ECMO-Einsatz bei hyperkapnischer Hirndruckkrise

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 376-381
DOI: 10.1055/s-0043-103506

Unter der Geburt trübte sich bei einer 29-jährigen Patientin die Vigilanz progredient bis zum Koma. Grund war eine schwere Hirnblutung als Komplikation eines bis dahin nicht erkennbaren HELLP-Syndroms. Nach der zerebralen OP entwickelte die Patientin aggravierend ein schweres ARDS mit Hyperkapnie und kritischem Anstieg des intrakraniellen Druckes. Trotz Kontraindikation war eine ECMO-Therapie für insgesamt 31 Tage letztlich erfolgreich.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2ruWLq5

Präoperative Vorbereitung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 324-325
DOI: 10.1055/s-0043-108751

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Infusionsmenge korreliert mit interstitieller Flüssigkeitsansammlung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 320-321
DOI: 10.1055/s-0043-108530

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Präoperative Vorbereitung und Evaluation: der ältere Patient

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 342-355
DOI: 10.1055/s-0042-109286

Aufgrund der steigenden Lebenserwartung müssen sich heutzutage immer mehr ältere und hochbetagte Patienten einer Operation unterziehen – eine Herausforderung für die Chirurgie und insbesondere für die Anästhesiologie. Dieser Beitrag beschreibt, wie altersbedingte Besonderheiten präoperativ erfasst und entsprechende Maßnahmen eingeleitet werden können, um das Risiko der postoperativen Morbidität – oder gar Pflegebedürftigkeit – zu verringern.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Guter Einstieg

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 322-322
DOI: 10.1055/s-0042-108793

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Akutschmerztherapie bei Appendektomie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 367-374
DOI: 10.1055/s-0043-104599

Schmerztherapie spielt in der Chirurgie eine zentrale Rolle. Eine strukturierte Akutschmerztherapie verbessert unmittelbar die Lebensqualität, senkt mittelfristig die Morbidität und verhindert langfristig eine Schmerzchronifizierung – bei deutlichen ökonomischen Vorteilen wie reduzierter Krankenhausverweildauer und kürzerem Krankenstand. Diese 4 Aspekte werden oft und gerade bei scheinbar „kleinen Operationen" stiefmütterlich behandelt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2qbcFSM

Masterplan Medizinstudium 2020

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 313-313
DOI: 10.1055/s-0043-109409

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2rvePk6

Composites make the heart beat better

Publication date: Available online 22 May 2017
Source:Materials Today
Author(s): Cordelia Sealy




http://ift.tt/2rb75nu

Dopants go against the grain in ceramics

Publication date: Available online 22 May 2017
Source:Materials Today
Author(s): Cordelia Sealy




http://ift.tt/2rK8tup

Simple solution to making nanowires on the cheap

Publication date: Available online 22 May 2017
Source:Materials Today
Author(s): Cordelia Sealy




http://ift.tt/2rbb7Mr

Hey sucker!

Publication date: Available online 22 May 2017
Source:Materials Today
Author(s): David Bradley




http://ift.tt/2rK9XEY

Nanoscale fibers get drug delivery just right

Publication date: Available online 22 May 2017
Source:Materials Today
Author(s): Cordelia Sealy




http://ift.tt/2rbmBjp

"I feel my arm shaking": Partial cataplexy mistaken for drug-resistant focal epilepsy

There is often a considerable delay in the diagnosis of narcolepsy1,2. This is partly due to the insidious nature of disease onset and incomplete presence of characteristic symptoms2. Moreover, narcolepsy may mimic other neurological diseases (in particular, epilepsy) due to the presence of paroxysmal events3. Epilepsy, which is much more prevalent, might thus appear as a straightforward diagnosis, especially if the symptoms are focal and associated with abnormal movements or jerks.table 1.

http://ift.tt/2rN3t7o

Immer wichtiger in Zeiten der Multiresistenz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 322-322
DOI: 10.1055/s-0042-122774

Georg Thieme Verlag KG Stuttgart · New York

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Wiederaufnahme auf die Intensivstation taugt nicht als Prognosekriterium

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 317-317
DOI: 10.1055/s-0043-109144

Georg Thieme Verlag KG Stuttgart · New York

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Präoperative Vorbereitung: Optimierung pulmonaler Erkrankungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 356-366
DOI: 10.1055/s-0042-108926

Lungenerkrankungen wie COPD oder Asthma sind bedeutende Risikofaktoren perioperativer pulmonaler Komplikationen. Die Optimierung dieser Erkrankungen ist deshalb wichtiger Bestandteil des präoperativen Managements. Das Wissen um die Pathophysiologie und medikamentöse Therapie ist dabei essenziell.
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Georg Thieme Verlag KG Stuttgart · New York

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