Head and Neck Diseases by Alexandros G.Sfakianakis: 06/09/17

Παρασκευή 9 Ιουνίου 2017

Drill-induced Cochlear Injury During Otologic Surgery: Intracochlear Pressure Evidence of Acoustic Trauma.

Hypothesis: Drilling on the incus produces intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli. Background: New-onset sensorineural hearing loss (SNHL) following mastoid surgery can occur secondary to inadvertent drilling on the ossicular chain. To investigate this, we test the hypothesis that high sound pressure levels are generated when a high-speed drill contacts the incus. Methods: Human cadaveric heads underwent mastoidectomy, and fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures (PIC). Stapes velocities (Vstap) were measured using single-axis laser Doppler vibrometry. PIC and Vstap were measured while drilling on the incus. Four-millimeter diamond and cutting burrs were used at drill speeds of 20k, 50k, and 80k Hz. Results: No differences in peak equivalent ear canal noise exposures (134-165 dB SPL) were seen between drill speeds or burr types. Root-mean-square PIC amplitude calculated in third-octave bandwidths around 0.5, 1, 2, 4, and 8 kHz revealed equivalent ear canal (EAC) pressures up to 110 to 112 dB SPL. A statistically significant trend toward increasing noise exposure with decreasing drill speed was seen. No significant differences were noted between burr types. Calculations of equivalent EAC pressure from Vstap were significantly higher at 101 to 116 dB SPL. Conclusion: Our results suggest that incidental drilling on the ossicular chain can generate PIC comparable to high-intensity acoustic stimulation. Drill speed, but not burr type, significantly affected the magnitude of PIC. Inadvertent drilling on the ossicular chain produces intense cochlear stimulation that could cause SNHL. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Subjective Visual Vertical in Idiopathic Bilateral Vestibular Hypofunction: Enhanced Role of Vision, Neck, and Body Proprioception.

Introduction: We aimed to study the participation of proprioceptive and visual inputs in subjective visual vertical (SVV) in bilateral vestibular hypofunction and in normal subjects. Study Design: Prospective case-control study. Setting: Tertiary referral center. Materials and Methods: SVV (six replicates) was measured on a tiltable rehabilitation seat in 26 adult patients with idiopathic bilateral vestibular hypofunction (IBVH) and 33 adult controls. Subjects were asked to place vertically a 45 degrees-tilted red line on a screen (three replicates to left and three to right alternatively) using a remote control in total darkness and in seven body positions: vertical, head, and body left- and right-tilts to 12 and 24 degrees, and then body left- and right-tilt to 24 degrees with the head upright. Results: In the vertical position, SVV did not differ between IBVH and controls. Patients with IBVH were more sensitive to body tilt than controls (SVV: -8.1 +/- 4.66 degrees for IBVH versus -0.2 +/- 3.23 for control at 24 degrees body and head left-tilt, p

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Diagnostic performance of 18fluorodesoxyglucose positron emission/computed tomography and magnetic resonance imaging in detecting T1-T2 head and neck squamous cell carcinoma

Objectives/Hypothesis

The aim of this study was to assess and compare the diagnostic accuracy of ¹⁸fluorodesoxyglucose positron emission/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) to detect T1-T2 head and neck squamous cell carcinoma (HNSCC).

Study Design

Prospective case series.

Methods

Thirty-five consecutive patients with histologically proven T1-T2 HNSCC were prospectively included. All patients underwent pretherapeutic FDG-PET/CT and MRI. Two nuclear medicine physicians and 2 radiologists blindly reviewed all FDG-PET/CT and MRI, respectively. A five-point qualitative scale was used to estimate tumor detection ability. Sensitivity of each modality was compared together using a McNemar test. Interobserver variability was assessed by kappa index (κ) of Cohen statistics. Maximal standardized uptake value (SUV_MAX), metabolic tumor volume (MTV) in FDG-PET/CT, and gadolinium enhancement (%GE) in MRI of each tumor were recorded and compared with T stage using a Mann-Whitney test. Tumor-to-normal tissue ratios in FDG-PET/CT and MRI (TNR_PET and TNR_MRI) were calculated and compared together using a Student t test.

Results

Among the 35 primary tumors, 29 were detected by FDG-PET/CT and 22 by MRI. MRI detected none of the six lesions incorrectly identified by FDG-PET/CT. FDG-PET/CT correctly identified seven of the 13 MRI false-negative results. Sensitivity of FDG-PET/CT to detect T1-T2 HNSCC was significantly higher than MRI (83% vs. 63%, P = .015). T stage was significantly correlated with MTV (P = .002) unlike with SUV_MAX (P = .06) and %GE (P = .70). TNR_PET was significantly higher than TNR_MRI (3.5 ± 3.2 vs. 1.2 ± 0.3, P < .0001).

Conclusions

Our study showed a higher diagnostic accuracy of FDG-PET/CT than MRI to detect T1-T2 HNSCC with a good interobserver agreement.

Level of Evidence

4 Laryngoscope, 2017

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Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis

Objectives

The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia.

Data Sources

PubMed, Embase, Cochrane, and Scopus databases.

Review Methods

A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created.

Results

The combined sensitivity of five studies (n = 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n = 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97).

Conclusions

The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery. Laryngoscope, 2017

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Social media presence of otolaryngology journals: The past, present, and future

Objectives/Hypothesis

Evaluate the use of Twitter by otolaryngology journals and determine the relationship between social media altmetrics and measures of academic impact.

Study Design

Cross-sectional analysis.

Methods

Twitter profiles from the top 50 otolaryngology journals per 2016 SCImago Journal & Country Rank (SJR) were included. Twitter activity for each profile was calculated using Twitonomy analytics and Riffle software. Social media influence was measured using Klout scores. Annual SJR rank and H-Index scores between 2008 and 2016 were recorded for each journal. Associations between social media influence and academic indices were assessed using Wilcoxon rank sum test, Spearman's rank order test, and Pearson correlation coefficients (α = .05).

Results

Average SJR was 0.86 ± 0.3 and H-Index was 50.9 ± 24. Eighteen journals had Twitter profiles. Journals with social media accounts had significantly higher SJR (P = .03) and H-Index (P = .01) scores compared to those without. The average Klout score of Twitter profiles was 32.5 ± 13. There was a significant association between a journal's Klout score and SJR rank (P = .004). Older Twitter profiles had higher Klout scores (P = .04). There was a direct relationship between a journal's total Twitter followers and H-Index score (P = .009), and a direct relationship between tweets and academic influence (P = .03 and .01 for SJR and H-Index, respectively).

Conclusions

Social media is often underutilized and remains an untapped resource by many journals to increase readership and disseminate research. Journals with social media profiles had significantly higher academic metrics, and among journals with profiles, increased online activity was a predictor for academic influence. Future studies are warranted to elucidate causal relationships.

Level of Evidence

NA Laryngoscope, 2017

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What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis

Objectives/Hypothesis

Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss.

Study Design

Prospective, multi-institutional, observational cohort study.

Methods

There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics.

Results

Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains.

Conclusions

Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS.

Level of Evidence

2c Laryngoscope, 2017

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Diagnostic performance of 18fluorodesoxyglucose positron emission/computed tomography and magnetic resonance imaging in detecting T1-T2 head and neck squamous cell carcinoma

Objectives/Hypothesis

Study Design

Prospective case series.

Methods

Results

Conclusions

Our study showed a higher diagnostic accuracy of FDG-PET/CT than MRI to detect T1-T2 HNSCC with a good interobserver agreement.

Level of Evidence

4 Laryngoscope, 2017

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Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis

Objectives

Data Sources

PubMed, Embase, Cochrane, and Scopus databases.

Review Methods

Results

Conclusions

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Social media presence of otolaryngology journals: The past, present, and future

Objectives/Hypothesis

Evaluate the use of Twitter by otolaryngology journals and determine the relationship between social media altmetrics and measures of academic impact.

Study Design

Cross-sectional analysis.

Methods

Results

Conclusions

Level of Evidence

NA Laryngoscope, 2017

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What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis

Objectives/Hypothesis

Study Design

Prospective, multi-institutional, observational cohort study.

Methods

Results

Conclusions

Level of Evidence

2c Laryngoscope, 2017

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Switchable and pH responsive porous surfaces based on polypeptide-based block copolymers

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): A.S. de León, A. del Campo, J. Rodríguez-Hernández, A. Muñoz-Bonilla
In the current work, we prepared stimuli responsive porous films by the breath figure approach using polymer blends consisting of high molecular weight polystyrene (HPS) and an amphiphilic block copolymer based on a pH sensitive poly(l-glutamic acid) (PGA) polypeptide. Thus, due to the breath figure mechanism the pores were enriched in pH responsive negatively charged carboxylate groups able to immobilize cationic molecules at pH above the pKa of the PGA. As a proof of concept, Rhodamine 6G was attached through electrostatic interactions at basic pH inside the cavities as shown by fluorescence microscopy. The variation of the wettability and the reversible immobilization of Rhodamine 6G as a function of pH were investigated by contact angle and fluorescence measurements. Moreover, the kinetics of the adsorption process of Rhodamine 6G onto the prepared smart films was explored evidencing a pseudo-second order kinetic model while the maximum absorption capacity at equilibrium was found to be ~6.4nmolg⁻¹.

Graphical abstract

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Flexible design of cellular Al2TiO5 and Al2TiO5-Al2O3 composite monoliths by reactive firing

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Eleonora Lalli, Nuno M.D. Vitorino, Carla A.M. Portugal, João G. Crespo, Cristiana Boi, Jorge R. Frade, Andrei V. Kovalevsky
Cellular Al2TiO5 and Al2TiO5 – Al2O3 composite ceramics were obtained by emulsification of liquid paraffin in aqueous suspensions of mixed TiO2+Al2O3 powders, with subsequent burnout of the organic phase and 2-step reactive firing at high temperatures. The reactants ratio and paraffin to suspension volume ratio were used as primary parameters to control the phase composition and relevant microstructural features, while firing conditions were also adjusted for greater flexibility in designing Al2TiO5-based cellular materials. Taguchi experimental planning was used to assess the relevant impacts of 2-step firing parameters on phase composition and porosity, characterized by detailed XRD/SEM/EDS studies. The results emphasized the positive effects of Al2O3 excess in Al2TiO5 – Al2O3 composite ceramics on stabilization of the Al2TiO5 phase and also for flexible design of cellular materials with controlled porosity and phase distributions. Analysis of correlation matrixes identified the 2-step firing parameters with greatest impact on the porosity and phase composition, and these trends were confirmed by multivariate linear regression. The observed trends indicated significant differences in reactivity and densification mechanisms between compositions with nominal Al2TiO5 stoichiometry and composite materials. These differences were most obvious for samples with significant residual fractions of unreacted titania.

Graphical abstract

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Influence of core joints in sandwich composites under in-plane static and fatigue loads

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Elias A. Toubia, Abraham Elmushyakhi
Most designers are unaware of the influence of core junction in lightweight sandwich structures under axial load. Quantifying this effect and its criticality on the life of the structure is still a challenging task. In this study, a novel testing methodology was used to characterize this effect. Scarf and butt core joints in foam core sandwich composites were subjected to axial static and fatigue loads (R=0.1 and R=−1). Under cyclic axial load, differential movement (through-the-thickness) between the foam and core joint was more significant than anticipated. Non-destructive evaluation techniques were used to locate the damage and assess the failure mechanisms. The root-cause-failure analysis showed that cracks were initiated in the facesheets for the butt-joint, and in the core for the scarf-joint samples, respectively. Consequently, at 80% residual strength, the butt-joint reduced the predicted fatigue life by 42% and 32% at low and high cycle fatigue, respectively. Residual tensile tests revealed the sizeable damage induced by the traditional butt-joint design. This research confirmed that despite the facesheets' primary in-plane load carrying mechanisms, core junction will substantially influence the axial fatigue life of the structure.

Graphical abstract

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Compressive properties of functionally graded lattice structures manufactured by selective laser melting

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Sing Ying Choy, Chen-Nan Sun, Kah Fai Leong, Jun Wei
Additive manufacturing provides great geometrical freedom for fabricating structures with complex or customized architecture. One of the applications benefiting from this technology is the fabrication of functionally graded materials with high degree of control of internal architecture which can be strategic application in advanced energy absorption. This study aims to explore the mechanical properties of functionally graded lattice structures fabricated by an additive manufacturing technique namely, selective laser melting (SLM), with Ti-6Al-4V as the building material. Both cubic lattice and honeycomb lattice structures with varied strut diameter and density were designed and manufactured, and their physical characteristics, deformation behavior and compressive properties were investigated. The collapse of structure always started from least dense layer to the denser layers. In contrast, samples with uniform density showed abrupt shear failure with diagonal cracking across the whole structure. The plateau stress and specific energy absorption of density graded samples were higher than for uniform density samples for three out of four designs by up to 67% and 72%, respectively. In addition, density graded lattices showed distinct energy absorption behavior with cumulative energy absorption increasing as a power of strain function while uniform density lattices showed a near-linear relationship.

Graphical abstract

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Intermittent compressive stress regulates Notch target gene expression via transforming growth factor-β signaling in murine pre-osteoblast cell line

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Jeeranan Manokawinchoke, Prasit Pavasant, Thanaphum Osathanon
ObjectiveDifferent mechanical stimuli regulate behaviors of various cell types, including osteoblasts, osteocytes, and periodontal ligament fibroblasts. Notch signaling participates in the mechanical stress-regulated cell responses. The present study investigated the regulation of Notch target gene and sclerostin (Sost) expression in murine pre-osteoblast cell line (MC3T3-E1) under intermittent compressive stress.MethodsMC3T3-E1 were subjected to the intermittent compressive force under the computerized controlled machine. In some experiments, cells were pretreated with chemical inhibitors for Notch and transforming growth factor (TGF)-β signaling prior to mechanical stimuli. To evaluate role of Notch signaling in MC3T3-E1 cells under unloaded condition, cells were seeded on indirect immobilized Notch ligand (Jagged1). Gene expression was determined using real-time quantitative polymerase chain reaction.ResultsThe intermittent compressive stress significantly upregulated Notch target gene expression (Hes Family BHLH transcription factor 1; Hes1 and Hairy/enhancer-of-split related with YRPW motif protein1; Hey1). The intermittent stress-induced Hes1 and Hey1 mRNA expression could be inhibited by a γ-secretase inhibitor (DAPT) or a TGF-β superfamily type I activing receptor-like kinase receptors inhibitor (SB431542). The results imply that intermittent compressive stress regulates Notch signaling via TGF-β pathway. Further, the intermittent compressive stress reduced Sost mRNA expression and this phenomenon could be rescued by a DAPT pretreatment, implying the involvement of Notch signaling. However, activation of Notch signaling under the unloaded condition resulted in the increase of Sost expression and the reduction of osteogenic marker genes.ConclusionsThese results imply the involvement of Notch signaling in the homeostasis maintaining of osteogenic cells under mechanical stress stimuli.

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Effect of 1.2% of simvastatin gel as a local drug delivery system on Gingival Crevicular Fluid interleukin-6 & interleukin-8 levels in non surgical treatment of chronic periodontitis patients

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Gayathri Gunjiganur Vemanaradhya, Shilpa Emani, Dhoom Singh Mehta, Shilpy Bhandari
AimThe present study was carried out to evaluate the effect of 1.2% simvastatin gel as local drug delivery (LDD) system on Gingival Crevicular Fluid (GCF) Interleukin -6 (IL-6) and Interleukin-8 (IL-8) levels in chronic periodontitis patients, in addition to scaling and root planing (SRP).MethodsA total of 46 chronic periodontitis patients were equally divided into two groups. Group I patients were treated by SRP; Group II patients were treated by SRP followed by LDD of 1.2% simvastatin (SMV) gel. Plaque index (PI), Gingival index(GI), Sulcus Bleeding Index (SBI), Probing pocket depth (PPD) and Relative clinical attachment level (CAL) were recorded & GCF samples were collected at baseline (0day) and at 45th day from both the groups. The collected GCF samples were analysed for IL-6 and IL-8 levels with enzyme-linked immunosorbent assay (ELISA).ResultsBoth the groups showed significant reduction in all the clinical parameters scores and IL-6 and IL-8 levels after non-surgical periodontal therapy (SRP for group I/SRP+1.2% SMV gel for group II) in contrast to baseline values. However, a greater reduction was observed in group II. A non-significant positive correlation was observed between clinical parameters and IL-6 and IL-8 levels except at baseline, a significant correlation was observed between PPD &IL 6 levels in group II.ConclusionsIn adjunct to SRP, 1.2% Simvastatin gel acts as an effective local drug delivery agent for the management of chronic periodontitis.

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Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): João Vicente Rosar, Taís de Souza Barbosa, Ilo Odilon Villa Dias, Fernanda Yukie Kobayashi, Yuri Martins Costa, Maria Beatriz Duarte Gavião, Leonardo Rigoldi Bonjardim, Paula Midori Castelo
ObjectiveThe purpose was to evaluate the effect interocclusal appliance therapy on bite force (BF), sleep quality and salivary cortisol levels in adults with SB diagnosed by polysomnography. As a secondary aim, signs and symptoms of temporomandibular dysfunction (TMD) were evaluated.DesignForty-three adults (19–30 y/o) were divided into two groups: experimental group (GSB), composed of 28 subjects with SB, and control group (GC), without SB and TMD (n=15). GSB was treated with stabilization interocclusal splint and evaluated at time intervals: before (baseline), one month (T1) and two months (T2) after therapy began, to collect data related to BF, sleep quality (Pittsburgh Sleep Quality Index), salivary cortisol levels and TMD. GC was also examined three times and received no therapy. Data were analysed by means of normality tests, t-test/Mann-Whitney and One-way ANOVA repeated measures (Tukey post-test). Two-way ANOVA test for repeated measures was applied to verify the effect time*group interaction on the variance of each dependent variable (α=0.05).ResultsGSB showed an increase in BF and a positive effect on muscular symptomatology, range of mandibular movements and sleep quality; in GC these parameters did not differ. Cortisol concentration decreased between baseline and T1 in GSB (F(1,31)=4.46; test power=62%; p=0.017). The variance observed for BF, TMD and sleep quality among time points was dependent on the group (moderate effect size: partial Eta square >0.16; test power >80%).ConclusionsThe results suggested that short-term interocclusal appliance therapy had a positive effect on BF, temporomandibular symptomatology, sleep quality and salivary cortisol levels in adults with SB.

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Editorial Board

Publication date: July 2017
Source:Critical Reviews in Oncology/Hematology, Volume 115

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The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: Systematic review and meta-analysis

Publication date: Available online 9 June 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Ross D Dolan, Stephen T McSorley, Paul G Horgan, Barry Laird, Donald C McMillan
IntroductionCancer remains a leading cause of death worldwide. While a curative intent is the aim of any surgical treatment many patients either present with or go onto develop disseminated disease requiring systemic anti-cancer therapy with a palliative intent. Given their limited life expectancy appropriate allocation of treatment is vital. It is recognised that systemic chemoradiotherapy may shorten the quality/quantity of life in patients with advanced cancer. It is against this background that the present systematic review and meta-analysis of the prognostic value of markers of the systemic inflammatory response in patients with advanced cancer was conducted.MethodsAn extensive literature review using targeted medical subject headings was carried out in the MEDLINE, EMBASE, and CDSR databases until the end of 2016. Titles were examined for relevance and studies relating to duplicate datasets, that were not published in English and that did not have full text availability were excluded. Full texts of relevant articles were obtained and were then examined to identify any further relevant articles.ResultsThe majority of studies were retrospective. The systemic inflammatory response, as evidenced by a number of markers at clinical thresholds, was reported to have independent prognostic value, across tumour types and geographical locations. In particular, C-reactive protein (CRP, 63 studies), albumin (33 studies) the Glasgow Prognostic Score (GPS, 44 studies) and the Neutrophil Lymphocyte Ratio (NLR, 59 articles) were consistently validated across tumour types and geographical locations. There was considerable variation in the thresholds reported to have prognostic value when CRP and albumin were examined. There was less variation in the thresholds reported for NLR and still less for the GPS.DiscussionThe systemic inflammatory response, especially as evidenced by the GPS and NLR, has reliable prognostic value in patients with advanced cancer. Further prospective studies of their clinical utility in randomised clinical trials and in treatment allocation are warranted.

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Adiponectin: its role in obesity-associated colon and prostate cancers

Publication date: Available online 9 June 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Santoshi Muppala, Siva KP Konduru, Neha Merchant, Judy Ramsoondar, Carlos Karan Rampersad, Balney Rajitha, Vidya Mukund, Jyothsna Kancherla, Anthea Hammond, Tapan Kumar Barik, Mastan Mannarapu, Afroz Alam, Riyaz Basha, Pallavula Veera Bramhachari, Dheeraj Verma, Pinninti Santosh Sushma, Subasini Pattnaik, Ganji Purnachandra Nagaraju
Adipose tissue synthesizes many proteins and hormones collectively called adipokines, which are linked to a number of diseases, including cancer. Low levels of adiponectin are reported to be a risk factor for obesity-related cancers including colorectal and prostate cancers. Accordingly, obesity/lifestyle-related diseases, including certain cancers, may be treated by developing drugs that act specifically on adiponectin levels in circulation. Adiponectin may also serve as a clinical biomarker in obesity-related diseases. Adiponectin-based therapies are known to inhibit cancer advancement and thus may provide a therapeutic approach to delay cancer progression. Better understanding of the function of adiponectin is of great significance in the fight against cancer. This timely review is concentrated on the role of adiponectin and the impact of obesity on the development of cancers, especially colorectal and prostate cancers.

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BIOMARKERS OF RESPONSE TO PD-1/PD-L1 INHIBITION

Publication date: Available online 6 June 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Saman Maleki Vareki, Carmen Garrigós, Ignacio Duran
Immunotherapy is a promising treatment strategy for cancer that has recently shown unprecedented survival benefits in selected patients. A number of immunomodulatory agents that target immune system checkpoints such as the cytotoxic T-lymphocyte antigen 4 (CTLA-4), the programmed death-1 (PD-1) or its ligand (PD-L1), have received regulatory approval for the treatment of multiple cancers including malignant melanoma, non-small cell lung cancer, renal cell carcinoma, classical Hodgkin lymphoma, and recurrent or metastatic head and neck squamous cell carcinoma. Nevertheless, a substantial proportion of patients treated with checkpoint inhibitors have little or no benefit while these treatments are costly and might have associated toxicities. Hence, the establishment of valid predictors of treatment response has become a priority. This review summarizes the current evidence around biomarkers of response to PD-1/PD-L1 inhibition, considering features related to the tumor and to the host immune system.

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Interaction of Immunoglobulin with Cytomegalovirus-Infected Cells

Viral Immunology , Vol. 0, No. 0.

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Sub-solid Nodule Detection Performance on Reduced-dose Computed Tomography with Iterative Reduction

Publication date: Available online 9 June 2017
Source:Academic Radiology
Author(s): Yukihiro Nagatani, Masashi Takahashi, Mitsuru Ikeda, Tsuneo Yamashiro, Hisanobu Koyama, Mitsuhiro Koyama, Hiroshi Moriya, Satoshi Noma, Noriyuki Tomiyama, Yoshiharu Ohno, Kiyoshi Murata, Sadayuki Murayama
Rationale and ObjectivesThis study aimed to compare sub-solid nodule detection performances (SSNDP) on chest computed tomography (CT) with Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR 3D) between 7 mAs (0.21 mSv) and 42 mAs (1.28 mSv) in total and in subgroups classified by nodular size, characteristics, and location, and analyze the association of SSNDP with size-specific dose estimate (SSDE).Materials and MethodsAs part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases Study, a Japanese multicenter research project, 68 subjects underwent chest CT with 120 kV, 0.35 seconds per rotation, and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). The research committee of the study project outlined and approved our study protocols. The institutional review board of each institution approved this study. Axial 2-mm-thick CT images were reconstructed using AIDR 3D. Standard reference was determined by CT images at 84 mAs. Four radiologists recorded SSN presence by continuously distributed rating on CT at 7 mAs and 42 mAs. Receiver operating characteristic analysis was used to evaluate SSNDP at both doses in total and in subgroups classified by nodular longest diameter (LD) (≥5 mm), characteristics(pure and part-solid), and locations (ventral, intermediate, or dorsal; central or peripheral; and upper, middle, or lower). Detection sensitivity was compared among five groups of SSNs classified based on particular SSDE to nodule on CT with AIDR 3D at 7 mAs.ResultsTwenty-two part-solid and 86 pure SSNs were identified. For larger SSNs (LD ≥ 5 mm) as well as subgroups classified by nodular locations and part-solid nodules, SSNDP was similar in both methods (area under the receiver operating characteristics curve: 0.96 ± 0.02 in CT at 7 mAs and 0.97 ± 0.01 in CT at 42 mAs), with acceptable interobserver agreements in five locations. For larger SSNs (LD ≥ 5 mm), on CT at 42 mAs, no significant differences in detection sensitivity were found among the five groups classified by SSDE, whereas on CT with 7 mAs, four groups with SSDE of 0.65 or higher were superior in detection sensitivity to the other group, with SSDE less than 0.65 mGy.ConclusionsFor SSNs with 5 mm or more in cases with normal range of body habitus, CT at 7 mAs was demonstrated to have comparable SSNDP to CT at 42 mAs regardless of nodular location and characteristics, and SSDE higher than 0.65 mGy is desirable to obtain sufficient SSNDP.

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Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates

Abstract

This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6–155 months) were analyzed. Patients were grouped as "extrusion" (n = 9, 7%) if the prosthesis extruded, "failure" (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and "stable" (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5–3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5–3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15–48 months). Mean timing for reoperation was 30.7 months (range 5–131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.

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Tailored Design of Multifunctional and Programmable pH-responsive Self-assembling Polypeptides as Drug Delivery Nanocarrier for Cancer Therapy

Publication date: Available online 9 June 2017
Source:Acta Biomaterialia
Author(s): Tzu-Wei Wang, Chia-Wei Yeh, Chen-Hsiang Kuan, Li-Wen Wang, Liang-Hsin Chen, Hsi-Chin Wu, Jui-Shen Sun
Breast cancer has become the second leading cause of cancer-related mortality in female wherein more than 90% of breast cancer-related death results from cancer metastasis to distant organs at advanced stage. The purpose of this study is to develop biodegradable nanoparticles composed of natural polypeptides and calcium phosphate (CaP) with sequential pH-responsivity to tumor microenvironments for active targeted drug delivery. Two different amphiphilic copolymers, poly(ethylene glycol)3400-aconityl linkage-poly(L-glutamic acid)15-poly(L-histidine)10-poly(L-leucine)10 and LyP1-poly(ethylene glycol)1100-poly(L-glutamic acid)15-poly(L-histidine)10-poly(L-leucine)10, were exploited to self-assemble into micelles in aqueous phase. The bio-stable nanoparticles provide three distinct functional domains: the anionic PGlu shell for CaP mineralization, the protonation of PHis segment for facilitating anticancer drug release at target site, and the hydrophobic core of PLeu for encapsulation of anticancer drugs. Furthermore, the hydrated PEG outer corona is used for prolonging circulation time, while the active targeting ligand, LyP-1, is served to bind to breast cancer cells and lymphatic endothelial cells in tumor for inhibiting metastasis. Mineralized DOX-loaded nanoparticles (M-DOX NPs) efficiently prevent the drug leakage at physiological pH value and facilitate the encapsulated drug release at acidic condition when compared to DOX-loaded nanoparticles (DOX NPs). M-DOX NPs with LyP-1 targeting ligand effectively accumulated in MDA-MB-231 breast cancer cells. The inhibition effect on cell proliferation also enhances with time, illustrating the prominent anti-tumor efficacy. Moreover, the in vitro metastatic inhibition model shows the profound inhibition effect of inhibitory nanoparticles. In brief, this self-assembling peptide-based drug delivery nanocarrier with multifunctionality and programmable pH-sensitivity is of great promise and potential for anti-cancer therapy.Statement of SignificanceThis tailored-design polypeptide-based nanoparticles with self-assembling and programmable stimulus-responsive properties enable to 1) be stable in physiological pH value with a low level of drug loss and effectively release the encapsulated drug with pH variations according to the tumor microenvironment, 2) enhanced targeting ability to hard-to-treat breast cancer cells and activated endothelial cells (tumor region), 3) significantly inhibit the growth and prevent from malignant metastasis of cancer cells in consonance with promising anti-tumor efficacy, and 4) keep tumors stick to localized position so that these confined solid tumors can be more accessible by different treatment modalities. The contribution of this work is how to design a programmable pH-responsive drug delivery system based on the tailor-designed polypeptides.

Graphical abstract

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Habenula and interpeduncular nucleus differentially modulate predator odor-induced innate fear behavior in rats

Publication date: 14 August 2017
Source:Behavioural Brain Research, Volume 332
Author(s): Daniel Vincenz, Kerstin E.A. Wernecke, Markus Fendt, Jürgen Goldschmidt
Fear is an important behavioral system helping humans and animals to survive potentially dangerous situations. Fear can be innate or learned. Whereas the neural circuits underlying learned fear are already well investigated, the knowledge about the circuits mediating innate fear is still limited. We here used a novel, unbiased approach to image in vivo the spatial patterns of neural activity in odor-induced innate fear behavior in rats. We intravenously injected awake unrestrained rats with a 99m-technetium labeled blood flow tracer (99mTc-HMPAO) during ongoing exposure to fox urine or water as control, and mapped the brain distribution of the trapped tracer using single-photon emission computed tomography (SPECT). Upon fox urine exposure blood flow increased in a number of brain regions previously associated with odor-induced innate fear such as the amygdala, ventromedial hypothalamus and dorsolateral periaqueductal grey, but, unexpectedly, decreased at higher significance levels in the interpeduncular nucleus (IPN). Significant flow changes were found in regions monosynaptically connected to the IPN. Flow decreased in the dorsal tegmentum and entorhinal cortex. Flow increased in the habenula (Hb) and correlated with odor effects on behavioral defensive strategy. Hb lesions reduced avoidance of but increased approach to the fox urine while IPN lesions only reduced avoidance behavior without approach behavior. Our study identifies a new component, the IPN, of the neural circuit mediating odor-induced innate fear behavior in mammals and suggests that the evolutionarily conserved Hb-IPN system, which has recently been implicated in cued fear, also forms an integral part of the innate fear circuitry.

http://ift.tt/2rWunuY

Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates

Abstract

http://ift.tt/2rfEbhK

Fully automated breast boundary and pectoral muscle segmentation in mammograms

Publication date: Available online 9 June 2017
Source:Artificial Intelligence in Medicine
Author(s): Andrik Rampun, Philip J. Morrow, Bryan W. Scotney, John Winder
Breast and pectoral muscle segmentation is an essential pre-processing step for the subsequent processes in computer aided diagnosis (CAD) systems. Estimating the breast and pectoral boundaries is a difficult task especially in mammograms due to artifacts, homogeneity between the pectoral and breast regions, and low contrast along the skin-air boundary. In this paper, a breast boundary and pectoral muscle segmentation method in mammograms is proposed. For breast boundary estimation, we determine the initial breast boundary via thresholding and employ Active Contour Models without edges to search for the actual boundary. A post-processing technique is proposed to correct the overestimated boundary caused by artifacts. The pectoral muscle boundary is estimated using Canny edge detection and a pre-processing technique is proposed to remove noisy edges. Subsequently, we identify five edge features to find the edge that has the highest probability of being the initial pectoral contour and search for the actual boundary via contour growing. The segmentation results for the proposed method are compared with manual segmentations using 322, 208 and 100mammograms from the Mammographic Image Analysis Society (MIAS), INBreast and Breast Cancer Digital Repository (BCDR) databases, respectively. Experimental results show that the breast boundary and pectoral muscle estimation methods achieved dice similarity coefficients of 98.8% and 97.8% (MIAS), 98.9% and 89.6% (INBreast) and 99.2% and 91.9% (BCDR), respectively.

http://ift.tt/2sMLsY6

A hybrid framework for reverse engineering of robust Gene Regulatory Networks

Publication date: Available online 9 June 2017
Source:Artificial Intelligence in Medicine
Author(s): Mina Jafari, Behnam Ghavami, Vahid Sattari
The inference of Gene Regulatory Networks (GRNs) using gene expression data in order to detect the basic cellular processes is a key issue in biological systems. Inferring GRN correctly requires inferring predictor set accurately. In this paper, a fast and accurate predictor set inference framework which linearly combines some inference methods is proposed. The purpose of the combination of various methods is to increase the accuracy of inferred GRN. The proposed framework offers a linear weighted combination of Pearson Correlation Coefficient (PCC) and two different feature selection approaches, namely: Information Gain (IG) and ReliefF. In order to set the appropriate weights, Genetic Algorithm (GA) is used. Similarity measure is considered as fitness function to guide GA. At the end, based on the obtained weights, the best predictor set of GRN using three aforementioned inference methods is selected and the network topology is formed. Due to the huge volume of gene expression data, GRN inference algorithms should infer GRN at a reasonable runtime. Hence, a novel criterion is provided to evaluate GRNs based on runtime and accuracy. The simulation results using biological data indicate that the proposed framework is fast and more reliable compared to other recent methods [1–7].

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Premature Ventricular Contraction Detection Combining Deep Neural Networks and Rules Inference

Publication date: Available online 9 June 2017
Source:Artificial Intelligence in Medicine
Author(s): Fei-yan Zhou, Lin-peng Jin, Jun Dong
Premature ventricular contraction (PVC), which is a common form of cardiac arrhythmia caused by ectopic heartbeat, can lead to life-threatening cardiac conditions. Computer-aided PVC detection is of considerable importance in medical centers or outpatient ECG rooms. In this paper, we proposed a new approach that combined deep neural networks and rules inference for PVC detection. The detection performance and generalization were studied using publicly available databases: the MIT-BIH arrhythmia database (MIT-BIH-AR) and the Chinese Cardiovascular Disease Database (CCDD). The PVC detection accuracy on the MIT-BIH-AR database was 99.41%, with a sensitivity and specificity of 97.59% and 99.54%, respectively, which were better than the results from other existing methods. To test the generalization capability, the detection performance was also evaluated on the CCDD. The effectiveness of the proposed method was confirmed by the accuracy (98.03%), sensitivity (96.42%) and specificity (98.06%) with the dataset over 140,000 ECG recordings of the CCDD.

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Sharp foreign body ingestion by a young girl

Publication date: Available online 9 June 2017
Source:Alexandria Journal of Medicine
Author(s): Riyadh Mohamad Hasan
A 16year old patient had ingested two sewing needles about 4.5cm long accidentally that eventually resided in extra intestinal tract position, and being asymptomatic, she ignored the problem for a long period about 2years. She only consulted the hospital after having symptoms. The needles were located by X-ray imaging and retrieved with the aid of C-arm fluoroscope at a laparotomy. Her postoperative period was uneventful.

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Ameliorative effect of apelin on streptozotocin-induced diabetes and its associated cardiac hypertrophy

Publication date: Available online 9 June 2017
Source:Alexandria Journal of Medicine
Author(s): Islam Ibrahim Hegab
AimApelin, an adipocyte-derived factor, exhibited a number of cardioprotective properties; however, its effect in diabetes which is a major risk factor for cardiovascular disease (CVD) needs to be further studied. So this work was designed to evaluate the effect of apelin on diabetes and its associated cardiac hypertrophy with its possible underlying protective mechanisms.Experimental protocolThirty male adult Wistar rats were categorized into three groups, 10 rats each, normal control group: received standard food and water regime. Diabetic control group: received streptozotocin (STZ) at a dose of (55mg/kg, i.p., once) dissolved in citrate buffer (pH 4.5). Apelin-13 treated diabetic group: STZ diabetic rats received an intra peritoneal injection of apelin-13 at a dose of (100nmol/kg/day), and given daily for 8weeks. at the end of the experiment, oral glucose tolerance test (OGTT) was assayed, then rats were sacrificed and serum glucose, insulin, triglyceride (TG), total cholesterol, high density lipoprotein (HDL) cholesterol, serum lactate dehydrogenase (LDH) and serum creatine kinase – MB (CK-MB) were measured, together with cardiac hypertrophy index (CHI), left ventricular hypertrophy index (LVHI) and left ventricular protein and collagen content levels. Myocardial superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and malondialdehyde (MDA) were determined in the myocardial tissue of experimental rats.ResultsTreatment with apelin-13 improved hyperglycemia and hyperlipidemia, and significantly protected against STZ-induced structural alterations in cardiac tissue, it also produced a significant reduction in MDA while it elevated the level of antioxidant enzymes in hearts of diabetic rats.ConclusionThis study suggested that apelin can ameliorate diabetes and its associated myocardial hypertrophy through mainly its anti diabetic, anti hyperlipidemic and anti oxidative stress properities.

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Central Tibetan Plateau atmospheric trace metals contamination: A 500-year record from the Puruogangri ice core

Publication date: 1 December 2017
Source:Science of The Total Environment, Volumes 601–602
Author(s): Emilie Beaudon, Paolo Gabrielli, M. Roxana Sierra-Hernández, Anna Wegner, Lonnie G. Thompson
A ~500-year section of ice core (1497–1992) from the Puruogangri ice cap has been analyzed at high resolution for 28 trace elements (TEs: Ag, Al, As, Ba, Bi, Cd, Co, Cr, Cs, Cu, Fe, Ga, Li, Mg, Mn, Na, Nb, Ni, Pb, Rb, Sb, Sn, Sr, Ti, Tl, U, V and Zn) to assess different atmospheric contributions to the ice and provide a temporal perspective on the diverse atmospheric influences over the central Tibetan Plateau (TP). At least two volcanic depositions have significantly impacted the central TP over the past 500years, possibly originating from the Billy Mitchell (1580, Papua New Guinea) and the Parker Peak (1641, Philippines) eruptions. A decreasing aeolian dust input to the ice cap allowed the detection of an atmospheric pollution signal. The anthropogenic pollution contribution emerges in the record since the early 1900s (for Sb and Cd) and increases substantially after 1935 (for Ag, Zn, Pb, Cd and Sb). The metallurgy (Zn, Pb and steel smelting) emission products (Cd, Zn, Pb and Ag) from the former Soviet Union and especially from central Asia (e.g., Kyrgyzstan, Kazakhstan) likely enhanced the anthropogenic deposition to the Puruogangri ice cap between 1935 and 1980, suggesting that the westerlies served as a conveyor of atmospheric pollution to central Tibet. The impact of this industrial pollution cumulated with that of the hemispheric coal and gasoline combustion which are respectively traced by Sb and Pb enrichment in the ice. The Chinese steel production accompanying the Great Leap Forward (1958–1961) and the Chinese Cultural Revolution (1966–1976) is proposed as a secondary but proximal source of Pb pollution affecting the ice cap between 1958 and 1976. The most recent decade (1980–1992) of the enrichment time series suggests that Puruogangri ice cap recorded the early Sb, Cd, Zn, Pb and Ag pollution originating from developing countries of South (i.e., India) and East (i.e., China) Asia and transported by the summer monsoonal circulation.

Graphical abstract

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Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Abigail Silva, Yamile Molina, Bijou Hunt, Talar Marossian, Nazia Saiyed
IntroductionThe Affordable Care Act's (ACA) preventive services provision (PSP) removes copayments for preventive services such as cancer screening. We examined: 1) whether a shift in breast cancer stage occurred, and 2) the impact of the provision on racial/ethnic disparities in stage.Materials and methodsData from the National Cancer Database were used. The pre- and post-PSP periods were identified as 2007–2009 and 2011–2013, respectively. Proportion differences (PDs) and 95% confidence Intervals (CIs) were calculated.ResultsAll three racial/ethnic groups experienced a statistically significant shift toward Stage I breast cancer. Pre-PSP, the black:white disparity in Stage I cancer was −9.5 (95% CI: −8.9, −10.4) and the Latina:white disparity was −5.2 (95% CI: −4.0, −6.1). Post-PSP, the disparities improved slightly.DiscussionPreliminary data suggest that the ACA's PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities.

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Pollution and regional variations of lung cancer mortality in the United States

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Justin Xavier Moore, Tomi Akinyemiju, Henry E. Wang
IntroductionThe aims of this study were to identify counties in the United States (US) with high rates of lung cancer mortality, and to characterize the associated community-level factors while focusing on particulate-matter pollution.MethodsWe performed a descriptive analysis of lung cancer deaths in the US from 2004 through 2014. We categorized counties as "clustered" or "non-clustered" – based on whether or not they had high lung cancer mortality rates − using novel geospatial autocorrelation methods. We contrasted community characteristics between cluster categories. We performed logistic regression for the association between cluster category and particulate-matter pollution.ResultsAmong 362 counties (11.6%) categorized as clustered, the age-adjusted lung cancer mortality rate was 99.70 deaths per 100,000 persons (95%CI: 99.1–100.3). Compared with non-clustered counties, clustered counties were more likely in the south (72.9% versus 42.1%, P<0.01) and in non-urban communities (73.2% versus 57.4, P<0.01). Clustered counties had greater particulate-matter pollution, lower education and income, higher rates of obesity and physical inactivity, less access to healthcare, and greater unemployment rates (P<0.01). Higher levels of particulate-matter pollution (4th quartile versus 1st quartile) were associated with two-fold greater odds of being a clustered county (adjusted OR: 2.10; 95%CI: 1.23–3.59).ConclusionWe observed a belt of counties with high lung mortality ranging from eastern Oklahoma through central Appalachia; these counties were characterized by higher pollution, a more rural population, lower socioeconomic status and poorer access to healthcare. To mitigate the burden of lung cancer mortality in the US, both urban and rural areas should consider minimizing air pollution.

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Socioeconomic measures influence survival in osteosarcoma: an analysis of the National Cancer Data Base

Publication date: August 2017
Source:Cancer Epidemiology, Volume 49
Author(s): Benjamin J. Miller, Yubo Gao, Kyle R. Duchman
BackgroundWhile previous studies have identified low socioeconomic status as a risk factor for metastatic disease in patients with high-grade osteosarcoma, the influence of socioeconomic status on overall survival remains unclear. The present study aims to investigate the relationship between survival and socioeconomic status in patients with high-grade conventional osteosarcoma.MethodsThe National Cancer Data Base (NCDB) was queried from 1998-2012 to identify all patients <40years of age with a diagnosis of high-grade conventional osteosarcoma. A total of 3,503 patients were identified that met inclusion and exclusion criteria. Univariate relationships were investigated using Kaplan-Meier survival analysis and associated log-rank tests in order to determine patient, socioeconomic, tumor, and treatment variables associated with overall survival. Multivariate analysis was performed to determine independent predictors of survival.ResultsIn order of decreasing magnitude, metastatic disease (Hazard Ratio [HR] 3.28, 95% Confidence Interval [CI] 2.82-3.82), primary site in the pelvis or spine (HR 2.15, 95% CI 1.79-2.59), positive surgical margins (HR 1.82, 95% CI 1.46-2.27), tumor size >8cm (HR 1.47, 95% CI 1.24-1.74), age ≥18 years (HR 1.30, 95% CI 1.14-1.48), lowest quartile of composite socioeconomic status (HR 1.23, 95% CI 1.02-1.51), and Medicaid insurance (HR 1.18, 95% CI 1.02-1.38) were predictors of decreased survival at 5 years.ConclusionTreating providers should be aware that some of their patients may have challenges unrelated to their diagnosis that make timely presentation, adherence to treatment, and continued close surveillance difficult. This investigation suggests that socioeconomic variables influence overall survival for osteosarcoma in the United States, although not as dramatically as established tumor- and treatment-related risk factors.

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Natural radionuclides in plants, soils and sediments affected by U-rich coal mining activities in Brazil

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Juliana Aparecida Galhardi, Rafael García-Tenorio, Daniel Marcos Bonotto, Inmaculada Díaz Francés, João Gabriel Motta
Mining activities can increase the mobility of metals by accelerating the dissolution and leaching of minerals from the rocks and tailing piles to the environment and, consequently, their availability for plants and subsequent transfer to the food chain. The weathering of minerals and the disposal of coal waste in tailing piles can accelerate the generation of acid mine drainage (AMD), which is responsible for the higher dissolution of metals in mining areas. In this context, the behavior of U, Th and K in soils and sediment, and the transfer factor (TF) of ²³⁸U, ²³⁴U and ²¹⁰Po for soybean, wheat, pine and eucalyptus cultivated around a coal mine in southern Brazil was evaluated. Alpha and gamma spectrometry were used for the measurements of the activity concentration of the radioelements. ²¹⁰Po was the radionuclide that is most accumulated in the plants, especially in the leaves. When comparing the plant species, pine showed the highest TF values for ²³⁴U (0.311 ± 0.420) for leaves, while eucalyptus showed the highest TF for ²³⁸U (0.344 ± 0.414) for leaves. In general, TF were higher for the leaves of soybean and wheat when compared to the grains, and grains of wheat showed higher TF for ²¹⁰Po and ²³⁸U than grains of soybean. Deviations from the natural U isotopic ratio were recorded at all investigated areas, indicating possible industrial and mining sources of U for the vegetables. A safety assessment of transport routes and accumulation of radionuclides in soils with a potential for cultivation is important, mainly in tropical areas contaminated with solid waste and effluents from mines and industry.

Graphical abstract

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Early stage minor salivary gland adenoid cystic carcinoma has favourable prognosis

Abstract

The purpose of the study was to evaluate the long-term outcome of minor salivary and mucous gland (MiSG) adenoid cystic carcinoma (ACC) of the head and neck and to compare the results with earlier reports including our recently published series on major salivary gland (MaSG) ACC. The study comprised 68 MiSG ACCs operated during 1974–2012 at the Helsinki University Hospital, Helsinki, Finland. Medical records and histological samples were reviewed. Our previously published cohort comprising 54 MaSG ACCs during the years from 1974 to 2009 was used for comparison. The most common locations were the oral cavity and sinonasal cavities. Most patients presented stages IV (33.8%) and I (23.5%) disease. Primary treatment with curative intent, mainly surgery, was offered for 64 patients. Thirty-three (51.6%) of these patients developed a disease recurrence and 22 (66.7%) patients in less than 5 years. The difference in the length of recurrence-free time (<5 vs. >5 years) had an impact on OS and DSS (p < 0.001) showing worse prognosis for the earlier recurring group. T classes 2–4 (p = 0.005, p < 0.001, and p = 0.001, respectively) and stages II–IV (p = 0.019, p < 0.001, and p = 0.002, respectively) were associated with worse OS, DSS, and DFS. MiSG ACC had a similar long-term survival compared to MaSG ACC. Patients with stage I MiSG ACC seem to carry a favourable prognosis compared with those with stages II, III, and IV tumours. It is thus noteworthy that stage II tumours represent a truly advanced disease entity warranting a more aggressive treatment approach.

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Ptosis as a complication of Kawasaki disease

Kawasaki disease is an acute febrile exanthematous disease that affects children younger than 5 years of age. It is regarded as the most common cause of childhood acquired heart disease, but ocular and neurological problems are among the other important clinical findings. We present a 3-year-old boy who developed bilateral ptosis on day 21, 5 days after intravenous immunoglobulin. The ptosis was due to bilateral paralysis of the levator palpebrae superioris muscles and resolved spontaneously on day 25. There were no cardiac sequelae.

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Extensive cutaneous involvement due to herpes simplex virus infection

Description

A 39-year-old woman, with a medical history of oligofrenia, obesity and varicella at 8 years of age, presented to the emergency department (ED) with multiple skin lesions of upper limb, which began with the appearance of vesicles, associated with intense pain and pruritus and with 3 days of evolution. No fever was reported. She was discharged home medicated with acyclovir and hydroxyzine.

Three days later, she returned to the ED with worsening complaints of pain and itching, and extension of cutaneous lesions throughout the body.

On physical examination, she was febrile (T: 38.5°C), with erythematous-pruriginous lesions, some of which were typically targeted, associated with numerous bullae dispersed throughout the body with oral mucosa involvement (figure 1A–C).

Figure 1

(A) Erythematous lesions associated with numerous bullae dispersed throughout the right upper limb. (B) Erythematous lesions associated with numerous bullae dispersed throughout the left upper limb. (C) Erythematous lesions some of which were...

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A rare case of Ludwigs angina after viper bite

Description

A previously healthy 20-year-old woman presented to our Accident and Emergency Department of Degehbur Hospital, a small district hospital in Somali region of Ethiopia, with complaints of rapidly progressive swelling in her neck and difficulty in swallowing for the past 2 days (figures 1 and 2). She was bitten by a snake, which was later identified as a viper, over her right lower jaw while sleeping on the floor. She did not seek any medical treatment until day 3 when the swelling became worse and involved both submandibular region and the tongue. She also complained of rapidly increase shortness of breath for the past 24 hours.

Figure 1

The patient presented to emergency department with severe swelling of her tongue, neck and submandibular area.

Figure 2

Lateral view of the patient showing severe submandibular swelling that obscuring the airway.

...

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Identification of CD146 as a novel molecular actor involved in systemic sclerosis

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Regulatory effects of Interleukin (IL)-15 on allergen-induced airway obstruction

IL-15 deficiency promotes airway obstruction and IL-15 overexpression protects mice from allergen-Induced airway obstruction including AHR , resistance and compliance in an experimental asthma model.

http://ift.tt/2raUpxs

Age-specific profiling of cutaneous allergy at high temporal resolution suggests age-related alterations in regulatory immune function

We report the age-specific prevalence of cutaneous allergy in 45110 patients over a 30 year period. Our analysis reveals complex allergen-specific sensitization profiles which may reflect alterations in T-cell mediated immunity and regulatory immune function.

http://ift.tt/2rVPRrP

A new fluorescent-avidin-based method for quantifying basophil activation in whole blood

We report herein a simple new fluorescent-avidin-based method to detect activated basophils in the whole blood of normal or allergic subjects, and compare this method to a basophil activation test based on detection of CD63.

http://ift.tt/2rbo2OW

Asthma Control Status in Pregnancy, BMI, and Maternal Vitamin D Levels

Higher maternal 25OHD levels at early pregnancy could reduce the associated risk of uncontrolled asthma status during pregnancy. Obesity might attenuate this effect and is a predictor of uncontrolled status during pregnancy.

http://ift.tt/2rVPPQJ

Cancer in primary immunodeficiency diseases: Cancer incidence in the United States Immune Deficiency Network Registry

This study demonstrates that patients with primary immunodeficiency diseases have an increased risk of certain cancers, but have similar risks as the age-matched general population of developing the most common solid tumor malignancies.

http://ift.tt/2rbwf5J

“3D Bioprinting for Reconstructive Surgery: Principles, Applications and Challenges”

Despite the increasing laboratory research in the growing field of 3D bioprinting there are few reports of successful translation into surgical practice. This review outlines the principles of 3D bioprinting including software and hardware processes, biocompatible technological platforms and suitable bioinks. The advantages of 3D bioprinting over traditional tissue engineering techniques in assembling cells, biomaterials and biomolecules in a spatially controlled manner to reproduce native tissue macro-, micro- and nano-architecture is discussed, together with an overview of current progress in bioprinting tissue types relevant for plastic and reconstructive surgery.

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Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials

Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effect of gabapentin and pregabalin on post-surgical pain among patients undergoing breast cancer surgery.

http://ift.tt/2t4AexG

“A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial jump graft in facial palsy treatment.”

Nerve reconstructions are the preferred technique for short standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve gives a strong motor signal. The signal of a cross-face nerve graft is weaker, but spontaneous. Spontaneity in facial expression is believed to be of importance for psychological wellbeing. Therefore combination of the two procedures combines the best of both: a strong motor signal and a spontaneous smile.

http://ift.tt/2s6RLb3

Breast reconstruction by exclusive fat grafting: what about the breast projection?

Autologous fat grafting in exclusive breast reconstruction has been booming in recent years (1,2). This technique has many advantages (autologous reconstruction, reduced scar, absence of muscle sample) as well as a secondary benefit on the improvement of patient silhouette. Its main disadvantage is still the need for performing several successive procedures under general anesthesia, most often to achieve a satisfactory breast volume.

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Body Contouring Procedures in Three or More Anatomical Areas are Associated with Long Term Body Mass Index Decrease in Massive Weight Loss Patients - a retrospective cohort study

– Massive weight loss (MWL) patients who undergo body contouring plastic surgery (BCPS) display superior long-term weight maintenance. The effect of the number of anatomical areas contoured on weight dynamics is undetermined.

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Fishing bacteria with a nanonet

Publication date: Available online 9 June 2017
Source:Materials Today
Author(s): F. De Cesare, E. Di Mattia, A. Macagnano

http://ift.tt/2rKHqBf

Adiponectin: its role in obesity-associated colon and prostate cancers

BIOMARKERS OF RESPONSE TO PD-1/PD-L1 INHIBITION

Editorial Board

Publication date: October 2017
Source:Auris Nasus Larynx, Volume 44, Issue 5

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Diagnosis and following up of Ménière’s disease using multifrequency tympanometry—Cutoff values and temporal changes in measurements

Publication date: Available online 9 June 2017
Source:Auris Nasus Larynx
Author(s): Kazuyuki Ishizu, Akihiro Tamae, Kazuhiko Kubo, Takamasa Yoshida, Nozomu Matsumoto, Tetsurou Yasui, Takashi Nakagawa
ObjectiveThis study aimed to verify cutoff values for G width (the width of bimodal peaks for the waveform obtained when measuring conductance at 2000Hz) in Japanese individuals diagnosed with Ménière's disease (MD) using multifrequency tympanometry (MFT) and to determine the relationship between the G width and ability to hear low-pitched sounds using measurements over time.MethodsThe study included 51 patients with clinically diagnosed MD, who had not undergone endolymphatic sac surgery, but had no other known ear disease (57 ears in patients aged 22–80 years were affected, and 45 ears in patients aged 18–83 years were unaffected; mean age: 53.3±16.9 years). We also enlisted 80 healthy controls with no prior history of ear disease (160 ears, aged 22–76 years, mean age: 40.8±15.7 years). MFT was used to measure the bimodal peak width of the waveform obtained when measuring conductance at resonance frequency of 2000Hz. For patients who had G width measured several times over multiple outpatient visits, we used initial test data to analyze cutoff values. In nine cases with four or more measurements over time, we evaluated a possible correlation between G width and the sum of the hearing threshold for three low-pitched frequencies (125Hz, 250Hz, and 500Hz). We used Student's t-test to determine significance.ResultsThe both ears in the MD patients had a G width wider than the distribution in the control group. There was a significant difference between G width in the control group and in affected ears with MD (p=0.00026) and there was also a significant difference between G width in the control group and in unaffected ears of MD patients (p=0.0056). The cutoff value set with a specificity of 95% was 200daPa, with a sensitivity of 35.1% and specificity of 95.6%. The cutoff value set with a sensitivity of 50% was 140daPa, with sensitivity of 50.9% and specificity of 78.8%. There was no significant difference between resonance frequency of ears in the control group and ears with MD (p=0.41). In nine cases with four or more measurements over time, a case showed a statistically significant positive correlation between the G width and hearing ability threshold for low-pitched sounds (125Hz, 250Hz, and 500Hz) (p=0.03), while an another case showed a tendency toward a positive correlation, which was not statistically significant (p=0.08). Further, there were cases that did not show significant differences in the present study, but might have shown a negative correlation if the number of measurements had been increased.ConclusionMeasurement of G width using MFT may have accuracy as the traditional endolymphatic hydrops test. MFT is non-invasive, causes little discomfort for patients, requires little time to perform, and can be performed by paramedics. MFT was shown to be useful in screening for MD and it is effective in diagnosing MD to measure the change over time of G width using MFT.

http://ift.tt/2s6OkB6

Effects of Prone Position and Positive End-Expiratory Pressure on Noninvasive Estimators of ICP: A Pilot Study

Background: Prone positioning and positive end-expiratory pressure can improve pulmonary gas exchange and respiratory mechanics. However, they may be associated with the development of intracranial hypertension. Intracranial pressure (ICP) can be noninvasively estimated from the sonographic measurement of the optic nerve sheath diameter (ONSD) and from the transcranial Doppler analysis of the pulsatility (ICPPI) and the diastolic component (ICPFVd) of the velocity waveform. Methods: The effect of the prone positioning and positive end-expiratory pressure on ONSD, ICPFVd, and ICPPI was assessed in a prospective study of 30 patients undergoing spine surgery. One-way repeated measures analysis of variance, fixed-effect multivariate regression models, and receiver operating characteristic analyses were used to analyze numerical data. Results: The mean values of ONSD, ICPFVd, and ICPPI significantly increased after change from supine to prone position. Receiver operating characteristic analyses demonstrated that, among the noninvasive methods, the mean ONSD measure had the greatest area under the curve signifying it is the most effective in distinguishing a hypothetical change in ICP between supine and prone positioning (0.86±0.034 [0.79 to 0.92]). A cutoff of 0.43 cm was found to be a best separator of ONSD value between supine and prone with a specificity of 75.0 and a sensitivity of 86.7. Conclusions: Noninvasive ICP estimation may be useful in patients at risk of developing intracranial hypertension who require prone positioning.

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The Use of Intracranial Doppler as a Cause for Intraoperative Hyperthermia

No abstract available

http://ift.tt/2sdfYNL

Effects of an Intraoperative Dexmedetomidine Bolus on the Postoperative Blood Pressure and Pain Subsequent to Craniotomy for Supratentorial Tumors

Background: Control of emergence hypertension and pain is important after craniotomy for monitoring the neurological status. This prospective double-blinded study investigated the hemodynamics after a single bolus of dexmedetomidine (DEX) infusion administered to the patient undergoing craniotomy under general anesthesia, and its effect on emergence hypertension and postsurgical pain. Methods: Adult patients scheduled for elective surgery for supratentorial tumors were randomized to receive a 10-minute intraoperative DEX infusion of 0.4 μg/kg (small dose, n=43) or 0.8 μg/kg (medium dose, n=46), or normal saline (vehicle control, n=45), ∼60 minutes before the end of anesthesia. Results: A transient increase in the blood pressure associated with DEX was observed; 53.5% and 91.3% of the patients in the small-dose and the medium-dose groups, respectively, required treatment. Emergence mean arterial pressure and heart rates were significantly lower in the DEX groups compared with the control group. Incidence rates of postoperative hypertension in the small-dose (16.3%) and the medium-dose groups (15.2%) were significantly lower relative to that of the control group (35.6%). Patients who received DEX had a lower Verbal Numerical Rating Scale (VNRS) score in the neurosurgical ICU than the control group, and postsurgical pain (VNRS≥4) was lower in the medium-dose group (41.3%) than in the control group (71.1%). No shivering was observed in the medium-dose group, which was significantly less than that of the other 2 groups. Conclusions: An intraoperative bolus of DEX risks a transient increase in mean arterial pressure, but controls emergence hypertension effectively. Dose-related reductions in postsurgical pain and shivering were observed.

http://ift.tt/2scP6xs

Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains.

http://ift.tt/2scWrx7

Effects of Acupuncture in Anesthesia for Craniotomy: A Meta-Analysis

Background: Acupuncture treatment has been used in China for >2500 years, and at present it is used worldwide as a form of analgesia in patients with acute and chronic pain. Furthermore, acupuncture is regularly used not only as a single anesthetic technique but also as a supplement or in addition to general anesthesia (GA). Objectives: The aim of this systematic review and meta-analysis was to assess the level of evidence for the clinical use of acupuncture in addition to GA in patients undergoing craniotomy. Design: This is a systematic review of randomized controlled trials with meta-analyses. Data Sources: The literature search (PubMed, Cochrane Library, and Web of Science) yielded 56 citations, published between 1972 and March 01, 2015. No systematic review or meta-analyses on this topic matched our search criteria. Each article of any language was assessed and rated for the methodological quality of the studies, using the recommendation of the Oxford Centre for Evidence Based Medicine. Ten prospective randomized controlled clinical trials with a total of 700 patients were included. Eligibility Criteria: Included in the meta-analysis were studies that involved any craniotomy under GA compared with a combination of GA and acupuncture. Exclusion criteria were no acupuncture during surgery, no GA during surgery, only postoperative data available, animal studies, and low grade of evidence. Results: The use of acupuncture significantly reduced the amount of volatile anesthetics during surgery (P

http://ift.tt/2scZ7eb

The Trigemino-cardiac Reflex: Is Treatment With Atropine Still Justified?

No abstract available

http://ift.tt/2sdfYgJ

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury

Background: Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. Materials and Methods: We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score 20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2200 mg/dL), hypoglycemia (glucose38°C). Results: A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (P

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Large-volume Epidural Blood Patch: An Alternative Technique

No abstract available

http://ift.tt/2scZK7l

Cerebral Gaseous Microemboli are Detectable During Continuous Venovenous Hemodialysis in Critically Ill Patients: An Observational Pilot Study

Background: Continuous venovenous hemodialysis (CVVHD) may generate microemboli that cross the pulmonary circulation and reach the brain. The aim of the present study was to quantify (load per time interval) and qualify (gaseous vs. solid) cerebral microemboli (CME), detected as high-intensity transient signals, using transcranial Doppler ultrasound. Materials and Methods: Twenty intensive care unit (ICU group) patients requiring CVVHD were examined. CME were recorded in both middle cerebral arteries for 30 minutes during CVVHD and a CVVHD-free interval. Twenty additional patients, hospitalized for orthopedic surgery, served as a non-ICU control group. Statistical analyses were performed using the Mann-Whitney U test or the Wilcoxon matched-pairs signed-rank test, followed by Bonferroni corrections for multiple comparisons. Results: In the non-ICU group, 48 (14.5-169.5) (median [range]) gaseous CME were detected. In the ICU group, the 67.5 (14.5-588.5) gaseous CME detected during the CVVHD-free interval increased 5-fold to 344.5 (59-1019) during CVVHD (P

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Bowel Preparation in Awake Craniotomy: An Overlooked Entity

No abstract available

http://ift.tt/2sMFkiP

Urinary Retention Manifesting as Excessive Venous Ooze During Cranio-Vertebral Junction Surgery

No abstract available

http://ift.tt/2sMjI65

Unusual Presentation of Refractory Autonomic Dysreflexia During General Anesthesia

No abstract available

http://ift.tt/2sMlh41

Noninvasive Hemodynamic Measurements During Neurosurgical Procedures in Sitting Position

Background: Neurosurgical procedures in sitting position need advanced cardiovascular monitoring. Transesophageal echocardiography (TEE) to measure cardiac output (CO)/cardiac index (CI) and stroke volume (SV), and invasive arterial blood pressure measurements for systolic (ABPsys), diastolic (ABPdiast) and mean arterial pressure (MAP) are established monitoring technologies for these kind of procedures. A noninvasive device for continuous monitoring of blood pressure and CO based on a modified Penaz technique (volume-clamp method) was introduced recently. In the present study the noninvasive blood pressure measurements were compared with invasive arterial blood pressure monitoring, and the noninvasive CO monitoring to TEE measurements. Methods: Measurements of blood pressure and CO were performed in 35 patients before/after giving a fluid bolus and a change from supine to sitting position, start of surgery, and repositioning from sitting to supine at the end of surgery. Data pairs from the noninvasive device (Nexfin HD) versus arterial line measurements (ABPsys, ABPdiast, MAP) and versus TEE (CO, CI, SV) were compared using Bland-Altman analysis and percentage error. Results: All parameters compared (CO, CI, SV, ABPsys, ABPdiast, MAP) showed a large bias and wide limits of agreement. Percentage error was above 30% for all parameters except ABPsys. Conclusion: The noninvasive device based on a modified Penaz technique cannot replace arterial blood pressure monitoring or TEE in anesthetized patients undergoing neurosurgery in sitting position.

http://ift.tt/2sMsosZ

Pediatric Neurosurgery. Tricks of the Trade

No abstract available

http://ift.tt/2scMFel

Intraoperative and Postoperative Administration of Dexmedetomidine Reduces Anesthetic and Postoperative Analgesic Requirements in Patients Undergoing Cervical Spine Surgeries

Background: Early recovery from anesthesia and avoidance of analgesics with respiratory depressant properties are vital for maintenance of extubated airway in cervical spine surgeries. The current study investigated the role of dexmedetomidine as an anesthetic sparing agent and as a sole postoperative analgesic in these cases. Materials and Methods: Sixty adult patients undergoing cervical spine surgeries were randomized into 2 groups. Group D received intravenous dexmedetomidine infusion 0.5 μg/kg/h throughout the surgery after a loading dose of 1 μg/kg over 10 minutes. Postoperatively, dexmedetomidine infusion was continued at 0.2 μg/kg/h for 24 hours. Group C received a volume-matched bolus and infusion of 0.9% saline. Intraoperative anesthetic requirement, time to recovery, and discharge were recorded. Patients were observed for rescue analgesic requirements for 24 hours after surgery. Hemodynamic stability, sedation scores, and pain scores were assessed for 48 hours after surgery. Results: There was significant reduction in intraoperative anesthetic requirement in group D (P

http://ift.tt/2sddNtJ

Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood

Introduction: Although some studies have reported an association between early exposure to anesthesia and surgery and long-term neurodevelopmental deficit, the clinical phenotype of children exposed to anesthesia is still unknown. Methods: Data were obtained from the Western Australian Pregnancy Cohort Study (Raine) with neuropsychological tests at age 10 years measuring language, cognition, motor function, and behavior. Latent class analysis of the tests was used to divide the cohort into mutually exclusive subclasses of neurodevelopmental deficit. Multivariable polytomous logistic regression was used to evaluate the association between exposure to surgery and anesthesia and each latent class, adjusting for demographic and medical covariates. Results: In our cohort of 1444 children, latent class analysis identified 4 subclasses: (1) Normal: few deficits (n=1135, 78.6%); (2) Language and Cognitive deficits: primarily language, cognitive, and motor deficits (n=96, 6.6%); (3) Behavioral deficits: primarily behavioral deficits, (n=151, 10.5%); and (4) Severe deficits: deficits in all neuropsychological domains (n=62, 4.3%). Language and cognitive deficit group children were more likely to have exposure before age 3 (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.17-3.81), whereas a difference in exposure was not found between Behavioral or Severe deficit children (aOR, 1.00; 95% CI, 0.58-1.73, and aOR, 0.85; 95% CI, 0.34-2.15, respectively) and Normal children. Conclusions: Our results suggest that in evaluating children exposed to surgery and anesthesia at an early age, the phenotype of interest may be children with deficits primarily in language and cognition, and not children with broad neurodevelopmental delay or primarily behavioral deficits.

http://ift.tt/2sMle8l

Acute Reduction in the End-Tidal Carbon Dioxide Level During Neurosurgery: Another Cause for Capnography Artifact

No abstract available

http://ift.tt/2sMnWdV

Use of Dexmedetomidine Along With Local Infiltration Versus General Anesthesia for Burr Hole and Evacuation of Chronic Subdural Hematoma (CSDH)

Background: In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment of CSDH. Materials and Methods: In this prospective-randomized study, 76 patients undergoing surgery for CSDH were divided into 2 groups using computer-generated randomized tables; Dex group ([n=38]; received IV bolus of dexmedetomidine 1 mcg/kg over 10 min followed by maintenance infusion 0.5 mcg/kg/h) and GA group ([n=38; of which 4 patients were dropped out]; received endotracheal intubation with balanced anesthesia). Results: Both anesthesia techniques (Dex group; n=35/38 [92.1%] and GA group; n=34/34 [100%]) were successfully used for surgical treatment of CSDH. Significantly less time for anesthesia onset (14.2±4.2 vs. 20.5±3.4 min, P=0.001), total duration of surgery (77.1±23.9 vs. 102.7± 24.8 min, P=0.001), and recovery from anesthesia (7.4±5.9 vs. 13.2±6.5 min, P=0.004) was observed in the Dex group compared with GA group. Perioperative hemodynamic fluctuations were more common in the GA group as against the Dex group. Postoperative complications (n=2 vs. 9, P=0.021) and length of hospital stay (1.05±0.23 vs. 1.79±2.1 d, P=0.007) were significantly less in the Dex group as against the GA group. Conclusions: Dexmedetomidine sedation with local anesthesia is a safe and effective technique for burr hole and evacuation of CSDH. It is associated with significantly shorter operative time, lesser hemodynamic fluctuations, postoperative complications, and length of hospital stay, thus it is a better alternative to GA.

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Obscure Retropharyngeal Mucocutaneous Masses Associated With Acoustic Neurofibromatosis: A Source of Difficult Airway Management

No abstract available

http://ift.tt/2sM8L4d

The Prophylactic Use of Remifentanil for Delayed Extubation After Elective Intracranial Operations: a Prospective, Randomized, Double-Blinded Trial

Background: Endotracheal extubation is a painful and stressful procedure. The authors hypothesized that the prophylactic use of remifentanil would attenuate the pain intensity and stress responses resulting from extubation in neurosurgical patients. Materials and Methods: In this prospective, randomized, double-blinded, controlled trial, 160 patients with planned delay extubation after elective intracranial operation were randomized 1:1 to receive either remifentanil or normal saline (control) before their extubation. The dose regime of remifentanil was a bolus of 0.5 μg/kg over 1 minute, followed by a continuous infusion of 0.05 μg/kg/min for 20 minutes. The primary outcome was the incidence of severe pain during the periextubation period. Secondary outcomes included changes in the pain intensity and vital signs, failing to pass an extubation evaluation after the study drug infusion, severe adverse events, postextubation complications, and clinical outcomes. Results: Two patients in the remifentanil group did not pass the extubation evaluation. The incidence of severe pain during the periextubation period was significantly lower in the remifentanil group compared with the control group (25.0% vs. 41.3%, P=0.029). Compared with the control group, the visual analog scale in the remifentanil group was significantly lower after the bolus of remifentanil (12±18 vs. 25±27, P=0.001) and immediately after extubation (19±25 vs. 34±30, P=0.001). There were no significant differences in the vital signs immediately after extubation between the 2 groups (P>0.05). Conclusions: The prophylactic use of remifentanil decreases the incidence of severe pain. Our preliminary findings merit a larger trial to clarify the effect of the prophylactic use of remifentanil on clinical outcomes and adverse events.

http://ift.tt/2sMjGLv

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! # Ola via Alexandros G.Sfakianakis on Inoreader

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Παρασκευή 9 Ιουνίου 2017

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