Single-unit implant-supported restoration adjacent to multiple lithium disilicate restorations, an approach to an esthetic challenge: A clinical report

Publication date: Available online 16 June 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Gelareh Ronaghi, Winston Chee, Stephanie Yeung
This clinical report describes a method for predictably shade matching a highly opaque yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) implant restoration adjacent to relatively translucent lithium disilicate veneers in the maxillary anterior region. To achieve a satisfactory outcome, the milled Y-TZP abutment was layered with low-fusing feldspathic porcelain to match the stump shade of the adjacent prepared teeth; this layer subsequently facilitated adhesive bonding of a veneer to the abutment before insertion.



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Making Use of Lasers in Periodontal Treatment: A New Gold Standard?

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Bactericidal Effect of Er:YAG Laser-Activated Sodium Hypochlorite Irrigation Against Biofilms of Enterococcus faecalis Isolate from Canal of Root-Filled Teeth with Periapical Lesions

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Optimization of Antimicrobial Photodynamic Therapy in Biofilms by Inhibiting Efflux Pump

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Presenting a Method to Improve Bone Quality Through Stimulation of Osteoporotic Mesenchymal Stem Cells by Low-Level Laser Therapy

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Light-Emitting Diode at 460 ± 20 nm Increases the Production of IL-12 and IL-6 in Murine Dendritic Cells

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Re: “Comprehensive Survey Results of Childhood Thyroid Ultrasound Examinations in Fukushima in the First Four Years After the Fukushima Daiichi Nuclear Power Plant Accident” by Suzuki et al. (Thyroid 2016;26:843–851)

Thyroid , Vol. 0, No. 0.


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Outbreak of immediate-type hydrolyzed wheat protein allergy due to a facial soap in Japan

Wheat proteins in hydrolyzed form have been widely used in cosmetic products. The number of patients allergic to hydrolyzed wheat protein (HWP) in cosmetic products seems to be small in Western countries (see Table E1 and this article's Online Repository at www.jacionline.org). However, in Japan, Fukutomi et al1 first reported 5 Japanese patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) after using the facial soap containing 0.3% of a specific type of HWP, Glupearl 19S, in 2009, and thousands of subjects showed allergic contact urticaria, anaphylaxis, and/or WDEIA after using the soap.

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Re: “Comprehensive Survey Results of Childhood Thyroid Ultrasound Examinations in Fukushima in the First Four Years After the Fukushima Daiichi Nuclear Power Plant Accident” by Suzuki et al. (Thyroid 2016;26:843–851)

Thyroid , Vol. 0, No. 0.


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Expression and characterization of recombinant bifunctional enzymes with glutathione peroxidase and superoxide dismutase activities

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Tuchen Guan, Jian Song, Yanan Wang, Liying Guo, Lin Yuan, Yingding Zhao, Yuan Gao, Liangru Lin, Yali Wang, Jingyan Wei
To balance the production and decomposition of reactive oxygen species, living organisms have generated antioxidant enzymes and non-enzymatic antioxidant defense systems. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) are two important antioxidant enzymes. Apart from their catalytic functions, they protect each other, resulting in more efficient removal of reactive oxygen species, protection of cells against injury, and maintenance of the normal metabolism of reactive oxygen species. SOD catalyzes the dismutation of the superoxide anion (O2^•−) to oxygen (O2) and hydrogen peroxide (H2O2). H2O2 is then detoxified to water by GPx. In this study, human GPx1^Ser and the Alvinella pompejana SOD (ApSOD) gene were used to design and generate several recombinant proteins with both GPx and SOD activities by combining traditional fusion protein technology, a cysteine auxotrophic expression system, and a single protein production (SPP) system. Among the fusion proteins, Se-hGPx1^Ser-L-ApSOD exhibited the highest SOD and GPx activities. Additional research was conducted to better understand the properties of Se-hGPx1^Ser-L-ApSOD. The synergism of Se-hGPx1^Ser-L-ApSOD was evaluated by using an in vitro model. This research may facilitate future studies on the cooperation and catalytic mechanisms of GPx and SOD. We believe that the bifunctional enzyme has potential applications as a potent antioxidant.



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Editorial Board

Publication date: July 2017
Source:Free Radical Biology and Medicine, Volume 108





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Cell Saver for Adult Spinal Deformity Surgery Reduces Cost

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Jeffrey L. Gum, Leah Yacat Carreon, Michael P. Kelly, Richard Hostin, Chessie Robinson, Douglas C. Burton, David W. Polly, Christopher I. Shaffrey, Virginie LaFage, Frank J. Schwab, Christopher P. Ames, Han Jo Kim, Justin S. Smith, R. Shay Bess
Study DesignRetrospective cohort.ObjectivesTo determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery.Summary of Background DataRecent studies have questioned the clinical value of cell saver during spine procedures.MethodsASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group).ResultsThere were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009).Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient.ConclusionCompared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422.Level of EvidenceLevel III.



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Table of Contents

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4





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Biomechanical Modeling of Spine Flexibility and Its Relationship to Spinal Range of Motion and Idiopathic Scoliosis

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Tishya A.L. Wren, Skorn Ponrartana, Ervin Poorghasamians, Sarah Moreau, Patricia C. Aggabao, Tracy L. Zaslow, Bianca R. Edison, Vicente Gilsanz
Study designCross-sectional.ObjectiveTo examine the relationships between spine morphology, spine flexibility, and idiopathic scoliosis.BackgroundGirls have a higher incidence of clinically significant scoliosis than boys, along with smaller vertebrae and greater flexibility. Based on biomechanical modeling, we hypothesized that smaller vertebral width relative to intervertebral disc (IVD) height would be associated with both greater lateral flexibility of the spine and with idiopathic scoliosis.MethodsMagnetic resonance imaging was used to measure IVD height, vertebral width, and paraspinous musculature in 22 girls with mild and moderate idiopathic scoliosis and 29 girls without scoliosis ages 9–13 years. Clinical measurement of maximum lateral bending was also performed in the girls without scoliosis. A simple biomechanical model was used to estimate bending angle from the ratio of IVD height to vertebral half-width for L1–L4. The average ratio (Ravg) and calculated total bending angle (αtot) for L1–L4 were compared to the clinical measurements of lateral bending flexibility in the control group. These measures were also compared between the scoliosis and control groups.ResultsThere was a significant positive relationship between clinical flexibility and both Ravg (p = .041) and αtot (p = .042) adjusting for skeletal age, height, body mass index, and paraspinous muscle area as covariates. The ratio was significantly higher (Ravg = 0.45 vs. 0.38, p < .0001) and the bending angle was significantly greater (αtot = 107° vs. 89°, p < .0001) for girls with scoliosis compared with controls.ConclusionThese results suggest that differences in spine morphology and corresponding changes in spine flexibility may be related to idiopathic scoliosis. If these relationships can be corroborated in larger prospective studies, these easily measured morphologic traits may contribute to a better understanding of the etiology of idiopathic scoliosis and an improved ability to predict scoliosis progression.Level of EvidenceLevel III.



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A Critical Analysis of Sagittal Plane Deformity Correction With Minimally Invasive Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Gregory M. Mundis, Jay D. Turner, Vedat Deverin, Juan S. Uribe, Pierce Nunley, Praveen Mummaneni, Neel Anand, Paul Park, David O. Okonkwo, Michael Y. Wang, Shay Bess, Adam S. Kanter, Richard Fessler, Stacie Nguyen, Behrooz A. Akbarnia
IntroductionSagittal plane realignment is important to achieve desirable clinical outcomes after adult spinal deformity (ASD) surgery. This study evaluates the impact of minimally invasive (MIS) techniques on sagittal plane alignment and clinical outcomes in ASD patients.MethodsA retrospective, multi-center review of ASD patients (age ≥18 years, and with one of the following: coronal Cobb ≥20°, sagittal vertical axis [SVA] >5 cm, and/or pelvic tilt >25°), MIS surgery, and four or more levels instrumented. Patients were stratified by baseline SRS-Schwab global alignment modifier (GAM) into three groups: 0 (SVA <4 cm), + (SVA 4–9.5 cm), or ++ (SVA >9.5 cm). Radiographic and clinical outcomes measures were analyzed with a minimum of 2-year follow-up.ResultsA total of 96 ASD patients were identified, and 63 met the study's inclusion criteria of circumferential MIS or posterior MIS only, with four or more levels instrumented (n: Group 0 = 37, Group + = 15, and Group ++ = 11). Group 0 was younger than ++ (56.8 vs. 69.6 years), with a higher proportion of females than Group + or ++ (83.8% vs. 66.7% and 54.5%, respectively).Baseline HRQoL was similar. Postoperatively, Groups 0 and + had improved Oswestry Disability Index (ODI) and numeric rating scale (NRS) back and leg scores. Group ++ only had improvement in NRS scores. At the latest follow-up, Groups 0 and ++ had similar sagittal measurements except for PT (21.6 vs. 23.6, p = .009). The + group had improvement in PI–LL (24.2 to 17; p = .015) and LL (30.9 to 38.3; p = .013). Eight of 27 (21.6%) Group 0 patients deteriorated (4 to Group +, 4 to Group ++). Three of 15 (20.0%) Group + patients deteriorated to Group ++, and 3 improved to Group 0. Six of 11 (54.5%) Group ++ patients improved (3 to Group + and 3 to Group 0).ConclusionsMIS techniques successfully stabilized ASD patients with Group 0 and + deformities and improved HRQoL. This study suggests that severe sagittal imbalance is not adequately treated with MIS approaches.



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Radiographic Outcomes of Shilla Growth Guidance System and Traditional Growing Rods Through Definitive Treatment

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Scott J. Luhmann, June C. Smith, Ann McClung, Frances L. McCullough, Richard E. McCarthy, George H. Thompson
Study DesignRetrospective review of a multicenter database.ObjectivesTo compare the radiographic outcomes of patients who had undergone the Shilla Growth Guidance System (SGGS) and traditional growing rod (GR) treatment for management of early-onset scoliosis (EOS) through definitive treatment.Summary of Background DataThe efficacy of surgical treatment of EOS can only be determined after definitive treatment has been completed. We wanted to review our experience with the SGGS and GR for management of EOS through definitive treatment.MethodsPatients who had surgical treatment with SGGS or GR and had undergone definitive treatment were included. The patients were matched by age, preoperative curve magnitude, and diagnosis. The study population consisted of 36 patients (18 in each group) whose mean age at initial surgery was as follows: SGGS, 7.9 years; and GR, 7.7 years (not significant [NS]). Length of follow-up after initial surgery was 6.1 years for SGGS and 7.4 years for GR (NS). Definitive treatment was posterior spinal fusion (15 SGGS, 17 GR), implant removal (3 SGGS), or completion of lengthenings (1 GR).ResultsThe preoperative curve was 61 degrees for SGGS and 65 degrees for GR (NS). After index surgery, the major curve decreased to 24 degrees (−37 degrees) for SGGS and 38 (−27 degrees) for GR (p < .05). At last follow-up, the major curve was 34 degrees (44%) for SGGS and 36 degrees (45%) for GR (NS). The initial T1–T12 length for SGGS was 188 mm and for GR, 181 mm; at last follow-up, SGGS was 234 mm (46 mm increase) and GR was 233 mm (52 mm increase) (NS).ConclusionOur analysis shows the final radiographic outcomes (and changes) and complications (implant-related and infection) between the SGGS and GR groups were not statistically different. The main difference between the two groups was the threefold difference in overall surgeries.



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Editorial Board

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4





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Instructions for Authors

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4





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The Efficacy of Local Autologous Bone Dust: A Systematic Review

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Matthew Street, Ryan Gao, Waldron Martis, Jacob Munro, David Musson, Jillian Cornish, John Ferguson
Study DesignA systematic review of bone dust as an autologous bone graft to encourage osseous fusion.ObjectiveTo identify and review studies that report on the therapeutic potential of bone dust. The research question was structured as follows: populations—animal and human sources of bone dust harvested using burrs; interventions—autologous bone dust compared with other clinically utilized bone graft options; outcomes assessed—(1) in vitro cell viability, cell differentiation, and osteogenic potential and (2) clinical efficacy in the form of fusion rates as assessed using plain radiographs; study designs—in vitro, preclinical in vivo and clinical studies investigating the therapeutic potential of bone dust, harvested by burring, are included in this systematic review.Summary of Background DataLittle is known about the efficacy of bone dust, generated during burring of local bone in spine surgery, as a bone graft to encourage osseous union.MethodsA systematic search was conducted in Medline, PubMed, OVID, Scopus, and Cochrane library. The following key words were used: bone dust, bone burring, bone paste, bone pate.ResultsA total of 285 studies were reviewed. Fourteen articles were identified as relevant for inclusion in this systematic review. Current evidence suggests that bone dust retains osteogenic properties, but limited information is available regarding the osteoinductive potential of bone dust.ConclusionBone dust represents a free source of autologous bone, which can be easily collected during the time of surgery and used as an augment to aid osseous fusion. Further research is required to evaluate the osteoinductive potential of bone dust. The retained growth factors in bone dust may potentially induce local osteoprogenitor cells to proliferate and mineralize to form new bone.



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Masthead

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4





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Trends in Attendance at Scoliosis Research Society Annual Meetings (SRS AM) and International Meeting on Advanced Spine Techniques (IMAST): Location, Location, Location

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Foster Chen, Woojin Cho, Han Jo Kim, David B. Levine
Study DesignDescriptive, respective.ObjectiveAlthough overall membership in Scoliosis Research Society (SRS) has grown over the years, we were curious to see the effects of changing event venue location and timing on conference attendance.Summary of Background DataEvery year, the SRS hosts two major meetings: the Annual Meeting (SRS AM) in the autumn, and the International Meeting on Advanced Spine Techniques (IMAST) in the summer. Sites have alternated from within and outside North America. Often, these meetings have also overlapped with several holidays in certain countries.MethodsThis was an observational study of attendance from past SRS AM and IMAST meetings. Fourteen years of AM and 8 years of IMAST data were made available from the SRS. Participation based on delegate type and countries were tallied. Details from the 10 most represented nations and host nations per year were also tallied, and their national holidays were reviewed for overlaps with the AM.ResultsMembership in AM and IMAST increased from 820 in 2003 to 1,323 in 2016. Attendance at the AM has increased, whereas attendance at IMAST has declined, even after adjusting for membership size. Trends in participation were highly influenced by location. Participation by attendees from the host continent, and especially the host country, is generally high. The negative impact of distant meetings is profoundly seen with North Americans, whereas the positive impact of a nearby meeting was mostly clearly demonstrated by South Americans. Although SRS AM overlapped with holidays in China, Japan, or Korea nearly 50% of the time, this did not influence participation by delegates from these countries.ConclusionParticipation in the AM is highly influenced by location. Although North Americans represented the largest constituency, their presence was not needed to drive total attendance and was not sufficient to turn around the downturn in IMAST attendance. Choice of location can encourage the participation of delegates from the host and neighboring nations; through strategic selection of location, a balance can be reached between participation and global representation.



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A Novel Method for Estimating Three-Dimensional Apical Vertebral Rotation Using Two-Dimensional Coronal Cobb Angle and Thoracic Kyphosis

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): T. Barrett Sullivan, Tracey Bastrom, Fredrick Reighard, Megan Jeffords, Peter O. Newton
Study DesignRetrospective cohort analysis.ObjectivesTo use a large cohort of three-dimensional (3D) spinal reconstructions to create a simple mathematical formula capable of estimating 3D apical vertebral rotation (AVR) based on the correlation with routinely obtained two-dimensional (2D) measurements of scoliosis.Summary of Background DataQuantification of vertebral rotation in AIS using 2-dimensional (2D) imaging is inherently challenging as the axial plane cannot be directly visualized.MethodsA database of 279 3D spinal reconstructions was queried for patients with thoracic major adolescent idiopathic scoliosis (AIS). 2D thoracic Cobb angle, T5–T12 thoracic kyphosis, pelvic incidence, sacral slope, and pelvic tilt were recorded. 3D AVR was calculated for each patient from 3D reconstructions. Patients were divided into development (n = 186) and validation (n = 93) cohorts. Within the development cohort, univariate analysis was performed between 2D measurements and 3D AVR with significance set at p < .05 for inclusion in multivariate analysis. In multivariate analysis, significance was set at p < .01 for inclusion in the final model. Model performance was tested in development and validation cohorts.ResultsOnly 2D thoracic Cobb and T5–T12 thoracic kyphosis had significance in univariate (p < .05) and multivariate analyses (p < .01), meriting inclusion in the final model. 3D AVR (°) = 0.26*(T5–T12 kyphosis) + 0.34*(coronal Cobb) − 5.38. In the development cohort, the model performed well (R = 0.739, r² = 0.54). In testing with the validation cohort, the model proved generalizability (R = 0.703) and had a mean absolute error <5°.ConclusionsThis model is capable of estimating 3D AVR given 2D thoracic Cobb and T5–T12 kyphosis. The accuracy of this method is comparable to previously reported methods of 2D axial rotation measurement. However, this model provides 3D axial rotation and requires no physical instruments, non-standard measurements, or software programs. Such a model is valuable for both routine evaluation of AIS and operative preparation.Level of EvidenceLevel II, diagnostic.



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The Risk of Curve Progression and Surgery in African Americans With Adolescent Idiopathic Scoliosis

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Taylor Lara, Nelson Astur, Tamekia L. Jones, Vinayak Perake, Alice Moisan, William C. Warner, Jeffery R. Sawyer, Derek M. Kelly
Study DesignRetrospective clinical cohort study.ObjectiveTo determine if certain risk factors (age, curve magnitude, skeletal maturity, gender, and curve pattern) traditionally associated with curve progression and surgical intervention in the general population apply equally to African Americans.Summary of Background DataCurrently, information is limited on the role that a patient's race plays in the risk of curve progression of adolescent idiopathic scoliosis (AIS), and existing studies have conflicting results.MethodsRetrospective search of records identified patients who were African American, had been diagnosed with AIS, had a major curve Cobb angle of 10 degrees or more, and had at least two clinical visits with spinal radiographs at least 90 days apart to determine the risk factors for surgical treatment, and 2 years apart to determine the risk factors for curve progression. Patients with a medical condition likely to cause scoliosis were excluded.ResultsOf 738 African American patients with AIS, 223 were assessed for surgical risk factors, and 72 were assessed for curve progression risk factors. Fifty-six (29.17%) had progression of the major coronal curve, and 38 (17.04%) underwent surgery. Age at presentation and curve magnitude at presentation were significant risk factors for surgical intervention. Curve magnitude at presentation was a significant risk factor for curve progression. No significant relationships were found for gender or curve type as they relate to surgical intervention or curve progression.ConclusionAge and curve magnitude at presentation were significantly associated with surgery, as is true in other scoliosis populations. Curve magnitude at presentation was associated with curve progression. In contrast to studies in other populations, however, no significant association was observed between curve progression and age at presentation, curve type, or gender, or between surgery and curve type or gender.Level of EvidenceLevel III, prognostic cohort study.



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Tridimensional Analysis of Rotatory Subluxation and Sagittal Spinopelvic Alignment in the Setting of Adult Spinal Deformity

Publication date: July 2017
Source:Spine Deformity, Volume 5, Issue 4
Author(s): Emmanuelle Ferrero, Renaud Lafage, Bassel G. Diebo, Vincent Challier, Brice Illharreborde, Frank Schwab, Wafa Skalli, Pierre Guigui, Virginie Lafage
Study DesignRetrospective single-center.ObjectiveTo investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes.BackgroundRecent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes. However, there is still a lack of knowledge regarding the clinical impact of 3D evaluation and rotatory subluxation. Recent developments in stereoradiography allow clinicians to obtain full-body standing radiographs with low-dose radiation and 3D reconstruction.MethodsOne hundred thirty lumbar ASD patients underwent full-spine biplanar radiographs (EOS Imaging, Paris, France). Clinical outcomes were recorded. Using sterEOS software, spinopelvic parameters and lateral listhesis were measured. 3D transverse plane parameters included apical axial vertebral rotation, axial intervertebral rotation (AIR), and torsion index (sum of AIR in the curve). ASD patients were divided in three groups: AIR <5°, 5°< AIR <10°, AIR >10°. Groups were compared with respect to radiographic and clinical data. Correlations were performed between the transverse and sagittal plane parameters and clinical outcomes.ResultsPatients with AIR >10° were significantly older, with larger Cobb angle (39.5°) and greater sagittal plane deformity (pelvic incidence–lumbar lordosis mismatch 11.7° and pelvic tilt 22.6°). The AIR >10° group had significantly greater apical vertebra axial rotation apex (24.8°), torsion index (45°), and upper-level AIR (21.5°) than the two other groups. Overall, 27% of AIR patients did not have two-dimensional (2D) lateral listhesis. Patients with AIR >10° had significantly worse Oswestry Disability Index and more low back pain.ConclusionFor patients in which lateral listhesis was unreadable in 2D imaging, rotatory subluxation was revealed using stereoradiography and at an earlier disease stage. Moreover, different 3D transverse plane parameters are related to different patient-reported outcomes. Therefore, axial rotation can be considered in evaluation of lumbar degenerative scoliosis severity and prognosis.Level of EvidenceLevel III.



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Does anaesthesia stop the clock?

Anyone who has undergone general anaesthesia (GA) remembers the strange state of disorientation lasting for quite some time after waking up. Until recently, the idea that one's biological clock had just "paused" for a few hours was not a concept that was considered to explain (part of) this discombobulation. Yet it seems that when we go into the operating room, we come out in another time zone, or rather, time stands still: in other words, GA induces jet-lag. Post-operative recovery may be hindered by circadian disruption and the resulting sleep disturbances, and may also impair mood, alertness, cognitive performance, and even immune function.

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Preclinical evaluation of melanocortin-1 receptor (MC1-R) specific 68Ga- and 44Sc-labeled DOTA-NAPamide in melanoma imaging

Publication date: Available online 16 June 2017
Source:European Journal of Pharmaceutical Sciences
Author(s): Gábor Nagy, Noémi Dénes, Adrienn Kis, Judit P. Szabó, Ervin Berényi, Ildikó Garai, Péter Bai, István Hajdu, Dezső Szikra, György Trencsényi
PurposeAlpha melanocyte stimulating hormone (α-MSH) enhances melanogenesis in melanoma malignum by binding to melanocortin-1 receptors (MC1-R). Earlier studies demonstrated that alpha-MSH analog NAPamide molecule specifically binds to MC1-R receptor. Radiolabeled NAPamide is a promising radiotracer for the non-invasive detection of melanin producing melanoma tumors by Positron Emission Tomography (PET). In this present study the MC1-R selectivity of the newly developed Sc-44-labeled DOTA-NAPamide was investigated in vitro and in vivo using melanoma tumors.MethodsDOTA-NAPamide was labeled with Ga-68 and Sc-44 radionuclides. The MC1-R specificity of Ga-68- and Sc-44-labeled DOTA-NAPamide was investigated in vitro and in vivo using MC1-R positive (B16-F10) and negative (A375) melanoma cell lines. For in vivo imaging studies B16-F10 and A375 tumor-bearing mice were injected with ⁴⁴Sc/⁶⁸Ga-DOTA-NAPamide (in blocking studies with α-MSH) and whole body PET/MRI scans were acquired. Radiotracer uptake was expressed in terms of standardized uptake values (SUVs).Results⁴⁴Sc/⁶⁸Ga-labeled DOTA-NAPamide were produced with high specific activity (approx. 19 GBq/μmol) and with excellent radiochemical purity (99%<). MC1-R positive B16-F10 cells showed significantly (p≤0.01) higher in vitro radiotracer accumulation than that of receptor negative A375 melanoma cells. In animal experiments, also significantly (p≤0.01) higher Ga-68-DOTA-NAPamide (SUVmean: 0.38±0.02), and Sc-44-DOTA-NAPamide (SUVmean: 0.52±0.13) uptake was observed in subcutaneously growing B16-F10 tumors, than in receptor negative A375 tumors, where the SUVmean values of Ga-68-DOTA-NAPamide and Sc-44-DOTA-NAPamide were 0.04±0.01 and 0.07±0.01, respectively. Tumor-to-muscle (T/M SUVmean) ratios were approximately 15-fold higher in B16-F10 tumor-bearing mice, than that of A375 tumors, and this difference was also significant (p≤0.01) using both radiotracers after 60 min incubation time.ConclusionOur newly synthesized ⁴⁴Sc-labeled DOTA-NAPamide probe showed excellent binding properties to melanocortin-1 receptor (MC1-R) positive melanoma cell and tumors. Due to its high specificity and sensitivity ⁴⁴Sc-DOTA-NAPamide is a promising radiotracer in molecular imaging of malignant melanoma.



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Hepatitis C Virus in Pakistan: Community Education Is an Effective Weapon Against the Killer

Viral Immunology , Vol. 0, No. 0.


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Transmission analysis of TGFB1 gene polymorphisms in non-syndromic cleft lip with or without cleft palate

Transforming growth factor beta1 (TGF-β1) plays a significant role in craniofacial development. Previous linkage studies reported that the TGF-β1-locus at 19q13.1 harbour predisposing genes for non-syndromic oral clefts. In the present study case parents triads were evaluated to find the transmission effects of genetic variants in TGF- β1 towards non-syndromic cleft lip or palate (NSCL/P).

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Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy

To identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy.

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Response to the letter to the editor regarding ‘‘Evaluation of vitamin D levels in children with primary epistaxis’’

We would like to thank Mr. Akdoğan and Mr. Hızal for their interest in our study entitled ''Evaluation of vitamin D levels in children with primary epistaxis,'' and we appreciate their valuable comments [1].

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Letter to the editor regarding ‘Evaluation of vitamin D levels in children with primary epistaxis’

We are writing in reference to the paper titled ''Evaluation of vitamin D levels in children with primary epistaxis'' [1]. Almis et al. aimed to investigate whether there is a relationship between serum 25-hydroxy vitamin D [25(OH)D 3] values and incidences of primary epistaxis among children. For that purpose, the authors compared 42 primary epistaxis cases and 55 matched controls, retrospectively, and found that serum 25(OH)D 3 values were lower in the primary epistaxis group compared with the healthy control group.

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Otoplasty for prominent ears – demographics and surgical timing in different populations

Prominent ears are seen in approximately 5% of the population. This benign condition can be treated surgically to reduce or prevent psychological and social problems, most commonly in children before the start of school. Our aim was to examine the demographic characteristics of patients undergoing prominent ear surgery in Finland, and compare findings with international data.

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Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children

Obstructive sleep apnea (OSA) affects 1-5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA.

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Utilization and trends in surgical instrument use in pediatric adenotonsillectomy

Examine trends in surgical instrument usage for pediatric adenotonsillectomy.

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Exposure to non-microbial N-Glycolylneuraminic acid protects farmers’ children against airway inflammation and colitis

Capsule Summary: In addition to microbial exposure, exposure to non-microbial molecules contributes to the protection of farmers' children against airway inflammation and colitis.

http://ift.tt/2sCLuoE

Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique

One hundred and one patients with complete or incomplete cleft lip underwent the anatomical subunit approximation technique for repair. The patients were followed up prospectively for 1year. The objective of this study was to determine the outcomes for the nasolabial area through anthropometric measurements and assessment of the Asher-McDade Aesthetic Index and Steffensen's criteria at 1year after surgery. Six assessors (three cleft surgeons and three non-surgeon medical professionals) examined cropped images; reliability was assessed using Cronbach's alpha.

http://ift.tt/2rpsHZT

Association study of childhood food allergy with GWAS-discovered loci of atopic dermatitis and eosinophilic esophagitis

We found associations between FA and 14 GWAS-identified loci of AD and EoE: C11orf30/LRRC32, TMEM232/SLC25A46, TNFRSF6B/ZGPAT, OVOL1, KIF3A/IL13, GLB1, CCDC80, ZNF365, OR10A3/NLRP10, IL2/IL21, CLEC16A/DEXI, ZNF652, TSLP/WDR36 and STAT6. These findings improve our understanding of the complex heterogeneity of FA.

http://ift.tt/2tcFtfF

A distinct biomolecular profile identifies monoclonal mast cell disorders in patients with idiopathic anaphylaxis

Patients with IA may have an underlying clonal mast cell disorder, which may be suspected on the basis of specific clinical and laboratory findings.

http://ift.tt/2sCLvJe

RNA-containing exosomes in induced sputum of asthmatic patients

This is the first demonstration of RNA-containing exosomes in induced sputum from allergic asthmatic patients, both before and after an allergen provocation. Exosomes could serve as future candidate biomarkers in asthma.

http://ift.tt/2sCWJO0

Mitochondrial DNA depletion induces innate immune dysfunction rescued by interferon-γ

Monocytes from sepsis patients have mitochondrial DNA (mtDNA) depletion and immune deactivation. Here we find that THP-1 cell immune responses are impaired by experimentally depleting mtDNA, through dysregulated immune signalling, and rescued by interferon-γ treatment.

http://ift.tt/2tchrBf

Patterns and predictors of atopic dermatitis disease control past childhood: An observational cohort study

Individuals experience distinct patterns of atopic dermatitis disease control over time; female sex, lower income, non-white race, atopic history and earlier age of onset were highly predictive of persistently active disease into early adulthood.

http://ift.tt/2sD2gEn

Food protein-induced enterocolitis syndromes with and without bloody stool have distinct clinicopathological features

http://ift.tt/2tcDBmY

Severe disease and greater impairment of NF-κB activation in IκBa point mutants versus truncation mutants in autosomal dominant anhidrotic ectodermal dysplasia with immune deficiency

Capsule Summary: Higher levels of mutant protein may explain the more severe disease and the impaired development of secondary lymphoid organs in patients with IκBα point mutations, and thereby the poor response of these patients to hematopoietic stem cell transplantation.

http://ift.tt/2sDcQLg

Unique Influenza A crossreactive memory CD8 TCR repertoire has a potential to protect against Epstein Barr virus seroconversion

http://ift.tt/2tcmBwY

Antiobesity, antioxidant and hepatoprotective effects of Diallyl trisulphide (DATS) alone or in combination with Orlistat on HFD induced obese rats

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Sivakumar Annamalai, Lavanya Mohanam, Veena Raja, Alwin Dev, Venkataraman Prabhu
The increasing rate of obesity in the past years has become a worldwide concern and it causes many diseases. Even though, Orlistat, a synthetic anti-obesity drug approved by FDA, it causes severe side effects. DATS, a natural product from garlic have gained attention in many biological activities. The aim of the study is to determine the impact of Dially trisulpide (DATS) and its combination with Orlistat therapy on obese animals. 30 male Wistar rats (150–180g) were assigned into 5 groups (n=6). Group 1 rats received normal diet and Group 2 fed with high fat diet (HFD) for 14 weeks. Group 3–5 animals fed with HFD for 8 weeks, after that respective drugs were given simultaneously along with HFD for 6 weeks; Group 3: HFD+Orlistat; Group 4: HFD+DATS; Group 5: HFD+Orlistat+DATS. Before and after drug treatment, body weight was measured and blood was collected for assessment of lipid and liver function profiles. After end of the treatment 14 weeks, liver and adipose tissues were collected for antioxidants determination and histological observations. The significantly (p<0.05) increased body weight, serum glucose, total cholesterol, triglycerides, LDL-cholesterol were observed while significantly (p<0.05) decreased HDL-cholesterol and liver function parameters in HFD induced rats when compared to control group. The significantly (p<0.05) decreased activities of SOD, CAT, GPx and GSH levels were observed while significantly (p<0.05) increased LPO in both the tissues of HFD treated group when compared to control. Histopathological changes were observed in both the liver and adipose tissue of HFD treated group. The DATS and its combination with orlistat supplementation restored all the parameters significantly (p<0.05) especially liver function parameters and also retrieved histopathological changes when compared to orlistat alone. DATS and its combination with Orlistat had great effect than Orlistat alone.



http://ift.tt/2txHXEt

2-Methylpyridine-1-ium-1-sulfonate from Allium hirtifolium: An anti-angiogenic compound which inhibits growth of MCF-7 and MDA-MB-231 cells through cell cycle arrest and apoptosis induction

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Hamid-Reza Mohammadi-Motlagh, Yalda Shokohinia, Mahdi Mojarrab, Hassan Rasouli, Ali Mostafaie
Natural products have well been recognized as sources of drugs in cancer treatment. Some medicinal plants contain the constituents with potent anti-angiogenic and anti-cancer effects, which have offered great hopes of being used as drugs for treating various cancers. The present study aims at identifying the anti-angiogenic effects of 2-Methylpyridine-1-ium-1-sulfonate (MPS) isolated from the ethyl acetate extract (EA) of Persian shallot (Allium hirtifolium). In a concentration-dependent manner, the MPS was able to inhibit endothelial cell migration and angiogenesis in both in vivo and in vitro assays, and also significantly suppressed proliferation of MCF-7 and MDA-MB-231 human breast cancer cell lines. Additionally, treatment with MPS showed a significant reduction in the vascular endothelial growth factor (VEGF) secretion level and production/activity of matrix metalloproteinases (MMP-2 and MMP-9) in the studied cells. The flow cytometry analysis indicated that MPS suppressed growth of MCF-7 and MDA-MB-231 cells at G0/G1 and S phases, respectively. Our results indicated that the induction of cell cycle arrest was correlated with the obvious changes in expression of p21, p27 and p53. According to the DNA fragmentation assay, MPS caused apoptosis in both cell lines, which confirms the results obtained with the growth assay. Moreover, the compound-mediated apoptosis accompanied with the increase in the Bax/Bcl-2 ratio and caspase-3 and −9 activities. Molecular docking results indicated that the MPS compound can surprisingly bind to VEGF and VEGF receptors and interacts with their critical amino acids. Finally, compounds with anticancer inhibitory activity (e.g. MPS) are abundant in nature and can be obtained from several sources. So, our data can be clinically developed for treating angiogenesis and cancer significantly.

Graphical abstract

http://ift.tt/2szJrAK

Fusaric acid (FA) protects heart failure induced by isoproterenol (ISP) in mice through fibrosis prevention via TGF-β1/SMADs and PI3K/AKT signaling pathways

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Xin Li, Zhou-Long Zhang, Hui-Fen Wang
Fusaric acid (FA) is a novel compound derived from a class of nicotinic acid derivatives, exhibiting activity against cancers. However, its role in regulating cardiac injury is limited. Our study was aimed to investigate the role and the underlying molecular mechanism of FA in heart fibrosis and hypertrophy. Isoproterenol (ISP) was used to induce cardiac fibrosis and hypertrophy in vitro and in vivo. FA administration ameliorated hypertrophy by reducing atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and β −myosin heavy chain (β-MHC) in vitro and in vivo. Additionally, FA reduced collagen accumulation and fibrosis-related signals, including α- smooth muscle actin (α-SMA), Collagen type I and Collagen type III. Transforming growth factor-β1 (TGF-β1)/SMADs and mitogen-activated protein kinases (MAPKs), including p38, extracellular signal regulated kinase 1/2 (ERK1/2), c-Jun N-terminal kinase (JNK), signalling pathways were highly activated for ISP induction, which were prevented due to FA administration. Further, FA suppressed ISP-induced PI3K/AKT activity in a dose dependent manner. Of note, FA-reduced MAPKs phosphorylation was associated with phosphoinositide 3-Kinase (PI3K)/Protein kinase B (AKT) activity caused by ISP. However, PI3K/AKT activation showed no effects on TGF-β1/SMADs expression in FA-treated cells after ISP exposure. Together, FA might be an effective candidate agent for preventing cardiac fibrosis by modulating TGF-β1/SMADs and PI3K/AKT signalling pathways.



http://ift.tt/2szxTxL

Re: Ipsilateral full-thickness skin grafts to repair the donor site defect of a radial forearm free flap: a reflection on technique

I read with interest the recent paper by Krishnan and Mitchell.1 As a trainee, I worked in two head and neck units with different approaches to closing the donor sites of radial forearm free flaps (RFFF). The preferred sites were the ipsilateral forearm, and a combination of the iliac fossa and forearm (biased towards the iliac fossa). We used a validated system (the Patient and Observer Scar Assessment Scale)2 to assess the appearance, function, and symptoms at the RFFF of the donor or recipient sites about 18 months after operation.

http://ift.tt/2szwwyY

Extracapsular dissection in the parapharyngeal space: benefits and potential pitfalls

The aim of this study was to investigate the benefits and potential pitfalls of transcervical extracapsular dissection in the treatment of parotid gland tumours in the parapharyngeal space. We retrospectively evaluated the records of all patients with parapharyngeal parotid gland lesions treated between 2000 and 2015 by transcervical extracapsular dissection. Patients having revision operations and patients whose records were not complete were excluded, leaving 49 patients in the study. We found acceptable oncological and functional outcomes throughout.

http://ift.tt/2txvRva

Myositis in the head and neck: challenges in diagnosis and management

Myositis in the head and neck may present with non-specific symptoms, and radiographically may mimic malignancy. Multidisciplinary management is often essential, and we describe the challenges in an effort to raise awareness of the condition.

http://ift.tt/2txakm7

Evaluation of four designs of short implants placed in atrophic areas with reduced bone height: a three-year, retrospective, clinical and radiographic study

The aim of the present study was to evaluate retrospectively the clinical and radiographic behaviour of four commercially-available short implants with different macrodesigns and microdesigns in areas in which the height of the bone was reduced. We took into account the success and survival, peri-implant crestal bone loss, and the level of probing at which the gum bled. Patients were included if they had been given one or more short implants (≤8.5mm long) in the posterior jaws at least three years earlier.

http://ift.tt/2txnBeC

New approach to improve the keratinised peri-implant soft tissues in patients with intraoral osteocutaneous reconstruction using a free flap

Patients with large mandibular bony defects after operations for oral cancer or trauma have the defects reconstructed with osteocutaneous microvascular free flaps. These provide adequate bone and soft tissue for reconstruction, but result in altered anatomy that can affect both function and aesthetics (Fig. 1).

http://ift.tt/2szsjeu

Can sagittal approach for cadaveric study of TTP block spread more than transverse approach?

An ultrasound-guided transversus thoracic plane (TTP) block can release the pain at internal mammary area [1,2]. An injection point of the TTP block was between the transversus thoracic muscle and the intercostal muscle between the fourth and fifth ribs next to the sternum [3]. The spread of local anesthetic for peripheral nerve block is important for good perioperative pain management. In particular, the spread of local anesthetic for the TTP block is more important because of trunk block. There was no study, which investigated the difference of local anesthetic's spread in approach of the TTP block.

http://ift.tt/2sIAcPm

Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials

To compare the use of inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting.

http://ift.tt/2rpA3fJ

Neuraxial hypothermia incidence misinterpreted

We read with interest the recent systematic review by Shaw et al. [1] and applaud the authors for discussing the prevalence of perioperative hypothermia in patients receiving neuraxial anesthetics. However, we have concerns that they have inaccurately interpreted the data of a 2017 publication by Frisch et al. [2] examining hypothermia in patients undergoing total hip and knee arthroplasty, a population that often receives neuraxial anesthesia. When describing the Frisk et al. study, the Shaw et al.

http://ift.tt/2sI9BSI

The LMA Supreme: Is it a suitable alternative to the i-gel and LMA ProSeal for airway maintenance in children?

In this issue of the Journal of Clinical Anesthesia, Bhattacharjee and colleagues [1] present their results from a meta-analysis of randomized controlled trials comparing the LMA Supreme™ (Teleflex; Triangle park, NC USA) with the i-gel™ (Intersurgical, Wokingham UK) and LMA ProSeal™ (Teleflex; Triangle park, NC USA) in children. This comparison of supraglottic airway (SGA) devices is timely, as emerging data continues to suggest that SGA use for airway management in children result in fewer peri-operative airway complications when compared to tracheal intubation [2,3].

http://ift.tt/2rpuRZk

Did we open a treasure chest of chest blocks? The jury is out.

According to estimates from the American Cancer Society, there will be more than 250,000 new cases of breast cancer diagnosed in the United States with breast cancer remaining as the second leading cause of over 40,000 cancer deaths in women in the year 2017 [1]. Many patients who are diagnosed will choose to undergo multiple oncoplastic surgical interventions, including breast conserving and reconstructive procedures. For these patients, acute postoperative and chronic pain remains a prevalent and devastating outcome that impacts on physical and psychosocial well-being.

http://ift.tt/2sIWobZ

Revolutionizing medication administration safety: Automated carts are here - Are anesthesiologists ready?

In this month's issue of the Journal of Clinical Anesthesia, Wang and colleagues [1] present a randomized controlled trial assessing the use of an automated operating room anesthesia cart and its effect on the recording of medication errors. A search of the US National Library of Medicine database (PubMed, at http://ift.tt/1cTZOuj) for the term, "medication error" performed at the time of the writing of this editorial retrieved a total of 17,808 citations. So, why is another such article needed? In this innovative and important study, 78 anesthesiologists were trained on the use of an automated medication-dispensing cart, and the anesthetic management then was randomized to intraoperative medication administration using either the automated cart or a conventional manual cart [1].

http://ift.tt/2rpryS2

Fishing for answers in an ocean of data: The potential for big data analytics to enhance our knowledge of the complex regional pain syndromes

In an era of expanding costs and declining reimbursement, the healthcare industry has dramatically expanded the collection of demographic and clinical data to facilitate billing efficiency and maintain financial solvency. Electronic health data collection has primarily emphasized the capture of diagnostic coding, medication delivery, laboratory utilization, and procedural interventions to support third party reimbursement claims, improve efficiency, and provide transparency. Although much of the electronic stored data was never directly intended to answer clinical questions, or guide clinical care, the use of data analytics has created opportunities to winnow through the vast data collections and pull out useful insights into previously unrecognized patterns of common and uncommon medical disorders [1–3].

http://ift.tt/2rpBKtQ

Maurice S. Albin, pioneer neuroanesthesiologist dies at 93; pioneered spinal cord injury care

Maurice Simeon Albin, MD, MSc, a pioneering anesthesiologist who specialized in neuroanesthesia, died at age 93 in Birmingham, Alabama.

http://ift.tt/2sIJoTN

Acute pain management in the pediatric ambulatory setting: How do we optimize the child's postoperative experience?

The accompanying article by Cai and colleagues in this edition of The Journal of Clinical Anesthesia characterizes factors that influence postoperative pain in 204 healthy preschool age children during the first two weeks following outpatient surgery. [1] Postoperative pain management is a complex and challenging issue in pediatrics, especially with regard to ambulatory surgery. The authors, in their prospective study, explored the impact of various demographic, intra-operative, and parental factors on both pain and behavior-related outcomes in young children undergoing outpatient surgical procedures.

http://ift.tt/2rpGTBT

Overnight call and cognitive functioning: Will tablet-based assessment be the solution for safety check in residents?

In this issue of the Journal of Clinical Anesthesia, Williams and colleagues investigated whether measurable sensorimotor and executive function differences exist in anesthesiology residents after a single overnight call shift versus a routine daytime shift using two tablet-based pointing tasks (i.e., ProPoint and AntiPoint) [1]. They found increased reaction times on both tasks amongst overnight call residents compared to those residents working daytime hours, which was suggestive of sensorimotor and cognitive slowing in the overnight call residents.

http://ift.tt/2rpJ5JL

Dexmedetomidine and Renal Protection after Cardiac Surgery

Dexmedetomidine is a well-known alpha 2 adrenergic agonist and widely used drug. First approved by Food and Drug Administration (FDA) in 1999 as a sedative, now dexmedetomidine has been a focus of extensive research because of its anti-inflammatory, sympatholytic actions. In a recent study Brandao et al. has described significantly lower reoperation rate, neurological injury, decrease hospital stay and improved thirty day mortality in their retrospective analysis of cardiac surgical patients who received dexmedetomidine during procedure [1].

http://ift.tt/2sIATIz

Sensorimotor and executive function slowing in anesthesiology residents after overnight shifts

Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures.

http://ift.tt/2rpIebP

Erratum to “Anesthesiologists' perceptions of minimum acceptable work habits of nurse anesthetists” [J Clin Anesth 38 (2017) 107–110]

The authors regret that the affiliation A was incorrectly displayed. This affiliation should read "Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA".

http://ift.tt/2sIEiHk

Bioimpedence: A noninvasive measure of stroke volume and cardiac output

If a non-invasive measure of cardiac output is not accurate is it still non-invasive?

http://ift.tt/2sIyde5

Acetaminophen and ondansetron: The central serotonergic connection

Acetaminophen is one of the most widely used analgesic drugs, yet the exact mechanism of its analgesic effect remains largely unknown. Although originally thought to share similar mechanistic properties with cyclooxygenase (COX) inhibitors, acetaminophen is only weakly anti-inflammatory [1] and appears to inhibit prostaglandin synthesis centrally rather than peripherally, accounting for its antipyretic activity [2]. However, COX inhibition by acetaminophen may only occur under specific low peroxide conditions, likely explaining its known tissue selectivity [3].

http://ift.tt/2rpMyIi

Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists

Clinical repercussions of perioperative treatment with ACEIs/ARBs.

http://ift.tt/2sIp6d8

Workload, efficiency, and productivity following open access scheduling in a gastrointestinal endoscopy suite

In this issue of the Journal, Tsai and colleagues describe a managerial intervention in their gastrointestinal endoscopy suite to accommodate the scheduling of additional cases for a new pediatric gastroenterologist on one day of the week [1]. Their intervention was to share the 2 existing locations with first case starts among the 3 separate gastroenterology groups, rather to expand the number of anesthetizing locations staffed at the start of the workday from 2 to 3 locations. One anesthesia provider was allocated to one adult group, and the other provider was shared between a second adult gastroenterology group and a new pediatric gastroenterologist in the third group.

http://ift.tt/2rpDNy0

Assessing effects of intubating stylet use on early postoperative pharyngeal pain

In a small size randomized clinical trial assessing the effects of stylet use during tracheal intubation on early postoperative pharyngeal pain in anesthetized patients, Komasawa et al. [1] show that stylet use results in an increased incidence of early postoperative pharyngeal pain. To differentiate the effects of one factor on primary study endpoint, however, all of other factors have to be standardized for avoidance of potential biases. In this study, postoperative pharyngeal pain was evaluated when patients leaved operation room after sufficient recovery.

http://ift.tt/2rpMtEg

The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen.

http://ift.tt/2sIpMzb

Post-operative cognitive dysfunction after total knee arthroplasty: It ain't what you do, it's the way that you do it

In this edition, Tanaka et al. [1] describe a prospective study designed to ascertain whether propofol vs desflurane anesthesia affects the incidence of early postoperative cognitive dysfunction (POCD) in elderly obese patients undergoing elective total knee arthroplasty (TKA).

http://ift.tt/2rAASGW

Abcb1a (P-glycoprotein) limits brain exposure of the anticancer drug candidate seliciclib in vivo in adult mice

Publication date: Available online 16 June 2017
Source:Brain Research Bulletin
Author(s): Franciska Erdő, Ildikó Nagy, Beáta Tóth, Annamária Bui, Éva Molnár, Zoltán Tímár, Rémi Magnan, Peter Krajcsi
Seliciclib displayed limited brain exposure in vivo in adult rats with mature blood-brain barrier (BBB). Selicilib was shown to be a specific substrate of human ABCB1 in vitro.To demonstrate that ABCB1/Abcb1 can limit brain exposure in vivo in mice we are showing that seliciclib is a substrate of mouse Abcb1a, the murine ABCB1 ortholog expressed in the BBB as LLC-PK-Abcb1a cells displayed an efflux ratio (ER) of 15.31±3.54 versus an ER of 1.44±0.10 in LLC-PK1-mock cells. Additionally, in the presence of LY335979, an ABCB1/Abcb1a specific inhibitor, the observed ER for seliciclib in the LLC-PK1-mMdr1a cells decreased to 1.05±0.25. To demonstrate in vivo relevance of seliciclib transport by Abcb1a mouse brain microdialysis experiments were carried out that showed that the AUCbrain/AUCblood ratio of 0.143 in anesthetized mice increased about two-fold to 0.279 in the presence of PSC833 another ABCB1/Abcb1a specific inhibitor. PSC833 also increased the brain exposure (AUCbrain) of seliciclib close to 2-fold (136 vs 242) in awake mice.In sum, Abcb1a significantly decreases seliciclib permeability in vitro and is partly responsible for limited brain exposure of seliciclib in vivo in mice.

Graphical abstract

http://ift.tt/2sIItmz

Reply to: ‘Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up’

We read with great interest the paper entitled 'Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up,' by Rose et al.1 The article raised some excellent points regarding the necessity and sustainability of regular specialist follow-up of low-risk squamous cell carcinoma (SCC). We too have recently conducted an analysis of SCC recurrence and follow-up schedules via a retrospective analysis of SCCs excised by the senior author over a 2-year period from January 2014 to January 2016.

http://ift.tt/2tcjkhe

Delaying Implant-Based Mammary Reconstruction After Radiotherapy Does Not Decrease Capsular Contracture: An In Vitro Study

The most common complication of irradiated implant-based mammary reconstruction is fibrosis and capsular contracture. The indications for post mastectomy adjuvant radiotherapy have significantly broadened. Facing an increased number of patients who will require radiotherapy, most guidelines recommend delaying reconstruction after radiotherapy to prevent long-term fibrotic complications. Does radiotherapy permanently alter cellular properties which will adversely affect implant-based reconstruction? If so, is there a benefit in delaying reconstruction after radiotherapy?Our in-vitro model simulates two implant-based mammary reconstruction approaches: the irradiated implant and the delayed implant reconstruction beneath healthy un-irradiated tissue post radiotherapy.

http://ift.tt/2sCOyku

Microneedling: Where do we stand now? A systematic review of the literature

Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.

http://ift.tt/2tcgx7R

Pedicled Omental Flaps in the treatment of complex spinal wounds after en-bloc resection of spine tumors

A retrospective study of 5 patients who underwent pedicled omental flap following spine tumor removal.

http://ift.tt/2sCFvAc

Measuring the carbon footprint of Plastic Surgery: a preliminary experience in a Chilean teaching hospital

Global warming is an ongoing phenomenon defined by a steady increase in the Earth temperature. Even though still controversial, evidence suggests that human activity could have an impact on this process by the emission of the so-called greenhouse gases.

http://ift.tt/2tbUVZ7

A prospective randomized study comparing centrifugation and sedimentation for fat grafting in breast reconstruction

Fat grafting is an efficient method to correct large volumetric defects after mastectomy.There is ongoing debate regarding the best method of processing the harvested fat before fat grafting. The aim of this study was to introduce a new MRI-model and to compare two fat processing techniques measuring the gain in soft tissue thickness after fat grafting to the chest wall.

http://ift.tt/2sCFuw8

A 64-bp sequence containing the GAAGA motif is essential for CaMV-35S promoter methylation in gentian

Publication date: Available online 15 June 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Asahi Shimada, Azusa Okumura, Satoshi Yamasaki, Yuji Iwata, Nozomu Koizumi, Masahiro Nishihara, Kei-ichiro Mishiba
This study investigated sequence specificity and perenniality of DNA methylation in the cauliflower mosaic virus (CaMV) 35S promoter of transgenic gentian (Gentiana triflora×G. scabra) plants. Unlike conventional transgene silencing models, 35S promoter hypermethylation in gentian is species-specific and occurs irrespective of the T-DNA copy number and genomic location. Modified 35S promoters were introduced into gentian, and single-copy transgenic lines were selected for methylation analysis. Modified 35S promoter lacking a core (−90) region [35S(Δcore)] in gentian conferred hypermethylation and high levels of de novo methylation of the CpHpH/CpCpG sites in the 35S enhancer regions (−298 to −241 and −148 to −85). Therefore, promoter transcription may not be an absolute requirement for the methylation machinery. In vitro, de novo methylation persisted for more than eight years. In another modified 35S promoter, two "GAAGA" motifs (−268 to −264 and −134 to −131) were replaced by "GTTCA" in the two highly de novo methylated regions. It did not support hypermethylation and showed transgene expression. A 64-bp fragment of the 35S enhancer region (−148 to −85) was introduced into gentian and the resultant transgenic lines analyzed. The 64-bp region exhibited hypermethylation at the CpG/CpWpG sites, but the CpHpH/CpCpG methylation frequency was lower than those of the unmodified 35S- and 35S(Δcore) promoters. Nevertheless, a distinct CpHpH/CpCpG methylation peak was found in the 64-bp region of all single-copy transgenic lines. These results suggest that the 64-bp region may contain an element required for 35S methylation but insufficient for high de novo methylation compared with those in the unmodified 35S and 35S(Δcore) promoters.



http://ift.tt/2sCzTpP

Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database

J reconstr Microsurg
DOI: 10.1055/s-0037-1603739

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.
[...]

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

http://ift.tt/2rFNpnl

Undifferentiated sarcoma of the sphenoid sinus

Publication date: Available online 16 June 2017
Source:Auris Nasus Larynx
Author(s): Masaya Nagaishi, Kensuke Suzuki, Yoshiki Sugiura, Issei Takano, Yoshihiro Tanaka, Akio Hyodo
Paranasal sinuses sarcomas are rare and no treatments have been established. We report a young-adult case of sphenoid sinus sarcoma treated by carbon-ion radiotherapy. The patient presented with progressive left-sided visual impairment. A tumor was then identified and partial resection by transnasal approach was performed. The resected mass showed typical morphology of mesenchymal tumor, and morphological and molecular analyses ruled out a predominant-differentiation phenotype. The pathological diagnosis was undifferentiated sarcoma. The residual lesion was treated with carbon-ion radiotherapy, and tumor progression was absent for one year. The patient died of the tumor regrowth 20 months after initial diagnosis. Although this case had a poorer outcome compared with cases of the more-common sarcoma types, our experience suggested that carbon-ion radiotherapy is potentially beneficial in unresectable undifferentiated sarcomas cases of sphenoid sinus.



http://ift.tt/2txg8ME

A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

Publication date: Available online 16 June 2017
Source:Auris Nasus Larynx
Author(s): Takashi Matsuzuka, Masahiro Suzuki, Masakazu Ikeda, Kaoru Sato, Junko Fujimoto, Rumi Hosaka, Yuko Tanji, Shu Soeda, Shigeyuki Murono
The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job. Under local anesthesia, resection was performed, and PGA sheet grafting were used to shield the skin defect. After resection, she was relieved from pain, and could stay home without daily wound treatment. One and half months after resection, the wound was almost epithelialized. The PGA sheets consist of soft, elastic, nonwoven fabric made of PGA. In recent years, PGA sheet grafting has been widely used in the reconstruction and was chosen to shield the skin defect for this case. PGA sheet grafting after resection of cervical skin tumor can be an acceptable method for palliative care to relieve pain, bleeding, offensive smell, and ugly appearance.



http://ift.tt/2szdqJj

Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Publication date: Available online 16 June 2017
Source:Auris Nasus Larynx
Author(s): Hideaki Nishi, Takeshi Shinozaki, Toshifumi Tomioka, Takashi Maruo, Ryuichi Hayashi
ObjectiveSquamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.MethodsWe retrospectively analyzed the outcome and prognosis of 45 patients (38 men, 7 women) with SCC of the retromolar trigone who underwent treatment in our department between July 1992 and March 2011.ResultsMean age was 62.4 years. Clinical stages were: stage I (n=4, 8.9%); stage II (n=10, 22.2%); stage III (n=5, 11.1%); and stage IVa (n=26, 57.8%). Surgical resection was performed in all patients and 6 patients also received postoperative radiotherapy. Reconstructive surgery using free flaps was performed in 38 patients; postoperative complications occurred in 5 of these patients. The 3-year local control rate was 80%, and the 3-year over all survival rates for stage I, II, III, and IV disease were 100%, 80%, 40%, and 49.2%, respectively. Cause of death was the original disease in 23 cases and other diseases in 2 cases. The most common cause of death from the original disease was cervical lymph node metastasis.ConclusionThe presence of cervical lymph node metastasis was a negative prognostic factor. Marginal mandibulectomy may be selected for patients without distinct bone-marrow infiltration.



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The extended bundle of the tensor veli palatini: Anatomic consideration of the dilating mechanism of the Eustachian tube

Publication date: Available online 16 June 2017
Source:Auris Nasus Larynx
Author(s): Ryuhei Okada, Satoru Muro, Kohtaro Eguchi, Kohei Yagi, Hisayo Nasu, Kumiko Yamaguchi, Koh Miwa, Keiichi Akita
ObjectiveThe aim of this study was to analyze the topographical structures of the muscles surrounding the Eustachian tube.Materials and methodsWe conducted macroscopic and histological studies of 24 halves of 12 heads from Japanese cadavers.ResultsThe main findings were as follows: 1) the infero-lateral muscle bundles of the tensor veli palatini didn't turn medially at the pterygoid hamulus but were distributed laterally and continuous with the buccinator; 2) the tensor veli palatini attached laterally to the membranous part of the Eustachian tube; 3) the superior pharyngeal constrictor was not only adjacent to the buccinator at the pterygomandibular raphe but also had muscular continuation with it laterally and 4) some bundles of the superior pharyngeal constrictor adhered with the palatine aponeurosis.ConclusionWe believe that the cooperation of the muscles contributes to the dilating mechanism of the Eustachian tube, due to the complex topographical structures of the surrounding muscles: the tensor veli palatini, the levator veli palatini, the superior pharyngeal constrictor and the buccinator.



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Physiological characteristics of Plantago major under SO 2 exposure as affected by foliar iron spray

Abstract

Sulfur dioxide (SO₂) is considered as a main air pollutant in industrialized areas that can damage vegetation. In the present study, we investigated how exposure to SO₂ and foliar application of iron (Fe) would affect certain physiological characteristics of Plantago major. The plant seedlings exposed or unexposed to SO₂ (3900 μg m⁻³) were non-supplemented or supplemented with Fe (3 g L⁻¹) as foliar spray. Plants were exposed to SO₂ for 6 weeks in 100 × 70 × 70 cm chambers. Fumigation of plants with SO₂ was performed for 3 h daily for 3 days per week (alternate day). Lower leaf Fe concentration in the plants exposed to SO₂ at no added Fe treatment was accompanied with incidence of chlorosis symptoms and reduced chlorophyll concentration. No visible chlorotic symptoms were observed on the SO₂-exposed plants supplied with Fe that accumulated higher Fe in their leaves. Both at with and without added Fe treatments, catalase (CAT) and peroxidase (POD) activity was higher in the plants fumigated with SO₂ in comparison with those non-fumigated with SO₂. Foliar application of Fe was also effective in increasing activity of antioxidant enzymes CAT and POD. Exposure to SO₂ led to reduced cellulose but enhanced lignin content of plant leaf cell wall. The results obtained showed that foliar application of Fe was effective in reducing the effects of exposure to SO₂ on cell wall composition. In contrast to SO₂, application of Fe increased cellulose while decreased lignin content of the leaf cell wall. This might be due to reduced oxidative stress induced by SO₂ in plants supplied with Fe compared with those unsupplied with Fe.

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Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes

Publication date: Available online 16 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Hussein Okasha, Shaimaa Elkholy, Mohamed Sayed, Ahmed Salman, Yahia Elsherif, Emad El-Gemeie
Background and study aimsIntra-abdominal and mediastinal lymphadenopathy are often difficult to diagnose, particularly in the absence of a primary lesion. Endosonography (EUS)-guided fine-needle aspiration and cytology (FNAC) has provided an easy and safe access to these lymph nodes, sparing the use of invasive and costly interventions. The main aim of this study is to assess the specificity, sensitivity, and predictive value of EUS-guided FNAC in the diagnosis of benign and malignant lymph nodes. In addition, the study aims to determine significant EUS features that could help in predicting lymph node malignancy.Patients and methodsThis prospective study included 142 patients with intra-abdominal or intrathoracic lymphadenopathy who were referred for EUS-guided FNAC because of inaccessibility by other imaging modalities. Ninety (63.3%) patients were found to have malignant lymph nodes, and 52 (36.6%) had lymphadenopathy of benign nature.ResultsEUS-guided FNAC had a sensitivity and specificity of 92% and 100% respectively. It had positive and negative predictive values of 100% and 88% for malignancy, respectively. By logistic regression analysis, EUS features and shortest diameter were found to be potential predictors of malignancy with p-value of <0.0001.ConclusionEUS-guided FNAC is a powerful modality in the diagnosis of benign and malignant lymph nodes. Additional complementary EUS features could be added to this technique for definitive diagnosis.



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Comparative study on the effect of low intensity laser and growth factors on stem cells used in experimentally-induced liver fibrosis in mice

Publication date: Available online 16 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Eman Naguib, Ashraf Kamel, Osama Fekry, Gamal Abdelfattah
Background and study aimsThe therapeutic effects of human umbilical cord-derived mesenchymal stem cells (UC-MSCs) exposed to diode laser and/or hepatocyte growth factor (HGF) were compared in mice with experimental liver fibrosis induced by carbon tetra chloride (CCl4).Material and methodsAnimal model of liver cirrhosis was induced by intraperitoneal injection of CCl4 in a dose of 0.4ml/kg, twice a week for 6weeks. UC-MSCs were obtained from normal full term placentas and were exposed to diode laser and/or HGF. Before treatment, UC-MSCs were labelled with red fluorescent PKH26. Fifty four male mice weighing 25–35g were randomly divided into four groups control, stem cells, CCl4, and treated groups. After the experimental period, body and liver weights were recorded, and the liver specimens were processed for histological examination using haematoxylin and eosin, Periodic Acid-Schiff (PAS), and Masson's Trichrome staining (MT).ResultsResults showed that administration of UC-MSCs stimulated by diode laser and/or HGF improved body and liver weights, reduced vascular dilatation and congestion, reduced mononuclear cellular infiltration, reduced hepatocyte vacuolation, eosinophilia, and pyknosis. Furthermore, periportal fibrosis was minimized and PAS reaction was increased. These effects were maximum when UC-MSCs were exposed to both diode laser and HGF.ConclusionUC-MSCs stimulated by both diode laser and HGF proved to be an effective therapeutic option in experimental liver fibrosis induced by CCl4 in mice.



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Novel use of fully covered self-expandable metal stent for drainage of perirectal abscess. A case series

Publication date: Available online 16 June 2017
Source:Arab Journal of Gastroenterology
Author(s): Mindy Lee, Manhal Izzy, Sammy Ho




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Understanding the Holobiont: How Microbial Metabolites Affect Human Health and Shape the Immune System

Publication date: Available online 15 June 2017
Source:Cell Metabolism
Author(s): Thomas Siegmund Postler, Sankar Ghosh
The human gastrointestinal tract is populated by a diverse, highly mutualistic microbial flora, which is known as the microbiome. Disruptions to the microbiome have been shown to be associated with severe pathologies of the host, including metabolic disease, cancer, and inflammatory bowel disease. Mood and behavior are also susceptible to alterations in the gut microbiota. A particularly striking example of the symbiotic effects of the microbiome is the immune system, whose cells depend critically on a diverse array of microbial metabolites for normal development and behavior. This includes metabolites that are produced by bacteria from dietary components, metabolites that are produced by the host and biochemically modified by gut bacteria, and metabolites that are synthesized de novo by gut microbes. In this review, we highlight the role of the intestinal microbiome in human metabolic and inflammatory diseases and focus in particular on the molecular mechanisms that govern the gut-immune axis.

Teaser

The bacteria inhabiting the gastrointestinal tract, collectively referred to as the microbiome, have emerged as important regulators of human health. In this review, Postler and Ghosh discuss how the microbiome affects metabolic and inflammatory diseases, with a particular focus on the molecular mechanisms that govern the gut-immune axis.


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Title Page

Publication date: May–June 2017
Source:Current Problems in Cancer, Volume 41, Issue 3





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Information for Readers

Publication date: May–June 2017
Source:Current Problems in Cancer, Volume 41, Issue 3





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Table of Contents

Publication date: May–June 2017
Source:Current Problems in Cancer, Volume 41, Issue 3





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Considerations of developing an NGS assay for clinical applications in precision oncology: The NCI-MATCH NGS assay experience

Publication date: May–June 2017
Source:Current Problems in Cancer, Volume 41, Issue 3
Author(s): Chih-Jian Lih, Naoko Takebe
Next generation sequencing (NGS) technologies have been widely adapted in clinical oncology by utilizing the profiled genetic mutation information to select patients and to guide the choice of target therapy. To fulfill the regulatory compliance, development of an NGS assay that will be used in clinical trials requires an analytical validation to meet its intend clinical use. NCI-MATCH trial is the largest precision oncology basket trial which uses a single NGS assay (NCI-MATHC NGS assay) to screen the actionable mutations in 6000 patients, who have relapsed/refractory solid tumors and lymphomas after standard systemic treatment, and assigns matched treatment. This article reviews on the critical considerations during development and validation of NGS assays as an investigational device for genomic based clinical trials and provides the experiences from the development of NCI-MATCH NGS assay.



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Tooth brushing motion patterns with manual and powered toothbrushes—a randomised video observation study

Abstract

Introduction

Systematic reviews have shown that powered toothbrushes (PTs) are more effective than manual toothbrushes (MTs), but with only minor effect sizes. Whether PTs are used adequately, however, has not been investigated so far. The aim of the present study was therefore to analyse motion habits with PT in comparison to MT toothbrushes by video observation.

Materials and methods

One hundred subjects were enrolled in this observational trial and brushed their teeth in randomised order with a MT and PT while being video-filmed, resulting in 95 analysable sets of recordings. Parameters of interest were brushing duration (s; median (min;max)), type of brushing strokes, area of brushing, changes between areas (n; median (min;max)) and brushing sequence.

Results

Brushing duration was 145 s (60;354) and 135 s (48;271) for PT and MT, respectively (p ≤ 0.001). Subjects brushed vestibular surfaces completely, but reached oral surfaces to a much lesser extent, regardless of the toothbrush type. With both toothbrushes, subjects moved frequently between areas (MT 35 (14;79); PT 33 (14;85); n.s.) and brushed predominantly with circling and horizontal strokes; with the PT, 50.5% of the subjects spent only <10% of the brushing duration with passive brushing (positioning the brush head on the teeth with ≤2 movements/s).

Conclusions

Intra-individual motion patterns were similar with both MT and PT, and most subjects persisted in their habitual motion patterns regardless of the toothbrush type.

Clinical relevance

The use of PT and MT may need intensive training and supervision from oral hygiene educators in order to help subjects taking full advantage from these devices.

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Acute pediatric neck infections: Outcomes in a seven-year series

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Filipa Camacho Côrte, João Firmino-Machado, Carla Pinto Moura, Jorge Spratley, Margarida Santos
ObjectivesThe aim of this study was to analyse the epidemiology, clinical presentation, diagnostic clues, as biochemical parameters and imaging studies, of children with acute neck infections (ANI) to identify possible independent prognostic factors leading to complications and prolonged hospitalization. Methods: Records of children admitted to a tertiary university hospital from January 2008 to December 2014 with a diagnosis of ANIs were reviewed retrospectively. Diseases were categorized according to the site of infection and patients were divided into two groups: children (aged<10 years) and adolescents (aged 10–18 years).ResultsA total of 102 patients belonged to the children's group and 57 were adolescents. Forty-nine patients (27.2%) received antibiotics prior to presentation. The most frequent ANI was peritonsillar abscess (n = 72). Four peritonsillar abscesses progressed to parapharyngeal and retropharyngeal abscesses (n = 2 respectively). An association between age and type of abscess was found, with most of the retropharyngeal abscesses occurring in children (p = 0.05), and the submandibular abscesses in adolescents (p < 0.001). The most frequent symptoms/signs were fever (63.9%) and odynophagia (50.6%). Upon admission, all patients received intravenous antibiotics and 86.8% underwent drainage of the abscess. Cultures were harvested in 87 abscesses and the most frequent pathogen isolated was Streptococcus pyogenes. Signs of airway obstruction occurred in two patients with submandibular abscess, one with peritonsillar and one with parapharyngeal abscess. There were no cases of death or severe sequelae. Recurrent ANIs were observed in eight patients including two infected branchial cysts. Children, presence of multiple abscesses and palpable cervical mass on admission, absence of odynophagia and pharyngeal bulging, surgery with general anaesthesia and surgery after 24 h, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission were identified as predictors of complications.ConclusionsThe present study found, that often, the diagnosis and treatment of neck abscesses in paediatric patients is not straightforward, but can achieve a favourable outcome. The primary location of the ANI appears to vary in different paediatric age groups. Younger age, presence of multiple abscesses or a palpable cervical mass on admission, were associated with prolonged hospitalization. Presence of toothache and neck pain on admission was identified as possible predictors of complications.



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Brain-shift compensation using intraoperative ultrasound and constraint-based biomechanical simulation

Publication date: Available online 15 June 2017
Source:Medical Image Analysis
Author(s): Fanny Morin, Hadrien Courtecuisse, Ingerid Reinertsen, Florian Le Lann, Olivier Palombi, Yohan Payan, Matthieu Chabanas
Purpose. During brain tumor surgery, planning and guidance are based on preoperative images which do not account for brain-shift. However, this deformation is a major source of error in image-guided neurosurgery and affects the accuracy of the procedure. In this paper, we present a constraint-based biomechanical simulation method to compensate for craniotomy-induced brain-shift that integrates the deformations of the blood vessels and cortical surface, using a single intraoperative ultrasound acquisition. Methods. Prior to surgery, a patient-specific biomechanical model is built from preoperative images, accounting for the vascular tree in the tumor region and brain soft tissues. Intraoperatively, a navigated ultrasound acquisition is performed directly in contact with the organ. Doppler and B-mode images are recorded simultaneously, enabling the extraction of the blood vessels and probe footprint respectively. A constraint-based simulation is then executed to register the pre- and intraoperative vascular trees as well as the cortical surface with the probe footprint. Finally, preoperative images are updated to provide the surgeon with images corresponding to the current brain shape for navigation. Results. The robustness of our method is first assessed using sparse and noisy synthetic data. In addition, quantitative results for five clinical cases are provided, first using landmarks set on blood vessels, then based on anatomical structures delineated in medical images. The average distances between paired vessels landmarks ranged from 3.51 to 7.32 (in mm) before compensation. With our method, on average 67% of the brain-shift is corrected (range [1.26; 2.33]) against 57% using one of the closest existing works (range [1.71; 2.84]). Finally, our method is proven to be fully compatible with a surgical workflow in terms of execution times and user interactions. Conclusion.In this paper, a new constraint-based biomechanical simulation method is proposed to compensate for craniotomy-induced brain-shift. While being efficient to correct this deformation, the method is fully integrable in a clinical process.

Graphical abstract

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Structural Basis for Ribosome Rescue in Bacteria

Publication date: Available online 16 June 2017
Source:Trends in Biochemical Sciences
Author(s): Paul Huter, Claudia Müller, Stefan Arenz, Bertrand Beckert, Daniel N. Wilson
Ribosomes that translate mRNAs lacking stop codons become stalled at the 3′ end of the mRNA. Recycling of these stalled ribosomes is essential for cell viability. In bacteria three ribosome rescue systems have been identified so far, with the most ubiquitous and best characterized being the trans-translation system mediated by transfer–messenger RNA (tmRNA) and small protein B (SmpB). The two additional rescue systems present in some bacteria employ alternative rescue factor (Arf) A and release factor (RF) 2 or ArfB. Recent structures have revealed how ArfA mediates ribosome rescue by recruiting the canonical termination factor RF2 to ribosomes stalled on truncated mRNAs. This now provides us with the opportunity to compare and contrast the available structures of all three bacterial ribosome rescue systems.



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ASBA CEO David Gergen Has a Distinguished Pedigree – By Alan Hickey

David Gergen and Alan Hickey

The CEO of the American Sleep and Breathing Academy has a clear mission: Educate and spread awareness of oral appliance therapy and sleep disorders to the public, and to the medical and dental professions. Serving as the ASBA's CEO for the past five years, David Gergen has leveraged the power of athletic celebrity to shine a bright light on sleep disorders.

His enormous push in the industry and the ASBA's massive amount of success is largely in part due to his distinguished pedigree. Gergen is no stranger to elite leadership, coming from a family lineage that has generals and officers in the U.S. military. His family ties also include the first female bank president in the U.S., prominent politicians, national leaders who have served in presidential cabinets and Hall of Fame athletes in various sports/states. The Gergen family success doesn't stop there, as clearly seen by his son Johnny's Minnesota state record for the largest recorded fish ever caught in the history of the state, his daughter Lennon's successful modeling career appearing as the Mello Yellow girl and television actress in multiple T.V commercials and his oldest son David's state championship football achievement in high school.

I can say with full confidence athleticism runs deep in the Gergen blood. I've seen David's plaque signed by President Jimmy Carter recognizing him as a national record holder and champion broad jumper for the 11-12 year old age group in 1977, jumping 9' 8 ¾". That and many other state records are still held today which have stood for over 30 years. His state championship in the 100 meter sprint is no small feat either. As a state champion football player and coach, he went on to being the only coach in Arizona state history to win a national championship, being presented with a plaque from the Arizona State Governor. Later in 2004, Gergen was presented with the Small Businessman of the Year award. Despite all of his triumphs, Gergen is still the most humble person I've ever met; it took me years of knowing him for him to ever mention any of this to me.

 

David Gergen running the 200 Meter Sprint

When I thought, "All of this can't possibly be true," I was finally able to verify everything he told me after speaking with his best friends since childhood- Warren and Will Faulkner. Warren added to his accomplishments telling me, "I convinced him to play with us in the Mormon church league and we took the team all the way to nationals. David's shot was so consistent I had to name him the invincible armada, his mere presence gives strength to the weak. David was good for 15-20 points a game and just as many rebounds. Despite being 5'7" he could easily dunk the basketball. Hops like that are super natural." Another thing I wasn't aware, Faulkners are direct descendants of Edward Faulkner who was commissioned by Brigham Young to colonize Arizona. His loyalty to friends, family and business partners is unrivaled; David even hired Will Faulkner's son, Skylar Faulkner, who is his personal assistant. Skylar has said to me, "Working with David Gergen has shown me an entirely different side of success than I have ever seen. He is a real winner, and it's showed through everything he touches. The man has no fear whether it's taking a business risk or a bar room brawl, he's down for the task."

-Alan Hickey

 

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Dr. Kent Smith, President | ASBA, Pushing Dental Sleep Medicine Through First-Rate Education

Dr. Kent Smith, President of the American Sleep and Breathing Academy (ASBA), has worked to push the dental sleep industry by providing dentists with his knowledge of treating patients who have been diagnosed with sleep apnea through use of oral appliance therapy. His mission to build and support a community of dentists dedicated to enhancing the lives of others is what has been the driving force behind his biggest annual event, known as The Roundtable, which has been running seven years strong.

The Roundtable provides a rare opportunity to learn from the best in both formal lectures and informal conversations. The weekend event has seen over 2,000 dentists learn how to successfully add sleep apnea diagnosis and treatment to their practices using hands on programs. Although 2017's meeting took place exactly one month after the ASBA's Sleep and Wellness Conference, dentists who attended both the ASBA annual meeting and Dr. Smith's Roundtable said they were "glad they went to both meetings" due to the value each held.

"The ASBA had a variety of topics with speakers who are unrivaled at other shows. They showed that the academy was really moving our industry forward and that's something I'll definitely support. Dr. Kent Smith's meeting was a little more hands on. These two meetings in conjunction with each other are the two most important meetings of the year."

Find out more about the ASBA Sleep and Wellness Conference 2018 by calling 602-478-9713 or emailing david@myasba.com.

Find out more about The Roundtable by visiting 21stcenturydental.com

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American Thyroid Association Awards Research Grant to to Connie Rhee, MD, MSc, The Regents of the University of California (University of California Irvine)

Supported by the ATA

The American Thyroid Association (ATA) is pleased to announce that it has awarded a 2016 Thyroid Research Grant to Connie Rhee, MD, Assistant Professor, Department of Medicine, Division of Nephrology and Hypertension, University of California Irvine (Orange, CA), for the project entitled "Thyroid Functional Disease, Mental Health, and  Quality of Life in Chronic Kidney Disease Patients." The overall goal of Dr. Rhee's project is to determine whether thyroid functional disorders increase risk of depression and reduced health-related quality of life (QOL) in patients with chronic kidney disease (CKD) and, if so what is the potential to ameliorate these effects using thyroid hormone replacement.

Patients with CKD, many of whom require dialysis, are more likely to have thyroid functional disease than their peers without CKD. Recent findings indicate that hypothyroidism is associated with a higher risk of death in patients with CKD, but no mechanism to explain this link has been identified. Depression may be an important contributor to this increased mortality risk, as it is a complication of both thyroid dysfunction and CKD.

Dr. Rhee will first examine of thyroid dysfunction on patient-reported mental health and quality of life in a group of patients with CKD undergoing hemodialysis, based on data collected in an NIH-sponsored study. She will then explore the association between hypothyroidism and the development of new-onset depression in pre-dialysis CKD patients and whether the use of thyroid hormone replacement can impact the development of depression and reduced QOL using data from hundreds of thousands of U.S. veterans.

Dr. Motoyasu Saji, Chair, ATA Research Committee says, "The ATA research grant program has been supporting young scientists in various thyroid-related research area, including clinical, translational, and basic areas. Every year we receive over 50 Grant applications from various countries. We excite to see young thyroid researchers, who attack current clinical problems and basic scientific questions using state of art technologies, new ideas, and new views. Many current leaders in the ATA were award recipients and this tells us how this program is important for us. We hope that this grant will be one of gateway to succeed in carrier as thyroid researchers and they will become leaders in next generation in the ATA. Finally, we appreciate all supports from members and various organizations, including cancer survivors, to make us possible creating excellent program."

The American Thyroid Association (ATA) has awarded 85 thyroid research grants totaling over $2.2 million since the inception of the Research Fund. In addition, the ATA rigorously manages the selection of research projects and distribution of over $1.8 million generously donated to the ATA specifically for research grants from ThyCa: Thyroid Cancer Survivors' Association, Inc., Bite Me Cancer and Thyroid Head and Neck Cancer Foundation. For information on other research grants underway and funded by the ATA, see http://ift.tt/2l3TSGC.

ThyCa: Thyroid Cancer Survivors' Association, Inc. (ThyCa) has provided funding in support of 60 special research grants totaling $1,680,000 focused on thyroid cancer and medullary thyroid cancer since 2003. ThyCa is supporting three research grants in 2016 and three renewing grants. ThyCa is a member of the ATA Alliance for Patient Education. Find out more at www.thyca.org.

Bite Me Cancer (BMC) is our newest grant funder supporting five thyroid cancer grants since 2014 for a total of $143,750. BMC will be supporting a new thyroid cancer grant in 2016 and one renewing grant. BMC is a member of the ATA Alliance for Patient Education. Find out more at www.bitemecancer.org.

###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their family through education and awareness efforts.

Celebrating its 94^th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology, VideoEndocrinology and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease.

More information about ATA is found at www.thyroid.org.

The post American Thyroid Association Awards Research Grant to to Connie Rhee, MD, MSc, The Regents of the University of California (University of California Irvine) appeared first on American Thyroid Association.

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American Thyroid Association Awards Research Grant to David Sharlin, PhD, Minnesota State University, Mankato

Supported by the ATA

The American Thyroid Association has awarded a Research Grant to David Sharlin, Ph.D., Assistant Professor, Department of Biological Sciences, Minnesota State University, Mankato, for his project entitled "Thyroid Hormone and Local Insulin-like Growth Factor Production in Developing Brain." Reduced levels of thyroid hormone (TH) during development put a child at risk of permanent neurological deficits. Dr. Sharlin proposes that these neurological defects result, at least in part, from a significant decrease in the production of insulin-like growth factor (Igf1) in the brain of patients with developmental hypothyroidism. Furthermore, Dr. Sharlin suggests that the reduced levels of brain Igf1 are independent of changes in blood levels of Igf1 in hypothyroidism.  Dr. Sharlin will perform studies in a mouse model to determine in what brain regions Igf1 is reduced following developmental hypothyroidism, to compared the changes in brain and serum Igf1 levels, and to demonstrate that the neurological effects of low TH are a direct result of reduced brain Igf1.

Dr. Motoyasu Saji, Chair, ATA Research Committee says, "The ATA research grant program has been supporting young scientists in various thyroid-related research area, including clinical, translational, and basic areas, over many years. Every year we receive more than 50 Grant applications from various countries around the world. We are excited to see young thyroid researchers, who attack current clinical problems and basic scientific questions using state of art technologies, new ideas, and new views.  Many current leaders in the ATA were award recipients, showing the long-lasting importance of the research grant program. The ATA views the grant program as a gateway to a career in thyroid research and further engagement with the ATA.  Finally, we appreciate the generous support from members and cancer survivors, to make possible the continuation of this excellent program."

The American Thyroid Association (ATA) has awarded 85 thyroid research grants totaling over $2.2 million since the inception of the Research Fund. In addition, the ATA rigorously manages the selection of research projects and distribution of over $1.8 million generously donated to the ATA specifically for research grants from ThyCa: Thyroid Cancer Survivors' Association, Inc., Bite Me Cancer and Thyroid Head and Neck Cancer Foundation. For information on other research grants underway and funded by the ATA, see http://ift.tt/2twzu4r/.

ThyCa: Thyroid Cancer Survivors' Association, Inc. (ThyCa) has provided funding in support of 60 special research grants totaling $1,680,000 focused on thyroid cancer and medullary thyroid cancer since 2003. ThyCa is supporting three research grants in 2016 and three renewing grants. ThyCa is a member of the ATA Alliance for Patient Education. Find out more at www.thyca.org

Bite Me Cancer (BMC) is our newest grant funder supporting five thyroid cancer grants since 2014 for a total of $143,750. BMC will be supporting a new thyroid cancer grant in 2016 and one renewing grant. BMC is a member of the ATA Alliance for Patient Education. Find out more at www.bitemecancer.org

###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their family through education and awareness efforts.

Celebrating its 94^th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology, VideoEndocrinology and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease.

More information about ATA is found at www.thyroid.org.

The post American Thyroid Association Awards Research Grant to David Sharlin, PhD, Minnesota State University, Mankato appeared first on American Thyroid Association.

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