Head and Neck Diseases by Alexandros G.Sfakianakis: 06/26/17

Δευτέρα 26 Ιουνίου 2017

Histological case control study of peeling-induced skin changes of different peeling agents in surgically subcutaneous undermined skin flaps in facelift patients

A histological evaluation of peeling-induced skin changes in subcutaneous undermined preauricular facial skin flaps of 9 patients was performed. There were 3 treatment groups Trichloroacetic acid (TCA) 25%, TCA 40% and phenol/croton oil; 1 group served as control. Two independent evaluators determined the epidermal and dermal thickness and the depth of necrosis (μm). The percentual tissue damage due to the peeling was calculated and a one sample t-test for statistical significance was performed.

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Cranial bone structure in children with sagittal craniosynostosis: relationship with surgical outcomes

Whilst spring-assisted cranioplasty has become a widespread technique to correct scaphocephaly in children with sagittal synostosis, predicting head shape changes induced by the gradual opening of the springs remains challenging. The aim of this study was to explore the role of cranial bone structure on surgical outcomes.

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The supraorbital region revisited – an anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache

Recent findings on the pathogenesis of frontal migraine headache support, besides a central vasogenic cause, an alternative peripheral mechanism involving compressed craniofacial nerves. Supported further by the efficiency of Botulinum Toxin injections as a new treatment option in frontal migraine headache patients.

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US guided wire localization of malignant melanoma subcutaneous metastases

The American joint committee on cancer defines in transit (IT) metastases as any skin or subcutaneous nodule that is more than two centimetres away from the primary lesion but is not beyond the regional nodal basin. IT metastases usually present as cutaneous or subcutaneous nodules, which may or may not be pigmented. Occasionally the nodules are impalpable and are only picked up following imaging, thus making it difficult to isolate them perioperatively.

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AHNS Series – Do you know your guidelines? Principles of treatment for glottic cancer: A review of the National Comprehensive Cancer Network guidelines

Abstract

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for primary and adjuvant treatment of cancer of the glottic larynx are reviewed here in a systematic fashion according to stage.

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Moving into poverty during childhood is associated with later sleep problems

A social gradient in sleep has been demonstrated across the life span, but previous studies have been cross-sectional and used self-reported socioeconomic status (SES) indicators. Using registry-based data on family income trajectories, the current study examined the association between relative poverty in childhood and subsequent sleep in adolescence.

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Utility of new-generation pacemakers in sleep apnea screening

Patients with cardiac pacemakers present a high prevalence of undiagnosed sleep apnea syndrome (SAS). New-generation pacemakers have algorithms that identify sleep respiratory events. Our aim was to evaluate their accuracy in the diagnosis of SAS.

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Validation of the screening tool ApneaLink® in comparison to polysomnography for the diagnosis of sleep-disordered breathing in children and adolescents

While out-of-center testing was introduced as an alternative for the diagnosis of obstructive sleep apnea in adults, polysomnography (PSG) is still considered mandatory in the diagnosis of sleep-disordered breathing (SDB) in children. The purpose of this study was to validate the outpatient screening device ApneaLink® in comparison to PSG in children and adolescents for the diagnosis of SDB.

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Relationship between stress coping and sleep disorders among the general Japanese population: a nationwide representative survey

To clarify the prevalence of stress, and examine the relationship between sleep disorders and stress coping strategies among highly stressed individuals in the general Japanese population.

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Relationship between obstructive sleep apnea and neuroimaging signatures of cerebral small vessel disease in community-dwelling older adults. The Atahualpa Project

/Objectives: Evidence of a relationship between obstructive sleep apnea (OSA) and neuroimaging signatures of cerebral small vessel disease (SVD) is limited. The present study aimed to evaluate this association in older adults living in rural Ecuador, where small vessel disease is a major pathogenetic mechanism underlying stroke.

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Proximate composition and mineral contents in the body wall of two species of sea cucumber from Oman Sea

Abstract

The proximate composition and mineral contents of Stichopus horrens and Holothuria arenicola from Chabahar Bay were analyzed and investigated. During the present study, we aimed to demonstrate the nutritive value. The approximate percent composition of moisture, protein, fat, and ash were 92.8, 3.47, 0.4, and 3.33% in S. horrens and 93, 4.4, 0.6, and 2% in H. arenicola, respectively. Atomic absorption spectrophotometry of the ashes indicated the body wall of two species of sea cucumbers contained higher amounts of both macro minerals (92.5 mg/100 g Mg in S. horrens and 115 mg/100 g Mg in H. arenicola; 106.25 mg/100 g Ca in S. horrens and 83.25 mg/100 g Ca in H. arenicola) and trace elements (521.781 mg/100 g Fe in S. horrens; 60.354 mg/100 g Fe in H. arenicola, and 0.096 mg/100 g Zn in S. horrens; 0.04 mg/100 g Zn in H. arenicola). For both species, there were high content of protein and essential mineral. Also, they have low content of fat in the body wall of two species in the experiment.

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Post-traumatic headache in patients with minimal traumatic intracranial hemorrhage after traumatic brain injury: a retrospective matched case-control study

No evidence is available on the risks of neurologically asymptomatic minimal traumatic intracranial hemorrhage (mTIH) in patients with traumatic brain injury (TBI) for post-traumatic headache (PTH). The purpos...

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Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study

Laryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR.

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Lateral cervical approach for supracricoid partial laryngectomy

The supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor.

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Angiotensin 1-7 inhibits angiotensin II-stimulated head and neck cancer progression

Angiotensin II (Ang II) is the product of the proteolytic action of angiotensin-converting enzyme (ACE) on the precursor peptide, angiotensin I (Ang I). In addition to its vasoactive properties, Ang II is able to stimulate angiogenesis and act as a mitogen, promoting cellular proliferation. Recently, evidence has emerged that Ang II is also able to promote tumour invasion, a key step in the metastatic cascade, although the mechanisms by which it does so remain largely obscure. Here we show that Ang II is able to promote the invasion and migration of head and neck squamous cell carcinoma (HNSCC) cells both in an autocrine manner and by triggering stromal tumour-paracrine interactions. The effects of Ang II on autocrine and paracrine signalling pathways are mediated by angiotensin receptor 1 (AT₁R) and inhibited by angiotensin 1-7 (Ang 1-7), a peptide produced from Ang II by the action of angiotensin-converting enzyme 2 (ACE2). These data are the first to demonstrate a role for the renin–angiotensin system in oral carcinogenesis and raise the possibility of utilizing AT₁R receptor antagonists and/or Ang 1-7 as novel therapeutic agents for HNSCC.

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Oral problems and quality of life of preschool children: self-reports of children and perception of parents/caregivers

The purpose of this study was to evaluate the association between oral health problems and oral health-related quality of life (OHRQoL) of preschool children according to both self-reports and the reports of parents/caregivers. A school-based, cross-sectional study was conducted with 769 preschool children and their parents/caregivers. The OHRQoL was evaluated using the Scale of Oral Health Outcomes for Five-Year-Old Children (SOHO-5). Based on logistic regression for complex samples, the following variables were found to be associated with poorer OHRQoL in the parent/caregiver version: toothache (OR = 6.77; 95% CI: 3.95–11.59); consequences of untreated dental caries (OR = 2.69; 95% CI: 1.27–5.70); and anterior open bite (OR = 2.01; 95% CI: 1.13–3.56). The following variables were associated with poorer OHRQoL in the child self-report version: toothache (OR = 3.34; 95% CI: 2.11–5.29); cavitated lesions (anterior teeth) (OR = 2.20; 95% CI: 1.26–3.84); occurrence of traumatic dental injury (OR = 1.77; 95% CI: 1.19–2.61); and anterior open bite (OR = 1.95; 95% CI: 1.16–3.29). We conclude that children with dental caries (or its sequelae) had poorer OHRQoL. Having experienced a traumatic dental injury and having a malocclusion were also associated with a poorer OHRQoL.

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Antibiotic-prescribing habits among Norwegian dentists: a survey over 25 years (1990–2015)

Bacterial antibiotic resistance is a steadily growing global problem, which today is compared with issues such as global warming, ozone depletion, and extinction of species. Consequently, calls come from global, Pan-European, and national authorities to gain insight into, limit, and stringently qualify the use of antibiotics in human and veterinary medicine, as well as in food production. Dentists are not considered to be frequent prescribers of antibiotics. However, few studies have identified how much, and in which situations, dentists prescribe such drugs. The aims of the present study were to survey Norwegian dentists' antibiotic-prescribing habits in 2015 and to compare the findings with previous studies (1990 and 2004) and with the actual numbers of dispensed prescriptions obtained from the 'Norwegian National Prescription Register'. The results from 1990 to 2004 show that there was a general increase in antibiotic prescriptions by Norwegian dentists, followed by a reduction or flattening of the prescription volume curve from 2004 to 2015. Despite this, possibilities for further improvements have been identified and recommendations given for targeted campaigns to reduce the prescription volume in dentistry by a further 30%, which has been ordered by the Norwegian National Assembly.

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Treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study

Lateral cervical approach for supracricoid partial laryngectomy

Water dissociation on multimetallic catalysts

Publication date: 5 December 2017
Source:Applied Catalysis B: Environmental, Volume 218
Author(s): José L.C. Fajín, M. Natália D.S. Cordeiro, José R.B. Gomes
DFT based calculations were employed in the study of the dissociation of the water molecule onto copper and nickel (110) and (111) surface models, incorporating two additional metallic elements, because it was found previously that metal alloying leads to strong synergic effects in the catalysis of this reaction. The dissociation reaction was studied on the Pt/Ru/Ni, Pt/Ru/Cu, Rh/Ru/Cu, Ni/Ru/Cu and Al/Zn/Cu combinations, in a total of 25 trimetallic surfaces. Very low activation energy barriers for the dissociation of water were calculated on several of the surface models, suggesting that multimetallic surfaces can be interesting alternatives for catalyzing the dissociation of the water molecule, which is a crucial elementary step in the water gas shift reaction. Encouragingly, the calculations predict a facile dissociation of the water molecule onto the (AlZn)@Cu(111) catalyst model which is in agreement with recent experimental studies where it was found that a Cu0.5Zn0.5Al2O4 spinel oxide catalyst holds improved activity for the water gas shift reaction.

Graphical abstract

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Effect of preparation procedures on catalytic activity and selectivity of copper-based mixed oxides in selective catalytic oxidation of ammonia into nitrogen and water vapour

Publication date: 30 November 2017
Source:Applied Surface Science, Volume 423
Author(s): Magdalena Jabłońska, Marek Nocuń, Kinga Gołąbek, Regina Palkovits
The selective oxidation of ammonia into nitrogen and water vapour (NH3-SCO) was studied over Cu-Mg(Zn)-Al-(Zr) mixed metal oxides, obtained by coprecipitation and their subsequent calcination. The effect of acid-base properties of Cu-Mg-Al-Ox on catalytic activity was investigated by changing the Mg/Al molar ratio. Other Cu-containing oxides were prepared by rehydration of calcined Mg-Al hydrotalcite-like compounds or thermal decomposition of metal nitrate precursors. XRD, BET, NH3-TPD, H2-TPR, XPS, FTIR with adsorption of pyridine and CO as well as TEM techniques were used for catalysts characterization. The results of catalytic tests revealed a crucial role of easily reducible highly dispersed copper oxide species to obtain enhanced activity and N2 selectivity in NH3-SCO. The selective catalytic reduction of NO by NH3 (NH3-SCR) and in situ DRIFT of NH3 sorption indicated that NH3-SCO proceeds according to the internal selective catalytic reduction mechanism (i-SCR).

Graphical abstract

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Greenish yellow emission from wurtzite structured ZnS:Ce nanophosphor synthesized at low temperature

Publication date: December 2017
Source:Journal of Luminescence, Volume 192
Author(s): K.R. Bindu, E.I. Anila
Cerium doped ZnS nanoparticles were synthesized by aqueous colloidal precipitation method at 70°C and post sintering at 650°C. Their structural, morphological, and photoluminescence properties were investigated. Fourier transform infrared and X-ray diffraction were used to determine chemical bonding and crystal structure of the synthesized nanoparticles. A phase transformation from cubic to wurtzite structure was observed due to sintering at 650°C. Scanning electron microscope revealed that the sintered particles exhibit uneven blocky particles with irregular shape. The band-gap of the nanoparticles was determined from diffuse reflectance spectrum. For the sintered ZnS:Ce nanoparticles when excited at about 350nm, in addition to host UV emission, transitions from ²D to both ²F5/2 and ²F7/2 levels of Ce³⁺ in ZnS lattice were observed resulting in a broad greenish yellow emission band centered at 538nm.

Graphical abstract

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NIR luminescent heterodinuclear [ZnII LnIII] complexes: Synthesis, crystal structures and photophysical properties

Publication date: December 2017
Source:Journal of Luminescence, Volume 192
Author(s): Nidhi Dwivedi, Sumit K. Panja, Abhineet Verma, Tomohisa Takaya, Koichi Iwata, Sailaja S. Sunkari, Satyen Saha
Two series of new 3d-4f heterodinuclear [Zn^IILn^III] Schiff base complexes of general formula [Zn(µ-L1)(µ-CH3COO)Ln(NO3)2(S)] [Ln = Pr (1), Nd (2), Sm (3), Gd (4); S = MeOH; H2L1= N,N-bis(3-methoxysalicylidene)-1,4-diaminobutane] and [Zn(µ-L2)(µ-CH3COO)Ln(NO3)2(S)] [Ln= Pr (5), Nd (6), Sm (7), Gd (8), S= MeOH; H2L2= N,N-bis(3-ethoxysalicylidene)-1,4-diaminobutane] are synthesized and fully characterized. Complexes 1, 2, 3, 4, 5 & 7 are structurally characterized by single crystal X-ray crystallography. The crystallographic investigation indicates that the complexes contain 9 and 10-coordinated Ln^III ions, while the Zn^II ions always display a distorted square-pyramidal geometry. The crystal structure of the complexes are stabilized by inter molecular extended hydrogen bonding and C-H····π interactions resulting in supramolecular frameworks. Luminescence studies for the heterodinuclear compounds containing Nd^III & Sm^III reveal that the Zn-complex moiety acts as antenna for the emission from Ln^III ions. In addition to the ligand-centered emission in the UV–Vis region, complex 2 (having Nd^III) exhibits emission in NIR region also, thus resulting a new NIR emitting material.

Graphical abstract

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Names and phenotypes of CD163 positive macrophages in oral precancerous lesions

We are quite interested in the recently published article entitled "Programmed death ligand 1 (PD-L1) expression and tumor microenvironment: Implications for patients with oral precancerous lesions" [1]. The authors had explored the PD-L1 expression in the stoma cells in oral precancerous lesions and investigated the relationships among PD-L1 positive cells and malignant transformation of these cells. We have two questions on this article.

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Optimized DNA Vaccine Enhanced by Adjuvant IL28B Induces Protective Immune Responses Against Herpes Simplex Virus Type 2 in Mice

Viral Immunology , Vol. 0, No. 0.

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Genetic Polymorphisms of Tumor Necrosis Factor Alpha and Susceptibility to Dengue Virus Infection in a Mexican Population

Viral Immunology , Vol. 0, No. 0.

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Fathers' feeding practices and children's weight status in Mexican American families

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): Carlos Penilla, Jeanne M. Tschann, Julianna Deardorff, Elena Flores, Lauri A. Pasch, Nancy F. Butte, Steven E. Gregorich, Louise C. Greenspan, Suzanna M. Martinez, Emily Ozer
Mothers' feeding practices are associated with their children's weight status, but little is known about the associations between fathers' feeding practices and children's weight status. Moreover, there is a dearth of research on Latino fathers' feeding practices and children's weight status, even though Latino children suffer some of the highest obesity rates in the U.S. We examined the associations between fathers' feeding practices and child weight status, conditional on mothers' feeding practices, within 174 Mexican American families with children aged 8–10 years. Parents completed the Parental Feeding Practices Questionnaire, which consists of four subscales: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. To assess child weight status, body mass index (BMI) was calculated and converted to age- and gender-specific percentile scores (BMI z-score). We fit four sets of regression models, one set for each of the four parental feeding practices subscales, with child BMI z-score as the outcome variable. Fathers' pressure to eat (b = −0.20, p = 0.04; 95% CI: −0.39, −0.01) and use of food to control behavior (b = −0.36, p = 0.02; 95% CI: −0.65, −0.07) were associated with lower child BMI z-score, and restriction of amount of food (b = 0.56, p < 0.001; 95% CI: 0.27, 0.84) was associated with higher child BMI z-score, after accounting for mothers' feeding practices. Fathers' positive involvement in child eating was not associated with child BMI z-score. These findings provide empirical evidence that fathers' feeding practices are independently associated with children's weight status, even when mothers' feeding practices are taken into account, and suggest that fathers' feeding practices also matter in regard to children's weight status.

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Psychometric evaluation of the German version of the Intuitive Eating Scale-2 in a community sample

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): Ulrike Alexandra Ruzanska, Petra Warschburger
Intuitive eating is based on a strong physical connection with the body, aligned to internal cues of hunger and satiety, and a low preoccupation with food. The aim of this study was to provide a German version of the Intuitive Eating Scale-2 (IES-2) and to examine its psychometric properties with data collected from 532 participants aged 18–91 years. The IES-2 was translated into German following the World Health Organization guidelines (2016). Cronbach's alpha as a measure of internal consistency was 0.89 for the IES-2 total score, as well as 0.73 - 0.92 for the IES-2 subscale scores. For group differences, the results were as hypothesized: men had higher IES-2 scores than women, and participants with under- and average weight showed higher IES-2 scores than participants with overweight and obesity. Participants without a dieting history had higher IES-2 scores than former or current dieters. In line with our hypotheses regarding construct validity, the IES-2 score had negative associations with emotional eating, restraint eating, external eating, binge eating and eating disorder symptomatology, as well as positive associations with self-efficacy and mental health-related quality of life. Second-order confirmatory factor analysis replicated the four-factor solution, with intuitive eating as a higher-order factor. These findings demonstrate that the German version of the IES-2 is a useful tool to assess intuitive eating in the general German population.

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Is there an advantage in onset of action with mixing lignocaine and bupivacaine?

Ever since Lidocaine (lignocaine) was first synthesised in 1943 and Bupivacaine first synthesised in 1957, surgeons have been mixing these two local anaesthetics. Lidocaine with its shorter duration of action has been linked (inaccurately) with a more rapid onset of action while the longer duration of Bupivacaine has again been suggested to have a slower onset of action. This erroneous extrapolation has led to many mixing the two to have an anaesthetic solution which might have rapid onset and long duration.

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Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis

Knowledge of variants in the formation and position of the ansa cervicalis is important in head and neck surgery, specifically in reconstructions of the tongue that use the infrahyoid muscles, and in the anastomosis of the ansa cervicalis to the recurrent laryngeal nerve when the laryngeal muscles have been paralysed. We describe a rare variant of the superior root of the ansa cervicalis, which had a contribution from the vagus and hypoglossal nerves. The inferior root was formed by the C2 and C3 ventral rami, but it passed medial to the internal jugular vein before it joined the superior root to form the loop.

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Panton-Valentine leukocidin-producing Staphylococcus aureus infection of the neck that mimicked disseminated malignancy

A 50-year-old man presented to the emergency department of a teaching hospital in the UK with a midline swelling of the neck, chest pain, and fever. The swelling had been incised at another hospital two weeks previously, but after initial improvement it had increased in size and become more inflamed. He was taking flucloxacillin and phenoxymethylpenicillin prescribed by a general practitioner. His medical history included repair of a patent ductus arteriosus as a child. His temperature was 38.6°C and oxygen saturation 95% on air.

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Seven-year review of dental foundation year 2/senior house officer training at the Oral and Maxillofacial Surgery Unit in Oxford

The dental senior house officer (SHO)/dental foundation year 2 (DF2) posts in Oxford have provided hospital-based training for dentists, but in 2013 the Oral and Maxillofacial Surgery (OMFS) Unit withdrew from DF2 training because persistent negative feedback from the dental deanery varied from that obtained internally. We sent questionnaires to a consecutive group of 62 dentists who had worked at the John Radcliffe Hospital, Oxford, between 2006 and 2013 to find out about their experience of the posts.

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Adult cancer-related hemophagocytic lymphohistiocytosis – a challenging diagnosis: a case report

Adult hemophagocytic lymphohistiocytosis is a secondary immunopathologic phenomenon, mainly secondary to malignancy, infection, or autoimmune disorders.

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Systemic treatment for psoriasis and malignancies: A real risk?

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Systemic treatment for psoriasis and malignancies: A real risk?

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Ocular vestibular evoked myogenic potential in patients with myasthenia gravis

Myasthenia gravis (MG) is an archetypic disorder of neuromuscular junctions (NMJs) and autoantibody-mediated disease causing fatigable weakness of skeletal muscles with an ocular onset in up to 85%. The aim of this study was to detect extra ocular muscles (EOMs) abnormalities in MG patients using ocular vestibular evoked myogenic potential (oVEMP) n10 response.

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Prospective analysis of 231 elective neck dissections in oral squamous cell carcinoma with node negative neck—To decide the extent of neck dissection

To evaluate the incidence of level IIB and IV lymph node metastases in patients of oral carcinoma with N0 necks. This study will help to decide the extent and need of routine comprehensive removal of these specific lymph node groups in selective neck dissection.

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Ocular vestibular evoked myogenic potential in patients with myasthenia gravis

Prospective analysis of 231 elective neck dissections in oral squamous cell carcinoma with node negative neck—To decide the extent of neck dissection

Re: Gaskill CS, Awan JA, Watts CR, Awan SN. Acoustic and perceptual classification of within-sample normal, intermittently dysphonic, and consistently dysphonic voice types. J Voice. 2016;31:218–228

The recently published study of Gaskill et al constitutes a remarkable contribution to the understanding of time-variance of dysphonic voice quality, because time-variance is often neglected in the description of voice quality. This circumstance may cause problems in clinical voice quality evaluation. We acknowledge the authors' contributions to clarify the different semantic levels of voice quality description, which are the speech level, the segmental level, the signal frame level, and the level of cycles.

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Autoantibodies in juvenile-onset myositis: Their diagnostic value and associated clinical phenotype in a large UK cohort

Publication date: Available online 26 June 2017
Source:Journal of Autoimmunity
Author(s): Sarah L. Tansley, Stefania Simou, Gavin Shaddick, Zoe E. Betteridge, Beverley Almeida, Harsha Gunawardena, Wendy Thomson, Michael W. Beresford, Angela Midgley, Francesco Muntoni, Lucy R. Wedderburn, Neil J. McHugh
ObjectivesJuvenile myositis is a rare and heterogeneous disease. Diagnosis is often difficult but early treatment is important in reducing the risk of associated morbidity and poor outcomes. Myositis specific autoantibodies have been described in both juvenile and adult patients with myositis and can be helpful in dividing patients into clinically homogenous groups. We aimed to explore the utility of myositis specific autoantibodies as diagnostic and prognostic biomarkers in patients with juvenile-onset disease.MethodsUsing radio-labelled immunoprecipitation and previously validated ELISAs we examined the presence of myositis specific autoantibodies in 380 patients with juvenile-onset myositis in addition to, 318 patients with juvenile idiopathic arthritis, 21 patients with juvenile-onset SLE, 27 patients with muscular dystrophies, and 48 healthy children.ResultsAn autoantibody was identified in 60% of juvenile-onset myositis patients. Myositis specific autoantibodies (49% patients) were exclusively found in patients with myositis and with the exception of one case were mutually exclusive and not found in conjunction with another autoantibody. Autoantibody subtypes were associated with age at disease onset, key clinical disease features and treatment received.ConclusionsIn juvenile patients the identification of a myositis specific autoantibody is highly suggestive of myositis. Autoantibodies can be identified in the majority of affected children and provide useful prognostic information. There is evidence of a differential treatment approach and patients with anti-TIF1γ autoantibodies are significantly more likely to receive aggressive treatment with IV cyclophosphamide and/or biologic drugs, clear trends are also visible in other autoantibody subgroups.

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Implementation of a School‐Based Educational Program to Increase Breast Cancer Awareness and Promote Intergenerational Transmission of Knowledge in a Rural Mexican Community

AbstractBackground.Rural women have limited access to breast cancer education, which partially contributes to late diagnosis and treatment. In this pilot study, we tested the feasibility of implementing a school‐based breast cancer educational program for adolescents in a rural Mexican community. We hypothesized that the adolescents' knowledge on breast cancer would increase as a result of the program, and that there would be intergenerational transmission of that knowledge to their older female relatives.Materials and Methods.Female adolescents from a rural middle school received the educational program. The program would be considered feasible and acceptable if more than 75% reported being satisfied with its contents. Changes in knowledge in the students and their relatives were evaluated using baseline and 4 months follow‐up questionnaires.Results.One hundred twenty‐six students were enrolled. The program was considered acceptable by 96% of the participants. The students' knowledge regarding breast cancer increased significantly from baseline to 4 months follow‐up (63% to 82%). One hundred ninety‐four female relatives completed the initial knowledge questionnaires. The relatives' knowledge regarding breast cancer showed a significant increase from baseline to 4 months follow‐up (55% to 61%).Conclusion.Implementing breast cancer educational programs for adolescents in rural communities is feasible and acceptable. The program increased the adolescents' knowledge on breast cancer, and promoted the intergenerational transmission of that knowledge to their female relatives. Intergenerational transmission of knowledge represents a potential method for providing population‐based health awareness education globally.Implications for Practice.In limited‐resource settings, education is a valuable tool for achieving early detection and downstaging of breast cancer. Unfortunately, rural women lack access to educational opportunities and information about breast cancer, which is a factor contributing to late diagnosis and treatment. In this study, we demonstrated that implementing a school‐based breast cancer educational program for female adolescents in a rural Mexican community was feasible, acceptable, and increased their knowledge about breast cancer. Furthermore, the program encouraged the transmission of information to the students' older relatives. Intergenerational transmission of knowledge represents a novel and potentially effective tool in cancer education and promotion.

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Pregabalin for the Prevention of Oxaliplatin‐Induced Painful Neuropathy: A Randomized, Double‐Blind Trial

AbstractLessons Learned. Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days.Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin‐related neuropathic pain, compared with placebo.Background.Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin‐induced peripheral neuropathy (OXAIPN). Acute and chronic OXA‐related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti‐hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN.Methods.Pain‐free, chemotherapy‐naïve CRC patients receiving at least one cycle of modified‐FLOX [5‐FU(500mg/m2)+leucovorin(20mg/m2)/week for] 6weeks+Oxaliplatin(85mg/m2) at weeks 1‐3‐5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow‐up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0–10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique‐4 (DN‐4), pain dimensions (short‐ form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile.Results.One hundred ninety‐nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79–1.26), and 0.85 (95% CI = 0.64–1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN‐4, NPSI, and NCS and side‐effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1–11.2]; pregabalin 6.8 [5.6–8.0]).Conclusion.The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.

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Immune‐Related Adverse Events as a Biomarker in Non‐Melanoma Patients Treated with Programmed Cell Death 1 Inhibitors

AbstractBackground.The programmed death 1 (PD‐1) checkpoint inhibitors (CKIs) can lead to immune‐related adverse events (irAEs). We sought to evaluate whether the development of irAEs correlates with treatment response in non‐melanoma malignancies.Materials and Methods.We conducted a retrospective study of patients who received anti‐PD‐1 CKI monotherapy at Fox Chase Cancer Center. Endpoints included overall response rate (ORR), time to next therapy or death (TTNTD), and overall survival (OS). Fisher's exact tests and logistic regression models were used to determine the association between irAE incidence and ORR, and Kaplan‐Meier curves with log‐rank tests and Cox regression models were used for the comparison of TTNTD and OS.Results.Between November 2011 and November 2016, 160 patients were treated with >1 dose of an anti‐PD‐1 CKI. Seventy‐three (46%) were treated on a clinical trial. Immune‐related adverse events were noted in 64 patients (40%), with steroids required in 36 (23%). Of the 142 patients evaluable for clinical response, 28 patients (20%) achieved a partial response at first scan. An association between irAEs and ORR was seen in clinical trial patients (p = .007), but not in non‐trial patients (p = .13). When controlling for clinical trial participation and cancer type using multivariate analysis, low‐grade irAEs had higher ORR (p = .017) and longer TTNTD (p = .008). No association between irAE incidence and OS was seen (p = .827). Immune‐related adverse events that required steroid treatment were marginally associated with increased TTNTD (p = .05, hazard ratio 0.62) but were not associated with OS (p = .13).Conclusion.We demonstrate several positive associations between the development of irAEs and clinical outcomes in non‐melanoma patients treated with PD‐1 CKIs, for which further validation is required.Implications for Practice.This study evaluated whether the development of immune‐related adverse events in non‐melanoma patients treated with programmed cell death 1 checkpoint inhibitors correlates with improved clinical outcomes. The results indicate that for a subset of patients, in particular those with low‐grade immune‐related adverse events, immune‐related adverse events predicted for an improved response rate and longer time to next therapy or death.

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Palbociclib Combined with Fulvestrant in Premenopausal Women with Advanced Breast Cancer and Prior Progression on Endocrine Therapy: PALOMA‐3 Results

AbstractBackground.The efficacy and safety of palbociclib, a cyclin‐dependent kinase 4/6 inhibitor, combined with fulvestrant and goserelin was assessed in premenopausal women with advanced breast cancer (ABC) who had progressed on prior endocrine therapy (ET).Patients and Methods.One hundred eight premenopausal endocrine‐refractory women ≥18 years with hormone receptor–positive (HR+)/human epidermal growth factor receptor 2–negative (HER2−) ABC were among 521 women randomized 2:1 (347:174) to fulvestrant (500 mg) ± goserelin with either palbociclib (125 mg/day orally, 3 weeks on, 1 week off) or placebo. This analysis assessed whether the overall tolerable safety profile and significant progression‐free survival (PFS) improvement extended to premenopausal women. Potential drug‐drug interactions (DDIs) and ovarian suppression with goserelin were assessed via plasma pharmacokinetics and biochemical analyses, respectively. (ClinicalTrials.gov identifier: NCT01942135)Results.Median PFS for premenopausal women in the palbociclib (n = 72) versus placebo arm (n = 36) was 9.5 versus 5.6 months, respectively (hazard ratio, 0.50, 95% confidence interval: 0.29–0.87), and consistent with the significant PFS improvement in the same arms for postmenopausal women. Any‐grade and grade ≤3 neutropenia, leukopenia, and infections were among the most frequent adverse events reported in the palbociclib arm with concurrent goserelin administration. Hormone concentrations were similar between treatment arms and confirmed sustained ovarian suppression. Clinically relevant DDIs were not observed.Conclusion.Palbociclib combined with fulvestrant and goserelin was an effective and well‐tolerated treatment for premenopausal women with prior endocrine‐resistant HR+/HER2− ABC. Inclusion of both premenopausal and postmenopausal women in pivotal combination ET trials facilitates access to novel drugs for young women and should be considered as a new standard for clinical trial design.Implications for Practice.PALOMA‐3, the first registrational study to include premenopausal women in a trial investigating a CDK4/6 inhibitor combined with endocrine therapy, has the largest premenopausal cohort reported in an endocrine‐resistant setting. In pretreated premenopausal women with hormone receptor–positive advanced breast cancer, palbociclib plus fulvestrant and goserelin (luteinizing hormone–releasing hormone [LHRH] agonist) treatment almost doubled median progression‐free survival (PFS) and significantly increased the objective response rate versus endocrine monotherapy, achieving results comparable to those reported for chemotherapy without apparently interfering with LHRH agonist‐induced ovarian suppression. The significant PFS gain and tolerable safety profile strongly support use of this regimen in premenopausal women with endocrine‐resistant disease who could possibly delay chemotherapy.

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Ruthenium complex exerts antineoplastic effects that are mediated by oxidative stress without inducing toxicity in Walker-256 tumor-bearing rats

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Carlos Eduardo Alves de Souza, Helen de Morais Alves de Souza, Maria Carolina Stipp, Claudia Rita Corso, Claudia Martins Galindo, Carolina Riverin Cardoso, Rosangela Locatelli Dittrich, Edneia Amancio de Souza Ramos, Giseli Klassen, Rose Maria Carlos, Sílvia Maria Suter Correia Cadena, Alexandra Acco
The present study evaluated the in vivo antitumor effects and toxicity of a new Ru(II) compound, cis-(Ru[phen]2[ImH]2)²⁺ (also called RuphenImH [RuC]), against Walker-256 carcinosarcoma in rats. After subcutaneous inoculation of Walker-256 cells in the right pelvic limb, male Wistar rats received 5 or 10mgkg⁻¹ RuC orally or intraperitoneally (i.p.) every 3 days for 13 days. A positive control group (2mgkg⁻¹ cisplatin) and negative control group (vehicle) were also used. Tumor progression was checked daily. After treatment, tumor weight, plasma biochemistry, hematology, oxidative stress, histology, and tumor cell respiration were evaluated. RuC was effective against tumors when administered i.p. but not orally. The highest i.p. dose of RuC (10mgkg⁻¹) significantly reduced tumor volume and weight, induced oxidative stress in tumor tissue, reduced the respiration of tumor cells, and induced necrosis but did not induce apoptosis in the tumor. No clinical signs of toxicity or death were observed in tumor-bearing or healthy rats that were treated with RuC. These results suggest that RuC has antitumor activity through the modulation of oxidative stress and impairment of oxidative phosphorylation, thus promoting Walker-256 cell death without causing systemic toxicity. These effects make RuC a promising anticancer drug for clinical evaluation.

Graphical abstract

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Multiple functional strategies for amplifying sensitivity of amperometric immunoassay for tumor markers: A review

Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Zhongxue Tang, Zhanfang Ma
Multiple functional strategies have shown great potential in ultrasensitive amperometric immunoassays for tumor markers, which promote conductivity and signal multiple amplification. The sensitivity of amperometric immunoassays is significantly affected by the conductivity and specific area of the sensing interface as well as the electrochemical activity of redox species. Thus, these strategies are generally based on integrating various materials together and endowing immunosensing systems with many advantages, such as large specific area, high electrochemical activity, good conductivity, biocompatibility, and catalytic performance. Owing to the rapid development of functional materials (such as conductive hybrids, catalytic hybrids, enzyme-like materials, highly electrochemical active species, redox nanocomposites, porous materials, hydrogels, and metal-organic framework) and new bioactive substances (including new blocking agents and receptors like peptides and oligonucleotide chains), the sensitivity of related biosensors is usually higher than that of traditional ones, indicating that multiple functional strategies are promising in amperometric immunoassays. Herein, we provide an overview of recent advances in multiple functional strategies that have proven to dramatically enhance the sensitivity of amperometric immunoassays, which incorporate the following materials: (1) conductive nanomaterials hybrids; (2) catalytic nanomaterials hybrids; (3) new redox materials; (4) three-dimensional porous materials; (5) new receptors and blocking agents.

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In situ grown DNA nanotail-templated silver nanoclusters enabling label-free electrochemical sensing of terminal deoxynucleotidyl transferase activity

Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Yufang Hu, Qingqing Zhang, Zhiyong Guo, Sui Wang, Chunnuan Du, Chunyang Zhai
A novel label-free electrochemical strategy was established based on the unique electro-catalytic activity of graphene oxide (GO)-supported terminal deoxynucleotidyl transferase (TdT)-generated C-rich DNA nanotail-templated silver nanoclusters (DNA-AgNCs). TdT can catalyze the deoxycytidine triphosphate (dCTP) to the 3′-OH terminus of single-stranded DNA (ssDNA) with no template; then, in the presence of Ag(I), TdT-generated C-rich DNA sequence was employed for the synthetic template of AgNCs because of the formed complexes of nitrogen atoms of cytosine based with silver atoms. We proved that in situ grown DNA nanotail-templated AgNCs can be adsorbed on GO-modified electrode and possess high electro-catalytic activity to H2O2 reduction, presenting a good electrochemical indicator for signal readout. Under optimal conditions, the proposed biosensor could be employed for quantitatively monitoring TdT activity and within a dynamic range from 0.4 to 90U/mL and a low limit of detection is 0.08U/mL. With high sensitivity and excellent selectivity, this strategy offers a facile, convenient and specific electrochemical method for TdT activity detection and its relevant inhibitors screening. It holds a promising potential in the practical application of TdT-based biochemical research, disease diagnosis and drug discovery.

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Dietary Supplements as Surrogate of Mediterranean Diet in Healthy Smoking Subjects

Rejuvenation Research , Vol. 0, No. 0.

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Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report

Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is littl...

http://ift.tt/2sUucAH

Dataset on lipid profile of bovine oocytes exposed to Lα-phosphatidylcholine during in vitro maturation investigated by MALDI mass spectrometry and gas chromatography-flame ionization detection

Publication date: August 2017
Source:Data in Brief, Volume 13
Author(s): Alessandra A. Vireque, Christina R. Ferreira, Rafael R. Hatanaka, Alessandra Tata, Katia Roberta A. Belaz, Vanessa G. Santos, Marcos N. Eberlin, Marcos Felipe Silva de Sá, Rui A. Ferriani, Ana Carolina J.S. Rosa e Silva
Data presented in this article are related with the research article entitled "Effect of soybean phosphatidylcholine on lipid profile of bovine oocytes matured in vitro" [1]. This article describes the differences in the relative abundance of the lipid ions detected by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) in control and Lα-phosphatidylcholine-treated oocytes. In addition, the fatty acids (FA) content in pure Lα-phosphatidylcholine supplement and oocytes was analyzed by gas chromatography-flame ionization detection (GC-FID). The dataset provides information and inputs for further studies aiming to optimize in vitro maturation conditions and cryotolerance of mammalian oocytes.

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Differences Between Conditional and Marginal Propensity Score Estimates: A Real-World Application

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Vitamin D and Cardiovascular Disease: Controversy Unresolved

Abstract

Vitamin D deficiency is typically caused by inadequate cutaneous synthesis secondary to decreased exposure to sunlight. Serum levels of 25-hydroxyvitamin D l <20 ng/ml are diagnostic of vitamin D deficiency. Vitamin D has various cardiovascular pleiotropic effects by activating its nuclear receptor in cardiomyocytes and vascular endothelial cells and by regulating the renin-angiotensin-aldosterone system, adiposity, energy expenditure, and pancreatic cell activity. In humans, vitamin D deficiency is associated with the following: vascular dysfunction; arterial stiffening; left ventricular hypertrophy; and worsened metrics of diabetes, hypertension, and hyperlipidemia. It is also linked with worse cardiovascular morbidity and mortality. However, meta-analyses of vitamin D supplementation trials have failed to show clear improvements in blood pressure, insulin sensitivity, or lipid parameters, thus suggesting that the link between vitamin D deficiency and cardiovascular disease may be an epiphenomenon. Ongoing larger randomized trials will clarify whether monitoring and supplementation of vitamin D play roles in cardiovascular protection.

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JACC Instructions for Authors

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Reply: Adequate Blood Pressure Control and Monitoring Acute Kidney Injury in Older Hypertensive Patients

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Global Scourge of Cardiovascular Disease: Time for Health Care Systems Reform and Precision Population Health

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Sudden Cardiac Death in Patients With Spontaneous Coronary Artery Dissection

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Procedural Experience for Transcatheter Aortic Valve Replacement and Relation to Outcomes: The STS/ACC TVT Registry

AbstractBackground

Transcatheter aortic valve replacement (TAVR) has been introduced into U.S. clinical practice with efforts to optimize outcomes and minimize the learning curve.

Objectives

The goal of this study was to assess the degree to which increasing experience during the introduction of this procedure, separated from other outcome determinants including patient and procedural characteristics, is associated with outcomes.

Methods

The authors evaluated the association of hospital TAVR volume and patient outcomes for TAVR by using data from 42,988 commercial procedures conducted at 395 hospitals submitting to the Transcatheter Valve Therapy Registry from 2011 through 2015. Outcomes assessed included adjusted and unadjusted in-hospital major adverse events.

Results

Increasing site volume was associated with lower in-hospital risk-adjusted outcomes, including mortality (p < 0.02), vascular complications (p < 0.003), and bleeding (p < 0.001) but was not associated with stroke (p = 0.14). From the first case to the 400th case in the volume–outcome model, risk-adjusted adverse outcomes declined, including mortality (3.57% to 2.15%), bleeding (9.56% to 5.08%), vascular complications (6.11% to 4.20%), and stroke (2.03% to 1.66%). Vascular and bleeding volume–outcome associations were nonlinear with a higher risk of adverse outcomes in the first 100 cases. An association of procedure volume with risk-adjusted outcomes was also seen in the subgroup having transfemoral access.

Conclusions

The initial adoption of TAVR into practice in the United States showed that increasing experience was associated with better outcomes. This association, whether deemed a prolonged learning curve or a manifestation of a volume–outcome relationship, suggested that concentrating experience in higher volume heart valve centers might be a means of improving outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528)

http://ift.tt/2tNOAnj

Inconsistent Dosing of Non-Vitamin K Oral Anticoagulants: Differences Between the United States and Japan

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Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI

AbstractBackground

Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited.

Objectives

The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period.

Methods

TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers.

Results

A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium–defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p < 0.001 for both). Stroke and potentially life-threatening complications, such as annulus rupture or aortic dissection, remained stable over time, whereas rates of cardiac tamponade and pacemaker implantation significantly increased.

Conclusions

The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828)

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Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

AbstractBackground

The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

Objectives

The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

Methods

CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

Results

In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

Conclusions

CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

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The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study

Abstract

Aim

To assess the safety and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases.

Subjects and Methods

The total number of patients was 10, out of which 6 were male and 4 were female patients. Five patients had incision and drainage of perimandibular space infections, two patients had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture, and two patients had submandibular lymph node biopsies. Informed & written consent were obtained from the patients after they had the procedure explained to them. Medically compromised patients and those who were excessively anxious and apprehensive, patient who did not want the procedure to be done under regional anesthesia, and patients with a history of allergy to local anesthetic were excluded. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon under the supervision of anesthesiologist with continuous monitoring.

Results

SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study.

Conclusion

Superficial cervical plexus block anesthesia is a safe and useful anesthetic technique with the low risk of accidents and complications, thus a good alternative for regional anesthesia in selected cases in oral and maxillofacial surgery.

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TAVR, 15 Years Down: Shooting for the Moon, Reaching the Stars

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The Cardiovascular Effects of Cocaine

Abstract

Cocaine is the leading cause for drug–abuse-related visits to emergency departments, most of which are due to cardiovascular complaints. Through its diverse pathophysiological mechanisms, cocaine exerts various adverse effects on the cardiovascular system, many times with grave results. Described here are the varied cardiovascular effects of cocaine, areas of controversy, and therapeutic options.

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Arterial Remodeling After Bioresorbable Scaffolds and Metallic Stents

AbstractBackground

Although previous observational studies have documented late luminal enlargement and expansive remodeling following implantation of a bioresorbable vascular scaffold (BVS), no comparison with metallic stents has been conducted in a randomized fashion.

Objectives

This study sought to compare vessel remodeling patterns after either Absorb BVS or Xience metallic drug-eluting stent (DES) implantation (Abbott Vascular, Santa Clara, California) and determine the independent predictors of remodeling.

Methods

In the ABSORB II randomized trial, 383 lesions (n = 359) were investigated by intravenous ultrasound both post-procedure and at 3-year follow-up. According to vessel and lumen area changes over 3 years, we categorized 9 patterns of vessel remodeling that were beyond the reproducibility of lumen and vessel area measurements.

Results

The relative change in mean vessel area was significantly greater with the BVS compared to the DES (6.7 ± 12.6% vs. 2.9 ± 11.5%; p = 0.003); the relative change in mean lumen area was significantly different between the 2 arms (1.4 ± 19.1% vs. –1.9 ± 10.5%, respectively; p = 0.031). Multivariate analysis indicated that use of the BVS, female sex, balloon-artery ratio >1.25, expansion index ≥0.8, previous percutaneous coronary intervention, and higher level of low-density lipoprotein cholesterol were independent predictors of expansive remodeling. Furthermore, in the BVS arm, necrotic core pre-procedure was an independent determinant of expansive remodeling.

Conclusions

Expansive vessel wall remodeling was more frequent and intense with the BVS than the metallic DES and could be determined by patient baseline characteristics and periprocedural factors. The clinical effect of the observed lumen and vessel remodeling must be investigated in further large clinical studies to optimize the clinical outcome of patients and lesions treated by bioresorbable scaffolds. (ABSORB II Randomized Controlled Trial; NCT01425281)

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Calmodulin Mutants Linked to Catecholaminergic Polymorphic Ventricular Tachycardia Fail to Inhibit Human RyR2 Channels

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The Promise of Vascular Restoration Is Still Alive

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Adequate Control of Blood Pressure for the Elderly... in a Less Than Adequate Healthcare System

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Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation: From the TREAT-AF Study

AbstractBackground

Atrial fibrillation (AF) occurs in many clinical contexts and is diagnosed and treated by clinicians across many specialties. This approach has resulted in treatment variations.

Objectives

The goal of this study was to evaluate the association between treating specialty and AF outcomes among patients newly diagnosed with AF.

Methods

Using data from the TREAT-AF (Retrospective Evaluation and Assessment of Therapies in AF) study from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2012 were identified who had at least 1 outpatient encounter with primary care or cardiology within 90 days of the AF diagnosis. Cox proportional hazards regression was used to evaluate the association between treating specialty and AF outcomes.

Results

Among 184,161 patients with newly diagnosed AF (age 70 ± 11 years; 1.7% women; CHA₂DS₂-VASc score 2.6 ± 1.7), 40% received cardiology care and 60% received primary care only. After adjustment for covariates, cardiology care was associated with reductions in stroke (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.96; p < 0.001) and death (HR: 0.89; 95% CI: 0.88 to 0.91; p < 0.0001) and increases in hospitalizations for AF/supraventricular tachycardia (HR: 1.38; 95% CI: 1.35 to 1.42; p < 0.0001) and myocardial infarction (HR: 1.03; 95% CI: 1.00 to 1.05; p < 0.04). The propensity-matched cohort had similar results. In mediation analysis, oral anticoagulation prescription within 90 days of diagnosis may have mediated reductions in stroke but did not mediate reductions in survival.

Conclusions

In patients with newly diagnosed AF, cardiology care was associated with improved outcomes, potentially mediated by early prescription of oral anticoagulation therapy. Although hypothesis-generating, these data warrant serious consideration and study of health care system interventions at the time of new AF diagnosis.

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Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients: Should AKI Be Watched?

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Opportunities to Improve Outcomes in Atrial Fibrillation: Provider Specialty and Beyond

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Correction

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External validation of leukocytosis and neutrophilia as a prognostic marker in anal carcinoma treated with definitive chemoradiation

Publication date: Available online 26 June 2017
Source:Radiotherapy and Oncology
Author(s): Antoine Schernberg, Florence Huguet, Laurence Moureau-Zabotto, Cyrus Chargari, Eleonor Rivin Del Campo, Michel Schlienger, Alexandre Escande, Emmanuel Touboul, Eric Deutsch
PurposeTo validate the prognostic value of leukocyte disorders in anal squamous cell carcinoma (SCC) patients receiving definitive concurrent chemoradiation.Materials and methodsBi-institutional clinical records from consecutive patients treated between 2001 and 2015 with definitive chemoradiation for anal SCC were retrospectively reviewed. Prognostic value of pretreatment leukocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as leukocyte or neutrophil count exceeding 10G/L and 7G/L, respectively.ResultsWe identified 133 patients, treated in two institutions. Eight% and 7% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year overall survival (OS) and progression-free survival (PFS) were 88% and 77%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS (p<0.01), locoregional control (LRC) and Distant Metastasis Control (DMC) (p<0.05), also after stratification by each institution. In multivariate analysis, leukocytosis and neutrophilia remained as independent risk factors associated with poorer OS, PFS, LRC and DMC (p<0.05).ConclusionThis study validates leukocytosis and neutrophilia as independent prognostic factors in anal SCC patients treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters are clinically relevant biomarkers to be considered for further clinical investigations.

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The incidence of symptomatic brain metastases from extra-pulmonary small cell carcinoma: Is there a role for prophylactic cranial irradiation in a clinically relevant population cohort?

Publication date: Available online 26 June 2017
Source:Radiotherapy and Oncology
Author(s): Alex De Caluwé, Gale Bowering, Alan Nichol, Fred Hsu
Background and purposeTo examine the incidence and outcomes of patients with brain metastases from extra-pulmonary small cell carcinoma (EPSCC) and assess the indication for prophylactic cranial irradiation (PCI).Materials and methodsA Provincial cancer registry was used to conduct a retrospective, population-based study of patients diagnosed with EPSCC between January 1997 and December 2011. The primary end point was the incidence of brain metastases. The secondary endpoint was overall survival. A "PCI Eligible" cohort was defined to provide an estimation of the incidence of brain metastases in clinically relevant patients.ResultsIn 287 patients, the primary sites were 21% gastrointestinal, 34% genito-urinary, 14% gynecologic, 5% head/neck and 25% unknown primary. Thirty-five (12.5%) patients had brain metastases: 12 (4.2%) at initial diagnosis and 23 (8%) later in the disease course. In PCI Eligible patients, the 3-year cumulative incidence of new brain metastases was 5.5% for M0 stage disease and 26.3% for M1 disease. There was no significant difference in the incidence of brain metastases between primary sites.ConclusionsThe incidence of brain metastases in patients with EPSCC is comparatively low, even in a cohort of patients that were suitable for PCI. Based on our analysis, we cannot recommend PCI for patients with EPSCC.

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Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique

Abstract

Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child's most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are pneumatic otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.

We have developed a technique based on low-coherence interferometry—a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum—to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.

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Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique

Abstract

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In Vivo Investigation of the Safety and Efficacy of Pulsed Dye Laser with Two Spot Sizes in Port-Wine Stain Treatment: A Prospective Side-by-Side Comparison

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

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Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique

Abstract

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Primary epithelial salivary gland tumours in children and adolescents

Primary epithelial tumours of the salivary glands are very rare in paediatric patients. The aim of this study was to evaluate the clinical course, treatment, and outcomes of these uncommon neoplasms based on the authors' experience and the recent literature. The medical charts of 12 female patients and seven male patients with primary epithelial salivary gland tumours were reviewed. All were under 19 years of age and underwent surgical treatment between 1994 and 2016. The results of this group of paediatric patients were compared with those of 621 adult patients.

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Immediate full-arch rehabilitation of the severely atrophic maxilla supported by zygomatic implants: a prospective clinical study with minimum follow-up of 6 years

The aim of this study was to evaluate the outcomes of immediate full-arch prostheses supported by zygomatic implants alone or in combination with standard fixtures after a minimum of 6 years of loading. From October 2008 to April 2010, 15 patients with severely atrophic maxillae were treated using four zygomatic implants or two zygomatic implants in conjunction with two conventional fixtures. All subjects received a fixed screw-retained prosthesis within 3hours of surgery, while the final restoration was delivered after 6 months.

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Retraction Note: Human cathelicidin LL-37 enhance the antibiofilm effect of EGCG on Streptococcus mutans

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Intranasal Administration of Whole Inactivated Influenza Virus Vaccine as a Promising Influenza Vaccine Candidate

Viral Immunology , Vol. 0, No. 0.

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Helper T Cell Responses to Respiratory Viruses in the Lung: Development, Virus Suppression, and Pathogenesis

Viral Immunology , Vol. 0, No. 0.

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Quality of compounded hydrocortisone capsules used in the treatment of children

Objectives

Due to the lack of paediatric-licensed formulations, children are often treated with individualized pharmacy-compounded adult medication. An international web-based survey about the types of medication in children with adrenal insufficiency (AI) revealed that the majority of paediatric physicians are using pharmacy-compounded medication to treat children with AI. Observations of loss of therapy control in children with congenital adrenal hyperplasia with compounded hydrocortisone capsules and regained control after prescribing a new hydrocortisone batch led to this 'real world' evaluation of pharmacy-compounded paediatric hydrocortisone capsules.

Methods

Capsule samples were collected randomly from volunteering parents of treated children suffering from congenital adrenal hyperplasia from all over Germany. Analysis of net mass and hydrocortisone content by high-performance liquid chromatography with ultraviolet (HPLC-UV) detection method was performed based on the European Pharmacopeia.

Results

In a total of 61 batches that were sent, 5 batches could not be analysed because of missing dose information, insufficient number of capsules or were not possible to be evaluated. Fifty-six batches containing 1125 capsules were evaluated. 21.4% of the batches revealed insufficiency in uniformity of net mass or drug content and additional 3.6% failed because they did not contain the labelled drug.

Conclusions

Compounded medication is a possible cause of variation of steroid doses in children with adrenal insufficiency or congenital adrenal hyperplasia, putting these vulnerable patients at risk of poor disease control and adrenal crisis. These data may apply to other individualized compounded oral medication as well, emphasizing the need for development of licensed paediatric formulations approved by regulatory authorities.

http://ift.tt/2tdZTbd

Intraoperative sialendoscopy to assist with and confirm repair of Stensen’s duct

We describe the use of a sialendoscope to assist with and to check the repair of a partially transected Stensen's duct despite its late presentation with a sialocele. Sialendoscopy has improved the management of parotid sialolithiasis,1 but in cases of trauma, has been limited to locating the transected ends of ducts.2,3 We are not aware of reports of a scope being used to check for satisfactory repair. We used a sialendoscope to guide the operation, check patency, and detect leaks after repair of the duct.

http://ift.tt/2u9qPFA

Effect of different nitrogen forms on the toxicity of Zn in wheat seedling root: a modeling analysis

Abstract

Heavy metal stress in culture media is always rhizotoxic. Our study aims to investigate the role of negative potential (ψ ₀) at root cell membrane surface (CMs) on modeling Zn²⁺ toxicity to wheat seedling roots and to examine the effects of different nitrogen forms (NH₄⁺ and NO₃⁻) on ψ ₀ and Zn rhizotoxicity. Solution culture experiments were conducted to measure the root elongation and Zn accumulation under Zn²⁺ exposure. The role of two nitrogen forms in affecting Zn²⁺ toxicity was compared, giving particular consideration to ψ ₀ and Zn²⁺ activities at CMs ({Zn²⁺}₀). Results showed that NH₄⁺ alleviates Zn²⁺ rhizotoxicity and NO₃⁻ increases Zn²⁺ rhizotoxicity. In modeling the rhizotoxicity, root length correlated better with {Zn²⁺}₀ than {Zn²⁺}_b, and the predictive accuracy (r ²) of NH₄⁺ treatment increased from 0.748 to 0.917 when incorporation of {Zn²⁺}₀ and {Ca²⁺}₀ into analysis. Oppositely, ψ ₀ played a limited role in modeling Zn²⁺ rhizotoxicity and bioavailability in NO₃⁻ treated medium (r ² = 0.609). Moreover, higher concentration of Zn in roots was found in NO₃⁻ treatment, compared with the NH₄⁺ treatment. ψ ₀ rather than the rhizotoxicity data correlated better with Zn accumulation especially in the NO₃⁻ treatment (r ² > 0.7), which meant the electrical driving force at CMs playing a dominant role in modeling the metal accumulation. In conclusion, the alleviatory role of NH₄⁺ on Zn toxicity and uptake was well explained and modeled by electrostatic effects at CMs. Though our data do not explore mechanisms for the NO₃⁻-Zn²⁺ interactions, we propose that ψ ₀ worked better in affecting the driving force for root Zn uptake, than influencing metal bioavailability at CMs.

http://ift.tt/2seeK0t

Evaluation of air pollution tolerance index and anticipated performance index of plants and their application in development of green space along the urban areas

Abstract

Air pollution due to vehicular emissions has become one of the most serious problems in the whole world and has resulted in huge threat to both the environment and the health of living organisms (plants, humans, animals, microorganisms). Plants growing along the roadsides get affected at the maximum as they are the primary recipients to different air pollutants and show varied levels of tolerance and sensitivity. Taking this into account, the present work was based on assessment of seasonal variation in air pollution tolerance index (APTI) and anticipated performance index (API) of four roadside plants, namely, Alstonia scholaris, Nerium oleander, Tabernaemontana coronaria, and Thevetia peruviana belonging to family Apocynaceae. APTI was calculated by the determination of four important biochemical parameters, viz., pH, relative water content (RWC), total chlorophyll (TChl), and ascorbic acid (AsA) content of leaves. The leaf samples were collected from plants growing at seven different sites of Amritsar (Punjab), India, for pre-monsoon and post-monsoon seasons. Highest APTI (82.14) was reported in N. oleander during the pre-monsoon season while the lowest was recorded in T. coronaria (18.59) in the post-monsoon season. On the basis of API score, A. scholaris was anticipated to be an excellent performer during the pre-monsoon and post-monsoon seasons followed by N. oleander, T. coronaria, and T. peruviana. Linear regression analysis and Pearson's correlation coefficient depicted significant positive correlation between APTI and ascorbic acid content during the pre-monsoon and post-monsoon seasons.

http://ift.tt/2sIQXsO

Amnion-assisted conjunctival epithelial redirection in limbal stem cell grafting

Aims

To develop a technique using amniotic membrane (AM) to prevent admixture of conjunctival epithelial cells and limbal explant-derived corneal epithelial cells in patients undergoing limbal stem cell transplantation. To compare this technique with the current method of 'sequential sector conjunctival epitheliectomy' (SSCE).

Methods

26 patients with total limbal stem cell deficiency who underwent ocular surface reconstruction with limbal stem cells transplantation were retrospectively studied. Patients were categorised into group A (11) in which AM was used to direct the conjunctival epithelial cells away from the corneal surface so that the latter could be covered by the limbal explant-derived epithelial cells—the procedure was termed 'amnion-assisted conjunctival epithelial redirection' (ACER)—and group B (15) in which the conjunctival epithelium was prevented from migrating on to the corneal surface by SSCE.

Results

In nine eyes of group A, the conjunctival epithelium was successfully directed on to the AM, preventing admixture with limbal explant-derived corneal epithelial cells. The AM was removed or it came off spontaneously within 1–4 weeks. Patients treated with SSCE (group B) underwent two to four interventions until complete re-epithelialisation. 12 patients had pain or discomfort. 11 patients had conjunctival haemorrhage during SSCE. The cornea was epithelised from the limbal explant-derived epithelium in all patients.

Conclusions

ACER is a viable option in limbal transplantation that reduces multiple patient visits, bleeding and pain that can be associated with SSCE.

http://ift.tt/2tdZ1Dj

Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results

Purpose

To assess the refractive improvements and the corneal endothelial safety of an individualised topography-guided regimen for corneal crosslinking in progressive keratoconus.

Methods

An open-label prospective randomised clinical trial was performed at the Department of Clinical Sciences, Ophthalmology, Umeå University Hospital, Umeå, Sweden. Thirty-seven patients (50 eyes) with progressive keratoconus planned for corneal crosslinking were included. The patients were randomised to topography-guided crosslinking (photorefractive intrastromal crosslinking (PiXL); n=25) or uniform 9 mm crosslinking (corneal collagen crosslinking (CXL); n=25). Visual acuity, refraction, keratometry (K1, K2 and K_max) and corneal endothelial morphometry were assessed preoperatively and at 1, 3, 6 and 12 months postoperatively. The PiXL treatment involved an asymmetrical treatment zone centred on the area of maximum corneal steepness with treatment energies ranging from 7.2 to 15.0 J/cm²; the CXL treatment was a uniform 9 mm 5.4 J/cm² pulsed crosslinking. The main outcome measures were changes in refractive errors and corneal endothelial cell density.

Results

The spherical refractive errors decreased (p<0.05) and the visual acuity improved (p<0.01) at 3, 6 and 12 months after PiXL, but not after CXL. The between-groups differences, however, were not significant. K2 and K_max decreased at 3, 6 and 12 months after PiXL (p<0.01), but not after CXL (p<0.01 when comparing the two treatments). No corneal endothelial cell loss was seen after either treatment.

Conclusions

Individualised topography-based crosslinking treatment centred on the ectatic cone has the potential to improve the corneal shape in keratoconus with decreased spherical refractive errors and improved visual acuity, without damage to the corneal endothelium.

Trial registration number

NCT02514200, Results.

http://ift.tt/2tNiwzH

Retinal vessel calibre measurements by optical coherence tomography angiography

Purpose

To compare the vessel calibre measurements between optical coherence tomography angiography (OCTA) and colour fundus photography.

Methods

In this retrospective comparative study, OCTA and colour fundus images of healthy eyes and eyes with optic atrophy were evaluated. The colour fundus image was registered manually using Image J software to the OCTA image of the optic disc. Two independent graders measured the vessel calibre of the widest vein and artery in each peripapillary quadrant on a 3.4 mm diameter circle centred on the optic disc in the same location on both images. The difference in vessel calibre between the two techniques was assessed.

Results

A total of 312 vessels from 29 healthy eyes and 20 eyes with atrophic optic discs were included. There was a high level of agreement between graders for measurement of vessel calibre in both colour fundus (intraclass correlation coefficient=0.93, coefficient of variation=0.07) and OCTA images (intraclass correlation coefficient=0.94, coefficient of variation=0.05). The mean vessel calibre in colour fundus images (94.5±23.2 µm) and OCT images (112.2±26.1 µm) was correlated (r=0.8, p<0.001), but the difference was statistically significant (mean difference: 17.6±1.5 µm, p<0.001). This difference was evident for both arteries (mean difference: 18.2±16.3 µm, p<0.001) and veins (mean difference: 15.1±16.2 µm, p<0.001) individually, with a similar magnitude of difference for both vessel types (p=0.08). In addition, the magnitude of difference between imaging modalities was similar in atrophic and healthy discs (17.1±15.9 vs 18.4±15.2 µm, respectively, p=0.4). The difference, however, was significantly higher in vessels with a calibre of ≤94.5 compared with larger vessels (19.3±16.3 vs 15.6±14.4 µm, respectively, p=0.02).

Conclusions

Vessel calibre measurements were significantly larger in OCTA images compared with colour fundus photographs, particularly for smaller vessels. These differences may need to be accounted for when using OCTA-derived metrics.

http://ift.tt/2tN8RZY

Optical coherence tomography angiography of foveal hypoplasia

Aims

To discuss foveal development in the context of detailed retinal vasculature imaging in foveal hypoplasia using optical coherence tomography angiography.

Methods

In this case series, the optical coherence tomography angiography results of four patients with idiopathic foveal hypoplasia and two patients with foveal hypoplasia secondary to oculocutaneous albinism are presented.

Results

Cases with intact visual acuity demonstrated lower grades of foveal hypoplasia on optical coherence tomography, while those with poor vision demonstrated high grades of foveal hypoplasia. The superficial retinal capillary plexus was intact in the foveal area in all cases, with no demonstrable foveal avascular zone. The deep retinal capillary plexus was absent to variable degrees in most cases, but was most persistent in those cases with reduced vision.

Conclusions

The superficial retinal capillary plexus is present in cases with foveal hypoplasia, while the deep retinal capillary plexus is absent to varying degrees. Our findings support the hypothesis that an intact foveal avascular zone of the deep capillary plexus allows for outer retinal photoreceptor specialisation to occur unimpeded, resulting in preserved visual acuity, while this process may be inhibited by an absent deep capillary foveal avascular zone with resultant poor vision.

http://ift.tt/2teh90b

Retinal microvascular network geometry and cognitive abilities in community-dwelling older people: The Lothian Birth Cohort 1936 study

Aim

To examine the relationship between retinal vascular morphology and cognitive abilities in a narrow-age cohort of community-dwelling older people.

Methods

Digital retinal images taken at age ~73 years from 683 participants of the Lothian Birth Cohort 1936 (LBC1936) were analysed with Singapore I Vessel Assessment (SIVA) software. Multiple regression models were applied to determine cross-sectional associations between retinal vascular parameters and general cognitive ability (g), memory, processing speed, visuospatial ability, crystallised cognitive ability and change in IQ from childhood to older age.

Results

After adjustment for cognitive ability at age 11 years and cardiovascular risk factors, venular length-to-diameter ratio was nominally significantly associated with processing speed (β=–0.116, p=0.01) and g (β=–0.079, p=0.04). Arteriolar length-to-diameter ratio was associated with visuospatial ability (β=0.092, p=0.04). Decreased arteriolar junctional exponent deviation and increased arteriolar branching coefficient values were associated with less relative decline in IQ between childhood and older age (arteriolar junctional exponent deviation: β=–0.101, p=0.02; arteriolar branching coefficient: β=0.089, p=0.04). Data are presented as standardised β coefficients (β) reflecting change in cognitive domain score associated with an increase of 1 SD unit in retinal parameter. None of these nominally significant associations remained significant after correction for multiple statistical testing.

Conclusions

Retinal parameters contributed <1% of the variance in the majority of associations observed. Whereas retinal analysis may have potential for early detection of some types of age-related cognitive decline and dementia, our results present little evidence that retinal vascular features are associated with non-pathological cognitive ageing.

http://ift.tt/2tNmiZM

Comparison of anti-VEGF therapies on fibrovascular pigment epithelial detachments in age-related macular degeneration

Background

The aim is to compare the therapeutic effects of three antivascular endothelial growth factor (VEGF) drugs (bevacizumab, aflibercept and ranibizumab) on fibrovascular pigment epithelial detachments (fvPEDs) in age-related macular degeneration (AMD).

Methods

This was a retrospective, comparative, consecutive case series of 88 unique eyes with fvPEDs in neovascular AMD treated with anti-VEGF monotherapy for a minimum of 6 months. All eyes were treatment naive. Diagnosis was confirmed retrospectively by fluorescein angiography and spectral-domain optical coherence tomography. Exclusion criteria included serous/drusenoid PEDs or patients who switched anti-VEGF. Mean follow-up across all therapies was 313.9±85.3 days.

Results

Average age of all patients was 80.6 years. Baseline maximum subfoveal PED height was 326.8±185.1 μm, 394.5±238.6 μm and 258.0±145.3 μm for bevacizumab, aflibercept and ranibizumab, respectively (p=0.05). All patients had subretinal fluid, intraretinal fluid or a combination of the two at an initial presentation. Central retinal thickness decreased at all time points compared with baseline across all three anti-VEGF therapies. Subfoveal PED height decreased in patients treated with aflibercept at all time points and decreased in patients treated with bevacizumab at 1-month, 3-month and 6-month time points. Aflibercept reduced PED height more than bevacizumab at 1-month and 12-month follow-ups (p=0.02 and p=0.03, respectively) and ranibizumab at 1-month and 6-month follow-ups (p=0.03 and p=0.02, respectively). No differences in best-corrected visual acuity were appreciated at any time point between drugs.

Conclusions

There was a significant reduction in subfoveal PED height for aflibercept and bevacizumab compared with baseline. A direct comparison of drugs demonstrated a beneficial reduction of PED height, albeit inconsistently, favouring aflibercept. There were no differences in visual acuity across the groups at any time point.

http://ift.tt/2tehEHg

Diabetes and diabetic retinopathy in people aged 50 years and older in Hungary

Background/aims

The purpose of this study was to estimate the prevalence of diabetes mellitus (DM) and diabetic retinopathy (DR) in the population aged 50 years and older in Hungary, and to assess the coverage of diabetic eye care services.

Methods

In total, 105 clusters of 35 people aged 50 years or older were randomly selected. The standardised rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used. Participants were classified as having DM if they were known to have DM or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed.

Results

In total, 3523 (95.9%) out of 3675 eligible subjects were examined. And 705 (20.0%) out of 3523 had known (661) or newly diagnosed DM (44). Twenty per cent of participants with known DM had a blood glucose level ≥200 mg/dL, and 27.4% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 20.7% and prevalence of sight-threatening DR (STDR) was 4.3% in one or both eyes among participants with DM.

Conclusions

Prevalence of DM was in line with findings of other RAAB+DRM surveys and slightly lower than the unpublished earlier age-matched Hungarian estimate. Prevalence of DR was slightly lower than expected. The prevalence of STDR was low in people aged 50 years and older in Hungary compared with the results of other RAAB with DRM surveys. DR screening coverage was low. To prevent severe complications of DM and possible concomitant visual loss, the coverage of ophthalmic examinations in patients with DM should be increased.

http://ift.tt/2tN6K8q

Association between VEGF-A and VEGFR-2 polymorphisms and response to treatment of neovascular AMD with anti-VEGF agents: a meta-analysis

Aims

The purpose of this study is to investigate whether gene polymorphisms of the vascular endothelial growth factor A (VEGF-A) and its receptor (VEGFR-2) have a pharmacogenetics effect on the anti-VEGF treatment for neovascular age-related macular degeneration (nAMD).

Methods

We carried out a meta-analysis focusing on the relationship between VEGF-related gene polymorphisms and treatment response of nAMD.

Results

For the single nucleotide polymorphisms (SNPs) within VEGF-A and VEGFR-2, anti-VEGF treatment was much more effective in patients with nAMD having rs833061 (CC vs TT:OR=2.222, 95% CI 1.252 to 3.944, p=0.006; CT vs TT: OR=2.537,95% CI 1.478 to 4.356, p=0.001 and CC vs CT+TT: OR=2.362, 95% CI 1.414 to 3.946, p=0.001), particularly for Asians (CC vs TT: OR=2.903, 95% CI 1.150 to 7.330, p=0.024; CT vs TT: OR=3.849, 95% CI 1.522 to 9.733, p=0.004 and CC vs CT+TT: OR=3.339, 95% CI 1.369 to 8.145, p=0.008, respectively). In subgroup analysis, rs833061 was more likely to be a predictor of response to anti-VEGF therapy specifically when ranibizumab (RBZ) only regime was adopted or visual acuity (VA) was taken as the standardised assessment of outcome. No association with response to anti-VEGF treatment was detected for the other eight polymorphisms.

Conclusions

Pharmacogenetics of VEGF-A polymorphism rs833061 may play a positive role in response to anti-VEGF therapy for nAMD.

http://ift.tt/2tejHet

Natural history and effect of therapeutic interventions on subretinal fluid causing foveal detachment in macular telangiectasia type 2

Aim

To report the natural history of subretinal fluid (SRF) causing foveal detachment in macular telangiectasia type 2 (MacTel) and our experience of therapeutic intervention with intravitreal steroids or antivascular endothelial growth factor inhibitor (anti-VEGF) agents in some cases.

Methods

Retrospective case series. Three of the MacTel study's largest registries were searched to identify eyes with foveal detachment.

Results

We identified 7 eyes from 6 exclusively female patients. The prevalence of foveal detachment was low, present in 1.4% of the assessed MacTel population. Age at presentation ranged from 50 to 66 years. Follow-up ranged from 2 to 8 years. There was late-phase leakage on fluorescein angiography from what was presumed to be ectatic capillaries. The SRF fluctuated without a rapid decline in visual acuity in cases that were not treated. When they were, intravitreal anti-VEGF and steroid therapy in general reduced SRF, at least temporarily, but did not halt the gradual long-term decrease in visual acuity. In one case, optical coherence tomography angiography showed significant reduction in the extent of the predominantly deep intraretinal vascular complex 1 month after anti-VEGF therapy.

Discussion and conclusions

As the natural history of this unusual MacTel phenotype is not characterised by rapid visual decline, intervention with intravitreal anti-VEGF or steroid therapy may not be necessary.

http://ift.tt/2tNbCdG

Size and vitreomacular attachment of primary full-thickness macular holes

Purpose

To study the relationship between the size of primary full-thickness macular hole (MH) and the vitreomacular attachment status.

Design

Single-centre retrospective observational case series.

Methods

The records of 100 consecutive eyes operated for primary full-thickness MH were retrospectively reviewed. The vitreous status and MH diameter were assessed on the preoperative optical coherence tomography scans. MH were classified depending on the presence or absence of vitreomacular traction (VMT) and their size as small (<250 µm), medium (250–400 µm) and large (>400 µm), as suggested in the International VMT Study Group Classification.

Results

22% of MH had VMT and 13% had both VMT and a diameter <400 µm. The MH diameter was not significantly different depending on the presence or absence of VMT (respectively, 339±134 and 423±191 µm (p=0.094)), with large overlap between groups. Small, medium and large MH were similarly distributed regardless of the presence or absence of VMT (p=0.69).

Conclusions

Our series of 100 MH did not reveal any significant relationship between the MH size and the presence or absence of VMT. Only 13% of MH had VMT and a diameter <400 mm, then were eligible for intravitreal ocriplasmin as a possible treatment.

http://ift.tt/2rTZIxp

Association between OCT-based microangiography perfusion indices and diabetic retinopathy severity

Aim

To evaluate the association between retinal capillary non-perfusion and diabetic retinopathy (DR) severity using optical coherence tomography-based microangiography (OMAG).

Methods

33 patients (51 eyes) with a history of diabetes underwent imaging with a 68 kHz Cirrus-5000 spectral domain OMAG prototype. Demographic and clinical characteristics were collected. The perfusion index (PI) was defined as per cent coverage of area by retinal vessels with flow, measured within a minimum of 6.8x6.8 mm² OMAG scan. The PI in each ETDRS zone was analysed using an automated algorithm. Univariate and multivariate analyses were used to determine the degree of association between PI and DR severity.

Results

51 eyes with different DR severities were imaged. More severe DR was significantly associated with lower PI after adjusting for logarithm of the minimum angle of resolution best-corrected visual acuity, hyperlipidaemia, diabetes type and ETDRS ring in a multivariate mixed linear model. Compared with the none–mild non-proliferative diabetic retinopathy (NPDR) group, the moderate–severe NPDR group had 2.7 lower PI (p=0.03) and proliferative DR group had 4.3 lower PI (p=0.003). All ETDRS zones except for the foveal centre showed inverse associations between PI and DR severity (p values<0.001 to 0.862).

Conclusions

A statistically significant inverse association exists between PI and DR severity. Our study suggests that PI may become a useful biomarker in evaluating and following the progression of DR.

http://ift.tt/2td4XfB

Anatomical and functional outcomes following vitrectomy for advanced familial exudative vitreoretinopathy: a single surgeon's experience

Purpose

To assess the anatomical and functional results of vitreoretinal surgery in patients with advanced familial exudative vitreoretinopathy (FEVR).

Methods

Retrospective analysis of data for 10 eyes of 9 patients with advanced FEVR who underwent pars plana vitrectomy from March 1997 to May 2015 and had a follow-up of at least 12 months. The primary outcomes were final visual acuity (VA) and anatomical success.

Results

The average age at the time of the surgery was 10.1±6.5 years (range 2 months–18 years). The mean follow-up period was 58.4±75.1 months. The male-to-female ratio was 7/2. The mean number of vitreoretinal operations was 1.5. At the last visit, 7 (70%) eyes had complete or partial retinal attachment. Preoperatively, the mean Snellen VA was 20/4000 (n=8), and in the remaining 2 (20%) eyes it was recorded as 'central, steady and maintained'. At final examination, the mean Snellen VA was 20/330 (n=7), and in the remaining 3 (30%) eyes it was recorded as light perception. At the final visit, 5 eyes (50%) had improved VA, 2 eyes (20%) showed stabilisation, and 3 eyes (30%) with total retinal detachment had a decrease in VA. No progression to glaucoma was observed and no enucleation was necessary.

Conclusions

Advanced FEVR in young children tends to be more aggressive, leading to severe complications. These cases are challenging and require special consideration. Despite surgery, disease-related complications remain high. However, surgical intervention for advanced FEVR might be of benefit in helping to preserve vision.

http://ift.tt/2rTYHW3

Outcomes of keratoplasty in the mucopolysaccharidoses: an international perspective

Objective

To describe visual outcomes after penetrating keratoplasty and deep anterior lamellar keratoplasty in patients with mucopolysaccharidoses.

Methods

This is a retrospective review of keratoplasty in consecutive patients from Brazil, England, Finland, Germany, Portugal, Sweden and the USA. All patients had corneal clouding due to mucopolysaccharidoses. Preoperative and postoperative visual outcome and ocular comorbidities were identified. Success was arbitrarily defined as any improvement in visual acuity or best-corrected visual acuity better than logarithm of the minimum angle of resolution 0.30 (20/40). Statistical analysis included only data from first operated eyes in the 16 patients who underwent bilateral keratoplasty.

Results

Forty-eight eyes from 32 patients with mucopolysaccharidoses I, IV or VI are reported. Mean follow-up was 70 months (range: 5–186). Penetrating keratoplasty was performed in 45 eyes and deep anterior lamellar keratoplasty in 3 eyes. At last follow-up, a successful visual outcome for penetrating keratoplasty in first operated/only operated eyes was found in 63%. Rejection episodes occurred in 23% of grafts; however, a clear graft was recorded at last follow-up in 94%. Ocular pathway comorbidities were identified in 63% of eyes transplanted.

Conclusions

Clear corneal grafts can be obtained for patients with corneal clouding due to mucopolysaccharidosis with improvement in visual acuity in the majority.

http://ift.tt/2tcSPeo

The effects of transdermal testosterone and oestrogen therapy on dry eye in postmenopausal women: a randomised, placebo-controlled, pilot study

Aims

Sex hormones could provide a future treatment avenue for dry eye post menopause. However, there are few well-controlled studies. This study investigates the impact of testosterone and oestrogen on dry eye symptoms and signs in postmenopausal women.

Methods

A randomised double-blind placebo-controlled pilot study was conducted involving 40 women with dry eye (age 63.9±5.1 years, 13.2±6.3 years post menopause). Ten women were assigned to each of four treatment groups: transdermal testosterone, oestradiol, testosterone/oestradiol combination and placebo. Assessment at baseline and after 8 weeks: ocular symptoms, tear osmolarity, tear stability, tear secretion, meibomian gland assessment, corneal and conjunctival sensitivity, serum concentrations of 17β-oestradiol, 3-α-androstanediol-glucuronide and dehydroepiandrosterone sulfate. Differences from placebo were examined using one-way analysis of variance and Dunnett's t-test. Within-group analyses included paired t-tests and Spearman correlation.

Results

Dryness intensity after 8 weeks was significantly worse in the oestrogen group compared with placebo (p=0.04). No significant changes in other symptoms, tear function, meibomian gland function, lid morphology, corneal or conjunctival sensitivity were observed in any of the groups when compared with the change in placebo after 8 weeks. Within-group analyses showed increased tear secretion in the testosterone/oestradiol combination group (p=0.03) and a strong association between increased serum androgen and improved tear stability in the testosterone group (=0.83,p=0.01).

Conclusions

Oestrogen supplementation may worsen ocular symptoms in postmenopausal women with dry eye, whereas no impact of testosterone therapy on symptoms was apparent. The positive effects of oestrogen and testosterone on tear function require confirmation in a larger study, with sample size calculated from the data generated herein. Placebo control is essential in studies of dry eye therapies.

Trial registration number

ACTRN12612000281897.

http://ift.tt/2rU9MGB

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Δευτέρα 26 Ιουνίου 2017

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