Assessment of dynamic variables of fluid responsiveness to predict desufflation-induced hypotension during paediatric laparoscopic surgery

Abstract

Background: During laparoscopic surgery in paediatric patients, sudden hypotension may occur following peritoneal desufflation due to hypovolaemia or an acute increase in gastrointestinal venous capacitance by the release of intra-abdominal pressure. This study examined whether dynamic variables of fluid responsiveness during pneumoperitoneum can predict the occurrence of hypotension following desufflation.Methods: A total of 120 paediatric subjects were prospectively enrolled. A predictor was derived from the initial 83 subjects and validated thereafter in 37 high-risk subjects. The pleth variability index, respiratory variation in the pulse oximetry plethysmographic waveform (ΔPOP), systolic pressure variation and pulse pressure variation during pneumoperitoneum were obtained 1 min before desufflation. Predictors of desufflation-induced hypotension were investigated using the multivariable logistic regression analysis. Predictability was assessed using the area under the receiver-operating characteristic curve (AUC).Results: In the derivation cohort, 27% (n=23) of subjects developed hypotension. Only ΔPOP was found to be a predictor, and showed high predictability of desufflation-induced hypotension [AUC 0.87, P<0.0001, 95% confidence interval (CI): 0.78–0.93]. A ΔPOP cut-off point of 38% predicted hypotension with a sensitivity of 83% and a specificity of 90%. In the validation cohort, 43% (n=16) of subjects developed hypotension, and ΔPOP was verified to be highly predictive of the occurrence of hypotension (AUC 0.90, P<0.0001, 95% CI: 0.76–0.98). The sensitivity and specificity of a ΔPOP cut-off point of 38% to predict hypotension was 88% and 90%, respectively.Conclusions: The ΔPOP during pneumoperitoneum is useful in predicting desufflation-induced hypotension during paediatric laparoscopic surgery.Clinical trial registration: NCT02536521.

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Cortical Processing of Vocal and Nonvocal Sounds in Cochlear-Implanted Children: An Electrophysiological Study.

Objectives: For prelingually deaf children, cochlear implants (CIs) can restore auditory input to the auditory cortex and the ability to acquire spoken language. Language development is strongly intertwined with voice perception. The aim of this electrophysiological study was to investigate human voice processing using measures of cortical auditory evoked potentials (AEPs) in pediatric CI users. Design: Cortical AEPs were measured in 8 CI children (4 to 12 years old) with good auditory and language performance and 8 normal-hearing (NH) age-matched controls. The auditory stimuli were nonspeech vocal sounds (laughing, sighing, coughing) and environmental sounds (e.g., telephones, alarms, cars, bells, water, wind). Independent component analysis was used to minimize the CI artifact in cortical AEPs. Results: Fronto-temporal positivity to vocal sounds was found in NH children, with a significant effect in the 140 to 240 msec latency range. In CI children, there was a positive response to vocal sounds in the 170 to 250 msec latency range, with a more diffuse and anterior distribution than in the NH children. Conclusions: Cortical responses to vocal sounds were recorded in CI children. The topography and latency of response to voice differed from that of NH children. The results suggest that cortical reorganization for processing vocal sounds may occur in congenitally deaf children fitted with a CI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Auditory and Audiovisual Close Shadowing in Post-Lingually Deaf Cochlear-Implanted Patients and Normal-Hearing Elderly Adults.

Objectives: The goal of this study was to determine the effect of auditory deprivation and age-related speech decline on perceptuo-motor abilities during speech processing in post-lingually deaf cochlear-implanted participants and in normal-hearing elderly (NHE) participants. Design: A close-shadowing experiment was carried out on 10 cochlear-implanted patients and on 10 NHE participants, with two groups of normal-hearing young participants as controls. To this end, participants had to categorize auditory and audiovisual syllables as quickly as possible, either manually or orally. Reaction times and percentages of correct responses were compared depending on response modes, stimulus modalities, and syllables. Results: Responses of cochlear-implanted subjects were globally slower and less accurate than those of both young and elderly normal-hearing people. Adding the visual modality was found to enhance performance for cochlear-implanted patients, whereas no significant effect was obtained for the NHE group. Critically, oral responses were faster than manual ones for all groups. In addition, for NHE participants, manual responses were more accurate than oral responses, as was the case for normal-hearing young participants when presented with noisy speech stimuli. Conclusions: Faster reaction times were observed for oral than for manual responses in all groups, suggesting that perceptuo-motor relationships were somewhat successfully functional after cochlear implantation and remain efficient in the NHE group. These results are in agreement with recent perceptuo-motor theories of speech perception. They are also supported by the theoretical assumption that implicit motor knowledge and motor representations partly constrain auditory speech processing. In this framework, oral responses would have been generated at an earlier stage of a sensorimotor loop, whereas manual responses would appear late, leading to slower but more accurate responses. The difference between oral and manual responses suggests that the perceptuo-motor loop is still effective for NHE subjects and also for cochlear-implanted participants, despite degraded global performance. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Radiological Evaluation of Maxillary Sinus Anatomy: A cross-sectional study of 300 Patients

Publication date: Available online 29 July 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Naroa Lozano-Carrascal, Oscar Salomó-Coll, Sergio Alexandre Gehrke, José Luis Calvo-Guirado, Federico Hernández-Alfaro, Jordi Gargallo-Albiol
ObjectiveThe aim of the present study was to evaluate the principal anatomical characteristics of the maxillary sinus using Cone Beam Computed Tomography (CBCT) in order to facilitate prevention of intra- and post-operative complications.Materials and methodsThree hundred CBCT scans from patients undergoing implant surgery were analysed. The following anatomical structures were evaluated: (1) Residual ridge height (RRH) and width (RRW); (2) Ridge bone density (BD); (3) Maxillary sinus angle (MSA); (4) Maxillary sinus lateral wall thickness (LWT); (5) Schneiderian membrane thickness (MT); (6) Maxillary sinus septa (SS); (7) Posterior superior alveolar artery (PSAA).ResultsMean patient age was 59.5±13.6. Mean RRH at upper second premolar (2PM) was 8.66±3.95mm, 4.90±2.28mm at first molar (1M), and 5.26±2.13mm at second molar (2M). Mean RRW was 6.72±2.69mm at 2PM, 6.87±2.65mm at 1M and 7.09±2.80mm at 2M. Bone Density was 330.93±211.02 Hounsfield Units (HU) at first molar position and MSA was 73.39±15.23°. LWT was 1.95±0.98mm. Mean Schneider Membrane thickness (MT) was 1.82±1.59mm; MT was≤3mm in 72.9% of patients and >3mm in 27.10%. 20.56% of patients presented bucco-palatal oriented septa with a mean height of 13.11±3.82mm. PSAA was observed in 48.60% and mean distance to the top of the ridge was 13.15±3.71mm, and was mostly observed inside the sinus (53.85%).ConclusionsCBCT scanning has been shown to be a useful tool for evaluating maxillary sinus anatomical variations. CBCT should be considered the gold standard when evaluating the maxillary sinus area.



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Online Embryology teaching using learning management systems appears to be a successful additional learning tool among Egyptian medical students

Publication date: Available online 29 July 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Ahmed Farid Al-Neklawy
Although the traditional didactic lecture is considered to be efficient for presenting information and providing explanations, it usually does not provide adequate time for deeper learning activities. So, traditional lecture is one of the most widely criticized educational methods.Virtual learning environment (VLE) is a specially designed environment that facilitates teachers' management of educational courses for their students, using computer hardware and software, which involves distance learning.In this study, we evaluated the experiment of online teaching of General Embryology for Egyptian undergraduate medical students using WizIQ learning management system.A total of 100 students were invited to submit an online survey at the end of the course to evaluate delivery of instruction, creation of an environment that supported learning, and administrative issues.Most of the students reported that they were strongly satisfied with the efficacy of the instructional methods and were strongly satisfied with the degree of clarity of the course material. They strongly accepted the page format and design of the virtual classroom and strongly agreed that the learning environment supported the learning procedure. The item of easy logging into the virtual classroom had aberrant variable responses; it recorded the lowest mean response; this variation in responses was due to technical factors as the students used different devices with different speeds of internet connections.Ninety percent of students have strongly recommended the course attendance for their fellow students.These results demonstrate that online Anatomy teaching using learning management systems appears to be a successful additional learning tool among Egyptian medical students.



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Mechanistic insight into pyrene removal by natural sepiolites

Abstract

This paper investigates the sorption characteristics and mechanisms of pyrene onto two types of natural sepiolite-brown (B-Sep) and white (W-Sep). The effects of relevant properties such as clay content, surface area, pore diameter and volume, divalent cations, and organic carbon content were investigated by single component batch adsorption systems. The results suggest that pyrene has high affinity for both sepiolite and its sorption behavior could be mainly affected by exchangeable strongly hydrated cations such as Ca²⁺ and H₂O in the zeolite-like channels and by open channel defects (OCD) structures but no so much by the large number of Si-OH groups located on the sepiolite's basal surfaces. Mesoporosity rather than surface area largely controls the sorption capacity and intensity of both sepiolites. This is shown by the increase in pore volume that exhibited the greatest increase in BET surface area. Particle size and morphological changes of both sepiolites following pyrene adsorption determined by FE-SEM showed that the sepiolite fibers are much longer than their widths, which are only several laths (several nanometers). This is a result of growth, mostly along the c-axis, at the expense of the diffusion of pyrene molecules through aqueous solution. As a consequence, a significant fibrous morphology is produced following the adsorption of pyrene by both sepiolites.

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Clinical Similarity of the Biosimilar ABP 501 Compared With Adalimumab After Single Transition: Long-Term Results From a Randomised, Double-Blind, 52-Week, Phase 3 Study in Moderate-to-Severe Plaque Psoriasis Patients

Abstract

Background

ABP 501, an FDA- and EMA-approved biosimilar, is highly similar to adalimumab in structure, function, and pharmacokinetics.

Objective

Demonstrate similarity in efficacy, safety, and immunogenicity of ABP 501 versus adalimumab for moderate-to-severe plaque psoriasis.

Methods

Patients were randomised (1:1) to receive ABP 501 or adalimumab 40 mg every 2 weeks for 16 weeks. At Week 16, patients with ≥50% improvement from baseline in psoriasis area-and-severity index score (PASI) were eligible to continue to Week 52. Patients receiving ABP 501 continued; adalimumab patients were re-randomised (1:1) to continue adalimumab or undergo a single transition to ABP 501. Key efficacy assessments included % PASI improvement from baseline, PASI responders, and mean change in affected body surface area (BSA) from baseline to Weeks 16, 32, and 50. Safety was monitored via adverse events (AEs) and antidrug antibodies (ADAs) were assessed.

Results

308 patients were re-randomised at Week 16 (ABP 501/ABP 501, n=152; adalimumab/adalimumab, n=79; adalimumab/ABP 501, n=77). PASI percent improvements from baseline were similar across groups for Weeks 16, 32, and 50 (range: 85.8%-88.2%), with no significant differences detected across groups in percentages of PASI 50, 75, 90, and 100 responders. Changes from baseline in %BSA affected were similar across groups and timepoints. No new safety signals were detected. AEs were balanced between groups. Percentages of patients with binding and neutralizing ADAs were similar across treatments.

Conclusions

ABP 501 and adalimumab have similar clinical efficacy, safety, and immunogenicity profiles over 52 weeks, including after single transition, in this patient population.

This article is protected by copyright. All rights reserved.

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Clinical Similarity of the Biosimilar ABP 501 Compared With Adalimumab After Single Transition: Long-Term Results From a Randomised, Double-Blind, 52-Week, Phase 3 Study in Moderate-to-Severe Plaque Psoriasis Patients

Abstract

Background

ABP 501, an FDA- and EMA-approved biosimilar, is highly similar to adalimumab in structure, function, and pharmacokinetics.

Objective

Demonstrate similarity in efficacy, safety, and immunogenicity of ABP 501 versus adalimumab for moderate-to-severe plaque psoriasis.

Methods

Patients were randomised (1:1) to receive ABP 501 or adalimumab 40 mg every 2 weeks for 16 weeks. At Week 16, patients with ≥50% improvement from baseline in psoriasis area-and-severity index score (PASI) were eligible to continue to Week 52. Patients receiving ABP 501 continued; adalimumab patients were re-randomised (1:1) to continue adalimumab or undergo a single transition to ABP 501. Key efficacy assessments included % PASI improvement from baseline, PASI responders, and mean change in affected body surface area (BSA) from baseline to Weeks 16, 32, and 50. Safety was monitored via adverse events (AEs) and antidrug antibodies (ADAs) were assessed.

Results

308 patients were re-randomised at Week 16 (ABP 501/ABP 501, n=152; adalimumab/adalimumab, n=79; adalimumab/ABP 501, n=77). PASI percent improvements from baseline were similar across groups for Weeks 16, 32, and 50 (range: 85.8%-88.2%), with no significant differences detected across groups in percentages of PASI 50, 75, 90, and 100 responders. Changes from baseline in %BSA affected were similar across groups and timepoints. No new safety signals were detected. AEs were balanced between groups. Percentages of patients with binding and neutralizing ADAs were similar across treatments.

Conclusions

ABP 501 and adalimumab have similar clinical efficacy, safety, and immunogenicity profiles over 52 weeks, including after single transition, in this patient population.

This article is protected by copyright. All rights reserved.

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An index for the evaluation of 3D masticatory cycles stability

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Claudia Lúcia Pimenta Ferreira, Matteo Zago, Cláudia Maria de Felício, Chiarella Sforza
ObjectivesTo introduce an index (Masticatory Stability Index, MSI) to analyze the stability of chewing cycles in standardized conditions and test it in a group of patients with subclinical mild temporomandibular disorder (TMD).Design23 subjects with mild subacute TMD and 21 healthy subjects were involved; they all responded to a questionnaire about signs and symptoms of TMD (ProTMDmulti) and underwent a myofunctional orofacial evaluation with scores, using the protocol of orofacial myofunctional evaluation with scores (OMES). Their mandibular kinematics was assessed with a 3D motion capture system during deliberate unilateral gum chewing. The MSI was computed synthesizing the information contained in nine kinematics parameters into a single global figure. Patients' and controls' MSI were compared considering the preferred and non-preferred chewing side using a 2-way ANOVA (factors: group, side).ResultsTogether with a lower total score of myofunctional orofacial status, the TMD group showed a reduced stability based on MSI (p<0.05).ConclusionsThe MSI is an efficient method to measure the stability of the masticatory cycles. These preliminary results encourage validating the index on a larger sample. The variability in the motor behavior of chewing can impair the objectivity of its evaluations in several types of patients, including those with TMD. The MSI could be useful to complement clinical assessments, providing data for planning the rehabilitation of masticatory function in these patients.



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Obturator hernia: a rare cause of bowel obstruction

An obturator hernia is a rare condition and an unusual cause of intestinal obstruction. With a challenging diagnosis, it has one of the highest mortality rates of all abdominal wall hernias. The authors present a case of an elderly woman with bowel obstruction secondary to an incarcerated obturator hernia. An 80-year-old woman presented at the emergency room with complaints for the last 2 days of nausea, vomiting, constipation and lower right abdominal pain that radiated down to the right medial thigh. Abdominal tenderness to deep palpation of the right iliac fossa and mildly distention were noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated obturator hernia. The patient underwent emergency exploratory laparotomy. The incarcerated bowel was reduced and the defect was repaired with a plug of polypropylene mesh covered with peritoneum. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day.

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Thrombolytic therapy for the treatment of acute ischaemic stroke in adults with homozygous sickle cell disease

Stroke is a significant cause of morbidity and mortality in patients with homozygous sickle cell disease (SCD). A specific large-vessel vasculopathy is often responsible for both haemorrhagic and ischaemic strokes in patients with SCD. Although intravenous thrombolysis has been considered as a therapeutic option for acute ischaemic strokes in SCD, its use remains debated because of an increased risk of spontaneous intracranial haemorrhage reported in this disease. This risk of haemorrhage is mainly supported by the presence of a Moyamoya syndrome often associated with the specific vasculopathy in patients with homozygous SCD. We report two cases of patients with homozygous SCD treated with intravenous thrombolysis for an acute ischaemic stroke without haemorrhagic transformation. Our cases suggest that reperfusion strategy in acute ischaemic stroke in patients with homozygous SCD can be considered once associated Moyamoya syndrome has been ruled out. An international registry would be of interest as these situations are rare.

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Longitudinal Midline Sacral Split Fracture - A Rare Entity

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.

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Thalamic and cerebellar hypermetabolism and cortical hypometabolism during absence status epilepticus

We report on a 17-year-old girl with absence status epilepticus who developed recurrent motionless confusional state and continuous generalised 3–4 Hz rhythmic delta waves on electroencephalogram (EEG). The patient had no history of absence, myoclonus or generalised convulsion. Her seizure was resistant to a combination of antiepileptic drugs including carbamazepine. Ictal positron emission tomography using [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG-PET) revealed hypermetabolism of the bilateral thalamus and cerebellum and hypometabolism of the frontal, parietal and posterior cingulate cortices. We diagnosed her seizure as absence status and obtained remission by changing medication. The findings of ictal metabolic alteration in previous studies and in our case confirm the pathogenic importance of the thalamus in absence status and that associated cortical deactivation and cerebellar activation may be related to the generation or maintenance of epileptic EEG discharges.

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Acquired haemophilia A with a recalcitrant high-titre factor VIII inhibitor in the setting of interstitial lung disease

Acquired haemophilia A (AHA) is a bleeding disorder that results from autoantibodies against factor VIII (FVIII). A 70-year-old man with a history of interstitial lung disease presented with spontaneous bleeding into his thigh. He had undetectable FVIII levels and a high-titre FVIII inhibitor (>2000ââ'¬â°Bethesda units/mL) and was diagnosed with AHA. He had several relapses, required multiple haemostatic and immunosuppressive treatments but eventually achieved a stable remission after 2ââ'¬â°years of therapy.

Our patient matches the typical elderly male demographic of AHA. His relapsing course with remarkably high and persistent inhibitor titre highlights the need for close monitoring and aggressive upfront treatment. Whereas cyclophosphamide and steroids are often used first line in AHA, rituximab has also shown efficacy in refractory patients with high inhibitor levels. The FVIII and inhibitor concentration on presentation have been associated with treatment response and may be used as prognostic factors to tailor immunosuppressive regimens.

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Intraoperative image guidance in transoral robotic surgery: A pilot study

Abstract

Background

Intraoperative image guidance during transoral robotic surgery (TORS) is hampered by imaging-friendly instrumentation and intraoperative positioning. The purpose of this study was to develop and validate an accurate image-guidance system for TORS.

Methods

A custom radiolucent mouth retractor was fabricated from biocompatible material (Med-610; Stratasys, Minneapolis, MN). Teflon beads were placed in the oropharynx and carotid arteries of 3 cadavers. CT scans were obtained in the preoperative and intraoperative positions. Displacement of targets between preoperative and intraoperative scans was measured. Surgical navigation was based on the open-source Image-Guided Surgery Toolkit. Target registration error (TRE) was determined by measuring the distance between the tracker and bead registered to preoperative versus intraoperative scans.

Results

The inferior oropharyngeal targets demonstrated the greatest displacement between positions. A significant reduction in TRE was observed when registering the tracker to the intraoperative compared to the preoperative scan.

Conclusion

This study describes an accurate intraoperative image-guidance system for TORS.

http://ift.tt/2vRKA5Y

Intraoperative image guidance in transoral robotic surgery: A pilot study

Abstract

Background

Intraoperative image guidance during transoral robotic surgery (TORS) is hampered by imaging-friendly instrumentation and intraoperative positioning. The purpose of this study was to develop and validate an accurate image-guidance system for TORS.

Methods

A custom radiolucent mouth retractor was fabricated from biocompatible material (Med-610; Stratasys, Minneapolis, MN). Teflon beads were placed in the oropharynx and carotid arteries of 3 cadavers. CT scans were obtained in the preoperative and intraoperative positions. Displacement of targets between preoperative and intraoperative scans was measured. Surgical navigation was based on the open-source Image-Guided Surgery Toolkit. Target registration error (TRE) was determined by measuring the distance between the tracker and bead registered to preoperative versus intraoperative scans.

Results

The inferior oropharyngeal targets demonstrated the greatest displacement between positions. A significant reduction in TRE was observed when registering the tracker to the intraoperative compared to the preoperative scan.

Conclusion

This study describes an accurate intraoperative image-guidance system for TORS.

http://ift.tt/2vRKA5Y

Identifying Knowledge Gaps in Clinicians Who Evaluate and Treat Vocal Performing Artists in College Health Settings

The goal of this study was to identify knowledge gaps in clinicians who evaluate and treat performing artists for illnesses and injuries that affect vocal function in college health settings.

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Clinicopathological characteristics and prognosis of patients with multiple primary melanomas

Abstract

This narrative review provides an evidence-based overview of existing literature on the epidemiology, clinicopathological characteristics and prognostic outcomes of tumours arising in patients with multiple primary melanomas (MPM). PubMed and MEDLINE were searched for original research papers and review articles from 2000 to 2016 using the term 'multiple primary melanoma.' Population-wide increases in life expectancy, advances in early detection and increasing incidence of melanoma give rise to an expanding group of patients that are at an increased risk of developing subsequent primary tumours.

This article is protected by copyright. All rights reserved.

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Clinicopathological characteristics and prognosis of patients with multiple primary melanomas

Abstract

This narrative review provides an evidence-based overview of existing literature on the epidemiology, clinicopathological characteristics and prognostic outcomes of tumours arising in patients with multiple primary melanomas (MPM). PubMed and MEDLINE were searched for original research papers and review articles from 2000 to 2016 using the term 'multiple primary melanoma.' Population-wide increases in life expectancy, advances in early detection and increasing incidence of melanoma give rise to an expanding group of patients that are at an increased risk of developing subsequent primary tumours.

This article is protected by copyright. All rights reserved.

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Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms

Vitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children.

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Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms

Vitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children.

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Activity of Pazopanib and Trabectedin in Advanced Alveolar Soft Part Sarcoma

AbstractBackground.Alveolar soft part sarcoma (ASPS) is an exceedingly rare and orphan disease, without active drugs approved in the front line. Pazopanib and trabectedin are licensed for sarcoma treatment from second‐line, but very little and contradictory data are available on their activity in ASPS. Lacking ongoing and/or planned clinical trials, we conducted a multi‐institutional study involving the reference sites for sarcoma in Europe, U.S., and Japan, within the World Sarcoma Network, to investigate the efficacy of pazopanib and trabectedin.Materials and Methods.From May 2007, 14 of the 27 centers that were asked to retrospectively review their databases had identified 44 advanced ASPS patients treated with pazopanib and/or trabectedin. Response was evaluated by Response Evaluation Criteria in Solid Tumors 1.1. Progression‐free survival (PFS) and overall survival (OS) were computed by Kaplan‐Meier method.Results.Among 30 patients who received pazopanib, 18 were pretreated (13 with other antiangiogenics). Response was evaluable in 29/30 patients. Best responses were 1 complete response, 7 partial response (PR), 17 stable disease (SD), and 4 progressions. At a 19‐month median follow‐up, median PFS was 13.6 months (range: 1.6–32.2+), with 59% of patients progression‐free at 1 year. Median OS was not reached.Among 23 patients treated with trabectedin, all were pretreated and evaluable for response. Best responses were 1 PR, 13 SD, and 9 progressions. At a 27‐month median follow‐up, median PFS was 3.7 months (range: 0.7–109), with 13% of patients progression‐free at 1 year. Median OS was 9.1 months.Conclusion.The value of pazopanib in advanced ASPS is confirmed, with durable responses, whereas the value of trabectedin appears limited. These results are relevant to defining the best approach to advanced ASPS.Implications for Practice.This retrospective study, conducted among the world reference centers for treatment of sarcoma, confirms the value of pazopanib in patients with advanced alveolar soft part sarcoma (ASPS), with dimensional and durable responses, whereas trabectedin shows a limited activity. Alveolar soft part sarcoma is resistant to conventional cytotoxic chemotherapy. Pazopanib and trabectedin are licensed for treatment of sarcoma from second line; in the lack of prospective clinical trials, these results are relevant to defining ASPS best management and strongly support initiatives aimed at obtaining the approval of pazopanib in the front line of the disease.

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Fixed Dosing of Monoclonal Antibodies in Oncology

AbstractMost monoclonal antibodies in oncology are administered in body–size‐based dosing schedules. This is believed to correct for variability in both drug distribution and elimination between patients. However, monoclonal antibodies typically distribute to the blood plasma and extracellular fluids only, which increase less than proportionally with the increase in body weight. Elimination takes place via proteolytic catabolism, a nonspecific immunoglobulin G elimination pathway, and intracellular degradation after binding to the target. The latter is the primary route of elimination and is related to target expression levels rather than body size. Taken together, the minor effects of body size on distribution and elimination of monoclonal antibodies and their usually wide therapeutic window do not support body–size‐based dosing. We evaluated effects of body weight on volume of distribution and clearance of monoclonal antibodies in oncology and show that a fixed dose for most of these drugs is justified based on pharmacokinetics. A survey of the savings after fixed dosing of monoclonal antibodies at our hospital showed that fixed dosing can reduce costs of health care, especially when pooling of preparations is not possible (which is often the case in smaller hospitals). In conclusion, based on pharmacokinetic parameters of monoclonal antibodies, there is a rationale for fixed dosing of these drugs in oncology. Therefore, we believe that fixed dosing is justified and can improve efficiency of the compounding. Moreover, drug spillage can be reduced and medication errors may become less likely.Implications for Practice.The currently available knowledge of elimination of monoclonal antibodies combined with the publicly available data from clinical trials and extensive population pharmacokinetic (PopPK) modeling justifies fixed dosing. Interpatient variation in exposure is comparable after body weight and fixed dosing and most monoclonal antibodies show relatively flat dose‐response relationships. For monoclonal antibodies, this results in wide therapeutic windows and no reduced clinical efficacy after fixed dosing. Therefore, we believe that fixed dosing at a well‐selected dose can increase medication safety and help in reduction of costs of health care without the loss of efficacy or safety margins.

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TERT Promoter Hypermethylation in Gastrointestinal Cancer: A Potential Stool Biomarker

AbstractBackground.There is a high demand for noninvasive screening tools for gastrointestinal cancer (GIC) detection, and GIC‐specific markers are required for such purposes. It is established that induction of the telomerase reverse transcriptase gene (TERT) coupled with telomerase activation is essential for cancer development/progression and aberrant TERT promoter methylation of specific 5′—C—phosphate—G—3′ (CpGs) has been linked to TERT induction in oncogenesis. Here we analyzed TERT promoter methylation in fecal samples from GIC patients and healthy adults and determined its value as a stool biomarker for GIC detection.Materials and Methods.Sixty‐nine GIC patients (34 colorectal carcinoma and 35 gastric cancer) and 62 healthy adults were recruited and fecal samples were collected. Paired tumors and adjacent non‐cancerous tissues from 34 patients and normal mucosa tissues from 12 healthy individuals were collected. TERT promoter methylation density was determined using pyrosequencing.Results.We identified two GIC‐specific methylation sites at −218 (CpG site 1) and −210 (CpG site 2) in the TERT promoter in tumor tissues. Methylated TERT promoter CpG sites 1 and 2 were also detectable in patient stool, while only background levels were observed in healthy individuals. The overall sensitivity reached 52.2% (95% confidence interval [CI]: 48.3–56.0) for fecal methylated TERT promoter assays at 90% specificity, which was comparable to other known stool methylation markers for GIC detection. The combined assays of fecal TERT promoter methylation and occult blood (OB) significantly improved sensitivity and specificity in colorectal cancer (area under curves for methylation alone: 0.798, 95% CI: 0.707–0.889 vs. methylation + OB: 0.920, 95% CI: 0.859–0.981; p = .028), but not in gastric cancer.Conclusion.This proof‐of‐concept study suggests the feasibility of stool TERT promoter methylation analyses as an additional tool in noninvasive GIC screening. The OncologistImplications for Practice.Induction of telomerase reverse transcriptase (TERT) expression coupled with telomerase activation is essential for cancer development/progression, while aberrant TERT promoter methylation has been linked to TERT induction in oncogenesis. We identified two cancer‐specific methylation sites (CpG1 and 2) in the TERT promoter in tumors from GIC patients. Methylated TERT promoter CpG sites 1 and 2 were detectable in patient stool, while only background levels were observed in healthy individuals. The sensitivity and specificity was comparable to other known stool methylation markers for GIC detection. This proof‐of‐concept study suggests the feasibility of stool TERT promoter methylation analyses for noninvasive screening of GIC.

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Sleep and Alzheimer’s disease: A pivotal role for the suprachiasmatic nucleus?

Alzheimer's disease (AD), which accounts for most of the dementia cases, is, aside from cognitive deterioration, often characterized by the presence of non-cognitive symptoms. Society is desperately in need for interventions that alleviate the economic and social burden related to AD. Circadian dysrhythmia, one of these symptoms in particular, immensely decreases the self-care ability of AD-patients and is one of the main reasons of caregiver exhaustion. Studies suggest that these circadian disturbances form the root of sleep-wake problems, diagnosed in more than half of AD patients.

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Enlarged vestibular aqueduct: Audiological and genetical features in children and adolescents

Enlarged Vestibular Aqueduct (EVA) is one of the most common congenital malformations associated with sensorineural or mixed hearing loss. The association between hearing loss and EVA is described in syndromic (i.e. Pendred Syndrome, BOR, Waardenburg) and non-syndromic disorders, as isolate or familiar mutations of the SLC26A4 gene. The audiological phenotype of the EVA syndrome is heterogeneous, the type and entity of hearing loss may vary and vertigo episodes might also be present.

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Effects of vitamin E-diffused highly cross-linked UHMWPE particles on inflammation, apoptosis and immune response against S. aureus

Publication date: October 2017
Source:Biomaterials, Volume 143
Author(s): Weishen Chen, David A. Bichara, Jeremy Suhardi, Puyi Sheng, Orhun K. Muratoglu
Particle-induced osteolysis and periprosthetic joint infection (PJI) are closely associated with periprosthetic tissue immune function. The objective of this study was to determine the effects of polyethylene particles on inflammation and response against S. aureus. Effects that vitamin E-diffused cross-linked UHMWPE (VE-PE) particles had on apoptosis, inflammation, and bactericidal activities compared to virgin cross-linked UHMWPE (control PE) particles were examined. Murine RAW 264.7 macrophages exposed to VE-PE particles in vitro were less apoptotic, secreted less tumor necrosis factor (TNF)-α, and responded more effectively against lipopolysaccharide or S. aureus compared to control PE particles. Implantation of VE-PE particles in murine calvaria in vivo caused less reactive oxygen species generation, less apoptosis, and less osteolysis compared to control PE particles. Implantation of PE particles in mice calvaria for 28 days, followed by inoculation with S. aureus in the same site where PE particles were implanted, demonstrated enhanced S. aureus clearance in the VE-PE group at day 33 after inoculation. These findings indicate that VE-PE particles might be less inflammatory and might preserve innate immunity of local tissue, allowing for enhanced clearance of bacteria.



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Influence of HfH2 addition on the microstructure and mechanical properties of TiC-NiTi cermets

Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Bolu Liu, Shuigen Huang, Jan Van Humbeeck, Jef Vleugels
(Ti,Hf)C0.7 cermets with different Ti/Hf atomic ratio and 20vol% NiTi binder were prepared by pressureless liquid-phase sintering at 1380°C for 60min. The Hf content was modified by adding up to 42.4wt% HfH2 powder in a TiC0.95+Ni49.4Ti50.6+TiH2 starting powder mixture. Upon HfH2 addition, the binder phase changed from austenite to martensite NiTi. The actual Hf content in the (Ti,Hf)C0.7 at different HfH2 addition was slightly lower than the theoretical value, due to some Hf dissolution in the binder phase. The (Ti,Hf)C0.7 grain size and binder mean free path length decreased whereas the apparent porosity slightly increased with increasing HfH2 content up to 42.4wt% HfH2. The hardness increased with increasing HfH2 addition up to 42.4wt%, while the elastic modulus remained the same. The bending strength and fracture toughness increased with increasing HfH2 addition to 19.9wt% but decreased upon further increasing the HfH2 content up to 42.4wt%.

Graphical abstract

http://ift.tt/2u685X9

Insight into γ-Ni/γ′-Ni3Al interfacial energy affected by alloying elements

Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Xuan L. Liu, Shun-Li Shang, Yong-Jie Hu, Yi Wang, Yong Du, Zi-Kui Liu
Interfacial energy (σγ/γ′) of the γ-Ni/γ′-Ni3Al interface is critical to understand and design Ni-based superalloys. In the present work, a first-principles methodology with constrained relaxations has been used to study the effect of dilute alloying element (X) on σγ/γ′ of the (100) coherent interface, where the sixteen X's include Al, Co, Cr, Fe, Hf, Mo, Nb, Pd, Pt, Re, Ru, Ta, Ti, W, Y, and Zr. σγ/γ′=19mJ/m² has been predicted for the unalloyed γ/γ′ interface, agreeing well with the previous estimations. It is found that the σγ/γ′ value is the lowest when alloying element is in γ-Ni, while the addition to γ′-Ni3Al increases σγ/γ′ due mainly to the in-plane lattice expansion. Specifically, our calculations show that alloying elements Mo, W, and Re have the largest effect on the σγ/γ′ value by decreasing it to 4–5mJ/m² when partitioned to γ-Ni; Ru and Pt are shown to increase greatly the σγ/γ′ value up to 25–28mJ/m² when partitioned to γ-Ni; all ternary additions substituting for Ni in γ′-Ni3Al increase σγ/γ′ except for Pt; and for Ti and Ta, which segregate strongly to γ′-Ni3Al and substitute for Al, the σγ/γ′ values increase to 32 and 35mJ/m², respectively.

Graphical abstract

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Printable low-cost and flexible carbon nanotube buckypaper motion sensors

Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Joshua DeGraff, Richard Liang, Minh Quyen Le, Jean-Fabien Capsal, Florent Ganet, Pierre-Jean Cottinet
Wearable technology, which features affordable and flexible sensors integrated into fabrics and garments to detect both deliberate and subtle body movements, will reshape the way we approach self-rehabilitation, physical training, and many high-dexterity tasks by harvesting data about the wearer's activity. Metallic and semi-conductor sensors are currently the most commercially viable sensors. Metallic sensors designs are low profile and flexible; however, they are limited by low sensitivity and complex manufacturing. Semi-conductor sensor designs are highly sensitive but limited by their rigidity and brittle nature. Wearable sensors that are low profile, flexible, and sensitive to micro-strains are highly desired. We have developed a printable and low profile strain sensor using multi-wall carbon nanotube thin films called buckypaper (MWCNT-BP). Our tests indicate that the buckypaper sensors are 77% more sensitive than similar sensor designs. This paper explains the low-cost printing technology and displays the sensors' performance after integration into a fabric glove.

Graphical abstract

http://ift.tt/2u61hJ4

Medication-related osteonecrosis of the jaw in oncological patients with skeletal metastases: conservative treatment is effective up to stage 2

There is currently no widespread strategy for treating medication-related osteonecrosis of the jaw (MRONJ), so our aim was to evaluate retrospectively the outcome of a minimally invasive treatment protocol for patients with both MRONJ and cancer. We designed a retrospective cohort study of patients with cancer who had been diagnosed with MRONJ after treatment with denosumab or bisphosphonates given intravenously. Primary outcome measures were improvement in the clinical stage of MRONJ and the time course to its resolution.

http://ift.tt/2w8bshE

The applicability of new TNM classification for humanpapilloma virus-related oropharyngeal cancer in the 8th edition of the AJCC/UICC TNM staging system in Japan: A single-centre study

The purpose of this study is to validate the applicability of new TNM classification for human papillomavirus (HPV)-related oropharyngeal cancer (OPC) in the 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system in Japan.

http://ift.tt/2v83lUL

Evidence of surgical treatments for intractable Meniere’s disease

Meniere's disease is an inner ear disease, characterized by recurrent rotatory vertigo, sensorineural hearing loss and tinnitus. There are some with frequent vertigo attacks, progressive hearing loss and persistent annoying tinnitus even through the continuous standard medical treatments. These cases are thought to account for 10%–20% of all cases of Meniere's disease. In this review article, we would like to demonstrate the evidences for surgical treatments according to the previous papers, and consider the next therapeutic strategies including surgical options according to the international guidelines.

http://ift.tt/2vRNTdJ

The applicability of new TNM classification for humanpapilloma virus-related oropharyngeal cancer in the 8th edition of the AJCC/UICC TNM staging system in Japan: A single-centre study

The purpose of this study is to validate the applicability of new TNM classification for human papillomavirus (HPV)-related oropharyngeal cancer (OPC) in the 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system in Japan.

http://ift.tt/2v83lUL

Evidence of surgical treatments for intractable Meniere’s disease

Meniere's disease is an inner ear disease, characterized by recurrent rotatory vertigo, sensorineural hearing loss and tinnitus. There are some with frequent vertigo attacks, progressive hearing loss and persistent annoying tinnitus even through the continuous standard medical treatments. These cases are thought to account for 10%–20% of all cases of Meniere's disease. In this review article, we would like to demonstrate the evidences for surgical treatments according to the previous papers, and consider the next therapeutic strategies including surgical options according to the international guidelines.

http://ift.tt/2vRNTdJ

Effect of computed tomographic venography on donor selection in submandibular gland transplantation in patients with severe dry eye

A reliable anterior facial vein (AFV, donor vein) is cardinal for the success of submandibular gland (SMG) transplantation. This study determined the impact of computed tomographic (CT) venography in identifying AFV variations for SMG transplantation.

http://ift.tt/2vfLVXp

Do patients with malocclusion have a higher prevalence of temporomandibular disorders than controls both before and after orthognathic surgery? A systematic review and meta-analysis

The aim of this study was to identify, through meta-analysis, whether patients who require orthognathic surgery have a higher prevalence of temporomandibular disorders (TMDs) than controls, both before treatment and after.

http://ift.tt/2w88v0B

Identification of serum proteome signature of irritable bowel syndrome: Potential utility of the tool for early diagnosis and patient's stratification

Publication date: Available online 28 July 2017
Source:Journal of Proteomics
Author(s): Athanasios Tsigaridas, Athanassios K. Anagnostopoulos, Aggeliki Papadopoulou, Stamatia Ioakeim, Anna Vaiopoulou, Ioannis S. Papanikolaou, Nikos Viazis, George Karamanolis, Gerasimos J. Mantzaris, George T. Tsangaris, Maria Gazouli
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder with high incidence, and great heterogeneity of symptoms. Numerous factors are correlated with IBS development; however, the pathophysiology is not yet clear. In addition, there is no appropriate diagnostic tool available. The aim of this study was the identification of protein expression alterations in IBS patients compared to healthy individuals. Serum samples from 30 IBS patients (10 with IBS-Diarrhea, 10 IBS-Constipation and 10 IBS-Mixed) and 10 healthy individuals were subjected to proteomic analysis by 2-dimensional gel electrophoresis. Following evaluation of densitometrical data, protein spots exhibiting differential expression among the groups, were further characterized by matrix-assisted laser desorption tandem time-of-flight mass spectrometer and the results were confirmed by Western blot analysis. Eight significantly different expressed proteins were identified. Seven of them were overexpressed in IBS cases and only one was overexpressed in healthy individuals. These proteins were also differently expressed between the three IBS subgroups. IBS-D group overexpressed immunoglobulin light chain Lambda (LAC3) and apolipoprotein E (APOE), IBS-C group overexpressed apolipoprotein H (APOH) and collagen alpha-1 (XIV) chain (COEA1), and IBS-M group and healthy individuals overexpressed retinol-binding protein 4 (RET4). Our results show a different serum protein profile of IBS patients compared to healthy controls. Understanding the role of these eight proteins which are differently expressed in IBS patients, may contribute to a better clarification of IBS pathogenesis and to patient's stratification.SignificanceIrritable bowel syndrome (IBS) is a chronic gastrointestinal disorder with high incidence and great heterogeneity of symptoms without any appropriate diagnostic tool available. Eight significantly different expressed proteins were identified. Seven of them were overexpressed in IBS cases and only one was expressed in healthy individuals. These proteins were also differently expressed between the three IBS subgroups. Our results show that there is a different serum proteome signature in IBS compared to healthy individuals, as well as in IBS subgroups that could be used in the future for patient's stratification and as a diagnostic tool.

Graphical abstract

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Mini-encyclopaedia of the wound healing - Opportunities for integrating multi-omic approaches into medical practice

Publication date: Available online 28 July 2017
Source:Journal of Proteomics
Author(s): Lara Stolzenburg-Veeser, Olga Golubnitschaja
Wound healing is a highly complex life-important repair process triggered by plenty of local and/or systemic organ and tissue damaging events, such as an acute surgical invasion, accidental organ and tissue damages, acute and chronic diseases, aggressive local and systemic therapeutic approaches (e.g. irradiation and systemic chemotherapy). Individual health condition determines over the quality of wound healing. Impaired wound healing, in turn, may lead, for example, to post-surgical complications frequently observed in elderly, chronic ulcers in diabetic patients, hindered and ineffective pain management, etc. However, these well-acknowledged examples are just the tip of the iceberg. The entire spectrum of potential consequences is much broader. Therefore, all the aspects of wound healing need to receive a dedicated attention of many specialised medical fields and healthcare as a whole. In contrast, there is still strongly limited knowledge collected regarding the molecular and cellular mechanisms underlying the physiologic versus impaired wound healing. The contents of this article might be of great importance for multi-professional considerations as well as for the experts working in specific fields such as clinical proteomics, general practice, laboratory medicine, surgery including plastic surgery and aesthetic medicine, gerontology, psychology, diabetology, endocrinology, oncology, cardiovascular disease, radiology, and healthcare economy.SignificanceThe contents of this article are strongly motivated by the particular value of wound healing quality for medical care and might be of great importance for multi-professional considerations and experts working in specialised fields: predictive and preventive medicine, general practitioners, laboratory medicine, surgery including plastic surgery and aesthetic medicine, gerontology, psychology, diabetology, endocrinology, oncology, cardiovascular disease, radiology, and healthcare economy. The article is aiming at both educational and scientific purposes: on one side it summarises comprehensive information available regarding wound healing mechanisms and molecular pathways involved. On the other side the article provides highly innovative hypotheses for multi-professional considerations relevant for several research fields which may potentially advance medical services in the close future such as clinical proteomics and multi-omics.

Graphical abstract

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An online 2D-reversed-phase – Reversed-phase chromatographic method for sensitive and robust plasma protein quantitation

Publication date: Available online 28 July 2017
Source:Journal of Proteomics
Author(s): Vincent R. Richard, Dominik Domanski, Andrew J. Percy, Christoph H. Borchers
Offline high-pH reversed-phase fractionation is widely used to reduce sample complexity in proteomic workflows. This is due to the semi-orthogonality and high peak resolution of the two separations. Offline 2D fractionation, however, is low throughput and requires several manual manipulations and is prone to sample losses. To address these issues, we developed an online two dimensional high-pH – low-pH reversed-phase-reversed-phase LC-MRM (2D RPRP) method whereby hundreds of peptides can be quantified in a single LC-MS/MS injection. The method allowed the reproducible and sensitive quantitation of a test panel of 367 peptides (168 proteins) from undepleted human plasma. Of these, we were able to detect and quantify 95 peptides (29 proteins) by 2D-RPRP that were not detectable by 1D LC-MRM-MS. Online 2D RPRP resulted in an average increase of roughly 10-fold in sensitivity compared to traditional 1D low-pH separations, while improving reproducibility and sample throughput relative to offline 2D RPRP by factors of 1.7 and 5, respectively, compared to offline 2D RPRP. This paper serves as proof-of-concept of the feasibility and efficacy of online 2D RPRP at analytical flow rates for highly multiplexed targeted proteomic analyses.

Graphical abstract

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MiR-130b attenuates vascular inflammation via negatively regulating tumor progression locus 2 (Tpl2) expression

Publication date: October 2017
Source:International Immunopharmacology, Volume 51
Author(s): Peng Wang, Xue Zhang, Fulun Li, Kai Yuan, Maoran Li, Jiwei Zhang, Bin Li, Wei Liang
Endothelial cell (EC) activation and dysfunction have been linked to a wide variety of vascular inflammatory diseases. However, the role of microRNAs in EC activation and inflammation remains largely unknown. In this study, we found that miR-130b was significantly decreased in human umbilical vein endothelial cells (HUVECs) after lipopolysaccharides (LPS) treatment. Forced expression of miR-130b inhibited the LPS-induced activation of extracellular signal-regulated kinase (ERK) and the inflammatory genes expression, such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α). Furthermore, we identified that tumor progression locus 2 (Tpl2) is a direct target of miR-130b. Finally, in vivo overexpression of miR-130b via miR-130b agomir attenuates acute lung vascular inflammation in the LPS-induced sepsis mouse model. Taken together, our data demonstrated that miR-130b represses vascular inflammation via targeting Tpl2, suggesting that miR-130b mimics might be a promising therapeutic strategy for treatment of vascular inflammatory diseases.

Graphical abstract

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Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with chronic hepatitis B virus (HBV) infection

Publication date: October 2017
Source:International Immunopharmacology, Volume 51
Author(s): Zhidan Zhao, Jianhua Liu, Jiaxin Wang, Tinyan Xie, Qiuhuan Zhang, Sisi Feng, Hui Deng, Baiyun Zhong
ObjectiveThis retrospective study aimed to investigate the associations between the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and disease severity in patients with chronic HBV infection-related liver disease (CHB).MethodsPatients with CHB were retrospectively identified. Clinical data for 172 HBV-infected patients and 40 healthy controls were collected from the electronic patient medical record system database of our hospital.ResultsHBV-related-compensated-cirrhosis patients (HBV-CC patients) had a significantly lower mean PLR than did other patients (P<0.001). HBV-related-decompensated-cirrhosis patients (HBV-DC patients) had a significantly higher mean NLR than did any other patients (P<0.001). In the entire cohort of CHB patients, significant correlations were observed between the PLR and both serum HBV DNA (r=0.264, P<0.001) and serum HBeAg (r=0.240, P=0.002). The PLR was significantly correlated with serum HBV DNA in both HBV-CC patients (r=−0.116, P=0.044) and HBV-DC patients (r=0.456, P=0.008). In HBV-Active-Carriers patients (HBV-AC patients), the PLR was positively correlated with serum HBeAg level (r=0.321, P=0.023). In HBV-DC patients, the NLR was positively correlated with serum HBeAg level (r=0.372, P=0.033). In the logistic regression prediction model, a predictive probability cutoff of 0.392 had the highest sensitivity and specificity (sensitivity, 91.2%; specificity, 84.0%) in distinguishing between HBV-CC and HBV-AC patients. A NLR cutoff value of 2.94 had the highest sensitivity and specificity (sensitivity, 81.8%; specificity, 88.2%) in distinguishing between HBV-DC and HBV-CC patients.ConclusionThe PLR and NLR partially reflect the amounts of serum HBV DNA and serum HBeAg levels circulating in CHB patients. The logistic regression model including the PLR and age most accurately distinguished between HBV-CC and HBV-AC patients. The NLR may be useful for follow-up in HBV-CC patients to predict disease progression. In summary, the PLR and NLR provided a supplementary means for effectively managing chronic HBV infection and disease.



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Do Patients Access Appropriate Information Online?

Facial plast Surg 2017; 33: 428-433
DOI: 10.1055/s-0037-1603782

Health care providers should be aware of information available on the Internet to ensure proper patient care. The current analysis assesses the reliability, quality, and readability of internet information describing rhytidectomy. Previously validated survey instruments to assess the reliability, quality, and readability of online websites describing rhytidectomy were used. An internet search using Google with the search term "facelift" was conducted. The first 50 search results were reviewed, and 36 were deemed appropriate to be included in this analysis. Websites were divided based on type of authorship into professional organization, academic, physician based, and unidentified. The validated DISCERN instrument was used to determine reliability, quality, and overall rating of each site. The Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL) were used to measure readability. A 1 to 3 point scale was used to rate websites, with a higher number indicating a website that possessed either greater reliability or greater quality. Mean scores for reliability ranged from 1.7 (±0.99) in the academic group to 2.0 (±0.12) in the unidentified group. Mean scores for quality ranged from 1.5 (±0.13) in the unidentified group to 1.7 (±0.38) in the physician-based group. The highest overall rating was 1.4 (±0.22 and ± 0.31, respectively) in the unidentified and physician-based groups. The lowest overall rating was 1 (±0.58) in the academic group. FRESs ranged from 21.6 to 74.6. FKGLs ranged from 6.9 to 13.9. Information available online regarding rhytidectomy may be significantly deficient in reliability, quality, and readability. These deficiencies are present in articles with all types of author affiliations. This underscores the clinicians' duty to provide patients with high-quality information at an adequate level of comprehension.
[...]

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Nose and Identity

Facial plast Surg 2017; 33: 367-371
DOI: 10.1055/s-0037-1603787

This article explores the significance of the nose in daily human life. It presents examples of how a person's nose may dominate his/her life, how it is used as a nickname, considered an expression of his/her character, and may be a symbol of pride and wisdom. Also, examples from the literature and the arts are discussed. Cutting off the nose is the most severe humiliation as it deprives a person from his/her identity. In some cases in history the nose has been a means of identification.
[...]

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Platelet-Rich Plasma for the Aesthetic Surgeon

Facial plast Surg 2017; 33: 437-443
DOI: 10.1055/s-0037-1604240

Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.
[...]

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Objective Assessment of Nasal Patency

Facial plast Surg 2017; 33: 378-387
DOI: 10.1055/s-0037-1604356

The aim to objectify nasal airflow and patency is ongoing—many methods have been suggested, often lacking clinical relevance or showing weak correlations with patients' symptoms. It is crucial to thoroughly consult our patients presenting with nasal obstruction—and to inform them about realistic possible surgical outcomes. Often, a perfect-looking internal nose with a straight septum and normal-appearing turbinates does not guarantee a happy, symptom-free "owner." A review of the literature and the current technical market is presented here to facilitate the rhinosurgeon's decision to perform pre- and postoperative objective measurements of nasal airflow. Recommendations by the societies have been included.
[...]

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Flap Delay or Not? A Technical Detail for Nasal Reconstruction with a Forehead Flap

Facial plast Surg 2017; 33: 454-454
DOI: 10.1055/s-0037-1603785

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Is Selfie a New Cause of Increasing Rhinoplasties?

Facial plast Surg 2017; 33: 423-427
DOI: 10.1055/s-0037-1603781

The digital world and social media are becoming increasingly important. Social media connect people together in a visual manner. Profile photographs are required by most social networking sites. A trend toward the increasing popularity of selfies on social media has rendered people more aware of their appearance. A selfie is a photograph that one takes of oneself, usually employing a smartphone or webcam, which is then shared on social media. Thus, the demand for aesthetic procedures correcting imperfections such as a prominent nose has increased, for which the technique is a rhinoplasty. Patients with reasonable expectations, treated by skilled surgeons, are usually very happy with the results. Rhinoplasty does not cure low self-esteem, but does correct more visible imperfections of the face. Although some hope that a rhinoplasty will resolve many unwanted facial features besides nose problems, it can only change the size and shape of the nose, improving its form. However, in the age of the selfie, everyone wants to look better. Self-consciousness is increasing, as are concerns over grooming and appearance at work and social events. These issues have become more important in recent years with the increase in selfie-taking; people are now more aware of how their nose appears to others. In this review, we discuss whether selfie-taking has triggered a rise in rhinoplasties along with a detailed survey of the literature.
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The Human Sense of Olfaction

Facial plast Surg 2017; 33: 396-404
DOI: 10.1055/s-0037-1603828

The sense of olfaction is important not only for the detection of potential dangers such as fire or spoilt food, but also for the quality of life of human beings. In this article, we review the characteristics of the sense of smell and give a short overview about possible olfactory dysfunctions and their therapy.
[...]

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Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction

Facial plast Surg 2017; 33: 434-436
DOI: 10.1055/s-0037-1603948

In 2007, the senior author (G.S.K.) published a commentary on the importance of incorporating minimally invasive aesthetic procedures into facial plastic surgery practices and training programs. The now decade-old prediction suggested that failing to perform minimally invasive aesthetic procedures placed facial plastic surgeons at risk of practice "phase out." By not providing the most current options that patients' desire, we may lose patients to outside providers willing to perform those procedures. The aim of this article is to provide an update on this perspective by putting forth the results of the most up-to-date data on practice patterns with regard to minimally invasive aesthetic procedures.
[...]

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Care of the Cocaine User with Nasal Deformity

Facial plast Surg 2017; 33: 411-418
DOI: 10.1055/s-0037-1603791

Cocaine is the most commonly used stimulant in the Western world, and its use is increasing not only in young people but also in people older than 40 years. Intranasal use is associated with several pathologies, ranging from crusting and blockage, to fibrosis and scarring, to destruction of the osteocartilaginous structures of the midface. As its use becomes more prevalent in society, the reconstructive surgeon can accordingly expect to be faced with an increasing number of patients with cocaine-related nasal deformity. However, the use of cocaine adds a significant layer of complexity to the perioperative and operative care that requires careful consideration by the whole health care team. We present a practical evidence-based guide to management of reconstruction of the cocaine nose, taking in all aspects of periprocedural care. Finally, we present a model for surgical approach based on best evidence and the experience of the senior author. A search was performed of the Medline, Embase, and Cochrane Collection database using both MeSH keywords and free text words, identifying key articles on the epidemiology, pathophysiology, and medical and psychiatric comorbidities of cocaine users. Both case series and case reports reporting cocaine-associated defects and their reconstruction were reviewed together with the senior authors (A.D.S., A.J.), and a series of recommendations synthesized based on these recommendations. The nasal deformities associated with cocaine use represent only the tip of the iceberg of underlying associated pathology. The surgeon who embarks upon reconstruction of the cocaine nose should be aware of possible coexisting medical and psychiatric comorbidities that may complicate both the patient's motivations for surgery and their fitness to undergo anesthesia. Ultimately, successful reconstructive outcomes are critically dependent on holistic perioperative care and the surgeon's ability to be flexible in their surgical approach.
[...]

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Classification of Spreader Flap Techniques

Facial plast Surg 2017; 33: 453-453
DOI: 10.1055/s-0037-1604175

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Visual Assessment and the Use of the Scar Cosmesis Assessment and Rating Scale (SCAR Scale) for Facial Linear Scars

Facial plast Surg 2017; 33: 455-456
DOI: 10.1055/s-0037-1603784

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Lateral Wall Insufficiency after Septal Reconstruction

Facial plast Surg 2017; 33: 451-452
DOI: 10.1055/s-0037-1603786

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The Nose and Its Function

Facial plast Surg 2017; 33: 365-366
DOI: 10.1055/s-0037-1604176

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Nose and Identity

Facial plast Surg 2017; 33: 367-371
DOI: 10.1055/s-0037-1603787

This article explores the significance of the nose in daily human life. It presents examples of how a person's nose may dominate his/her life, how it is used as a nickname, considered an expression of his/her character, and may be a symbol of pride and wisdom. Also, examples from the literature and the arts are discussed. Cutting off the nose is the most severe humiliation as it deprives a person from his/her identity. In some cases in history the nose has been a means of identification.
[...]

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Determinants and Evaluation of Nasal Airflow Perception

Facial plast Surg 2017; 33: 372-377
DOI: 10.1055/s-0037-1603788

The sensation of nasal airflow, or nasal airway patency, is an important consideration in the treatment outcome of nasal airway obstruction. Clinicians striving to optimize the nasal passageway have relied on techniques aimed at decreasing peak airway resistance across nasal valves. Nonetheless, the evaluation of the nasal airway is multifaceted, and the objective determinants of subjective nasal patency remain incompletely elucidated. While rhinomanometry, peak nasal inspiratory airflow, and acoustic rhinometry have traditionally been used in research to focus on resistance as a measure of patency, an emerging body of evidence suggests that subjective nasal patency is more significantly correlated to the dynamic change of nasal mucosal temperature. The objective of this review is to provide the technical background on nasal airflow perception and intranasal trigeminal function as crucial to those performing functional and aesthetic rhinosurgery.
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Platelet-Rich Plasma for the Aesthetic Surgeon

Facial plast Surg 2017; 33: 437-443
DOI: 10.1055/s-0037-1604240

Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.
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Objective Assessment of Nasal Patency

Facial plast Surg 2017; 33: 378-387
DOI: 10.1055/s-0037-1604356

The aim to objectify nasal airflow and patency is ongoing—many methods have been suggested, often lacking clinical relevance or showing weak correlations with patients' symptoms. It is crucial to thoroughly consult our patients presenting with nasal obstruction—and to inform them about realistic possible surgical outcomes. Often, a perfect-looking internal nose with a straight septum and normal-appearing turbinates does not guarantee a happy, symptom-free "owner." A review of the literature and the current technical market is presented here to facilitate the rhinosurgeon's decision to perform pre- and postoperative objective measurements of nasal airflow. Recommendations by the societies have been included.
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Flap Delay or Not? A Technical Detail for Nasal Reconstruction with a Forehead Flap

Facial plast Surg 2017; 33: 454-454
DOI: 10.1055/s-0037-1603785

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Numerical Analysis of Nasal Breathing: A Pilot Study

Facial plast Surg 2017; 33: 388-395
DOI: 10.1055/s-0037-1603789

Currently, there is no fully sufficient way to differentiate between symptomatic and normal nasal breathing. Using the nose's total resistance is disputed as a valid means to objectify nasal airflow, and the need for a more comprehensive diagnostic method is increasing. This work's aim was to test a novel approach considering intranasal wall shear stress (WSS) as well as static pressure maps obtained by computational fluid dynamics (CFD). X-ray computed tomography (CT) scan data of six symptom-free subjects and seven symptomatic patients were used. Patient-specific geometries of the nasal cavity were segmented from these datasets. Inspiratory and expiratory steady airflow simulations were performed using CFD. Calculated static pressures and WSSs were mapped onto a common template of the nasal septum, allowing for comparison of these parameters between the two patient groups. Significant differences in WSS distributions during the inspiratory phase could be identified between the two groups, whereas no differences were found for the expiratory phase. It is assumed that one essential feature of normal nasal breathing probably consists of distinctively different intranasal flow fields for inspiration and expiration. This is in accordance with previous investigations. The proposed method seems to be a promising tool for developing a new kind of patient-specific assessment of nasal breathing. However, more studies and a greater case number of data with an expanded focus would be ideal.
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Is Selfie a New Cause of Increasing Rhinoplasties?

Facial plast Surg 2017; 33: 423-427
DOI: 10.1055/s-0037-1603781

The digital world and social media are becoming increasingly important. Social media connect people together in a visual manner. Profile photographs are required by most social networking sites. A trend toward the increasing popularity of selfies on social media has rendered people more aware of their appearance. A selfie is a photograph that one takes of oneself, usually employing a smartphone or webcam, which is then shared on social media. Thus, the demand for aesthetic procedures correcting imperfections such as a prominent nose has increased, for which the technique is a rhinoplasty. Patients with reasonable expectations, treated by skilled surgeons, are usually very happy with the results. Rhinoplasty does not cure low self-esteem, but does correct more visible imperfections of the face. Although some hope that a rhinoplasty will resolve many unwanted facial features besides nose problems, it can only change the size and shape of the nose, improving its form. However, in the age of the selfie, everyone wants to look better. Self-consciousness is increasing, as are concerns over grooming and appearance at work and social events. These issues have become more important in recent years with the increase in selfie-taking; people are now more aware of how their nose appears to others. In this review, we discuss whether selfie-taking has triggered a rise in rhinoplasties along with a detailed survey of the literature.
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The Human Sense of Olfaction

Facial plast Surg 2017; 33: 396-404
DOI: 10.1055/s-0037-1603828

The sense of olfaction is important not only for the detection of potential dangers such as fire or spoilt food, but also for the quality of life of human beings. In this article, we review the characteristics of the sense of smell and give a short overview about possible olfactory dysfunctions and their therapy.
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Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction

Facial plast Surg 2017; 33: 434-436
DOI: 10.1055/s-0037-1603948

In 2007, the senior author (G.S.K.) published a commentary on the importance of incorporating minimally invasive aesthetic procedures into facial plastic surgery practices and training programs. The now decade-old prediction suggested that failing to perform minimally invasive aesthetic procedures placed facial plastic surgeons at risk of practice "phase out." By not providing the most current options that patients' desire, we may lose patients to outside providers willing to perform those procedures. The aim of this article is to provide an update on this perspective by putting forth the results of the most up-to-date data on practice patterns with regard to minimally invasive aesthetic procedures.
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Auricular Composite Grafting in Functional Rhinoplasty

Facial plast Surg 2017; 33: 405-410
DOI: 10.1055/s-0037-1604107

Surgical correction of defects of the internal nasal valve, ala, vestibule, and sill is widely regarded as a challenge due to concerns of poor outcomes of facial aesthetics and nasal function. Auricular composite grafting is a reliable method of reconstruction of deformities of the nasal vestibule and sill. A classification system of types of defects may help surgeons in understanding the indications for composite grafting. Furthermore, we have developed surgical techniques that enhance survival of composite grafts of larger size. Composite grafting is an effective technique to repair a wide range of defects of the internal nasal valve, nasal sill/ala, and vestibule with excellent functional and aesthetic results.
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Care of the Cocaine User with Nasal Deformity

Facial plast Surg 2017; 33: 411-418
DOI: 10.1055/s-0037-1603791

Cocaine is the most commonly used stimulant in the Western world, and its use is increasing not only in young people but also in people older than 40 years. Intranasal use is associated with several pathologies, ranging from crusting and blockage, to fibrosis and scarring, to destruction of the osteocartilaginous structures of the midface. As its use becomes more prevalent in society, the reconstructive surgeon can accordingly expect to be faced with an increasing number of patients with cocaine-related nasal deformity. However, the use of cocaine adds a significant layer of complexity to the perioperative and operative care that requires careful consideration by the whole health care team. We present a practical evidence-based guide to management of reconstruction of the cocaine nose, taking in all aspects of periprocedural care. Finally, we present a model for surgical approach based on best evidence and the experience of the senior author. A search was performed of the Medline, Embase, and Cochrane Collection database using both MeSH keywords and free text words, identifying key articles on the epidemiology, pathophysiology, and medical and psychiatric comorbidities of cocaine users. Both case series and case reports reporting cocaine-associated defects and their reconstruction were reviewed together with the senior authors (A.D.S., A.J.), and a series of recommendations synthesized based on these recommendations. The nasal deformities associated with cocaine use represent only the tip of the iceberg of underlying associated pathology. The surgeon who embarks upon reconstruction of the cocaine nose should be aware of possible coexisting medical and psychiatric comorbidities that may complicate both the patient's motivations for surgery and their fitness to undergo anesthesia. Ultimately, successful reconstructive outcomes are critically dependent on holistic perioperative care and the surgeon's ability to be flexible in their surgical approach.
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Classification of Spreader Flap Techniques

Facial plast Surg 2017; 33: 453-453
DOI: 10.1055/s-0037-1604175

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Facial Defect Reconstruction with Scalp Skin Grafts

Facial plast Surg 2017; 33: 419-422
DOI: 10.1055/s-0037-1603783

The objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.
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Visual Assessment and the Use of the Scar Cosmesis Assessment and Rating Scale (SCAR Scale) for Facial Linear Scars

Facial plast Surg 2017; 33: 455-456
DOI: 10.1055/s-0037-1603784

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Erratum: Effects of Tumescent Solution on Fat Survival

Facial plast Surg 2017; 33: 457-458
DOI: 10.1055/s-0037-1604164

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Alternaria toxins in South African sunflower seeds: cooperative study

Abstract

Sunflower seed samples (N = 80) from different sunflower cultivars originating from different localities in South Africa were analyzed for 15 toxins produced by fungi of the genus Alternaria by means of a simple one-step extraction dilute-and-shoot HPLC-MS/MS approach. References for valine-tenuazonic acid (Val-TeA), altenusin (ALTS), and altenuisol (ALTSOH) were isolated from fungal culture extracts and spectroscopically characterized. Additionally, valine-tenuazonic acid was tested regarding its cytotoxicity in comparison with tenuazonic acid (TeA) and showed less activity on HT-29 cells. Furthermore, alternariol monomethyl ether-3-O-ß-D-glucoside (AME-3G) was produced by fermentation of alternariol monomethyl ether (AME) with the fungus Rhizopus oryzae. The seed samples were analyzed both with and without hulls. The method covers the AAL toxins TA₁ and TA₂, altenuene (ALT) and iso-altenuene (iso-ALT), altenuisol, altenusin, altertoxin I (ATX-I) and altertoxin II (ATX-II), alternariol (AOH) and alternariol monomethyl ether, alternariol monomethyl ether-3-O-ß-D-glucoside, tenuazonic acid, allo-tenuazonic acid (allo-TeA) and valine-tenuazonic acid, and tentoxin (TEN). More than 80% of the samples were positive for one or more analytes above the respective limit of detection (0.2–23 μg/kg). Alternariol, its monomethyl ether, tentoxin, tenuazonic acid, altenuisol, and valine-tenuazonic acid were found in quantifiable amounts. The highest prevalences were found for tentoxin (73% positive, mean content 13.2 μg/kg, maximum level 130 ± 0.9 μg/kg) followed by tenuazonic acid (51% positive, mean content 630 μg/kg, maximum level 6300 ± 560 μg/kg). The obtained data were further analyzed statistically to identify quantitative or qualitative relationships between the levels of Alternaria toxin in the samples.

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Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of

Journal Name: Journal of Pediatric Endocrinology and Metabolism
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MRI in medium-chain acyl-coenzyme a dehydrogenase deficiency: neuroimaging during the first month

Journal Name: Journal of Pediatric Endocrinology and Metabolism
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Health-related quality of life among children with Turner syndrome: controlled cross-sectional study

Journal Name: Journal of Pediatric Endocrinology and Metabolism
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Clinical features and genotyping of patients with primary carnitine deficiency identified by newborn screening

Journal Name: Journal of Pediatric Endocrinology and Metabolism
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Corrigendum to “A Survey of Eyespot Sexual Dimorphism across Nymphalid Butterflies”

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Influence of remaining coronal tooth structure on fracture resistance and failure mode of restored endodontically treated maxillary incisors

Publication date: Available online 27 July 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Domingo Santos Pantaleón, Brian R. Morrow, David R. Cagna, Cornelis H. Pameijer, Franklin Garcia-Godoy
Statement of problemLimited information is available on the effect of an incomplete ferrule because of the varying residual axial wall heights and the volume of residual tooth structure on the fracture resistance of endodontically treated and restored maxillary incisors.PurposeThe purpose of this in vitro investigation was to examine the effect of varying residual axial wall heights, residual coronal tooth structure, and the absence of 1 proximal axial wall on the fracture resistance and failure mode of endodontically treated teeth restored with metal posts.Material and methodsSixty intact human maxillary central incisors were divided into 6 groups (n=10): no ferrule (NF), 2-mm complete ferrule (CF2), 2-mm (IF2), 3-mm (IF3), and 4-mm (IF4) incomplete ferrules missing a single interproximal wall, and a control group that had a 6-mm incomplete ferrule (IF6). Cast metal post-and-cores were placed in all experimental specimens except for controls. Control specimens received 1 interproximal cavity preparation extending to the root canal access and a composite resin restoration. Complete metal crowns were then cemented on all specimens. Completed specimens were subjected to thermocycling (6000 cycles, 5°C/55°C) followed by the immediate testing of fracture resistance. Failed specimens were sectioned buccolingually and evaluated to identify the failure mode. The data were analyzed with an analysis of variance (ANOVA) and the Student-Newman-Keuls multiple comparison test (α=.05).ResultsAn incomplete ferrule (IF2) with 1 interproximal wall missing had significantly reduced fracture resistance (697 N) compared with a complete ferrule (932 N). An increase of 3 to 4 mm of remaining wall height improved fracture resistance, from 844 N (IF3) to 853 N (IF4). Partial decementation was noticed in 8 NF and 5 IF2 specimens. IF3 and IF4 had no decementations. Radicular fractures and cracks (catastrophic failure) were observed in all IF2, IF3, and IF4, 9 CF2, and 6 NF specimens. In 7 specimens without posts (IF6, control), composite resin foundation and/or coronal dentin fracture were observed and the failure was considered repairable.ConclusionsThe results of this in vitro study indicated that specimens with a 2-mm ferrule of uniform height were more resistant to fracture than specimens with a 2-mm ferrule and 1 missing interproximal wall. An increased wall height of 3 or 4 mm was associated with a significant increase in fracture resistance and can compensate for the missing interproximal wall.



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In pursuit of our ancestors' hand laterality

Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Amèlia Bargalló, Marina Mosquera, Sergi Lozano
The aim of this paper is to apply a previously published method (Bargalló and Mosquera, 2014) to the archaeological record, allowing us to identify the hand laterality of our ancestors and determine when and how this feature, which is exhibited most strongly in humans, appeared in our evolutionary history. The method focuses on identifying handedness by looking at the technical features of the flakes produced by a single knapper, and discovering how many flakes are required to ascertain their hand preference.This method can potentially be applied to the majority of archaeological sites, since flakes are the most abundant stone tools, and stone tools are the most widespread and widely-preserved remains from prehistory. For our study, we selected two Spanish sites: Gran Dolina-TD10.1 (Atapuerca) and Abric Romaní (Barcelona), which were occupied by pre-Neanderthal and Neanderthal populations, respectively.Our analyses indicate that a minimum number of eight flakes produced by the same knapper is required to ascertain their hand preference. Even though this figure is relatively low, it is quite difficult to obtain from many archaeological sites. In addition, there is no single technical feature that provides information about handedness, instead there is a combination of eight technical features, localised on the striking platforms and ventral surfaces. The raw material is not relevant where good quality rocks are used, in this case quartzite and flint, since most of them retain the technical features required for the analysis. Expertise is not an issue either, since the technical features analysed here only correlate with handedness (Bargalló and Mosquera, 2014). Our results allow us to tentatively identify one right-handed knapper among the pre-Neanderthals of level TD10.1 at Gran Dolina (Atapuerca), while four of the five Neanderthals analysed from Abric Romaní were right-handed. The hand preference of the fifth knapper from that location (AR5) remains unclear.



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Fundamentals of Laparoscopic Surgery: Not Only for Senior Residents

Publication date: Available online 27 July 2017
Source:Journal of Surgical Education
Author(s): Darren R. Cullinan, Matthew R. Schill, Angelia DeClue, Arghavan Salles, Paul E. Wise, Michael M. Awad
ObjectiveFundamentals of laparoscopic surgery (FLS) was developed by the Society of American Gastrointestinal and Endoscopic Surgeons to teach the physiology, fundamental knowledge, and technical skills required for basic laparoscopic surgery. We hypothesize that residents are doing more laparoscopic surgery earlier in residency, and therefore would benefit from an earlier assessment of basic laparoscopic skills. Here, we examine FLS test results and ACGME case logs to determine whether it is practical to administer FLS earlier in residency.DesignFLS test results were reviewed for the 42 residents completing FLS between July 2011 and July 2016. ACGME case logs for current and former residents were reviewed for laparoscopic cases logged by each postgraduate year. Basic and complex laparoscopic cases were determined by ACGME General Surgery Defined Category and Minimums Report. Descriptive statistics were used for analysis.SettingAcademic general surgery residency, Washington University in St. Louis School of Medicine.ParticipantsCurrent and former general surgery residents.ResultsA total of 42 residents took and passed FLS between July 2011 and July 2016. All residents successfully passed the FLS knowledge and skills examinations on the first attempt regardless of their postgraduate year (PGY 3n = 13, PGY 4n = 15, and PGY 5n = 14).Total laparoscopic case volume has increased over time. Residents who graduated in 2012 or 2013 completed 229 laparoscopic cases compared to 267 laparoscopic cases for those who graduated from 2014 to 2016 (p = 0.02). Additionally, current residents completed more laparoscopic cases in the first 2 years of residency than residents who graduated from 2012 to 2016 (median current = 38; former = 22; p < 0.001).Examining laparoscopic case numbers for current residents by PGY demonstrated that the number of total and complex laparoscopic cases increased in each of the first 3 years of residency with the largest increase occurring between the PGY 2 and PGY 3 years. In the PGY 4 and PGY 5 years, most laparoscopic cases were complex.ConclusionIncreased use of laparoscopic surgery has led to a corresponding increase in laparoscopic case volume among general surgery residents. We would advocate for FLS testing to serve as an early assessment of laparoscopic knowledge and skill and should be performed before a significant increase in complex laparoscopic surgery during training.



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