Table of Contents

Publication date: September 2017
Source:Magnetic Resonance Imaging, Volume 41





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Voluntary health insurance in Europe: Country experience [Internet].

No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved.

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Treatment of Osteoarthritis of the Knee: An Update Review [Internet].

To assess the evidence for the efficacy of the following interventions for improving clinical outcomes in adults with osteoarthritis (OA) of the knee: cell-based therapies; glucosamine, chondroitin, or glucosamine plus chondroitin; strength training, agility, or aerobic exercise (land or water based); balneotherapy, mud bath therapy; electrical stimulation techniques (including transcutaneous electrical stimulation [TENS], neuromuscular electrical stimulation, and pulsed electromagnetic field therapy [PEMF]); whole body vibration; heat, infrared, or ultrasound; orthoses (knee braces, shoe inserts, or specially designed shoes); weight loss diets; and home-based therapy or self-management.

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The Use of Osteochondral Allograft for the Ankle, Knee, and Shoulder: Clinical Effectiveness and Cost-Effectiveness [Internet].

To inform clinical practice on the treatment of patients who failed non-surgical or other surgical therapies for damaged articular cartilage, this report aimed to provide evidence on the clinical benefits and harms and cost-effectiveness of the use of fresh, prolonged fresh, or frozen osteochondral allografts for the lesions of the ankle, knee, and shoulder.

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Blue Light Cystoscopy in Patients with Suspected Non-Muscle Invasive Bladder Carcinoma: A Review of Clinical Utility [Internet].

According to Canadian Cancer Statistics, bladder cancer is the fifth most common cancer, accounting for more than 4% of all cancers or 7,800 cases per year. Of all incidents of bladder cancer cases at first diagnosis, about 80% were non-muscle invasive bladder cancer (NMIBC) and 20% were muscle invasive and advanced bladder cancer. Smoking is the main risk factor of bladder cancer., Other risk factors include exposure to chemicals such as aromatic compounds, radiation and chemotherapy., The most common symptom of bladder cancer is the presence of blood in the urine. Bladder cancer is diagnosed by means of cystoscopy and transurethral resection of the bladder tumor (TURBT) in combination with urine analysis and cytology., The tumors are classified based on the degree of invasion into layers of tissues; CIS (flat on surface or carcinoma in situ), Ta (raspberry growth on surface), and T1 (moves into submucosa layer) are those not yet invading into the muscle or NMIBC, while T2a, T2b, T3b and T4a are those invade deeper into the muscle layer and perivesical fat tissue. About 60% of NMIBC are Ta type, while CIS and T1 account for 10% and 30%, respectively. After the initial removal of NMIBC by TURBT, tumors can come back (recurrence) or come back and invade into the muscle layer (progression). Tumors are graded based on the risk of progression and metastasis. For instance, Ta tumors are usually low grade (non-aggressive) but have high risk of recurrence and just require repeated scraping, while CIS and T1 tumors are high grade (aggressive), have a high risk of progression to muscle layer and require more aggressive treatment.

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Aripiprazole for Borderline Personality Disorder: A Review of the Clinical Effectiveness [Internet].

Borderline personality disorder (BPD) is characterized by unstable interpersonal relationships, emotion and self-image, as well as marked impulsivity causing significant impairment. The term BPD describes a disease in the "borderline" between psychosis and neurosis. In the United States, it was reported in 2008 that the estimated prevalence was 1.4 percent in general population, but may be as high as 20% among psychiatry inpatients. BPD is predominantly (75%) diagnosed in women in clinical settings., However, there is no significant difference in the lifetime prevalence of BPD between men and women. This discrepancy of gender prevalence suggests that women with BPD are more likely to seek treatment than men. Co-morbidity with other psychiatric disorders is common in patients with BPD, especially with mood, anxiety, substance-use, and eating disorders. The cause of BPD is not known. Most hypotheses suggest that BPD is due to a combination of genetic, biologic, and psychosocial factors. Patients may experience spontaneous intermittent remission clinically sometimes. It is estimated that about 60% to 78% of BPD patients make suicide attempts, but the rate of completed suicides was found to be about 4% during a 10-years follow-up. An estimated lifetime risk of suicide of patients with BPD ranged from 3% to 10 %. The clinical diagnosis of BPD is based on a comprehensive psychiatric assessment. Clinicians use all available sources of information to make the diagnosis including the patient's self-reported clinical history, the clinician's observations during interviews, and information from family, friends, and medical records. Children or young adolescents are generally not diagnosed with BPD.,

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Before Consciousness: In Search of the Fundamentals of Mind.

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Anti-Vascular Endothelial Growth Factor Drugs for the Treatment of Retinal Conditions: A Review of the Safety [Internet].

Retinal conditions, such as age related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO), and choroidal neovascularization due to pathologic myopia (CNV due to PM) are an important public health concern that threatens the vision of millions of patients in Canada. The mechanism of these conditions involve the new formation of blood vessels in the retina that eventually leads to loss of vision. Anti-vascular endothelial growth factor (Anti-VEGF) inhibits this growth and allows the restoration of vision. Currently in Canada, two licensed anti-VEGF agents are available in the market; ranibizumab and aflibercept. Bevacizumab, on the other hand, has been developed as an anti-cancer drug. However, its close molecular resemblance to ranibizumab and identical mechanism of action has made it a widely used option, especially in environments that are strained on health resources.,

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Nonpharmacologic Treatments for Menopause-Associated Vasomotor Symptoms [Internet].

Vasomotor symptoms (VMS), which include hot flashes and night sweats, are the most common symptoms reported during the menopausal transition and are experienced by as many as 80% of women. VMS can lead to increased healthcare encounters for symptom relief and reductions in quality of life. The degree to which VMS is bothersome is determined not only by how frequently it occurs but also by other factors such as duration of VMS, coexisting sleep problems, and the extent to which VMS interferes with daily activities or job-related activities. Hormone therapy (HT) is an effective treatment for reducing VMS, but use of this therapeutic approach must be individualized through weighing benefits with known risks, such as cardiovascular events or uterine and breast cancers. Based on age (> 45 years), currently half of the approximately 360,000 women Veterans who use Veterans Health Administration healthcare are perimenopausal or postmenopausal. Due in part to concerns about possible harms from long-term hormone therapy and in part to uncertain efficacy and safety of pharmacologic treatments, many women with VMS seek nonhormonal, nonpharmacologic treatment options.

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Voluntary health insurance in Europe: role and regulation [Internet].

If public resources were unlimited, there would be no gaps in health coverage and no real need for voluntary health insurance (VHI). Most health systems face fiscal constraints, however, and VHI is often seen as a way to address these pressures. This study draws from the experiences of 34 countries to assess VHI's contribution to health spending and to understand its role in Europe and in relation to publicly financed coverage. It looks at who sells VHI, who purchases it and why. It also reviews public policy on VHI at the national and European Union (EU) levels and the related national policy debates.

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Osseointegrated Prosthetic Implants for Lower Limb Amputation: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet].

This Rapid Response seeks to assess the comparative clinical and cost-effectiveness of OIP versus either socket prostheses or no prosthesis, in people with lower limb amputation, as well as identify and review any evidence-based guidance for the procedure.

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Tympanostomy Tubes in Children With Otitis Media [Internet].

The objectives for the systematic review are to synthesize information on the effectiveness of tympanostomy tubes (TT) in children with chronic otitis media with effusion and recurrent acute otitis media, summarize the frequency of adverse effects or complications associated with TT placement, synthesize information on the necessity for water precautions in children with TT, and assess the effectiveness of available treatments for otorrhea in children who have TT.

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Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia.

This systematic review of interventions for antipsychotic-induced tardive dyskinesia found only underpowered trials of limited quality and recommended further well-designed pragmatic RCTs of currently used treatments.

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Nasal methicillin-resistant Staphylococcus aureus colonization among otherwise healthy children aged between 2 months and 5 years in northern Taiwan, 2005-2010.

Related Articles

Nasal methicillin-resistant Staphylococcus aureus colonization among otherwise healthy children aged between 2 months and 5 years in northern Taiwan, 2005-2010.

J Microbiol Immunol Infect. 2017 Aug 12;:

Authors: Tsai MS, Chen CJ, Lin TY, Huang YC

Abstract
BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been increasingly reported worldwide and are associated with nasal colonization. In Taiwan, available data disclosed a similar trend. We conducted a study for the updated childhood nasal MRSA carriage.
METHODS: From July 2005 to December 2010, children aged between 2 months and 5 years who presented for a well-child health care visit to a medical center or from kindergarten/daycare center were invited and a nasal swab specimen was obtained for the detection of MRSA. All MRSA isolates were characterized.
RESULTS: A total of 3226 children were included and the rate of nasal MRSA carriage was 10.2%. Children aged 2-6 months and >3 years were significantly associated with MRSA carriage, while pneumococcus colonization (p = 0.033) and breastfeeding (p = 0.025) were negatively associated with MRSA carriage. Of the 330 MRSA isolates, a total of 13 pulsotypes with two major patterns (type C, 47.0% and D, 29%) were identified. Most MRSA isolates belonged to two major clones, characterized as sequence type 59 (ST59)/pulsotype C/staphylococcal cassette chromosome (SCCmec) IV/Panton-Valentine leukocidin (PVL)-negative (45.8%) and ST59/pulsotype D/SCCmec VT/PVL-positive (22.7%). Two new clones as ST 508/SCCmec IV (9.7%) and ST573/SCCmec IV (7.3%) emerged and increased markedly since 2007.
CONCLUSION: Between 2005 and 2010, 10.2% of healthy children in northern Taiwan carried MRSA in anterior nares, with the highest carriage rate for infants aged 2-6 months. Two emerging clones, ST 508 and ST 573, were identified and the clinical significance needs further surveillance.

PMID: 28826854 [PubMed - as supplied by publisher]

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Case 245: Erdheim-Chester Disease.

Case 245: Erdheim-Chester Disease.

Radiology. 2017 Sep;284(3):910-917

Authors: Mamlouk MD, Aboian MS, Glastonbury CM

Abstract
History A 53-year-old man experienced headache and double vision that progressed over 1 year. After a traumatic fall, he was hospitalized, and proptosis was identified at physical examination. Laboratory tests were remarkable for leukocytosis. Hematocrit level, thyroid stimulating hormone level, autoimmune antibody level, erythrocyte sedimentation rate, and C-reactive protein level were normal. Computed tomography (CT) of the head revealed bilateral intraconal masses, for which magnetic resonance (MR) imaging of the orbits was subsequently performed ( Fig 1 ). CT imaging of the chest and abdomen ( Fig 2 ) revealed periaortic and retroperitoneal stranding. Perinephric biopsy was performed, and a diagnosis of immunoglobulin G4 (IgG4)-related disease was made based on identification of a few plasma cells per high-power field that were positive for IgG4. Orbital biopsy was then performed, but the results were inconclusive for IgG4-related disease. The patient was discharged and given steroid therapy for presumed IgG4-related disease. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text] Several months later, the patient returned to our institution with progressive symptoms despite ongoing steroid treatment. His case was reviewed by several specialists to develop alternative treatments for IgG4-related disease. After review of the available images, a neuroradiology fellow (M.D.M.) performed history taking and a physical examination and subsequently recommended radiography of the lower extremities ( Fig 3 ). [Figure: see text][Figure: see text].

PMID: 28825890 [PubMed - in process]

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Anticancer Agents; +170 new citations

170 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

Anticancer Agents

These pubmed results were generated on 2017/08/23

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report

Noninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive ...

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Gastrointestinal adenocarcinoma metastasizing to the vulva: a case report

Metastatic vulval adenocarcinoma is a rare occurrence with only a few cases reported to date. They can arise from the breast, gastrointestinal system, or endometrium.

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Klippel–Trenaunay–Weber syndrome with atypical presentation of hypersplenism and nephrotic syndrome: a case report

Klippel–Trenaunay–Weber syndrome is a rare syndrome; unfortunately, very few studies of the connection between hypersplenism, nephrotic syndrome, and Klippel–Trenaunay–Weber syndrome have been published.

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Ectopic cerebellar tissue in the occipital bone: a case report

Ectopic cerebellar tissue located distantly from the normal cerebellum is very rare, and its pathophysiology remains to be elucidated.

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Granulomatous rosacea: a case report

Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved.

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The Importance of Sex Education — Keeping Our Kids Safe!

Every single thought in this world has its own pros and cons. My claim to this world is: as long as any word or topic is considered taboo, the weight of its cons will be ...

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Tackling the Dark Side of Social Networking – Can We Put an End to Cyberbullying?

Our world today features marvels of science that make life simpler for us, and carry out various tasks in the blink of an eye. What is science? Is it the right way forward? Or is ...

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Use of antidepressants in dentistry: a systematic review

Abstract

Objective

Previous research has suggested that antidepressants can be used in oral health care. The aim of this systematic review was to search for scientific evidence of the efficacy of the use of antidepressants in dentistry.

Materials and Methods

The clinical question was as follows (PICO Question): dentistry patients (Patients); antidepressants (Intervention); no use or placebo or other drug (Comparison); efficacy in oral health problems (Outcome). An electronic search was conducted in seven databases, as well as a manual search without restriction regarding language and date of publication. Two independent reviewers selected studies based on eligibility criteria, extracted data and assessed methodological quality based on the PEDro Scale. The PROSPERO record is number CRD42016037442.

Results

A total of 15 randomized controlled trials were associated with the use of antidepressants to control chronic or acute pain in dentistry, among other conditions such as bruxism and burning mouth syndrome. The most commonly used drug in clinical trials was amitriptyline (more than 50% of studies).

Conclusions

Antidepressants may be effective in dentistry for acute and chronic pain, but there is a large amount of methodological heterogeneity among the evaluated studies. In summary, there is rationality for the indication of this class of medicine in dentistry in specific clinical situations.

This article is protected by copyright. All rights reserved.

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Modeling the mammalian sleep cycle

Publication date: October 2017
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Franz Weber
During sleep, the mammalian brain transitions through repeated cycles of non-rapid-eye-movement (NREM) and rapid-eye-movement (REM) sleep. The physiological implementation of this slow ultradian brain rhythm is largely unknown. Two differing dynamical mechanisms have been proposed to underlie the NREM–REM cycle. The first model type relies on reciprocal interactions between inhibitory and excitatory neural populations resulting in stable limit cycle oscillations. Recent experimental findings instead favor a model, in which mutually inhibitory interactions between REM sleep-promoting (REM-on) and REM sleep-suppressing (REM-off) neural populations stabilize the brain state. Sow modulations in the neural excitability, that are hypothesized to reflect the homeostatic need for REM sleep, abruptly switch the brain in and out of REM sleep.

Graphical abstract

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Characterizing and interpreting the influence of internal variables on sensory activity

Publication date: October 2017
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Richard D Lange, Ralf M Haefner
The concept of a tuning curve has been central for our understanding of how the responses of cortical neurons depend on external stimuli. Here, we describe how the influence of unobserved internal variables on sensory responses, in particular correlated neural variability, can be understood in a similar framework. We suggest that this will lead to deeper insights into the relationship between stimulus, sensory responses, and behavior. We review related recent work and discuss its implication for distinguishing feedforward from feedback influences on sensory responses, and for the information contained in those responses.



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Novel hemagglutinin nanoparticle influenza vaccine with Matrix-M™ adjuvant induces hemagglutination inhibition, neutralizing, and protective responses in ferrets against homologous and drifted A(H3N2) subtypes

Publication date: Available online 22 August 2017
Source:Vaccine
Author(s): Gale Smith, Ye Liu, David Flyer, Michael J. Massare, Bin Zhou, Nita Patel, Larry Ellingsworth, Maggie Lewis, James F. Cummings, Greg Glenn
Influenza viruses frequently acquire mutations undergoing antigenic drift necessitating annual evaluation of vaccine strains. Highly conserved epitopes have been identified in the hemagglutinin (HA) head and stem regions, however, current influenza vaccines induce only limited responses to these conserved sites. Here, we describe a novel seasonal recombinant HA nanoparticle influenza vaccine (NIV) formulated with a saponin-based adjuvant, Matrix-M™. NIV induced hemagglutination inhibition (HAI) and microneutralizing (MN) antibodies against a broad range of influenza A(H3N2) subtypes. In a comparison of NIV against standard-dose and high-dose inactivated influenza vaccines (IIV and IIV-HD, respectively) in ferrets NIV elicited HAI and MN responses exceeding those induced by IIV-HD against homologous A(H3N2) by 7 fold, A(H1N1) by 26 fold, and B strain viruses by 2 fold. NIV also induced MN responses against all historic A/H3N2 strains tested, spanning more than a decade of viral evolution from the 2000–2017 influenza seasons whereas IIV and IIV-HD induced HAI and MN responses were largely directed against the homologous A(H3N2), A(H1N1), and B virus strains. NIV induced superior protection compared to IIV and IIV-HD in ferrets challenged with a homologous or 10-year drifted influenza A(H3N2) strain. HAI positive and HAI negative neutralizing monoclonal antibodies derived from mice immunized with NIV were active against homologous and drifted influenza A(H3N2) strains. Taken together these observations suggest that NIV can induce responses to one or more highly conserved HA head and stem epitopes and result in highly neutralizing antibodies against both homologous and drift strains.



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Association Between Obesity and Chronic Kidney Disease, Defined by Both Glomerular Filtration Rate and Albuminuria, in Korean Adults

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


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Urticaria by thiamine (vitamin B1)

Publication date: Available online 23 August 2017
Source:Allergology International
Author(s): Ana Rodríguez-Fernández, Marcos Sánchez-Domínguez, Blanca Noguerado-Mellado, Patricia Rojas-Pérez-Ezquerra




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High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.

BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. DESIGN: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. DATA SOURCES: The Cochrane webpage was used to identify reviews for inclusion ( http://.ace.cochrane.org/). ELIGIBILITY CRITERIA: New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. RESULTS: A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). CONCLUSION: It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the quality of evidence. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

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High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.

BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. DESIGN: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. DATA SOURCES: The Cochrane webpage was used to identify reviews for inclusion ( http://.ace.cochrane.org/). ELIGIBILITY CRITERIA: New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. RESULTS: A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). CONCLUSION: It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the quality of evidence. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

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Sodium appetite elicited by low-sodium diet is dependent on p44/42 MAPK (ERK1/2) activation in the brain

Abstract

The sodium appetite is regulated by several signalling molecules, among which angiotensin II (ANG II) serves as a key driver of robust salt intake by binding to ANG II type 1 receptors (AT1R) in several regions in the brain. The activation of these receptors recruits the mitogen-activated protein kinase (MAPK) pathway, which has previously been linked to ANG II-induced increases in sodium appetite. Thus, we addressed the involvement of MAPK signalling in the induction of sodium appetite after four days of low-sodium diet consumption. An increase in extracellular signal-regulated kinase (ERK) phosphorylation in the laminae terminalis and mediobasal hypothalamus was observed after low-sodium diet consumption. This response was reduced by intracerebroventricular (icv) microinjection of an AT1R antagonist into the laminae terminalis but not the hypothalamus. This result indicates that low-sodium diet consumption activates the MAPK pathway via ANG II/AT1R signalling on the laminae terminalis. On the other hand, activation of the MAPK pathway in the mediobasal hypothalamus after low-sodium diet consumption seems to involve another extracellular mediator. We also evaluated whether a low-sodium diet could increase the sensitivity for ANG II in the brain and activate the MAPK pathway. However, icv injection of ANG II increased ERK phosphorylation on the laminae terminalis and mediobasal hypothalamus; this increase achieved a response magnitude similar to those in both the normal and low-sodium diet groups. These data indicate that low-sodium diet consumption for four days is insufficient to change the ERK phosphorylation response to ANG II in the brain. To investigate whether the MAPK pathway is involved in sodium appetite after low-sodium diet consumption, we performed icv microinjections of a MAPK pathway inhibitor (PD98059). PD98059 inhibited both saline and water intake after low-sodium diet consumption. Thus, the MAPK pathway is involved in the promoting the sodium appetite after low-sodium diet consumption.

This article is protected by copyright. All rights reserved.

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One stone two birds: novel carbon nanotube/Bi 4 VO 8 Cl photocatalyst for simultaneous organic pollutants degradation and Cr(VI) reduction

Abstract

In this work, visible light-responsive carbon nanotubes (CNTs)/Bi₄VO₈Cl composite photocatalysts have been prepared by a facile in situ hydrothermal method and characterized by various techniques. The photocatalytic properties of the photocatalysts are evaluated by the degradation of refractory azo-dye methyl orange (MO), hexavalent chromium Cr(VI), and bisphenol A (BPA) in water under visible light irradiation. It is found that the as-prepared composite with 4 wt% CNTs shows an optimal photocatalytic performance, and its photocatalytic activity is 30% higher than that of pure Bi₄VO₈Cl. The enhanced photocatalytic activity is ascribed to the synergetic effects induced by increased light absorption, increased adsorption efficiency for pollutant, and suppressed recombination rate of photogenerated charge carriers. Furthermore, efficient removals of Cr(VI), bisphenol A (BPA), and combined contamination of Cr(VI) and BPA over CNTs/Bi₄VO₈Cl composite further confirm that the degradation of organic pollutants is a photocatalytic mechanism rather than photosensitization of dye. Of particular importance is that removal efficiency of single pollutant can be promoted by the coexistence of the Cr(VI) and organics. The mechanism of synergetic promotion is discussed and attributed to the accelerated separation of charge carriers resulted from their simultaneously being captured by pollutants. Moreover, the CNTs/Bi₄VO₈Cl composite exhibits good stability and recycling performance in the photocatalytic degradation process. Therefore, the composite photocatalysts developed in the present work are expected to have the potential in purification of complex wastewater.

Graphical abstract

The separation of photogenerated charge carriers and adsorbing capacity as well as visible light absorption ability of Bi₄VO₈Cl are significantly promoted by coupling with carbon nanotubes. Simultaneous removal of Cr(VI) and organic pollutants can be achieved by CNTs/Bi₄VO₈Cl composite photocatalysts under visible light irradiation.

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Exposure of children aged 0–7 years to perfluorinated compounds in Foshan, China

Abstract

To evaluate the exposure of children to 14 perfluorinated compounds (PFCs) in a typical and representative industrial city, plasma samples from 476 children aged 0–7 years in Foshan, China, were analysed. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected in 100% of the samples, accounting for 82.27 and 11.46% of the total PFC concentrations, respectively, while PFOS peaked at age 0–1 years, for which the mean and median concentrations were 113.71 and 83.65 ng/mL, respectively, while PFOA peaked at age 3–4 years, for which the mean and median concentrations were 10.68 and 6.58 ng/mL, respectively. The concentrations of PFOS, perfluorohexane sulfonate and perfluorohexanoic acid decreased with age among children aged 0–7 years, and no gender-related differences were found in the concentrations of PFCs. A high correlation was found among all PFCs, especially between PFCs of similar carbon chains (r = 0.161–0.695, p < 0.05). In addition, the concentrations of PFOS and PFOA in children's plasma in Foshan were up to 40-fold higher than those reported in China and other countries. In conclusion, children in Foshan have extensive exposure to PFCs, especially in infancy. Further studies are needed to explore the impact of PFCs on children who live in a typical and representative industrial city in China.

Graphical abstract

ᅟ

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Cutaneous Manifestations of Small-Vessel Leukocytoclastic Vasculitides in Childhood

Abstract

In childhood, cutaneous small-vessel vasculitides include Henoch–Schönlein syndrome, a systemic vasculitis, and Finkelstein–Seidlmayer syndrome, a skin-limited vasculitis. Both Henoch–Schönlein and Finkelstein–Seidlmayer syndromes are seen more frequently in white or Asian compared with black children and occur especially in winter and spring with a male-to-female ratio of approximately 2:1. In everyday clinical practice, both conditions are diagnosed on clinical grounds without histological confirmation. The characteristic cutaneous hallmarks of Henoch–Schönlein syndrome include a purpuric rash in all and a subcutaneous edema in approximately every second case, which are often preceded by non-specific red or pink macular elements that mimic a non-itching urticarial rash. Recent data point out that Henoch–Schönlein children often present further cutaneous findings such as Köbnerization, Rumpel–Leede capillary fragility phenomenon, and blistering eruptions. Children with Finkelstein–Seidlmayer syndrome are usually ≤24 months of age and not ill-appearing. They present with (a) large, round, red to purpuric plaques (often with a targetoid appearance) predominantly over the cheeks, ears, and extremities and (b) often tender non-pitting edema of the distal extremities, ears, and face (without pruritus). Both in Henoch–Schönlein syndrome and Finkelstein–Seidlmayer syndrome, there is often scrotal involvement. The cutaneous findings remit without sequelae within 2 months in Henoch–Schönlein and 3 weeks in Finkelstein–Seidlmayer syndrome.

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The impact of treatment for head and neck cancer on positive psychological change within a year of completing treatment

Head and neck cancer carries a high level of morbidity and mortality. So why could anyone find having such a disease a positive event? The adversity hypothesis of "what doesn't kill you makes you stronger" suggests that people can use adversity to develop as human beings. This positive psychological change has received little attention in relation to head and neck cancer. Responses to the Silver Lining Questionnaire, University of Washington Quality of Life Questionnaire, and Short-Form 12 were collected from a postal survey, 3 to 12 months after the completion of treatment for head and neck cancer.

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Relatively low invasive capacity of Porphyromonas gingivalis strains into human gingival fibroblasts in vitro

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ju Young Jang, Keum Jin Baek, Youngnim Choi, Suk Ji
ObjectiveBacterial invasion into host cells is a common strategy to escape the host immune system. Gingival fibroblasts (GFs) are the most predominant non-phagocytic cell type in gingival connective tissue. Therefore, invasion into GFs was thought to be the first strategy for the survival of Porphyromonas gingivalis. The present study compared the invasive ability of P. gingivalis into GFs with those of other red-complex and relatively less pathogenic bacterial strains, especially Fusobacterium nucleatum.Materials and methodsInvasive ability of bacterial strains into GFs was measured using a flow cytometric invasion assay at a multiplicity of infection of 1000. The effect of dual infection with F. nucleatum CCUG 37843T on P. gingivalis ATCC 49417 invasion was investigated. The invasive ability of F. nucleatum and P. gingivalis was confirmed using confocal microscopy.ResultsThe invasive ability of red-complex bacteria was markedly lower than that of F. nucleatum or Campylobacter gracilis. The invasive ability of 4 types and 10 clinical strains of P. gingivalis was less than 6%, and that of F. nucleatum strains was greater than 45%. Confocal analysis revealed that the percentage of bacteria invading GFs in the cell-treated P. gingivalis and F. nucleatum were 0.0068% and 1.22%, respectively. Dual infection with F. nucleatum increased the invasive ability of P. gingivalis.ConclusionThe invasive capacities of P. gingivalis into GFs were comparatively lower than those of relatively less pathogenic bacteria. Invasion into GFs cannot be the first strategy for survival of P. gingivalis in gingival connective tissue.



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“Metabolism of Odontoblast-like cells submitted to transdentinal irradiation with blue and red LED”

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Leopoldina de Fátima Dantas de Almeida, Fernanda Gonçalves Basso, Ana Paula Silveira Turrioni, Carlos Alberto de-Souza-Costa, Josimeri Hebling
ObjectivesThe present study evaluated the trans-dentinal effect of light emitting diodes (LEDs) irradiation on the metabolism of odontoblast-like cells.MethodsSeventy-two dentin discs (0.2mm thick) were obtained from human molar teeth. MDPC-23 cells (20,000 cells/disc) were seeded on the pulpal side of the discs using DMEM, supplemented with 10% fetal bovine serum (FBS). After 12h, the culture medium was replaced with DMEM containing 0.5% FBS. After additional 12h, blue (455±10nm) or red (630±10nm) LEDs were used at irradiances of 80 and 40mW/cm², respectively, to irradiate the occlusal side of the discs. The energy doses were fixed at 2 or 4J/cm². Cell viability, alkaline phosphatase activity (ALP), total protein production and collagen synthesis were evaluated 72h after irradiation. Data were submitted to Kruskal-Wallis and Mann-Whitney tests (α=0.05).ResultsRed light promoted proliferative effects at the energy dose of 4J/cm². Conversely, cell cultures irradiated with 2J/cm² emitted by the blue light showed reduced viability. ALP production was stimulated by red light in comparison with blue light at 4J/cm². Total protein production was reduced after exposure to blue light at 4J/cm², while no effect was observed on collagen production.ConclusionsIrradiation with red LED at 4J/cm² bio-stimulated the viability of odontoblast-like cells, whilst blue light had unfavorable effects on the cellular metabolism.



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Interpretation of thyroid scintigraphy is inconsistent among endocrinologists

http://ift.tt/2iqXVQ9

Characteristics of Real-World Signal to Noise Ratios and Speech Listening Situations of Older Adults With Mild to Moderate Hearing Loss.

Objectives: The first objective was to determine the relationship between speech level, noise level, and signal to noise ratio (SNR), as well as the distribution of SNR, in real-world situations wherein older adults with hearing loss are listening to speech. The second objective was to develop a set of prototype listening situations (PLSs) that describe the speech level, noise level, SNR, availability of visual cues, and locations of speech and noise sources of typical speech listening situations experienced by these individuals. Design: Twenty older adults with mild to moderate hearing loss carried digital recorders for 5 to 6 weeks to record sounds for 10 hours per day. They also repeatedly completed in situ surveys on smartphones several times per day to report the characteristics of their current environments, including the locations of the primary talker (if they were listening to speech) and noise source (if it was noisy) and the availability of visual cues. For surveys where speech listening was indicated, the corresponding audio recording was examined. Speech-plus-noise and noise-only segments were extracted, and the SNR was estimated using a power subtraction technique. SNRs and the associated survey data were subjected to cluster analysis to develop PLSs. Results: The speech level, noise level, and SNR of 894 listening situations were analyzed to address the first objective. Results suggested that as noise levels increased from 40 to 74 dBA, speech levels systematically increased from 60 to 74 dBA, and SNR decreased from 20 to 0 dB. Most SNRs (62.9%) of the collected recordings were between 2 and 14 dB. Very noisy situations that had SNRs below 0 dB comprised 7.5% of the listening situations. To address the second objective, recordings and survey data from 718 observations were analyzed. Cluster analysis suggested that the participants' daily listening situations could be grouped into 12 clusters (i.e., 12 PLSs). The most frequently occurring PLSs were characterized as having the talker in front of the listener with visual cues available, either in quiet or in diffuse noise. The mean speech level of the PLSs that described quiet situations was 62.8 dBA, and the mean SNR of the PLSs that represented noisy environments was 7.4 dB (speech = 67.9 dBA). A subset of observations (n = 280), which was obtained by excluding the data collected from quiet environments, was further used to develop PLSs that represent noisier situations. From this subset, two PLSs were identified. These two PLSs had lower SNRs (mean = 4.2 dB), but the most frequent situations still involved speech from in front of the listener in diffuse noise with visual cues available. Conclusions: The present study indicated that visual cues and diffuse noise were exceedingly common in real-world speech listening situations, while environments with negative SNRs were relatively rare. The characteristics of speech level, noise level, and SNR, together with the PLS information reported by the present study, can be useful for researchers aiming to design ecologically valid assessment procedures to estimate real-world speech communicative functions for older adults with hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2wA71QY

Effects of High Sound Exposure During Air-Conducted Vestibular Evoked Myogenic Potential Testing in Children and Young Adults.

Objectives: Vestibular evoked myogenic potential (VEMP) testing is increasingly utilized in pediatric vestibular evaluations due to its diagnostic capability to identify otolith dysfunction and feasibility of testing. However, there is evidence demonstrating that the high-intensity stimulation level required to elicit a reliable VEMP response causes acoustic trauma in adults. Despite utility of VEMP testing in children, similar findings are unknown. It is hypothesized that increased sound exposure may exist in children because differences in ear-canal volume (ECV) compared with adults, and the effect of stimulus parameters (e.g., signal duration and intensity) will alter exposure levels delivered to a child's ear. The objectives of this study are to (1) measure peak to peak equivalent sound pressure levels (peSPL) in children with normal hearing (CNH) and young adults with normal hearing (ANH) using high-intensity VEMP stimuli, (2) determine the effect of ECV on peSPL and calculate a safe exposure level for VEMP, and (3) assess whether cochlear changes exist after VEMP exposure. Design: This was a 2-phase approach. Fifteen CNH and 12 ANH participated in phase I. Equivalent ECV was measured. In 1 ear, peSPL was recorded for 5 seconds at 105 to 125 dB SPL, in 5-dB increments for 500- and 750-Hz tone bursts. Recorded peSPL values (accounting for stimulus duration) were then used to calculate safe sound energy exposure values for VEMP testing using the 132-dB recommended energy allowance from the 2003 European Union Guidelines. Fifteen CNH and 10 ANH received cervical and ocular VEMP testing in 1 ear in phase II. Subjects completed tympanometry, pre- and postaudiometric threshold testing, distortion product otoacoustic emissions, and questionnaire addressing subjective otologic symptoms to study the effect of VEMP exposure on cochlear function. Results: (1) In response to high-intensity stimulation levels (e.g., 125 dB SPL), CNH had significantly higher peSPL measurements and smaller ECVs compared with ANH. (2) A significant linear relationship between equivalent ECV (as measured by diagnostic tympanometry) and peSPL exists and has an effect on total sound energy exposure level; based on data from phase I, 120 dB SPL was determined to be an acoustically safe stimulation level for testing in children. (3) Using calculated safe stimulation level for VEMP testing, there were no significant effect of VEMP exposure on cochlear function (as measured by audiometric thresholds, distortion product otoacoustic emission amplitude levels, or subjective symptoms) in CNH and ANH. Conclusions: peSPL sound recordings in children's ears are significantly higher (~3 dB) than that in adults in response to high-intensity VEMP stimuli that are commonly practiced. Equivalent ECV contributes to peSPL delivered to the ear during VEMP testing and should be considered to determine safe acoustic VEMP stimulus parameters; children with smaller ECVs are at risk for unsafe sound exposure during routine VEMP testing, and stimuli should not exceed 120 dB SPL. Using 120 dB SPL stimulus level for children during VEMP testing yields no change to cochlear function and reliable VEMP responses. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2xuju50

CorteXpert: A Model-based Method for Automatic Renal Cortex Segmentation

Publication date: Available online 23 August 2017
Source:Medical Image Analysis
Author(s): Dehui Xiang, Ulas Bagci, Chao Jin, Fei Shi, Weifang Zhu, Jianhua Yao, Milan Sonka, Xinjian Chen
This paper introduces a model-based approach for a fully automatic delineation of kidney and cortex tissue from contrast-enhanced abdominal CT scans. The proposed framework, named CorteXpert, consists of two new strategies for kidney tissue delineation: cortex model adaptation and non-uniform graph search. CorteXpert was validated on a clinical data set of 58 CT scans using the cross-validation evaluation strategy. The experimental results indicated the state-of-the-art segmentation accuracies (as dice coefficient): 97.86% ± 2.41% and 97.48% ± 3.18% for kidney and renal cortex delineations, respectively.

Graphical abstract

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Liver Transplantation for the Treatment of Complicated Iatrogenic Biliary Injuries: A National Review from the UNOS Dataset.

Background: Liver transplantation (LT) is rarely indicated in the management of iatrogenic bile duct injuries (IBDI), but occasionally it becomes the only remaining therapy. The purpose of this study is to evaluate potential complications of IBDI and their impact on perioperative mortality, graft and patient survival after LT. Methods: The UNOS database was queried for all LT performed in the United States between 1994 and 2014. Of the 101 238 liver transplants performed, 61 were related to IBDI. We performed a case matched analysis in a 5:1 ratio. Results: The median age for patients with IBDI was 50.16+11.7 years with a mean MELD score of 22.6 + 9.8. Patients receiving liver transplantation for IBDI were more likely women (54.1%, p 0.001), had lower incidence of hepatitis C virus infection (4.9%, p 0.001) and longer cold ischemic time (p 0.001). The mean BMI was 25.5+ 5.2) in patients transplanted for IBDI. IBDI was recognized as the strongest independent predictor associated with 8-fold increased risk of early graft loss (p 0.001, OR 8.4) and a 2.9-fold increased risk of 30-day mortality after LT in a case matched analysis (p 0.03). Conclusions: IBDI is an uncommon but challenging indication for liver transplantation. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Salvage Therapy in Advanced Adult Soft Tissue Sarcoma: A Systematic Review and Meta‐Analysis of Randomized Trials

AbstractBackground.Prognosis for patients with metastatic soft tissue sarcomas (STS) is dismal, with median overall survival (OS) of 8–12 months. The role of second‐line therapy has been inconsistently investigated over the last 20 years. This systematic review and meta‐analysis was performed to assess the efficacy of salvage treatment in pretreated adult type STS, gastrointestinal stromal tumor (GIST) excluded.Material and Methods.PubMed, Web of Science, SCOPUS, EMBASE, CINAHL, and The Cochrane Library were searched for randomized phase II/phase III trials exploring second‐ or beyond therapy lines in pretreated metastatic STS. Two independent investigators extracted data; the quality of eligible studies was resolved by consensus. Hazard ratio (HR) of death and progression (OS and progression‐free survival [PFS]) and odds ratio (OR) for response rate (RR) were pooled in a fixed‐ or random‐effects model according to heterogeneity. Study quality was assessed with the Cochrane's risk of bias tool, and publication bias with funnel plots.Results.Overall, 10 randomized trials were selected. The pooled HR for death was 0.81 (95% confidence interval [CI] 0.73–0.9). Second‐line therapy reduced the risk of progression by 49% (HR = 0.51, 95% CI 0.34–0.76). This translated into an absolute benefit in OS and PFS by 3.3 and 1.6 months, respectively. Finally, RR with new agents or chemotherapy doublets translated from 4.3% to 7.6% (OR = 1.78, 95% CI 1.22–2.50).Conclusion.Better survival is achieved in patients treated with salvage therapies (chemotherapy, as single or multiple agents or targeted biological agents). A 3‐months gain in OS and an almost double RR is observed. Second lines also attained a reduction by 50% the risk of progression.Implications for Practice.There is some evidence that salvage therapies after first‐line failure are able to improve outcome in metastatic soft tissue sarcoma (STS). Trabectedin, gemcitabine‐based therapy, and pazopanib are currently approved drugs used after conventional upfront treatment. This meta‐analysis reviews the benefit of new agents used in randomized trials in comparison with no active treatments or older agents for recurrent/progressed STS. The results show that modern drugs confer a statistically significant 3‐month benefit in terms of overall survival, and an increase in response rate. Despite a limited improvement in outcome, currently approved second‐line therapy should be offered to patients with good performance status.

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FDA Approval Summary: Pembrolizumab for Treatment of Metastatic Non‐Small Cell Lung Cancer: First‐Line Therapy and Beyond

AbstractOn October 24, 2016, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda; Merck 95% confidence interval [CI]: 0.41–0.89; p = .005), and significant improvement in PFS (HR 0.50; 95% CI: 0.37–0.68; p < .001). In KEYNOTE‐010, patients with disease progression on or after platinum‐containing chemotherapy received pembrolizumab IV 2 mg/kg, 10 mg/kg, or docetaxel 75 mg/m2 every 3 weeks. The HR and p value for OS was 0.71 (95% CI: 0.58–0.88), p < .001 comparing pembrolizumab 2 mg/kg with chemotherapy and the HR and p value for OS was 0.61 (95% CI: 0.49–0.75), p < .001 comparing pembrolizumab 10 mg/kg with chemotherapy.Implications for Practice.This is the first U.S. Food and Drug Administration approval of a checkpoint inhibitor for first‐line treatment of lung cancer. This approval expands the pembrolizumab indication in second‐line treatment of lung cancer to include all patients with programmed death‐ligand 1‐expressing non‐small cell lung cancer.

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AIP and the somatostatin system in pituitary tumours

Classic somatostatin analogues aimed at somatostatin receptor type 2, such as octreotide and lanreotide, represent the first-line treatment for acromegaly, which normally decrease hormone secretion and reduce tumour size; nevertheless, patients with a germline mutation in the aryl hydrocarbon receptor-interacting protein gene, AIP, develop young-onset acromegaly, poorly responsive to pharmacological therapy. In this review, we summarise the most recent studies on AIP-related pituitary adenomas, paying special attention to: the causes of the resistance to treatment in acromegaly; the somatostatin receptor profile in the somatotrophinoma, especially type 2, and type 5 and its truncated variants; the role of G proteins in this pathology; the use of pasireotide, a novel multi-ligand somatostatin analogues; and the role of ZAC1, a zinc-finger protein which, among other functions, acts as a key mediator in octreotide response in somatotrophinoma models and, interestingly, its expression is linked to AIP.

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Adjuvant radiotherapy after radical cystectomy and ileal orthotopic neobladder

Publication date: Available online 23 August 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Mohmed S. Zaghloul, Tarek M. Zaghloul




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Comment on “An evaluation of oxidative and nitrosative stress in children-who-stutter and its relationship to severity”

We have read the article entitled "An evaluation of oxidative and nitrosative stress in children-who-stutter and its relationship to severity," published by Bilal N et al. with great interest [1]. The authors evaluated the levels of oxidative and nitrosative stress by comparing a stuttering group and a control group and evaluated the relationship between the oxidative and nitrosative stress levels and the severity of the stutter. They examined malondialdehyde (MDA), 3-nitrotyrosine (3-NT), nitric oxide (NO), catalase (CAT), and superoxide dismutase (SOD) concentrations in blood.

http://ift.tt/2wGJPzx

Adaptive Face Coding Contributes to Individual Differences in Facial Expression Recognition Independently of Affective Factors.

Author: Palermo, Romina; Jeffery, Linda; Lewandowsky, Jessica; Fiorentini, Chiara; Irons, Jessica L.; Dawel, Amy; Burton, Nichola; McKone, Elinor; Rhodes, Gillian

DOI: 10.1037/xhp0000463

Publication Date: POST AUTHOR CORRECTIONS, 21 August 2017

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The Visualization of the Functional Role of the Depressor Septi Nasi Muscle by Ultrasound

No abstract available

http://ift.tt/2vMsiFF

Salvage of Infected Nasal Reconstruction with a Polymethyl Methacrylate Spacer

Summary: Total nasal reconstruction is a challenging multistage procedure. Infections can destroy the cartilage framework and seriously compromise the result. The use of polymethyl methacrylate with antibiotics as a spacer has been described in the treatment of skeletal infections. Using this same principle, the use of a polymethyl methacrylate with antibiotics spacer for an infected nasal reconstruction is reported in a clinical case.

http://ift.tt/2uovzaA

The resilient brain and the guardians of sleep: new perspectives on old assumptions

Resilience is the capacity of a system, enterprise or a person to maintain its core purpose and integrity in the face of dramatically changed circumstances. In human physiology, resilience is the capacity of adaptively overcoming stress and adversity while maintaing normal psychological and physical functioning. In this review, we investigate the resilient strategies of sleep. First, we discuss the concept of brain resilience, highlighting the modular structure of small-world networking, neuronal plasticity and critical brain behaviour.

http://ift.tt/2vhlnRX

Multifocal Balo's concentric sclerosis in children: Report of a case and review of literature

Sanjeev Kumar Bhoi, Suprava Naik, Jayantee Kalita, UK Misra

Journal of Neurosciences in Rural Practice 2017 8(5):136-138

Balo's concentric sclerosis (BCS) is a rare demyelinating lesion considered to be a variant of multiple sclerosis (MS). On magnetic resonance imaging (MRI) Balo's concentric sclerosis shows the typical concentric pattern. We report a case of 10 year old child with BCS who presented as post infectious acute disseminated encephalomyelitis (ADEM). He is asymptomatic and had no relapse after 6 years of follow-up.

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Depressive symptoms in persons with epilepsy: Methodological issues

Sandeep Grover

Journal of Neurosciences in Rural Practice 2017 8(5):3-4



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Epilepsy and depression: A bidirectional relationship

Sundar Gnanavel

Journal of Neurosciences in Rural Practice 2017 8(5):5-6



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Multiple inherited thrombophilias in a young patient with striatocapsular stroke

Isabel Taveira, Cláudia Vicente, Sofia Sobral, Hipólito Nzwalo, José Sousa E Costa

Journal of Neurosciences in Rural Practice 2017 8(5):154-155



http://ift.tt/2w5Agbj

Symptomatic bilateral xanthogranuloma of the choroid plexus

Selin Tural Emon, Erek Ozturk, Kaan Meric, Fugen Aker, Metin Orakdogen

Journal of Neurosciences in Rural Practice 2017 8(5):123-126

Xanthogranulomas (XGRs) of the choroid plexus are rare, asymptomatic, and benign lesions usually found incidentally. Here, we present a case of a 47-year-old male with bilateral XGR of the choroid plexus with periventricular edema and discuss our case in relation to a review of existing literature pertaining to the radiology of XGRs. To the best of our knowledge, this is the first reported case of bilateral trigonal XGR causing brain edema without ventricular dilatation. Despite the fact that they can cause hydrocephalus, XGRs are silent and benign lesions. Although the etiopathology of XGRs remains poorly understood, enhanced imaging analyses may provide additional information regarding edema and focal white matter signal changes.

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High frequency of depressive symptoms among adults with epilepsy: Results from a Hospital-based study

Syam C Chandrasekharan, Vikas Menon, Vaibhav Wadwekar, Pradeep Pankajakshan Nair

Journal of Neurosciences in Rural Practice 2017 8(5):13-19

Context: Assessment of comorbid burden of depression and associated factors among adult people living with epilepsy (PWE) has the potential to inform clinical evaluation and management to improve outcomes. Aim: The aim of this study is to determine frequency of depressive symptoms and factors associated with it among PWE attending a tertiary care hospital. Setting and Design: This was a cross-sectional observational study conducted in the outpatient clinic of a tertiary care center. Subjects and Methods: One hundred and fifty patients with epilepsy were recruited between May 2016 and August 2016. For assessing depression, Tamil validated version of Patient Health Questionnaire-12 was used. Frequency of depression and its association with various sociodemographic and clinical factors were assessed. Statistical Analysis Used: Student t-test and Chi-square test for univariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Results: Of the 150 subjects, 89 (59.3%) were males. Generalized tonic–clonic seizures were present in 131 people (87.3%). Genetic and unknown epilepsies contributed higher proportion (44.7%) as compared to structural epilepsies (37.3%). Majority (88%) were on one or two antiepileptic drugs. Thirty-one people (20.3%) had less than one seizure per year. Depressive symptoms were present in 95 patients (63.3%). In multivariate regression analysis, secondary generalized seizures and seizure frequency >1/month emerged as significant predictors of depression ( [OR]: 5.48 [95% (CI): 1.35–22.28] and OR: 2.53 [95% CI: 1.11–5.75], respectively). Conclusion: Depression is prevalent in a majority of adult PWE. Hence, a routine screening for depression as part of comprehensive epilepsy care is advisable for PWE attending the outpatient clinic.

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Advanced elbow joint tuberculosis with cervicothoracic junction extramedullary tuberculoma in a school boy: Unusual association

Guru Dutta Satyarthee

Journal of Neurosciences in Rural Practice 2017 8(5):147-149



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Cognitive impairment in rural elderly population in ecuador

Xavier Wong-Achi, Gabriela Egas, Dayana Cabrera

Journal of Neurosciences in Rural Practice 2017 8(5):20-22

Introduction: The Mini-Cog is a simple and short test that identifies cognitive impairment. Its detection helps provide an early dementia diagnosis, rapid access to treatments, and even delay or reversion. Materials and Methods: This multicenter, observational, descriptive, and cross-sectional study included 214 patients. Patients enrolled in this study were community dwellers aged ≥55-year-old, without prior diagnosis of cognitive impairment or dementia, with adequate hearing and vision functions. It was conducted in primary care health centers localized in rural communities of Ecuador. Results: Ages ranged from 50 to 98 years and there was predominance of female gender: 66% versus 33%. The percentage of illiteracy was 26.4% (CI: 25.32–27.48), and 63% (CI: 62.1–63.94) of patients had complete primary educational level. The overall prevalence of cognitive impairment was 50.9% (95% CI: 48.5–53.3) and 47.2% (95% CI: 45.2–49.2) in patients with risk factors. We found several established risk factors associated with cognitive impairment onset, including social factors, physiological factors, and comorbidities. Conclusion: This is the first epidemiological research of CI in rural populations in this country using the Mini-Cog as a screening tool. Adopting public health measures for the prevention and control of those modifiable risk factors could reduce the prevalence of cognitive impairment and even its progression to dementia.

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Is it time to study leukodystrophies?

Adriana Carol Eleonora Graziano

Journal of Neurosciences in Rural Practice 2017 8(5):1-2



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External validation of the rotterdam computed tomography score in the prediction of mortality in severe traumatic brain injury

Jose D Charry, Jesus D Falla, Juan D Ochoa, Miguel A Pinzón, Jorman H Tejada, Maria J Henriquez, Juan Pablo Solano, Camilo Calvache

Journal of Neurosciences in Rural Practice 2017 8(5):23-26

Introduction: Traumatic brain injury (TBI) is a public health problem. It is a pathology that causes significant mortality and disability in Colombia. Different calculators and prognostic models have been developed to predict the neurological outcomes of these patients. The Rotterdam computed tomography (CT) score was developed for prognostic purposes in TBI. We aimed to examine the accuracy of the prognostic discrimination and prediction of mortality of the Rotterdam CT score in a cohort of trauma patients with severe TBI in a university hospital in Colombia. Materials and Methods: We analyzed 127 patients with severe TBI treated in a regional trauma center in Colombia over a 2-year period. Bivariate and multivariate analyses were used. The discriminatory power of the score, its accuracy, and precision were assessed by logistic regression and as the area under the receiver operating characteristic curve. Shapiro–Wilk, Chi-square, and Wilcoxon tests were used to compare the real outcomes in the cohort against the predicted outcomes. Results: The median age of the patient cohort was 33 years, and 84.25% were male. The median injury severity score was 25, the median Glasgow Coma Scale motor score was 3, the basal cisterns were closed in 46.46% of the patients, and a midline shift of >5 mm was seen in 50.39%. The 6-month mortality was 29.13%, and the Rotterdam CT score predicted a mortality of 26% (P < 0.0001) (area under the curve: 0.825; 95% confidence interval: 0.745–0.903). Conclusions: The Rotterdam CT score predicted mortality at 6 months in patients with severe head trauma in a university hospital in Colombia. The Rotterdam CT score is useful for predicting early death and the prognosis of patients with TBI.

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Hydrocephalus associated with large vestibular schwannoma: Management options and factors predicting requirement of cerebrospinal fluid diversion after primary surgery

AR Prabhuraj, Nishanth Sadashiva, Santhosh Kumar, Dhaval Shukla, Dhananjaya Bhat, Bhagavatula Indira Devi, Sampath Somanna

Journal of Neurosciences in Rural Practice 2017 8(5):27-32

Objective: Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. Materials and Methods: This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. Results: Comparing the group who underwent direct surgery to the group who underwent VP shunt before definitive vestibular schwannoma surgery, the facial nerve preservation rates and surgical morbidity rates were comparable. In cases who underwent direct surgery, 10 out of 75 patients required postoperative permanent CSF diversion. Older age, male gender, duration of symptoms, larger tumor size, solid lesions, severe HCP, and clinical features of HCP were associated with postoperative requirement of CSF diversion but were not statistically significant. The most significant factor that correlated with the need for additional HCP treatment was the presence of postoperative hematoma of volume >10cc. Conclusions: Primary tumor removal is the optimal treatment for vestibular schwannoma associated with HCP. Postoperative hematoma may warrant close observation as these patients are at an increased risk of persistence of HCP.

http://ift.tt/2w5eOCZ

Parasellar chondrosarcoma in three young patients: A diagnosis of caution

Rakesh Kumar Gupta, Latika Gupta, Ravindra Kumar Saran, Anita Jagetia, Lalit Garg

Journal of Neurosciences in Rural Practice 2017 8(5):130-132

Parasellar chondrosarcoma is rare slowly growing intracranial tumors. A correct diagnosis of these tumors is challenging for clinician due to overlapping location and simulation of clinical presentations with much common pituitary adenomas. We are reporting three young patients diagnosed to have parasellar chondrosarcoma highlighting the pathological features of importance required for confirm diagnosis.

http://ift.tt/2wpisKS

Prehospital management of acute stroke in rural versus urban responders

Gregory Hansen, Simerpreet Bal, Kerri Lynn Schellenberg, Susan Alcock, Esseddeeg Ghrooda

Journal of Neurosciences in Rural Practice 2017 8(5):33-36

Objective: Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center. Materials and Methods: One hundred adult patients were randomly selected from the stroke registry. Patients were transported through Rural EMS bypass protocols or urban EMS protocols (both bypass and direct) to our stroke center between January and December 2013. Patients were excluded if they were first evaluated at any other health center. Prehospital care was assessed using ten indicators for EMS evaluation/management, as recommended by acute stroke guidelines. Results: Compliance with acute stroke EMS evaluation/management indicators were statistically similar for both groups, except administrating a prehospital diagnostic tool (rural 31.8 vs. urban 70.3%; P = 0.002). Unlike urban EMS, rural EMS did not routinely document scene time. Conclusion: Rural EMS responders' compliance to prehospital stroke evaluation/management was similar to urban EMS responders. Growth areas for both groups may be with prehospital stroke diagnostic tool utilization, whereas rural EMS responders may also improve with scene time documentation.

http://ift.tt/2w5GVSH

Prevention of neurotrauma: An evolving matter

Samer Hoz, Luis Rafael Moscote-Salazar

Journal of Neurosciences in Rural Practice 2017 8(5):141-143



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Traumatic cerrebral fungus: Experience from an institution in North East India

Binoy Kumar Singh, Abinash Dutta, Shameem Ahmed, Zakir Hussain, Rajib Hazarika, Bineta Singh

Journal of Neurosciences in Rural Practice 2017 8(5):37-43

Background: Traumatic brain fungus is manifestation of neglected head injury. Although rare it is not uncommon. The patients are usually intact with good Glasgow coma (GCS) score inspite of complex injuries and exposed brain parenchyma but morbidity and mortality is very high with time if no proper and timely management is offered. There is very less study on traumatic brain fungus with no defined management protocols. So an attempt was made to explain in details the surgical strategies and other management techniques in patients with traumatic brain fungus. Aims: To study and evaluate the pattern of causation, clinical presentations, modalities of management of traumatic brain fungus and outcome after treatment. Methods: All patients with fungus cerebri, admitted to our centre from January 2012 to December 2015 were studied prospectively. All the patients were examined clinically and triaged urgently for surgery. CT head was done in all patients to look for any brain parenchymal injury. All patients were managed surgically. Outcome was assessed as per the Glassgow Outcome Score. Results: Total 10 patients were included in the study. 8 were men and 2 women. The patients' ages ranged from 3-48 years (mean 31.6 years). The interval between initial injury and protrusion ranged from 3 days to 6 days (mean 4.1 days). Mean GCS at the time of presentation was 13.2.60% of the patients (n = 6) sustained moderate head injury. (GCS-9-13). Size of the fungus ranged from 5cm×3cm to 8cm×10cm. Conclusion: Early and proper local wound treatment prevents fungus formation. Pre-emptive antibiotics, AEDs and cerebral decongestants are recommended. Loose water-tight duroplasty prevents CSF leak. But mortality and morbidity can be reduced significantly if brain fungus is managed properly by applying basic surgical principles and antibiotic protocols combined with newer surgical modalities.

http://ift.tt/2w5A4so

Accidental dural pith during localization in anterior cervical surgery: An ounce of prevention is worth a pound of cure

Dhruv Kumar Agarwal, Eswararao Thamatapu, Rajaraman Kartikueyan, Prasad Krishnan

Journal of Neurosciences in Rural Practice 2017 8(5):152-153



http://ift.tt/2wpKDJy

Buckled Thyroid Cartilage: An Anatomic Variant

Anatomic abnormalities in the larynx can cause significant and bothersome symptoms. Identified here is an anatomical variant of the thyroid cartilage.

http://ift.tt/2v7kqiZ

Split internal jugular vein: surgical and radiological implications

The close association of the internal jugular vein (IJV) with the lower four cranial nerves, carotid vessels, and deep cervical lymph nodes makes it functionally, surgically, and radiologically important. Variants of the IJV are rare, and even less commonly, it could be absent. Partial or complete duplication of the vein have been reported, and occasionally it has had fenestrations along its course, with the spinal accessory nerve passing through the fenestration.

http://ift.tt/2w5yuGQ

Distance-dependent accuracy in Le Fort I maxillary repositioning procedures

It has been hypothesised that, in maxillary repositioning procedures, longer distances correlate with less accurate transfers and particularly the repositioning forces of facial skin and muscles that increase exponentially. However, this has not to our knowledge been confirmed. The purpose of this study was to search for differences in the accuracy of transfer from maxillary repositioning procedures parallel to the three orthogonal planes and with respect to three different anatomical landmarks of the first molar left and right (M1L and M1R) and the first incisor (I).

http://ift.tt/2wpgvOe

Hard neck lumps: a review of uncommon and sometimes overlooked causes of these worrying presentations

While a neck lump is a common presentation that can raise suspicion of a potentially serious underlying disease, a hard lump, though less common, may be even more concerning for the patient, and prompt urgent investigation. Metastatic squamous cell carcinoma is the commonest underlying diagnosis that must be excluded, but other diseases or even normal anatomy of the neck can be associated with lumps that are hard or bony. Many of these presentations are relatively rare and may not be familiar to oral and maxillofacial surgeons (OMFS) (particularly more junior clinicians) as a differential diagnosis of a hard neck mass.

http://ift.tt/2w5yqqA

Comprehensive analysis of the volume of bone for grafting that can be harvested from iliac crest donor sites

Our aim was to calculate the volumes of cancellous, cortical, and corticocancellous bone that can be harvested as a graft from the anterior and posterior iliac crests using 3-dimensional computed tomography (CT) and software in a living adult population. We selected random CT scans of the pelvis from 31 men and 29 women from the Department of Radiology imaging database. CT data in DICOM file format were imported into the Mimics software. The anterior iliac crest and posterior iliac crest bone graft-harvested boundaries were measured.

http://ift.tt/2wpwLPw

Scarless total maxillectomy: midfacial degloving with extended transconjunctival retrocaruncular approach

Large benign and malignant tumours of the maxillary sinus may require a total maxillectomy as part of their treatment.1 Traditionally access has been by the Weber-Fergusson incision, or one of its modifications. This gives excellent exposure, particularly if the resection needs to extend above the orbital floor, but can be associated with extensive complications that include ectropion, shortening of the lip, breakdown of the wound, and facial scars. The midfacial degloving approach avoids these visible scars, but usually does not provide sufficient access to resect as far as the lamina papyracea and ethmoids.

http://ift.tt/2w5ynLq

Pitfalls in monitoring of the facial nerve during operations for parotid cancer

The facial nerve splits into branches within the parotid gland and innervates the muscles of facial expression. Damage to it can result in temporary or permanent facial deformity, asymmetry of the smile, and ocular keratosis. Studies have shown that intraoperative use of a facial nerve monitor can reduce paralysis of the nerve.

http://ift.tt/2vhaP53

Do we need neuroimaging to treat insomnia effectively?

In recent years, the diagnosis of insomnia disorder has shown striking developments concerning its conceptualization, assessment and treatment. Notably, the main comprehensive models on insomnia have been behavioral or psychological [1]. These theoretical conceptualizations led to numerous intervention techniques, which continued to be used over the years [2,3]. Several studies such as randomized controlled trials (RCT) and meta-analyses have reinforced the efficacy and efficiency of cognitive-behavioral therapies for insomnia (CBT-I) [3].

http://ift.tt/2xuamxo

Prevalence of nocturnal sleep onset rapid movement sleep period (SOREMP) in narcolepsy type 1 and type 2

The Third Edition of International Classification of Sleep Disorders (ICSD-3) suggested that the nocturnal sleep onset rapid movement sleep period (SOREMP) obtained in a full night polysomnography (PSG) may substitute for one of the two SOREMPs required to meet the MSLT criteria, and added the levels of hypocretin lower than <110pg/mL as part of diagnostic criteria for narcolepsy type 1 and type 2. [1].

http://ift.tt/2wznMM5

Immediate loading of subcrestally placed dental implants in anterior and premolar sites

Immediate loading of dental implants has been evolving into an appropriate procedure for the treatment of partially edentulous jaws. The purpose of this study was to evaluate the clinical success and radiological outcome of immediately and delayed loaded dental implants in anterior and premolar sites.

http://ift.tt/2vgQtci

Correlation of general and oral health−related quality of life in malocclusion patients treated with a combined orthodontic and maxillofacial surgical approach

The aim of the study was to collect information about the oral health−related quality of life (OHRQoL) after combined orthodontic and maxillofacial surgical treatment as well as its influence on health-related quality of life (HRQoL).

http://ift.tt/2wG8eoX

Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review

We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.

http://ift.tt/2isimw4

Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data

Aims

To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4.

Methods

A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. Setting: UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes.

Interventions

Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. Main outcome measures: quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model.

Results

For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient.

Conclusions

The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy.

http://ift.tt/2vhrCF6

Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review

We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.

http://ift.tt/2isimw4

A pilot study to assess near infrared laparoscopy with indocyanine green (ICG) for intraoperative sentinel lymph node mapping in early colon cancer

Publication date: Available online 23 August 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Andrew C. Currie, Adela Brigic, Siwan Thomas-Gibson, Noriko Suzuki, Morgan Moorghen, John T. Jenkins, Omar D. Faiz, Robin H. Kennedy
BackgroundPrevious attempts at sentinel lymph node (SLN) mapping in colon cancer have been compromised by ineffective tracers and the inclusion of advanced disease. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping in T1/T2 clinically staged colonic malignancy.MethodsConsecutive patients with clinical T1/T2 stage colon cancer underwent endoscopic peritumoral submucosal injection of indocyanine green (ICG) for fluorescence detection of SLN using a near-infrared (NIR) camera. All patients underwent laparoscopic complete mesocolic excision surgery. Detection rate and sensitivity of the NIR-ICG technique were the study endpoints.ResultsThirty patients (mean age = 68 years [range = 38-80], mean BMI = 26.2 (IQR = 24.7-28.6) were studied. Mesocolic sentinel nodes (median= 3/patient) were detected by fluorescence within the standard resection field in 27/30 patients. Overall, ten patients had lymph node metastases, with one of these patients having a failed SLN procedure. Of the 27 patients with completed SLN mapping, nine patients had histologically positive lymph nodes containing malignancy. 3/9 had positive SLNs with 6 false negatives. In five of these false negative patients, tumours were larger than 35mm with four also being T3/T4.ConclusionICG mapping with NIR fluorescence allowed mesenteric detection of SLNs in clinical T1/T2 stage colonic cancer.ClinicalTrials.gov ID: NCT01662752.



http://ift.tt/2irFnPT

Die Begutachtung der Facialisparese in der österreichischen privaten Unfallversicherung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115733

In Westeuropa ist die periphere Facialisparese die häufigste Hirnnervenaffektion. Traumatisch bedingte Paresen weisen im Gegensatz zu nichttraumatischen Paresen eine höhere Defektheilungsrate auf. Die anlagebedingte Form tritt als Bell'sche Lähmung oder in Kombination mit anderen Pathologien, vor allem in Verbindung mit der Lyme'schen Erkrankung oder dem Zoster oticus, in Erscheinung. Die traumatische Parese ist überwiegend unfallbedingt und fast immer vergesellschaftet mit multiplen anderen Verletzungsmustern. Anlagebedingte Formen haben im Vergleich zur traumatischen Form eine niedrige Defektheilungsrate. Der Gutachter hat diese Defekte, so wie sie sich ihm aktuell bieten, zu beurteilen, wobei auch prognostische Überlegungen einfließen sollten. Die österreichische private Unfallversicherung deckt das Risiko einer unfallbedingten Verletzung. Dieser versicherungsrechtliche Unfallbegriff umfasst ein breites Spektrum von Verletzungsmustern sowie auch eine durch Zeckenbiss verursachte Facialisparese. Primär stellt die österreichische private Unfallversicherung auf die erlittene unfallbedingte Funktionsstörung ab. Trotzdem bietet sie auch eingeschränkt Deckung für ästhetische aus dem Unfall resultierende Folgen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://ift.tt/2irUl8h

Hypoglossus-Stimulation bei OSAS auch außerhalb von Studien sicher und effektiv

Laryngo-Rhino-Otol 2017; 96: 437-438
DOI: 10.1055/s-0043-105199

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SmFP

Schmerzhafte Raumforderung der Ohrmuschel

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116666

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SLrP

Unklarer Tumor des Oropharynx beim Kind

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116665

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SbKF

Ulzerierende Laryngitis bei einer 34-jährigen Patientin

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116664

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6S8OZ

Hörtestergebnisse bei 18- bis 20-jährigen Männern aus Kreiswehrersatzämtern von 2008–2010

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115732

Hintergrund Während eine mit dem Alter zunehmende Schwerhörigkeit im Hochtonbereich hinreichend belegt ist, sind das Ausmaß und die Zunahme möglicher Schwerhörigkeiten bei jungen Menschen weiterhin unklar. Da in diesem Altersbereich ein hoher Anteil an Normalhörigkeit zu erwarten ist, sind die Anforderungen an Screening-Methoden besonders hoch und die Motivation zur Teilnahme eher niedrig. Die verpflichtende Musterung umfasst u. a. eine audiologische Hörprüfung (Tonaudiogramm) und bietet daher die Möglichkeit das Hörvermögen junger männlicher Erwachsener zu analysieren. Material und Methoden Die Prävalenz für Hörbeeinträchtigungen wurde anhand der Luftleitungshörschwellen 18- bis 20-jähriger Männer von 54 deutschen Kreiswehrersatzämtern (KWEA) der Jahre 2008–2010 bestimmt. Als Kriterium wurde die Überschreitung einer Hörschwelle von 20 dB HL bei mindestens einer der Frequenzen 3, 4 oder 6 kHz auf mindestens einem Ohr verwendet. Diesem sehr strengen Kriterium wurden andere Definitionen für Hörschäden vergleichend gegenübergestellt. Ergebnisse Die Prävalenz von relevanten Hörschäden beträgt im Mittel 15,3 % und liegt damit im Bereich anderer Untersuchungen. Die Ergebnisse einzelner KWEA unterscheiden sich jedoch um bis zu einem Faktor 10. Schlussfolgerung Aufgrund stark schwankender Messqualität in den KWEA lässt sich nicht klären, ob regionale Unterschiede im Hörvermögen junger Männer bestehen und ob sich dieses im Vergleich zu früheren Untersuchungen verschlechtert hat. Die hohe Variabilität bei Messungen nahe der Hörschwelle erfordert eine ständige Qualitätskontrolle. Dabei können die Hörergebnisse im Screening nicht nach den strengen Kriterien bewertet werden, die für Hörprüfungen in audiologischen Zentren oder Studien anzusetzen sind.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://ift.tt/2g6S5Tj

Die Begutachtung der Facialisparese in der österreichischen privaten Unfallversicherung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115733

In Westeuropa ist die periphere Facialisparese die häufigste Hirnnervenaffektion. Traumatisch bedingte Paresen weisen im Gegensatz zu nichttraumatischen Paresen eine höhere Defektheilungsrate auf. Die anlagebedingte Form tritt als Bell'sche Lähmung oder in Kombination mit anderen Pathologien, vor allem in Verbindung mit der Lyme'schen Erkrankung oder dem Zoster oticus, in Erscheinung. Die traumatische Parese ist überwiegend unfallbedingt und fast immer vergesellschaftet mit multiplen anderen Verletzungsmustern. Anlagebedingte Formen haben im Vergleich zur traumatischen Form eine niedrige Defektheilungsrate. Der Gutachter hat diese Defekte, so wie sie sich ihm aktuell bieten, zu beurteilen, wobei auch prognostische Überlegungen einfließen sollten. Die österreichische private Unfallversicherung deckt das Risiko einer unfallbedingten Verletzung. Dieser versicherungsrechtliche Unfallbegriff umfasst ein breites Spektrum von Verletzungsmustern sowie auch eine durch Zeckenbiss verursachte Facialisparese. Primär stellt die österreichische private Unfallversicherung auf die erlittene unfallbedingte Funktionsstörung ab. Trotzdem bietet sie auch eingeschränkt Deckung für ästhetische aus dem Unfall resultierende Folgen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://ift.tt/2irUl8h

Hypoglossus-Stimulation bei OSAS auch außerhalb von Studien sicher und effektiv

Laryngo-Rhino-Otol 2017; 96: 437-438
DOI: 10.1055/s-0043-105199

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SmFP

Schmerzhafte Raumforderung der Ohrmuschel

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116666

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SLrP

Unklarer Tumor des Oropharynx beim Kind

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116665

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6SbKF

Ulzerierende Laryngitis bei einer 34-jährigen Patientin

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116664

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2g6S8OZ

Hörtestergebnisse bei 18- bis 20-jährigen Männern aus Kreiswehrersatzämtern von 2008–2010

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115732

Hintergrund Während eine mit dem Alter zunehmende Schwerhörigkeit im Hochtonbereich hinreichend belegt ist, sind das Ausmaß und die Zunahme möglicher Schwerhörigkeiten bei jungen Menschen weiterhin unklar. Da in diesem Altersbereich ein hoher Anteil an Normalhörigkeit zu erwarten ist, sind die Anforderungen an Screening-Methoden besonders hoch und die Motivation zur Teilnahme eher niedrig. Die verpflichtende Musterung umfasst u. a. eine audiologische Hörprüfung (Tonaudiogramm) und bietet daher die Möglichkeit das Hörvermögen junger männlicher Erwachsener zu analysieren. Material und Methoden Die Prävalenz für Hörbeeinträchtigungen wurde anhand der Luftleitungshörschwellen 18- bis 20-jähriger Männer von 54 deutschen Kreiswehrersatzämtern (KWEA) der Jahre 2008–2010 bestimmt. Als Kriterium wurde die Überschreitung einer Hörschwelle von 20 dB HL bei mindestens einer der Frequenzen 3, 4 oder 6 kHz auf mindestens einem Ohr verwendet. Diesem sehr strengen Kriterium wurden andere Definitionen für Hörschäden vergleichend gegenübergestellt. Ergebnisse Die Prävalenz von relevanten Hörschäden beträgt im Mittel 15,3 % und liegt damit im Bereich anderer Untersuchungen. Die Ergebnisse einzelner KWEA unterscheiden sich jedoch um bis zu einem Faktor 10. Schlussfolgerung Aufgrund stark schwankender Messqualität in den KWEA lässt sich nicht klären, ob regionale Unterschiede im Hörvermögen junger Männer bestehen und ob sich dieses im Vergleich zu früheren Untersuchungen verschlechtert hat. Die hohe Variabilität bei Messungen nahe der Hörschwelle erfordert eine ständige Qualitätskontrolle. Dabei können die Hörergebnisse im Screening nicht nach den strengen Kriterien bewertet werden, die für Hörprüfungen in audiologischen Zentren oder Studien anzusetzen sind.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://ift.tt/2g6S5Tj

Event-related potential N270 as an index of social information conflict in explicit processing

Publication date: Available online 23 August 2017
Source:International Journal of Psychophysiology
Author(s): Pei Wang, Chen-hao Tan, Yu Li, Qin Zhang, Yi-bo Wang, Jun-long Luo
As N270 has been widely shown to be sensitive to nonsocial information conflict, the present study investigated whether social information conflict can elicit increased N270 in either explicit or implicit processing conditions. Gender stereotype–related picture-word pairs and picture-word pairs in specific colors were used as social and nonsocial information, respectively. Participants performed an explicit task based on the S1-S2 paradigm in Study 1, and both social and nonsocial information conditions elicited larger N270 than the no-conflict condition. In Study 2, participants performed a word judgment task that was modified from the S1-S2 paradigm of Study 1. However, neither social information nor nonsocial information elicited larger N270 within the conflict condition. Social trials generally elicited a more negative ERP waveform than nonsocial trials overall. These findings suggest that N270 may reflect the processing of social information conflict only in explicit conditions and also that the cognitive basis of N270 is thus a general but explicit processing of working memory representation conflict.



http://ift.tt/2iquUUK

Orbital complications of acute sinusitis

Publication date: Available online 23 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Adam P. Campbell, Regan W. Bergmark, Ralph Metson
In the pre-antibiotic era, orbital complications of acute sinusitis were not infrequent, often leading to severe patient morbidity, including blindness. Today, treatment of orbital complications consists primarily of systemic antibiotic therapy with surgical intervention reserved for large or medically unresponsive orbital or subperiosteal abscesses. Staging systems have been created to assist physicians in management and prognosis of such complications, but do not replace clinical acumen. While powerful antibiotics have decreased the morbidity associated with orbital complications of acute sinusitis, the physician should remain aware of potential complications and ready to escalate treatment when necessary.



http://ift.tt/2vh0ohU

Cervical and craniofacial necrotizing fasciitis

Publication date: Available online 23 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Laura J. Vandelaar, Ibrahim Alava
Cervical and craniofacial necrotizing fasciitis is an aggressive disease process that at times has subtle etiologies and physical findings. Involvement in the head and neck is rare; however, when present it can have extensive morbidity and mortality. High index of suspicion is paramount for early treatment and survival. We describe the presentation, diagnosis and treatment of cervical and craniofacial necrotizing fasciitis. We detail the typical physical exam findings as well as diagnosis based on imaging. We then describe in-depth the operative techniques needed to properly treat these patients allowing for their best chance at survival from this deadly disease.



http://ift.tt/2wFSJNS

Commentary on “Cryopreserved Cadaveric Arterial Allograft for Arterial Reconstruction in Patients with Prosthetic Graft Infection”

Publication date: Available online 23 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): J.-B. Ricco, F. Schneider




http://ift.tt/2w4XldZ

Utility of Sox10 Labeling in Metastatic Breast Carcinomas

Publication date: Available online 23 August 2017
Source:Human Pathology
Author(s): Emily R Nelson, Rajni Sharma, Pedram Argani, Ashley Cimino-Mathews
Sox10 labeling by immunohistochemistry has been primarily reported in tumors of neural crest origin, such as nerve sheath tumors and melanoma. However, Sox10 also labels primary breast carcinomas, particularly those with the basal-like, triple negative phenotype. However, the utility of Sox10 labeling in metastatic breast carcinomas has not been reported. Here, we prospectively evaluated Sox10 labeling in surgically resected metastatic breast carcinomas from 26 patients sampled on tissue microarrays. In this cohort, Sox10 labeling was seen in 3 (12%) metastatic breast carcinomas, all of which were grade III, triple negative ductal carcinomas metastatic to the brain (n=2) or lung (n=1). Overall, 38% triple negative metastases were Sox10 positive, compared to 0% estrogen receptor (ER)⁺ or human epidermal growth factor 2 (HER-2) ⁺ metastases (p=0.045). In addition, we retrospectively reviewed the use of Sox10 immunohistochemistry in metastatic carcinomas in our clinical practice. We identified 21 cases from January 2012–July 2017 in which Sox10 immunohistochemistry was ordered on clinical sign-out in the work-up of a metastatic carcinoma as being of possible breast origin. Overall, Sox10 labeled 57% (n=12) of all evaluated metastatic carcinomas. All of the Sox10⁺ tumors were ER⁻, such that 71% of ER⁻ carcinomas were Sox10⁺ in comparison to 0% of ER⁺ carcinomas (p=0.049). In conclusion, the differential diagnosis of a Sox10⁺ malignancy of unknown origin should not be limited to metastatic melanoma. Sox10 labeling is seen in a subset of metastatic triple negative breast carcinomas, supporting its use as a marker of breast origin in this setting.



http://ift.tt/2vZJaJ2

Atypical mitoses in pleomorphic lipomas

Publication date: Available online 23 August 2017
Source:Human Pathology
Author(s): Michael Michal, Berrin Babaoglu, Dmitry V. Kazakov, Michal, Kemal Kosemehmetoglu




http://ift.tt/2xdLVoE

Trauma Management Therapy with Virtual-Reality Augmented Exposure Therapy for Combat-Related PTSD: A Randomized Controlled Trial

Publication date: Available online 23 August 2017
Source:Journal of Anxiety Disorders
Author(s): Deborah C. Beidel, B. Christopher Frueh, Sandra M. Neer, Clint A. Bowers, Benjamin Trachik, Thomas W. Uhde, Anouk Grubaugh
Virtual reality exposure therapy (VRET) realistically incorporates traumatic cues into exposure therapy and holds promise in the treatment of combat-related posttraumatic stress disorder (PTSD). In a randomized controlled trial of 92 Iraq and Afghanistan veterans and active duty military personnel with combat-related PTSD, we compared the efficacy of Trauma Management Therapy (TMT; VRET plus a group treatment for anger, depression, and social isolation) to VRET plus a psychoeducation control condition. Efficacy was evaluated at mid- and post-treatment, and at 3- and 6-month follow-up. Consistent with our hypothesis, VRET resulted in significant decreases on the Clinician Administered PTSD Scale and the PTSD Checklist-Military version for both groups. Also consistent with our hypothesis, significant decreases in social isolation occurred only for those participants who received the TMT group component. There were significant decreases for depression and anger for both groups, although these occurred after VRET and before group treatment. All treatment gains were maintained six-months later. Although not part of the original hypotheses, sleep was not improved by either intervention and remained problematic. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest that VRET alone does not result in optimal treatment outcomes across domains associated with PTSD.



http://ift.tt/2xtJFJc