Head and Neck Diseases by Alexandros G.Sfakianakis: 11/02/17

Πέμπτη 2 Νοεμβρίου 2017

Orthopaedic implant materials drive M1 macrophage polarization in a Spleen Tyrosine Kinase- and Mitogen-Activated Protein Kinase-dependent manner.

Publication date: Available online 2 November 2017
Source:Acta Biomaterialia
Author(s): Olwyn R. Mahon, Sarah O'Hanlon, Clare Cunningham, Geraldine M McCarthy, Christopher Hobbs, Valeria Nicolosi, Daniel J. Kelly, Aisling Dunne
Total joint replacements (TJR) are costly procedures required to relieve pain and restore function in patients suffering from end-stage arthritis. Despite great progress in the development and durability of TJRs, the generation of prosthesis-associated wear particles over time leads to an inflammatory cascade which culminates in periprosthetic osteolysis. Studies suggest that wear particles drive the polarization/differentiation of immature macrophages towards a pro-inflammatory M1 phenotype rather than an anti-inflammatory M2 phenotype associated with normal bone and wound healing. This, in turn, contributes to the initiation of peri-implant inflammation. As a result, modulating M1 macrophage cytokine production has been recognised as a viable therapeutic option. The aim of this study was to examine the impact of hydroxyapatite (HA) and poly(methyl methacrylate) (PMMA) particles on human macrophage polarization by comparing their effect on M1/M2-associated gene expression using real-time PCR. Furthermore, using immunoblotting to assess kinase activation, we sought to identify the intracellular signalling molecules activated by PMMA/HA particles and to determine whether pharmacological blockade of these molecules impacts on macrophage phenotype and cytokine production as measured by ELISA. We report that wear particles preferentially polarize macrophages towards an M1 phenotype, an effect that is dependent on activation of the membrane proximal kinase, Syk and members of the mitogen-activated protein kinase (MAPK) family of signalling molecules. Pre-treatment of macrophages with Syk inhibitors (R788/piceatannol) or MAPK inhibitors (SB203580 and PD98059), not only prevents M1 polarization, but also attenuates production of key pro-inflammatory mediators that have been specifically implicated in periprosthetic osteolysis and osteoclast differentiation.Statement of SignificanceIt is now well established that wear-debris particles from implanted materials drive deleterious inflammatory responses which can eventually lead to implant loosening. In this study, we provide further insight into the specific cellular pathways activated by wear particles in primary human immune cells. We demonstrate that PMMA bone cement and hydroxyapatite, a commonly used biomaterial, drive the polarization of macrophages towards an inflammatory phenotype and identify the specific signalling molecules that are activated in this process. Pre-treatment of macrophages with pharmacological inhibitors of these molecules in turn prevents macrophage polarization and dampens inflammatory cytokine production. Hence these signalling molecules represent potential therapeutic targets to treat or possibly prevent particulate induced osteolysis.

Graphical abstract

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Regarding complications following completion lymphadenectomy

Publication date: Available online 2 November 2017
Source:European Journal of Surgical Oncology
Author(s): Mark B. Faries, Alistair J. Cochran, John F. Thompson

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Performance and microbial characteristics of biomass in a full-scale aerobic granular sludge wastewater treatment plant

Abstract

By modification of the operational conditions of batch reactors, a municipal wastewater treatment plant was upgraded from activated sludge to aerobic granular sludge (AGS) technology. After upgrading, the volume of the biological reactors was reduced by 30%, but the quality of the effluent substantially improved. The concentration of biomass in the reactors increased twofold; the average biomass yield was 0.6 g MLVSS/g COD, and excess granular sludge was efficiently stabilized in aerobic conditions. Canonical correspondence analysis based on the results of next-generation sequencing showed that the time of adaptation significantly influenced the microbial composition of the granules. In mature granules, the abundance of ammonium-oxidizing bacteria was very low, while the abundance of the nitrite-oxidizing bacteria Nitrospira sp. was 0.5 ± 0.1%. The core genera were Tetrasphaera, Sphingopyxis, Dechloromonas, Flavobacterium, and Ohtaekwangia. Bacteria belonging to these genera produce extracellular polymeric substances, which stabilize granule structure and accumulate phosphorus. The results of this study will be useful for designers of AGS wastewater treatment plants, and molecular data given here provide insight into the ecology of mature aerobic granules from a full-scale facility.

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Advanced scoring method of eco-efficiency in European cities

Abstract

This paper analyzes a set of selected German and French cities' performance in terms of the relative behavior of their eco-efficiencies, computed as the ratio of their gross domestic product (GDP) over their CO₂ emissions. For this analysis, eco-efficiency scores of the selected cities are computed using the data envelopment analysis (DEA) technique, taking the eco-efficiencies as outputs, and the inputs being the energy consumption, the population density, the labor productivity, the resource productivity, and the patents per inhabitant. Once DEA results are analyzed, the Malmquist productivity indexes (MPI) are used to assess the time evolution of the technical efficiency, technological efficiency, and productivity of the cities over the window periods 2000 to 2005 and 2005 to 2008. Some of the main conclusions are that (1) most of the analyzed cities seem to have suboptimal scales, being one of the causes of their inefficiency; (2) there is evidence that high GDP over CO₂ emissions does not imply high eco-efficiency scores, meaning that DEA like approaches are useful to complement more simplistic ranking procedures, pointing out potential inefficiencies at the input levels; (3) efficiencies performed worse during the period 2000–2005 than during the period 2005–2008, suggesting the possibility of corrective actions taken during or at the end of the first period but impacting only on the second period, probably due to an increasing environmental awareness of policymakers and governors; and (4) MPI analysis shows a positive technological evolution of all cities, according to the general technological evolution of the reference cities, reflecting a generalized convergence of most cities to their technological frontier and therefore an evolution in the right direction.

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Rational Approach to Allergy Testing

Allergy testing is commonly used when symptoms of allergic rhinitis are refractory to symptoms and there is potential for treatment with institution of avoidance measures or immunotherapy. Once the decision for testing has been made, the method of testing by either in vivo skin testing by prick/puncture or intradermal testing or in vitro testing of serum-specific IgE is dictated by factors in the clinical history and an informed decision by the patient. Because there is no perfect testing method, understanding the benefits and limitations of each method is important in selecting the best testing option for each patient.

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Clinical Applications of Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is effective for the treatment of allergic rhinitis and allergic asthma in adults and children. In a limited number of studies, SLIT efficacy has been demonstrated for the treatment of food allergy. SLIT has a higher safety profile versus subcutaneous immunotherapy, although some systemic reactions have been reported. Appropriate patient selection, meticulous patient education, and routine follow-up are key for the safe and effective administration of SLIT. With organization and attention to detail, adding SLIT to one's practice can provide a highly valued patient service.

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Sujana S. Chandrasekhar

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Management of Anaphylaxis

Anaphylaxis is a severe systemic reaction that can be managed appropriately with expedient diagnosis and treatment. Intramuscular epinephrine continues to be the mainstay of treatment of anaphylaxis; however, it is still underused in the community and in the medical setting. Further education and counseling of patients and health care providers is required to prevent and manage anaphylaxis successfully. In-office management of anaphylaxis includes training of staff, preparedness with the necessary supplies and medication, and an effective action plan.

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Copyright-Page

Elsevier

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Allergy for the Otolaryngologist

The diagnosis and treatment of allergic disease is an integral part of otolaryngology practice, where care for inflammatory disorders of the nose, sinuses, and upper airway is common. This issue of Otolaryngologic Clinics of North America is designed to bring the practicing otolaryngologist up to date by focusing on where developments have occurred.

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CME Accreditation Page

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Allergy as Part of the Unified Otolaryngologic Practice

The management of allergic disorders is an integral part of the specialty of otolaryngology–head and neck surgery. Its importance in the comprehensive management of the ENT patient has become more and more apparent over time. In 1985, 58% of Otolaryngology residency programs offered no formal training in allergy. That situation had improved by 2006, when 62% of programs had active allergy programs, and the remainder were adding them.1,2

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Allergy for the Otolaryngologist

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Forthcoming Issues

Congenital Vascular Lesions of the Head and Neck

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Rational Approach to Allergy Testing

Clinical Applications of Sublingual Immunotherapy

Sujana S. Chandrasekhar

http://ift.tt/2A2lMcZ

Management of Anaphylaxis

Copyright-Page

Elsevier

http://ift.tt/2A2wvnG

Allergy for the Otolaryngologist

CME Accreditation Page

http://ift.tt/2A1vLiD

Allergy as Part of the Unified Otolaryngologic Practice

Contributors

SUJANA S. CHANDRASEKHAR, MD

http://ift.tt/2A26JQz

Allergy for the Otolaryngologist

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

http://ift.tt/2hzBnKb

Forthcoming Issues

Congenital Vascular Lesions of the Head and Neck

http://ift.tt/2A2p5Rs

Low-level laser therapy prevents endothelial cells from TNF-α/cycloheximide-induced apoptosis

Abstract

Low-level laser therapy (LLLT), widely used in physiotherapy, has been known to enhance wound healing and stimulate cell proliferation, including fibroblast and endothelial cells. Applying LLLT can increase cell proliferation in many kinds of cells including fibroblasts and endothelial cells. However, the protective mechanisms of LLLT on endothelial apoptosis remain unclear. We hypothesized LLLT can protect endothelial cells from inflammation-induced apoptosis. Human endothelial cell line, EA.hy926 cells, and TNF-α/cycloheximide (TNF/CHX) were used to explore the protective effects of LLLT (660 nm) on inflammation-induced endothelial apoptosis. Cell viability, apoptosis, caspase-3/7/8/9 activity, MAPKs signaling, NF-κB activity, and inducible/endothelial nitric oxide synthase (iNOS/eNOS) expression were measured. Our results showed that LLLT increased EA.hy926 cell proliferation, attenuated the TNF/CHX-induced apoptosis, and reduced the TNF/CHX-mediated caspase-3/7/8/9 activation. In addition, LLLT increased ERK MAPK phosphorylation and suppressed the TNF/CHX-increased p38 MAPK, JNK, IKK phosphorylation, NF-κB translocation, and iNOS expression. The caspases-3 cleavage and cell death were not increased in cells treating with ERK inhibitor U0126, which implicated that ERK is not to be responsible for the protective effects of LLLT. After treating with p38 mitogen-activated protein kinase (MAPK) activator, the protection of LLLT in cell apoptosis was no longer existed, showing that LLLT protected the endothelial cells by suppressing p38 MAPK signaling. Our results provide a new insight into the possible molecular mechanisms in which LLLT protects against inflammatory-induced endothelial dysfunction.

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Editorial Board/Aims & Scope

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Reconstruction Special Edition, Issue 1

The following four articles are the first part of a special series highlighting important aspects of Head and Neck Reconstruction. These peer-reviewed papers are grouped into four different categories: 1) Quality and Value; 2) Uncommon but versatile microvascular free flaps 3) Subsite reconstruction; and 4) Perioperative considerations.

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Reflections: Paul Bernard Chretien, MD (1931-2017)

The field of head and neck oncology and tumor immunology has lost one of its giants. Paul B. Chretien, MD died peacefully at home in Rockville, Maryland on August 16th, 2017 at age 86 after a prolonged decline in health. He was a true pioneer of head and neck tumor immunology and in the early 1970's, adapted the emerging discoveries of the differing immune functions of T and B lymphocytes to the study of head and neck cancer patients. Working at the National Cancer Institute Surgery Branch as a Senior Investigator (1966-1972), and Chief of the Tumor Immunology Section (1972-1980), he was the first to characterize deficiencies in T lymphocyte numbers and function in patients with head and neck cancer.

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A high ratio of IL-12Rβ2-positive tumor-infiltrating lymphocytes indicates favorable prognosis in laryngeal cancer

An estimated 13,430 newly diagnosed laryngeal cancer (LC) cases and 3620 deaths were in the U.S in 2016 [1], while the National Central Cancer Registry of China Report showed that about 26,400 new LC cases and 14,500 cancer deaths occurred in China in 2015, with increasing incidence and mortality in recent years [2]. In LC, tumor-infiltrating lymphocytes (TILs) are frequently found [3], and various laryngeal TILs and cytokines integrate with the immune system to either kill or promote tumors and thereby have roles in the elimination, equilibrium, and escape phases of cancer immunoediting and tumor progression [4,5].

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Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

Head and neck squamous cell carcinoma (HNSCC) represents the sixth most common malignant tumor worldwide, with over 600.000 new cases diagnosed per year [1]. In last 15 years, human papilloma virus (HPV) infection has been recognized to account for a distinct epidemiologic trend occurring mainly in western countries, leading to a rising incidence of oropharyngeal cancer (OPC) particularly in male patients in their 5 th decade of life [2,3]. Next to the pathogenesis of HPV-driven OPC [4], the development of HNSCC is still largely the result of a chronic exposure to tobacco and alcohol – induced field cancerization [5] of the upper aerodigestive mucosal tract.

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Percutaneous endoscopic gastrostomy feeding of locally advanced oro-pharygo-laryngeal cancer patients

Dysphagia is present in 5–57% of patients at the time of head and neck cancer [HNC] diagnosis [1,2], more than half of whom have experienced major weight loss, as a consequence not only of tumor-associated catabolism [3], but also due to tumor size and location itself, and functional limitations in chewing and swallowing [2,4–7].

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The effect of home-based program and outpatient physical therapy in patients with head and neck cancer: A randomized, controlled trial

More than 500,000 cases are diagnosed as head and neck cancer (HNC) annually worldwide [1,2]. In Taiwan, HNC is one of the top five increasing cancers over the past decade and the fifth most common cancer [3]. More than half of the patients with HNC survive more than 5 years [4], but this is accompanied by treatment-related complications and subsequent profound disability [5]. HNC treatments, including surgical dissection, chemotherapy, and radiation therapy, contribute to complications involving shoulder dysfunction, pain in the upper extremities, and physical inactivity [6–9].

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Reconstruction design before tumour resection: A new concept of through-and-through cheek defect reconstruction

Oral cancer is one of the most common cancers in the world and accounts for nearly 3% of all cancers [1–4]. Because of the high prevalence of betel quid chewing and smoking, the incidence of buccal squamous cell carcinoma (BSCC), together with other cancers of the oral cavity, has been increasing in China and other regions and countries of Asia [5]. Surgery is still the most important treatment modality [5–8]. Due to the anatomic complexity of the oral commissure and cheek, the result of tumour excision in this area is a great challenge to plastic surgeons.

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Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution

Mucosal melanoma is a rare malignant neoplasm, accounting for only 0.8–3.7% of all melanomas [1,2]. The most common site of mucosal melanoma is the upper aerodigestive tract, which accounts for 55% of all cases [1]. Several studies have reported that MMHN is more common in some parts of African countries and Japan than in Western countries [3,4]. The most common primary sites of MMHN are the sinonasal cavity and oral cavity. Although rare, MMHN is a very aggressive malignancy, with 5-year OS ranges from 20% to 40% [5–8].

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A pilot study of Merkel cell polyomavirus in squamous cell carcinoma of the tongue

The oral tongue and the floor of the mouth are the most common sites of squamous cell carcinoma (SCC) within the oral cavity, accounting for more than 50% of cases [1,2]. The increasing incidence of oral tongue SCC in young patients (ages 20–44years) who have a lower incidence and duration of tobacco and alcohol exposure suggests that genetic, environmental or viral factors may contribute to the pathogenesis of oral tongue SCC [3–6]. The tongue has a significantly different histologic makeup with a rich lymphatic supply compared to the other areas of the oral cavity.

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Synchronous, bilateral tonsillar carcinomas: Patient characteristics and human papillomavirus genotypes

The incidence of oropharyngeal squamous cell carcinomas (OPSCCs) is increasing in the Western world [1–3]. The increase is primarily driven by increasing numbers of human papillomavirus positive (HPV+) OPSCCs [1–3]. The subgroup of patients with HPV+ OPSCC has markedly better overall and progression-free survival than HPV-negative (HPV−) patients [4].

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The incidence and management of non-head and neck incidentalomas for the head and neck surgeon

A wide variety of imaging studies are employed for the staging or follow-up of head and neck cancer patients. It is not uncommon to encounter incidental findings outside of the head and neck region. Some of these "incidentalomas" (INs) represent distant metastatic disease, separate malignancies or non-malignant processes that can have significant clinical consequences if left untreated.

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Liquid biopsy: An emerging prognostic and predictive tool in Head and Neck Squamous Cell Carcinoma (HNSCC). Focus on Circulating Tumor Cells (CTCs)

Head and Neck Squamous Cell Carcinoma (HNSCC) is sixth most common malignancy worldwide, accounting for approximately 6% of all cases and is responsible for an estimated 1–2% of all cancer deaths [1]. HNSCC has been historically associated with tobacco and alcohol use; however, in the past decade, infection with high-risk human papillomaviruses (HPV) and especially type 16 has been implicated in the pathogenesis of a subset of HNSCCs, mainly those arising from the oropharynx. HPV-associated oropharyngeal cancer represents a distinct biological and clinical entity with a more favorable prognosis [2,3].

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40-year incidence trends for oropharyngeal squamous cell carcinoma in the United States

There were an estimated 61,760 incident cases of head and neck cancer (oral cavity, pharynx, oral cavity, and larynx) in the United States in 2016, accounting for about 3.7% of all new cancer cases [1]. Among oral cavity and pharynx cancer, oral cavity cancer rates are decreasing mostly due to decreases in smoking and alcohol use [2,3]. However, cancers of the base of tongue, tonsil, and oropharynx (oropharyngeal cancer) are increasing because of increases in human papillomavirus (HPV) infection.

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A failure-type specific risk prediction tool for selection of head-and-neck cancer patients for experimental treatments

Head-and-neck squamous cell carcinoma carcinoma (HNSCC) is a disease where the prognosis varies substantially between patients. Human papilloma virus (HPV) positive oropharyngeal carcinoma is, in relative terms, a favorable subtype with a 3-year overall survival (OS) of around 80% [1]. It has been suggested that treatment de-intensification would be possible in this group without compromising the treatment effect, and several such studies are ongoing [2]. This begs the question whether we can identify subset of HPV positive patients where de-intensification may be detrimental for long term survival due to a – for the group – unfavorable disease characteristics.

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Prognostic value of c-MET in head and neck cancer: A systematic review and meta-analysis of aggregate data

Squamous cell carcinoma of the head and neck (SCCHN), affecting the lips, oral cavity, pharynx, and larynx, accounts for over 650,000 new cases and 350,000 cancer deaths worldwide each year. While early stage disease is usually amenable to either surgery or radiotherapy, both with curative intents, the majority of patients still present with advanced stages. In the latter category, prognosis remains dismal because recurrences and distant metastases occur frequently, and novel treatment options are urgently needed [1,2].

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Frequent oncogenic BRAF V600E mutation in odontogenic keratocyst

Since the term odontogenic keratocyst (OKC) has been re-classified several times between cyst and tumor due to a debate over biological behaviors and oncogenic mutation of OKC [1,2]. Although a number of treatment methods have been developed in addition to simple enucleation, surgical approaches are often limited owing to the high recurrence of OKC as well as its locally destructive behavior [3]. While many targeted therapeutics for oncogenic mutation have become widely available recently, the molecular background of OKC and non-invasive therapeutic approaches based on oncogenic mutation have not been widely studied.

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Extracapsular extension is associated with worse distant control and progression-free survival in patients with lymph node-positive human papillomavirus-related oropharyngeal carcinoma

The presence of extracapsular extension (ECE) in lymph node-positive head and neck squamous cell carcinoma (HNSCC) leads to poor locoregional control (LRC), distant control (DC) and overall survival (OS) [1–8]. Due to its poor prognosis, histologically identified ECE is an indication for more aggressive adjuvant treatment, with both an increased dose of post-operative radiotherapy (RT) and concurrent chemotherapy [9]. Evidence supporting this approach largely stems from two contemporaneous, separately designed and run, phase III randomized trials, EORTC 22931 and RTOG 95–01, and the meta-analysis of their pooled data [10–12].

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Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer☆

Head and neck cancer (HNC) is common and its frequency is increasing, with over 61,000 cases in the United States per year [1–3]. After definitive treatment, approximately 30–40% will progress [4–6]. Platinum-based systemic chemotherapy is the first treatment for patients with incurable recurrent or metastatic disease. Until recently, no agent has demonstrated efficacy following progression after standard platinum-based regimens, with most data suggesting a median survival of 5–6months regardless of regimen [7–9].

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Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy

Salivary duct carcinoma (SDC) was originally described by Kleinsasser and colleagues in 1968 as a salivary malignancy that histologically resembles ductal carcinoma of the breast [1]. It occurs more commonly in the parotid gland than in the submandibular or minor salivary glands [2–6]. SDC has a propensity to metastasize early to regional lymph nodes and distant sites, as well as a high rate of recurrence [3–5,7–12]. The mainstay of therapy includes surgery and radiation; use of systemic therapy has been explored in some case series and small clinical trials [9,13,14].

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A study on diffusion and kurtosis features of cervical cancer based on non-Gaussian diffusion weighted model

Publication date: Available online 2 November 2017
Source:Magnetic Resonance Imaging
Author(s): Panying Wang, Deepa Thapa, Guangyao Wu, Qunqi Sun, Hongbing Cai, Fei Tuo
ObjectiveTo explore the diffusion and kurtosis features of cervical cancer (CC) and study the feasibility of diffusion kurtosis imaging (DKI) based on the non-Gaussian diffusion-weighted model to differentiate the stage and grade of CC.MethodsA total of 50 patients with pathologically confirmed CC were enrolled. MRI examinations including DKI (with 5b values 200, 500, 1000, 1500, and 2000smm⁻² were performed before any treatment. The apparent coefficient (Dapp) and the apparent kurtosis value (Kapp) were derived from the non-gaussian diffusion model, and the apparent diffusion coefficient (ADC) was derived from the Gaussian model. The parameters of CC and normal tissue (myometrium) were obtained, analyzed statistically, and evaluated with respect to differentiating stage and grade between the tissue and the CC.ResultsADC and Dapp values of CC were significantly lower than that of the normal myometrium (P=0.024 and P<0.001, respectively), while the Kapp value was not found to exhibit a significant difference. Compared to the well/moderately differentiated CC, poorly differentiated CC had a significantly decreased mean ADC and Dapp (P=0.018 and P=0.026, respectively); however, the mean Kapp (P=0.035) increased significantly. In the clinical staging, the DKI sequence was advantageous over conventional MRI sequences (degree of accuracy: 90% vs. 74%), Although in the quantitative analysis, these parameters did not show a significant difference.ConclusionsThe pilot study demonstrated that these diffusion and kurtosis indices from DKI based on the non-Gaussian diffusion-weighted model putatively differentiated the grade and stage of CC.

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Synthesis, nature and utility of universal iron chelator − siderophore: a review

Publication date: Available online 1 November 2017
Source:Microbiological Research
Author(s): Azmi Khan, Pratika Singh, Amrita Srivastava
Siderophores, the secondary metabolite of various microorganisms are ferric ion specific chelators secreted under iron stressed condition. These non-ribosomal peptides have been classified as catecholate, hydroxamate, carboxylate and mixed types. Recent studies focus on discovery of possible mammalian siderophores. The biosynthesis pathway including non-ribosomal dependent as well as non-ribosomal independent pathways are of great interest now a days. Many significant roles of siderophores such as virulence in pathogens, oxidative stress tolerance, classification of organisms etc. are being discovered. Studies on siderophore utilization in bioremediation and other heavy metal chelation have increased in past decade. The iron chelation ability of siderophores is being recently studied with regards to malignant cancerous cells. Not only this, it has been found that they possess antimicrobial properties which can be utilized against number of microbes. This review covers all recent aspects of siderophore and its applications.

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And yet it moves: Recovery of volitional control after spinal cord injury

Publication date: Available online 1 November 2017
Source:Progress in Neurobiology
Author(s): G. Taccola, D. Sayenko, P. Gad, Y.P. Gerasimenko, V.R. Edgerton
Preclinical and clinical neurophysiological and neurorehabilitation research has generated rather surprising levels of recovery of volitional sensory-motor function in persons with chronic motor paralysis following a spinal cord injury. The key factor in this recovery is largely activity-dependent plasticity of spinal and supraspinal networks. This key factor can be triggered by neuromodulation of these networks with electrical and pharmacological interventions. This review addresses some of the systems-level physiological mechanisms that might explain the effects of electrical modulation and how repetitive training facilitates the recovery of volitional motor control. In particular, we substantiate the hypotheses that: (1) in the majority of spinal lesions, a critical number and type of neurons in the region of the injury survive, but cannot conduct action potentials, and thus are electrically non-responsive; (2) these neuronal networks within the lesioned area can be neuromodulated to a transformed state of electrical competency; (3) these two factors enable the potential for extensive activity-dependent reorganization of neuronal networks in the spinal cord and brain, and (4) propriospinal networks play a critical role in driving this activity-dependent reorganization after injury. Real-time proprioceptive input to spinal networks provides the template for reorganization of spinal networks that play a leading role in the level of coordination of motor pools required to perform a given functional task. Repetitive exposure of multi-segmental sensory-motor networks to the dynamics of task-specific sensory input as occurs with repetitive training can functionally reshape spinal and supraspinal connectivity thus re-enabling one to perform complex motor tasks, even years post injury.

Graphical abstract

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Genioglossus muscle advancement and simultaneous sliding genioplasty in the management of sleep apnoea

Genioglossus muscle advancement (GMA) was reported in 1993 as an option for the surgical treatment of obstructive sleep apnoea syndrome (OSAS), in the context of phase I of the Stanford University (Powell–Riley) protocol. The rationale for this technique is the placement of tension on the base of the tongue, thus preventing the tongue from falling back into the posterior airway space. However, in retrognathic patients undergoing phase I of the Stanford University protocol, an additional genioplasty will provide a better aesthetic outcome.

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Fluctuating asymmetry of the normal facial skeleton

The purpose of this study was to produce reliable estimations of fluctuating facial asymmetry in a normal population. Fifty-four computed tomography (CT) facial models of average-looking and symmetrical Chinese subjects with a class I occlusion were used in this study. Eleven midline landmarks and 12 pairs of bilateral landmarks were digitized. The repeatability of the landmark digitization was first evaluated. A Procrustes analysis was then used to measure the fluctuating asymmetry of each CT model, after all of the models had been scaled to the average face size of the study sample.

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Changes in condylar volume and joint spaces after orthognathic surgery

The aim of this study was to evaluate the changes in condylar volume and joint spaces occurring in patients undergoing bimaxillary orthognathic surgery for the treatment of class II deformities, by means of cone beam computed tomography (CBCT). Initial and follow-up (at least 6 months) CBCT examinations of 114 condyles (57 patients) were studied retrospectively. Linear measurements of the joint space and volumetric analysis of changes in condylar volume were performed using Dolphin 3D Imaging in association with ITK-SNAP 3.0.0 segmentation software.

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On the tracks of sandarac, review and chemical analysis

Abstract

The sandarac resin (Tetraclinis articulata) has been long used for its properties, mostly as a varnish component. Called juniper resin until the nineteenth century, the real botanical origin of sandarac is still unclear. The first approach to this issue is the review of the evolution of the etymology, terminology, and botanical description of sandarac through time. It seems that sandarac was mainly coming from T. articulata but the use of some juniper resins before the twentieth century is not to be excluded. The second approach is a chemical one; we used gas chromatography coupled to mass spectrometry to characterise the resin. As sandarac was the main component of the famous Italian varnish Vernice liquida, its characterisation is important for old paintings studies. However, although we could hope to differentiate sandarac, Juniperus communis and Juniperus oxycedrus resins by looking at their chemical composition, it appears that these resins are very similar. Besides, we notice a lack of old varnishes containing sandarac which complicates our work.

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A facilitated diffusion mechanism establishes the Drosophila Dorsal gradient [RESEARCH ARTICLE]

Sophia N. Carrell, Michael D. O'Connell, Thomas Jacobsen, Amy E. Allen, Stephanie M. Smith, and Gregory T. Reeves

The transcription factor NF-B plays an important role in the immune system, apoptosis, and inflammation. Dorsal, a Drosophila homolog of NF-B, patterns the dorsal-ventral axis in the blastoderm embryo. During this stage, Dorsal is sequestered outside the nucleus by the IB homolog Cactus. Toll signaling on the ventral side breaks the Dorsal/Cactus complex, allowing Dorsal to enter the nucleus to regulate target genes. Fluorescent data show that Dorsal accumulates on the ventral side of the syncytial blastoderm. Here we use both modeling and experiment to show that this accumulation is due to facilitated diffusion, or shuttling, of Dorsal/Cactus complex. We also show that active Toll receptors are limiting in wildtype embryos, which is a key factor in explaining global Dorsal gradient formation. Our results suggest that shuttling is necessary for viability of embryos from mothers with compromised dorsal levels. Therefore, Cactus not only has the primary role of regulating Dorsal nuclear import, but also a secondary role in shuttling. Given that this mechanism has been found in other, independent systems, we suggest it may be more prevalent than previously thought.

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Chlorination disinfection by-products and comparative cost analysis of chlorination and UV disinfection in sewage treatment plants: Indian scenario

Abstract

Apart from numerous other well-known drawbacks of chlorination, viz. on-site operational hazards and residual chlorine toxicity, trihalomethane (THM) formation is the major factor that came into limelight in the last 40 years, primarily in drinking water treatment industry. Treated effluent from wastewater treatment plants is also chlorinated and then discharged, indirectly coming in human contact, so there is need to consider THM as a potable as well as wastewater parameter. In this study, THMs were identified in seven sewage treatment plants (STPs) in North India. STPs were selected based on treatment technology employed, viz., up-flow anaerobic sludge blanket (UASB), activated sludge process (ASP), sequential batch reactor (SBR), and oxidation pond (OP). THM concentrations obtained at all the seven STPs were below BIS standards of drinking water (0–40 μg L⁻¹). UASB plant shows considerably higher concentration of THM. UV followed by chlorination is suggested as an alternative to chlorination. Per million liter per day (MLD) capital and operation and maintenance (O&M) costs of UV disinfection were analyzed revealing decreasing per MLD capital cost of UV with increasing plant capacity. The comparative annual O&M cost analysis of chlorination, dechlorination, and UV disinfection shows that there is up to 63% reduction of the total annual O&M cost by UV in comparison to chlorination, whereas in the case of chlorination followed by dechlorination, total reduction is 71%.

http://ift.tt/2gZgK9A

Historical trends of trace metals in muddy deposit along the Zhejiang coast, East China Sea: response to economic development and hypoxia

Abstract

One sediment core spanning approximately 138 years was taken from the muddy deposits along the Zhejiang coast of the East China Sea, which is located in a hypoxic zone south of the Yangtze River estuary. When the sources of the trace metals in the core were analyzed, the three geochemical sources were identified as lithogenic, anthropogenic, and reductive deposits based on both principal component analysis and the ratios of terrigenous elements. The temporal distribution of the enrichment factor of copper in the sediment core matches the timeline of economic development and national policy in China. The rapid increase in human activity and economic development in the Yangtze River catchment accounts for the enrichment of copper in the sediment core. Based on the vertical distribution of arsenic concentration, the hypoxic zone south of the Yangtze River estuary may have not only existed, but worsened since 1875.

http://ift.tt/2ipolhY

Water quality and resource management in the dairy industry

Abstract

Food industry is one of the most important and fastest growing sectors of economy in Poland. This sector is also characterized by high demand for the resources, particularly for water. Polish food industrial plants consumed 793 hm³ of water in 2014. Dairy branch had a combined 35% share of the above consumption. As shown by the data obtained from the Polish Central Statistical Office, the majority of dairy plants use its own source of water, so this branch is also important water producer in Poland. Water used for dairy industry should meet the requirements of at least drinking water quality, so the factories need to treat the water. This paper analyses the correlations between selected technical process, equipment profiles and water quality, and consumption in two types of dairy factories (DF). The first one DF-1 processes approx. 50,000 L of milk, and the second, DF-2 processes approx. 330,000 L of milk per day. The water taken from the wells needs to be pre-treated because of iron and manganese concentration and due to specific requirements in various industrial processes. As a result of this work, we have managed to propose technological solutions in the context of water consumption rationalization. The proposed solutions aim at improving water and wastewater management by reducing the amount of consumed water by industry.

http://ift.tt/2ipoCkZ

Integrating water quality responses to best management practices in Portugal

Abstract

Nutrient nonpoint pollution has a significant impact on water resources worldwide. The main challenge of this work was to assess the application of best management practices in agricultural land to comply with water quality legislation for surface waters. The Hydrological Simulation Program—FORTRAN was used to evaluate water quality of Ave River in Portugal. Best management practices (infiltration basin) (BMP) were applied to agricultural land (for 3, 6, 9, 12, and 15% area) with removal efficiencies of 50% for fecal coliforms and 30% for nitrogen, phosphorus, and biochemical oxygen demand. The inflow of water quality constituents was reduced for all scenarios, with fecal coliforms achieving the highest reduction between 5.8 and 28.9% and nutrients and biochemical oxygen demand between 2 and 13%. Biochemical oxygen demand and orthophosphates concentrations achieved a good water quality status according to the European Legislation for scenarios of BMP applied to 3 and 12% agricultural area, respectively. Fecal coliform levels in Ave River basin require further treatment to fall below the established value in the abovementioned legislation. This study shows that agricultural watersheds such as Ave basins demand special attention in regard to nonpoint pollution sources effects on water quality and nutrient loads.

http://ift.tt/2gYvG7L

Electric arc furnace (EAF) dust: Application of air classification for improved zinc enrichment in in-plant recycling

Publication date: 10 February 2018
Source:Journal of Cleaner Production, Volume 174
Author(s): C. Lanzerstorfer
Currently, more than half of the electric arc furnace (EAF) dust produced worldwide is still sent to landfill. This dust contains approximately 7.0% of the world Zn production. The other half of the EAF dust is processed pyrometallurgically or hydrometallurgically to recover Zn. The processing costs for EAF dust strongly depend on the Zn concentration. Therefore, several steel mills apply in-plant enrichment of Zn by recycling part of the dust back into the furnace to reduce the specific processing cost for the EAF dust and at the same time decrease the amount of dust that has to be discharged. Separation of EAF dust into size fractions by air classification showed a distinct dependence of the Zn concentration on the particle size with an enrichment of Zn in the fine size fractions and depletion in the coarse fractions. Therefore, in in-plant dust recycling, air classification of the dust could be used to reduce the amount of recycled Zn and dust but still reaching the same Zn concentration in the discharged dust. This would reduce the energy demand for Zn volatilization in the furnace and the required capacity of the dust recycling system.

Graphical abstract

http://ift.tt/2z9tOBA

Contributors

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4

http://ift.tt/2zuJSk8

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4

http://ift.tt/2zdElh3

Forthcoming Issues

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4

http://ift.tt/2ztuyo3

Anesthesia Outside of the Operating Room: The Wild West or the New Frontier?

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Lee A. Fleisher

http://ift.tt/2ze45di

Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross

http://ift.tt/2zeoiPY

Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Wendy L. Gross, Lebron Cooper, Steven Boggs

Teaser

Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested.

http://ift.tt/2ztuvIT

Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Kelly Lebak, Jason Lane, Richard Taus, Hansol Kim, Michael S. Stecker, Michael Hall, Meghan B. Lane-Fall, Mark S. Weiss

Teaser

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non–operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients.

http://ift.tt/2zeoazY

Safety of Non–Operating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Zachary G. Woodward, Richard D. Urman, Karen B. Domino

Teaser

Malpractice claims for non–operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Fewer malpractice claims for NORA occurred than for OR anesthesia as assessed by the relative numbers of in NORA versus OR procedures. The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.

http://ift.tt/2ztupB1

Implementation and Use of Anesthesia Information Management Systems for Non–operating Room Locations

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jason T. Bouhenguel, David A. Preiss, Richard D. Urman

Teaser

Non–operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety.

http://ift.tt/2zdE1il

Monitoring for Nonoperating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Stylianos Voulgarelis, John P. Scott

Teaser

Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring.

http://ift.tt/2ztum8j

Use of Anesthesiology Services in Radiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Hansol Kim, Jason Lane, Rolf Schlichter, Michael S. Stecker, Richard Taus

Teaser

In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non–operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome.

http://ift.tt/2zfYrr9

An Anesthesiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Annie Amin, Jason Lane, Thomas Cutter

Teaser

The advent of radiology image–guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Anesthesiologists play a critical role in optimizing outcome in these patients. Knowledge by anesthesiologists of procedural goals, technology used, and inherit safety concerns of anesthetizing patients in the radiology suite are all critical to patients and proceduralists.

http://ift.tt/2ztue8P

Catheterization Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Paul N. Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak Shah

Teaser

The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.

http://ift.tt/2zstkJH

Anesthesia in the Electrophysiology Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jeff E. Mandel, William G. Stevenson, David S. Frankel

Teaser

The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.

http://ift.tt/2zdV7Nc

Cardioversions and Transthoracic Echocardiography

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Ronak Shah, Elizabeth Zhou

Teaser

Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available.

http://ift.tt/2ztu15x

Copyright

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4

http://ift.tt/2zfuJlV

Anesthesia for Colonoscopy and Lower Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): John Michael Trummel, Vinay Chandrasekhara, Michael L. Kochman

Teaser

Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks. There is no difference in outcome measures based on sedation received.

http://ift.tt/2ztwcWQ

Anesthesia Outside of the Operating Room: The Wild West or the New Frontier?

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Lee A. Fleisher

http://ift.tt/2ze45di

Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross

http://ift.tt/2zstLUl

Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross

http://ift.tt/2zeoiPY

Implementation and Use of Anesthesia Information Management Systems for Non–operating Room Locations

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jason T. Bouhenguel, David A. Preiss, Richard D. Urman

Teaser

Monitoring for Nonoperating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Stylianos Voulgarelis, John P. Scott

Teaser

Use of Anesthesiology Services in Radiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Hansol Kim, Jason Lane, Rolf Schlichter, Michael S. Stecker, Richard Taus

Teaser

A Radiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Sharath K. Bhagavatula, Jason Lane, Paul Shyn

Teaser

Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non–operating room anesthesia team. Collaboration and communication between the radiologist and anesthesiologist are key to safety and excellent patient outcomes.

http://ift.tt/2zdVbMW

Anesthesia in the Electrophysiology Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jeff E. Mandel, William G. Stevenson, David S. Frankel

Teaser

Cardioversions and Transthoracic Echocardiography

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Ronak Shah, Elizabeth Zhou

Teaser

Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Christopher D. Sharp, Ezekiel Tayler, Gregory G. Ginsberg

Teaser

This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. It additionally will address the nuances of endoscopic retrograde cholangiopancreatography and new natural orifice transluminal endoscopic surgery procedures including endoscopic cystgastrostomy and the per-oral endoscopic myotomy procedure.

http://ift.tt/2zdV4B0

Anesthesia for Colonoscopy and Lower Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): John Michael Trummel, Vinay Chandrasekhara, Michael L. Kochman

Teaser

Targeted muscle reinnervation for pain control in an elective transradial amputation

Targeted muscle reinnervation (TMR) is primarily used to transfer residual nerves of the amputated upper limb to reinnervate alternate target muscle groups, for intuitive control of a myoelectric prosthesis. Furthermore, TMR can significantly reduce the incidence of neuropathic and neuroma-related pain compared with conventional amputation techniques, by providing each nerve 'somewhere to go and something to do'.We report the use of TMR in a case of elective transradial amputation for intractable severe chronic post-traumatic and end neuroma limb pain (constant VAS pain score 10/10), 2 years following a severe crush injury to his left hand.

http://ift.tt/2iVMLDM

The liquid facelift: first hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy - a case series of 25 patients

Recently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in non-facial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients.

http://ift.tt/2z9zeMZ

Rapidly growing mycobacteria infections among “cosmetic tourists” returning to the netherlands

Medical tourism for cosmetic surgery is becoming increasingly popular1. Most cosmetic tourists travel to developing parts of the world, such as Latin America and South Asia.2 Cosmetic surgery abroad has advantages such as shorter waiting lists, anonymity and lower costs, combined with a vacation.1-2 Although this seems appealing, it also carries risks.

http://ift.tt/2iWOUyQ

3D graphene-based nanostructured materials as sorbents for cleaning oil spills and for the removal of dyes and miscellaneous pollutants present in water

Abstract

Oil spills over seawater and dye pollutants in water cause economic and environmental damage every year. Among various methods to deal oil spill problems, the use of porous materials has been proven as an effective strategy. In recent years, graphene-based porous sorbents have been synthesized to address the shortcomings associated with conventional sorbents such as their low uptake capacity, slow sorption rate, and non-recyclability. This article reviews the research undertaken to control oil spillage using three-dimensional (3D) graphene-based materials. The use of these materials for removal of dyes and miscellaneous environmental pollutants from water is explored and the application of various multifunctional 3D oil sorbents synthesized by surface modification technique is presented. The future prospects and limitations of these materials as sorbents are also discussed.

http://ift.tt/2AcnOrR

Microarray analysis of lncRNA and mRNA expression profiles in mice with allergic rhinitis

We aimed to identify the effect of lncRNAs in CD4+ T cells on Allergic rhinitis (AR).

http://ift.tt/2iorheA

CORRECTION

http://ift.tt/2zf3lo0

Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis

http://ift.tt/2zs5xcW

Gonadotropin regulation by pulsatile GnRH: Signaling and gene expression

Publication date: Available online 1 November 2017
Source:Molecular and Cellular Endocrinology
Author(s): George A. Stamatiades, Ursula B. Kaiser
The precise orchestration of hormonal regulation at all levels of the hypothalamic-pituitary-gonadal axis is essential for normal reproductive function and fertility. The pulsatile secretion of hypothalamic gonadotropin-releasing hormone (GnRH) stimulates the synthesis and release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by pituitary gonadotropes. GnRH acts by binding to its high affinity seven-transmembrane receptor (GnRHR) on the cell surface of anterior pituitary gonadotropes. Different signaling cascades and transcriptional mechanisms are activated, depending on the variation in GnRH pulse frequency, to stimulate the synthesis and release of FSH and LH. While changes in GnRH pulse frequency may explain some of the differential regulation of FSH and LH, other factors, such as activin, inhibin and sex steroids, also contribute to gonadotropin production. In this review, we focus on the transcriptional regulation of the gonadotropin subunit genes and the signaling pathways activated by pulsatile GnRH.

http://ift.tt/2h9pY6O

Sputum cell interleukin-1 receptor expression level is a marker of airway neutrophilia and airflow obstruction in asthma

Though expression levels of airway type-1, type-2 and type-17 markers are correlated, PLS analysis identifies the IL-1 receptor as predictive of neutrophilic asthma. The IL-1 pathway may be a potential therapeutic target in neutrophilic asthma.

http://ift.tt/2h7IMDE

Role of TWIK-related potassium channel-1 (TREK-1) in chronic rhinosinusitis

TREK-1 constitutively expressed in normal sinus mucosa is down-regulated in inflammatory sinus mucosa where it may be involved in defective epithelial and endothelial barrier integrity. These results suggest that TREK-1 activating compounds may be used therapeutically to maintain the epithelial and endothelial barrier integrity in chronic rhinosinusitis.

http://ift.tt/2z9Wi0g

Ectopic Lymphoid Tissues Support Local Immunoglobulin Production in Chronic Rhinosinusitis with Nasal Polyps

The contribution of ectopic lymphoid tissues (eLTs) to local immunoglobulin (Ig) hyperproduction in chronic rhinosinusitis with nasal polyps (CRSwNP) is unclear.

http://ift.tt/2h8u1As

Inhibition of ABCC4 potentiates combination beta agonist and glucocorticoid responses in human airway epithelial cells

ABCC4 inhibition potentiates cAMP signaling and the effect of glucocorticoids at the genomic and functional level, with implications for future asthma management.

http://ift.tt/2z8yPN1

Optimization of Peptide-based Polyagonists for Treatment of Diabetes and Obesity

Publication date: Available online 2 November 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Patrick Knerr, Brian Finan, Vasily Gelfanov, Diego Perez-Tilve, Matthias H. Tschöp, Richard D. DiMarchi

Graphical abstract

http://ift.tt/2iqgPU6

Treatment of seasonal allergic rhinitis

Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappreciated health burden for individuals and society (see Burden of Disease section). Guidelines to improve care for patients with AR have been evolving in an effort to respond to the introduction of new treatment approaches, to address the availability of additional studies that compare treatment options, and to incorporate the use of more standardized, evidence-based medicine methods to analyze data and make recommendations.

http://ift.tt/2iVEiAp

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

Severe asthma poses significant disease-related and economic burdens in the United States. Challenges in practice include how to define "severe asthma" for a given patient, knowing which are the right tests to perform and when, and having a better understanding of a patient's asthma phenotype. Furthermore, current guidelines do not address a clear, practical approach to treatment that is based on a patient's asthma phenotype.

http://ift.tt/2zbbt7g

American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists

The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians.

http://ift.tt/2A2mIxX

Allergy and immunology practice parameters and guidelines

It's spring break, and you're seeing a college student who has a history of moderate-to-severe spring and summer rhinoconjunctivitis. Skin testing shows remarkable wheal and flare reactions to tree and grass pollens. In addition to recommending aeroallergen avoidance measures, which initial treatment has the highest likelihood of helping this patient: intranasal corticosteroid monotherapy or intranasal corticosteroid combined with intranasal antihistamine? Previous practice parameters tended to outline treatments with good evidence of effectiveness, but they rarely provided specific recommendations for these types of questions.

http://ift.tt/2A1tO5D

P236 Comorbidities associated with poor short-acting beta-agonist inhaler handling among united states respiratory patients

Short-acting beta-agonists (SABA), in asthma and chronic obstructive pulmonary disease (COPD) are commonly administered using pressurized metered-dose inhalers (pMDI). Hand-breath coordination is a common challenge with pMDIs demonstrated to result in worse outcomes. This study evaluated the prevalence of comorbidities potentially affecting device handling in asthma and/or COPD patients using SABAs, including albuterol multidose dry powder inhaler (MDPI), the only MDPI not requiring hand-breath coordination.

http://ift.tt/2hAi4Ap

Treatment of seasonal allergic rhinitis

Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma

American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists

Allergy and immunology practice parameters and guidelines

P236 Comorbidities associated with poor short-acting beta-agonist inhaler handling among united states respiratory patients

Reliability and Validity of Speech Evaluation in Adductor Spasmodic Dysphonia: Common Mistake and Statistical Issues

I was interested to read the paper by Yanagida et al published in Journal of Voice on August 2017.1 The purposes of the authors were to evaluate speech in patients with adductor spasmodic dysphonia (ADSD) by perceptual evaluations and acoustic measures, and to examine the reliability and validity of these measures.1 Twenty-four patients with ADSD and 24 healthy volunteers were included in the study. Speech materials consisted of three sentences constructed from serial voiced syllables to elicit abductor voice breaks.

http://ift.tt/2AcsAFR

Parameters and Scales Used to Assess and Report Findings From Stroboscopy: A Systematic Review

Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies.

http://ift.tt/2xSN1FW

Examining the bleeding incidences associated with targeted therapies used in metastatic renal cell carcinoma

Publication date: Available online 1 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): MacKenzie Crist, Elizabeth Hansen, Lipika Chablani, Elizabeth Guancial
A systematic review was conducted to illustrate the bleeding risks associated with targeted therapies used in the treatment of metastatic renal cell carcinoma (mRCC). Eligible studies included phase II, III, or IV clinical trials using pazopanib, sunitinib, cabozantinib, lenvatinib, everolimus, temsirolimus, bevacizumab, axitinib, and/or sorafenib in the setting of mRCC. Types of bleeding event(s), bleeding event frequency, and incidence of thrombocytopenia were collected from the relevant articles. ClinicalTrials.gov was also searched for incidence of "Serious bleeding adverse effects" reported in these trials. The incidences of bleeding events ranged from 1 to 36%, and incidences of thrombocytopenia ranged from 2 to 78%. Available serious bleeding adverse events ranged from 1 to 7%. The highest percentage of bleeding incidences were seen with bevacizumab, while the lowest percentage of bleeding incidences were seen with axitinib. All of the included trials were of high quality per Jadad scoring.

http://ift.tt/2ypXL34

Enzymatic dynamics into the Eisenia fetida (Savigny, 1826) gut during vermicomposting of coffee husk and market waste in a tropical environment

Abstract

Epigeic worms modify microbial communities through their digestive processes, thereby influencing the decomposition of organic matter in vermicomposting systems. Nevertheless, the enzyme dynamics within the gut of tropically adapted earthworms is unknown, and the enzymes involved have not been simultaneously studied. The activities of 19 hydrolytic enzymes within three different sections of the intestine of Eisenia fetida were determined over a fasting period and at 24 h and 30, 60, and 90 days of vermicomposting, and data were evaluated by multivariate analyses. There were found positive correlations between the maximal activity of glycosyl hydrolases and one esterase with the anterior intestine (coincident with the reduction of hemicellulose in the substrate) and the activity of the protease α-chymotrypsin with posterior intestine. The results suggest that activities of enzymes change in a coordinated manner within each gut section, probably influenced by selective microbial enzyme enrichment and by the availability of nutrients throughout vermicomposting.

http://ift.tt/2h7zGH2

Ovarian growth impairment after chronic exposure to Roundup Ultramax® in the estuarine crab Neohelice granulata

Abstract

Adult females of the estuarine crab Neohelice granulata were exposed to the glyphosate formulation Roundup Ultramax® during the entire 3-month pre-reproductive period. At the end of the assay, a significant higher increment of glycemia was noted at both glyphosate concentrations assayed (0.01 and 0.2 mg/L, acid equivalent). Although no differences were observed in the gonadosomatic index, a significantly higher proportion of reabsorbed vitellogenic oocyte was observed at the highest glyphosate concentration, together with a significant decrease of vitellogenin content in the ovary. In addition, some in vitro assays were carried out by co-incubating small pieces of ovary with or without the addition of Roundup; at both concentrations tested (same as those used in vivo), a decrease in the ovarian vitellogenin content was observed, whereas the ovarian protein synthesis was significantly inhibited by glyphosate at 0.2 mg/L in the Roundup formulation used.

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Literature Commentary.

In this issue of Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD and Mark L. Moster, MD will discuss the following 6 articles: 1. Davoudi S, Ebrahimiadib N, Yasa C, Sevgi DD, Roohipoor R, Papavasilieou E, Comander J, Sobrin L. Outcomes in autoimmune retinopathy patients treated with rituximab. Am J Ophthalmol. 2017;180:124-132. 2. Metz LM, Li DKB, Traboulsee AL, Duquette P, Eliasziw M, Cerchiaro G, Greenfield J, Riddehough A, Yeung M, Kremenchutzky M, Vorobeychik G, Freedman MS, Bhan V, Blevins G, Marriott JJ, Grand'Maison F, Lee L, Thibault M, Hill MD, Yong VW; Minocycline in MS Study Team. Trial of minocycline in a clinically isolated syndrome of multiple sclerosis. N Engl J Med. 2017;376:2122-2133. 3. Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I; Movement Disorder Society-Endorsed PSP Study Group. Clinical diagnosis of progressive supranuclear palsy: the movement disorder society criteria. Mov Disord. 2017;32:853-864. 4. Sodhi M, Sheldon CA, Carleton B, Etminan M. Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: nested case-control study. Neurology. 2017;89:792-795. 5. Suzuki S, Ishikawa N, Konoeda F, Seki N, Fukushima S, Takahashi K, Uhara H, Hasegawa Y, Inomata S, Otani Y, Yokota K, Hirose T, Tanaka R, Suzuki N, Matsui M. Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan. Neurology. 2017;89:1127-1134. 6. Hennes EM, Baumann M, Schanda K, Anlar B, Bajer-Kornek B, Blaschek A, Brantner-Inthaler S, Diepold K, Eisenkolbl A, Gotwald T, Kuchukhidze G, Gruber-Sedlmayr U, Hausler M, Hoftberger R, Karenfort M, Klein A, Koch J, Kraus V, Lechner C, Leiz S, Leypoldt F, Mader S, Marquard K, Poggenburg I, Pohl D, Pritsch M, Raucherzauner M, Schimmel M, Thiels C, Tibussek D, Vieker S, Zeches C, Berger T, Reindl M, Rostasy K; BIOMARKER Study Group. Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome. Neurology. 2017;89:900-908. (C) 2017 by North American Neuro-Ophthalmology Society

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EUNOS Meeting, September 10-13, 2017, Budapest, Hungary.

No abstract available

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The Optic Disc Drusen Studies Consortium Recommendations for Diagnosis of Optic Disc Drusen Using Optical Coherence Tomography.

Background: Making an accurate diagnosis of optic disc drusen (ODD) is important as part of the work-up for possible life-threatening optic disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) has improved the visualization of more deeply buried ODD. There is, however, no consensus regarding the diagnosis of ODD using OCT. The purpose of this study was to develop a consensus recommendation for diagnosing ODD using OCT. Methods: The members of the Optic Disc Drusen Studies (ODDS) Consortium are either fellowship trained neuro-ophthalmologists with an interest in ODD, or researchers with an interest in ODD. Four standardization steps were performed by the consortium members with a focus on both image acquisition and diagnosis of ODD. Results: Based on prior knowledge and experiences from the standardization steps, the ODDS Consortium reached a consensus regarding OCT acquisition and diagnosis of ODD. The recommendations from the ODDS Consortium include scanning protocol, data selection, data analysis, and nomenclature. Conclusions: The ODDS Consortium recommendations are important in the process of establishing a reliable and consistent diagnosis of ODD using OCT for both clinicians and researchers. (C) 2017 by North American Neuro-Ophthalmology Society

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Predictive and prognostic potential of volume-based metabolic variables obtained by a baseline 18F-FDG PET/CT in breast cancer with neoadjuvant chemotherapy indication

Publication date: Available online 2 November 2017
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): A.M. Garcia-Vicente, J. Pérez-Beteta, M. Amo-Salas, D. Molina, G.A. Jimenez-Londoño, A.M. Soriano-Castrejón, F.J. Pena Pardo, A. Martínez-González
AimTo investigate the usefulness of metabolic variables using ¹⁸F-FDG PET/CT in the prediction of neoadjuvant chemotherapy (NC) response and the prognosis in locally advanced breast cancer (LABC).Materials and methodsProspective study including 67 patients with LABC, NC indication and a baseline ¹⁸F-FDG PET/CT. After breast tumor segmentation, SUV variables (SUVmax, SUVmean and SUVpeak) and volume-based variables, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were obtained. Tumors were grouped into molecular phenotypes, and classified as responders or non-responders after completion of NC. Disease-free status (DFs), disease-free survival (DFS), and overall survival (OS) were assessed. A univariate and multivariate analysis was performed to study the potential of all variables to predict DFs, DFS, and OS.ResultsFourteen patients were classified as responders. Median±SD of DFS and OS was 43±15 and 46±13 months, respectively. SUV and TLG showed a significant correlation (p<0.005) with the histological response, with higher values in responders compared to non-responders. MTV and TLG showed a significant association with DFs (p=0.015 and p=0.038 respectively). Median, mean and SD of MTV and TLG for patients with DFs were: 8.90, 13.73, 15.10 and 33.78, and 90.54 and 144.64, respectively. Median, mean and SD of MTV and TLG for patients with non-DFs were: 16.72, 29.70 and 31.09 and 90.89, 210.98 and 382.80, respectively. No significant relationships were observed with SUV variables and DFs. Volume-based variables were significantly associated with OS and DFS, although in multivariate analysis only MTV was related to OS. No SUV variables showed an association with the prognosis.ConclusionVolume-based metabolic variables obtained with ¹⁸F-FDG PET/CT, unlike SUV based variables, were good predictors of both neoadjuvant chemotherapy response and prognosis.

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Structural basis for the recognition and processing of DNA containing bulky lesions by the mammalian nucleotide excision repair system

Publication date: Available online 2 November 2017
Source:DNA Repair
Author(s): Alexey N. Evdokimov, Alexandra Yu. Tsidulko, Alexander V. Popov, Yury N. Vorobiev, Alexander A. Lomzov, Lyudmila S. Koroleva, Vladimir N. Silnikov, Irina O. Petruseva, Olga I. Lavrik
Mammalian nucleotide excision repair (NER) eliminates the broadest diversity of bulky lesions from DNA with wide specificity. However, the double incision efficiency for structurally different adducts can vary over several orders of magnitude. Therefore, great attention is drawn to the question of the relationship among structural properties of bulky DNA lesions and the rate of damage elimination. This paper studies the properties of several structurally diverse synthetic (model) DNAs containing bulky modifications. Model DNAs have been designed using modified nucleosides (exo-N-{2-N-[N-(4-azido-2,5-difluoro-3-chloropyridin-6-yl)-3-aminopropionyl]aminoethyl}-2′-deoxycytidine (Fap-dC) and 5-{1-[6-(5[6]-fluoresceinylcarbomoyl)hexanoyl]-3-aminoallyl}-2′-deoxyuridine (Flu-dU)) and the nonnucleosidic reagent N-[6-(9-antracenylcarbomoyl)hexanoyl]-3-amino-1,2-propandiol (nAnt). The impact of these lesions on spatial organization and stability of the model DNA was evaluated. Their affinity for the damage sensor XPC was also studied. It was expected, that the values of melting temperature decrease, bending angles and KD values clearly define the row of model DNA substrate properties such as Flu-dU-DNA>>nAnt≈Fap-dC-DNA. Unexpectedly the experimentally estimated levels of the substrate properties were actually in the row: nAnt-DNA>>Flu-dU-DNA>>Fap-dC-DNA. Molecular dynamics simulations have revealed structural and energetic bases for the discrepancies observed. DNA destabilization patterns plotted explain these results on a structural basis in terms of differences in dynamic perturbations of stacking interactions.

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Cathelicidin-WA polarizes E. coli K88-induced M1 macrophage to M2-like macrophage in RAW264.7 cells

Publication date: January 2018
Source:International Immunopharmacology, Volume 54
Author(s): Shan Chen, Zeqing Lu, Fengqin Wang, Yizhen Wang
Immune cells - macrophages induced by E. coli K88 will lead to a pro-inflammatory response, which is important in host defense. Cathelicidin-WA (CWA) is an efficient antimicrobial peptide (AMP) and can exert immunomodulatory properties. Many studies have demonstrated that AMP can modulate cellular subsets but whether CWA can regulate macrophage polarization by transferring E. coli K88-induced M1 macrophage towards M2 one that of anti-inflammation remains unclear. In this study, E. coli K88 increased the expression of pro-inflammatory cytokines interleukin-6, interleukin-1β, tumor necrosis factor-α and chemokine CCL3 in RAW264.7 cells with a time-dependent manner, as well as the expression of reactive oxygen species (ROS) and inducible nitric oxide synthase (iNOS). On this basis, CWA significantly decreased the pro-inflammatory molecules but increased the anti-inflammatory mediators interleukin-4, interleukin-10 and other M2-related genes in E. coli K88-induced macrophages. Western blot analysis indicated that CWA suppressed the expression of TLR-4 and the phosphorylation of STAT1 and NF-κB which modulated M1 macrophage while induced the phosphorylation of STAT6 which activated M2 macrophage. Double staining of M1-specific CD86 and M2-specific CD206 also proved the hypothesis. These results suggested that CWA might dampen the inflammation by modulating M1 phenotype to M2 phenotype in E. coli K88-induced macrophages.

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The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions.

Background and Objectives: Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program data set. The study population was divided into 2 groups: patients undergoing regional anesthesia (RA) and those undergoing GA. The primary end point for our study was 30-day mortality. The secondary end points were return to the operating room, surgical site infections, pulmonary complications, acute kidney injury, urinary tract infection, cardiac arrest, myocardial infarction, perioperative transfusions, thromboembolisms, sepsis, composite measure of postoperative complications, and days from operation to discharge. Results: Twelve thousand seven hundred twenty-three patients were identified. Older patients, white patients, patients with a higher body mass index, patients without dyspnea, patients with independent functional status, smokers, patients with sepsis, and patients with bleeding disorders were associated with receiving GA. Hispanic patients, patients with chronic obstructive pulmonary disease, and patients with congestive heart failure were associated with receiving RA. Our study did not reveal a 30-day mortality difference between RA and GA. Regional anesthesia was associated with a significantly decreased need for perioperative blood transfusions (11.8% vs 16.5%, P

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Challenging Conventions to Make a Difference in Patient Care: The 2017 Gaston Labat Award Lecture.

No abstract available

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Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension.

Purpose of review: To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). Recent findings: Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP. Summary: Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Updates in the management of sinonasal mucosal melanoma.

Purpose of review: Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. Recent findings: In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. Summary: Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The role of frontal sinus drillouts in nasal polyposis.

Purpose of review: Historically, the common frontal sinusotomy has been reserved only for salvage frontal sinus surgery in patients with severely recalcitrant inflammatory sinus disease. By understanding the pathophysiology of inflammatory sinus disease and the long-term role of topical medication in their treatment, the indications for Draf3 have expanded. Recent findings: A major therapeutic impact from endoscopic sinus surgery for inflammatory sinus disease is imparted by allowing sinus access to topical therapies to work. Although traditionally, the Draf3 frontal sinus procedure has been reserved for revision surgery in severe cases, advancements in technology, instrumentation, and techniques has allowed the Draf3 to evolve to efficient and safe procedure, often applied primarily in select patients. There is evidence to support the indication for Draf3 in primary surgery for severe cases. Summary: In inflammatory sinus disease, the goal of endoscopic sinus surgery is to convert the complex and limited frontal sinus outflow tracts into a simple common cavity. This allows for local, topical anti-inflammatory treatments to control the disease. When patients have broader inflammatory airway disease and asthma, the Draf3, as part of a neo-sinus cavity, is commonly applied early in surgical care. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Internal dosimetry of inhaled iodine-131

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Mitra Kiani Nasab, Laleh Rafat Motavalli, Hashem Miri Hakimabad
In this paper, the dose assessment for the iodine inhalation exposure in 19 aerosol sizes and three gas/vapor forms at three levels of thyroid uptake, was performed. Two different modes of work (light vs. heavy) and breathing (nose vs. mouth) for aerosol inhalation were investigated. In order to calculate the cumulated activities per unit of inhaled activity, a combined model which included the latest models of both human respiratory and alimentary tract was developed. The S values for ¹³¹I were computed based on the ICRP adult male and female reference voxel phantoms by the Monte Carlo method. Then, the committed equivalent and committed effective dose coefficients were obtained (The data are available at http://ift.tt/2zgPtKh). In general, for the nonzero thyroid uptakes, the maximum cumulated activity was found in the thyroid. When the thyroid is blocked, however, the maximum depends on the work and breathing mode and radioisotope form. Overall, the maximum CED coefficient was evaluated for the inhalation of elemental iodine at thyroid uptake of ∼27% (2.8 × 10⁻⁸ Sv/Bq). As for the particle inhalation per se, mouth breathing of 0.6 nm and 0.2 μm AMTD particles showed to have the maximum (2.8 × 10⁻⁸ Sv/Bq) and minimum (6.4 × 10⁻⁹ Sv/Bq) CED coefficients, respectively. Compared to the reference CED coefficients, the authors found an increase of about 58% for inhalation of the aerosols with AMAD of 1 μm and 70% for 5 μm.

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Assessment of the calibration of gamma spectrometry systems in forest environments

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Alan J. Cresswell, David C.W. Sanderson, Katsuhiko Yamaguchi
A Monte Carlo simulation was used to develop a model of the response of a portable gamma spectrometry system in forest environments. This model was used to evaluate any corrections needed to measurements of ¹³⁷Cs activity per unit area calibrated assuming an open field geometry. These were shown to be less than 20% for most forest environments. The model was also used to assess the impact of activity in the canopy on ground level measurements. For similar activity per unit area in the lower parts of the canopy as on the ground, 10-25% of the ground based measurement would be due to activity in the canopy, depending on the depth profile in the soil. The model verifies that an optional collimator cap can assess activity in the canopy by repeat survey.

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Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial.

Objectives: Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring. Design: A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up. Results: After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohen's d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention. Conclusions: Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of iCBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required. Registered at clinicaltrials.gov: NCT02370810 on 5/03/2015. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Local allergic rhinitis: evolution of concepts

The discovery of an exclusive local production of IgE antibodies dates back to the 1970s, but only recently the pathophysiology of such phenomenon was deeply investigated, leading to the concept of local aller...

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 2 Νοεμβρίου 2017

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