The importance of dermoscopy for the diagnosis of acquired bilateral telangiectatic macules: the angioid streak pattern reveals underlying chronic liver disease

Abstract

Background

Acquired bilateral telangiectatic macules (ABTM) are a newly recognized disease entity, which manifest as multiple telangiectatic pigmented macules confined mostly to the upper arms.

Objectives

To evaluate clinical and dermoscopic features in a group of 50 patients with ABTM and to determine the diagnostic usefulness of dermoscopy in ABTM

Methods

Patients were selected from two tertiary teaching hospitals in Korea (Pusan National University Hospitals [Busan and Yangsan]). Fifty patients (41 males and 9 females; mean age 48.1 years; range 26-78 years) with ABTM were included in the study. The dermoscopic findings were graded using a 4-point scale: none (0), mild (1), moderate (2), and severe (3). In addition, the results of 23 patients with and 27 patients without chronic liver disease (CLD) were compared to determine whether the presence of CLD affect dermoscopic findings.

Results

Three distinct dermoscopic patterns were observed; brown pigmentations, telangiectasia (linear-irregular vessels) and an angioid streak pattern. Brown pigmentation in the group without CLD had higher severity score than those in CLD group (mean score: 2.00 vs 1.48, P =0.033). However, mean telangiectasia severity score was higher in the CLD group (2.14 vs 1.39, P < 0.001). The angioid streak pattern was more severe and more common in patients with CLD than in those without (1.37 vs 0.35 (P < 0.001) and 63.0% vs. 26.1%, respectively).

Conclusion

Detailed observations with dermoscopy can provide first clues of the presence of ABTM and underlying chronic liver disease.

This article is protected by copyright. All rights reserved.

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Disfiguring facial mycoses- a diagnostic and therapeutic challenge

Some fungal infections may lead to devastating destruction of face, sometimes followed by fatal consequences. Conidiobolus coronatus is a rare, but serious emerging fungal pathogen of humans, causing Conidiobolomycosis, commonly infecting nasal mucosa and with potential to extend to involve vital structures such as brain and eyes. Treatment of this infection is extremely difficult and can cause significant disfiguring sequale, unless aggressively treated. We illustrate an interesting case, encountered within a short space of time affected by such infections and emphasize the need for thorough evaluation, investigation and aggressive initial treatment to achieve a good clinical response.

This article is protected by copyright. All rights reserved.

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Anxiety Sensitivity and Sleep Disturbance: Investigating Associations among Patients with Co-occurring Anxiety and Substance Use Disorders

Publication date: Available online 7 November 2017
Source:Journal of Anxiety Disorders
Author(s): Laura J. Dixon, Aaron A. Lee, Kim L. Gratz, Matthew T. Tull
Sleep disturbance is a common problem among individuals with anxiety and substance use disorders (SUD). Anxiety sensitivity (AS) is elevated in patients with anxiety disorders and SUD and has been linked to sleep-related problems, including insomnia and somnolence (i.e., daytime sleepiness). We examined the unique roles of AS cognitive, physical, and social concerns in sleep disturbance among a sample of 99 residential SUD patients with anxiety disorders. Clinical levels of insomnia or somnolence were evidenced by 53.5% of the sample. Consistent with predictions, AS physical concerns was significantly associated with insomnia, and AS cognitive concerns was significantly related to insomnia and somnolence. Hierarchical linear regression models were conducted to test the association of AS cognitive and physical concerns with insomnia and somnolence symptoms while controlling for relevant factors. AS cognitive concerns accounted for unique variance, above and beyond withdrawal symptoms, anxiety, and depressive symptoms, in the model examining insomnia symptoms (B=0.30, SE=0.13, p=.023). Results suggest that AS cognitive concerns may represent an important transdiagnostic mechanism underlying sleep disturbance among individuals with dual diagnosis.



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Multifunctional pH sensitive 3D scaffolds for treatment and prevention of bone infection

Publication date: Available online 8 November 2017
Source:Acta Biomaterialia
Author(s): Mónica Cicuéndez, Juan C. Doadrio, Ana Hernández, M. Teresa Portolés, Isabel Izquierdo-Barba, María Vallet-Regí
Multifunctional-therapeutic three-dimensional (3D) scaffolds have been prepared. These biomaterials are able to destroy the S. aureus bacterial biofilm and to allow bone regeneration at the same time. The present study is focused on the design of pH sensitive 3D hierarchical meso-macroporous 3D scaffolds based on MGHA nanocomposite formed by a mesostructured glassy network with embedded hydroxyapatite nanoparticles, whose mesopores have been loaded with levofloxacin (Levo) as antibacterial agent. These 3D platforms exhibit controlled and pH-dependent Levo release, sustained over time at physiological pH (7.4) and notably increased at infection pH (6.7 and 5.5), which is due to the different interaction rate between diverse Levo species and the silica matrix. These 3D systems are able to inhibit the S. aureus growth and to destroy the bacterial biofilm without cytotoxic effects on human osteoblasts and allowing an adequate colonization and differentiation of preosteoblastic cells on their surface. These findings suggest promising applications of these hierarchical MGHA nanocomposite 3D scaffolds for the treatment and prevention of bone infection.Statement of significanceMultifunctional 3D nanocomposite scaffolds with the ability for loading and sustained delivery of an antimicrobial agent, to eliminate and prevent bone infection and at the same time to contribute to bone regeneration process without cytotoxic effects on the surrounding tissue has been proposed. These 3D scaffolds exhibit a sustained levofloxacin delivery at physiological pH (pH 7.4), which increasing notably when pH decreases to characteristic values of bone infection process (pH 6.7 and pH 5.5). In vitro competitive assays between preosteoblastic and bacteria onto the 3D scaffold surface demonstrated an adequate osteoblast colonization in entire scaffold surface together with the ability to eliminate bacteria contamination.

Graphical abstract

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Fatigue performance of additively manufactured meta-biomaterials: the effects of topology and material type

Publication date: Available online 8 November 2017
Source:Acta Biomaterialia
Author(s): S.M. Ahmadi, R. Hedayati, Y. Li, K. Lietaert, N. Tümer, A. Fatemi, C.D. Rans, B. Pouran, H. Weinans, A.A. Zadpoor
Additive manufacturing (AM) techniques enable fabrication of bone-mimicking meta-biomaterials with unprecedented combinations of topological, mechanical, and mass transport properties. The mechanical performance of AM meta-biomaterials is a direct function of their topological design. It is, however, not clear to what extent the material type is important in determining the fatigue behavior of such biomaterials. We therefore aimed to determine the isolated and modulated effects of topological design and material type on the fatigue response of metallic meta-biomaterials fabricated with selective laser melting. Towards that end, we designed and additively manufactured Co-Cr meta-biomaterials with three types of repeating unit cells and three to four porosities per type of repeating unit cell. The AM meta-biomaterials were then mechanically tested to obtain their normalized S-N curves. The obtained S-N curves of Co-Cr meta-biomaterials were compared to those of meta-biomaterials with same topological designs but made from other materials, i.e. Ti-6Al-4V, tantalum, and pure titanium, available from our previous studies. We found the material type to be far more important than the topological design in determining the normalized fatigue strength of our AM metallic meta-biomaterials. This is the opposite of what we have found for the quasi-static mechanical properties of the same meta-biomaterials. The effects of material type, manufacturing imperfections, and topological design were different in the high and low cycle fatigue regions. That is likely because the cyclic response of meta-biomaterials depends not only on the static and fatigue strengths of the bulk material but also on other factors that may include strut roughness, distribution of the micro-pores created inside the struts during the AM process, and plasticity.Statement of SignificanceMeta-biomaterials are a special class of metamaterials with unusual or unprecedented combinations of mechanical, physical (e.g. mass transport), and biological properties. Topologically complex and additively manufactured meta-biomaterials have been shown to improve bone regeneration and osseointegration. The mechanical properties of such biomaterials are directly related to their topological design and material type. However, previous studies of such biomaterials have largely neglected the effects of material type, instead focusing on topological design. We show here that neglecting the effects of material type is unjustified. We studied the isolated and combined effects of topological design and material type on the normalized S-N curves of metallic bone-mimicking biomaterials and found them to be more strongly dependent on the material type than topological design.

Graphical abstract

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Surface modifications and oxidative degradation in MPC-grafted highly cross-linked polyethylene liners retrieved from short-term total hip arthroplasty

Publication date: Available online 7 November 2017
Source:Acta Biomaterialia
Author(s): Shine Tone, Masahiro Hasegawa, Leonardo Puppulin, Giuseppe Pezzotti, Akihiro Sudo
Highly cross-linked polyethylene (HXLPE) hip liners grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) on their bearing surfaces have recently been commercialized as components of a new generation of artificial hip joints, while improvements in wear resistance and biocompatibility were reported based on in vitro studies. The present study aimed at evaluating the surface modification and oxidative degradation in short-term retrieved MPC-grafted liners by X-ray photoelectron spectroscopy (XPS), Fourier-transform infrared spectroscopy (FT-IR) with attenuated total reflection (ATR) equipment and Raman spectroscopy. In none of 3 samples of retrieved MPC-grafted liners, detectable MPC graft remained on the bearing surfaces although 2 samples yet contained remains of MPC polymer in their rim zone. These results revealed that the MPC polymer might have quickly disappeared from the bearing surface under in vivo loading, which is more severe than the in vitro one. Furthermore, a detectable oxidation index (OI) value (>0.1) was not only observed in any zone of any sample investigated, but also in the rim zones of Samples 1 and 2, which surprisingly experienced the most remarkable increase in OI value detected in this study. We thus confirmed that: (i) annealing of HXLPE cannot completely remove free radicals; (ii) the MPC graft has no beneficial effect in protecting HXLPE against oxidation and wear; and, (iii) lipid absorption occurred even in the rim zone where the MPC layer remained. Based on these evidences we consider that the declaimed advanced MPC technology is not a suitable one to elongate the in vivo lifetime of hip joints.Statement of significanceSeveral studies reported that highly crosslinked polyethylene (HXLPE) have resulted in reduced wear in total hip arthroplasty. Beyond those studies, HXLPE hip liners grafted with 2-methacryloyloxyethyl phosphorylcholine (MPC) on their bearing surface were extensively studied in vitro and then commercialized as a new generation of artificial hip joints. The present study reports for the first time results about the evaluation of surface modification and oxidative degradation in retrieved the MPC grafted liners. The findings of this investigation clearly show that the MPC layer has been peeled off on the bearing surface of the liner main wear zone although the MPC layer remained on the surface of the rim zones. Furthermore, we assessed the microstructural modifications and the oxidation drifts that occurred in vivo in the hip joints despite the presence of the MPC layer.

Graphical abstract

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Lectin-Conjugated pH-Responsive Mesoporous Silica Nanoparticles for Targeted Bone Cancer Treatment

Publication date: Available online 7 November 2017
Source:Acta Biomaterialia
Author(s): Marina Martínez-Carmona, Daniel Lozano, Montserrat Colilla, María Vallet-Regí
A novel multifunctional nanodevice based in doxorubicin (DOX)-loaded mesoporous silica nanoparticles (MSNs) as nanoplatforms for the assembly of different building blocks has been developed for bone cancer treatment. These building blocks consists of: i) a polyacrylic acid (PAA) capping layer grafted to MSNs via an acid-cleavable acetal linker, to minimize premature cargo release and provide the nanosystem of pH-responsive drug delivery ability; and ii) a targeting ligand, the plant lectin concanavalin A (ConA), able to selectively recognize, bind and internalize owing to certain cell-surface glycans, such as sialic acids (SA), overexpressed in given tumor cells. This multifunctional nanosystem exhibits a noticeable higher internalization degree into human osteosarcoma cells (HOS), overexpressing SA, compared to healthy preosteoblast cells (MC3T3-E1). Moreover, the results indicate that small DOX loading (2.5 µg mL^-1) leads to almost 100% of osteosarcoma cell death in comparison with healthy bone cells, which significantly preserve their viability. Besides, this nanodevice has a cytotoxicity on tumor cells 8-fold higher than that caused by the free drug. These findings demonstrate that the synergistic combination of different building blocks into a unique nanoplatform increases antitumor effectiveness and decreases toxicity towards normal cells. This line of attack opens up new insights in targeted bone cancer therapy.Statement of SignificanceThe development of highly selective and efficient tumor-targeted smart drug delivery nanodevices remains a great challenge in nanomedicine. This work reports the design and optimization of a multifunctional nanosystem based on mesoporous silica nanoparticles (MSNs) featuring selectivity towards human osteosarcoma cells and pH-responsive antitumor drug delivery capability. The novelty and originality of this manuscript relies on proving that the synergistic assembly of different building blocks into a unique nanoplatform increases antitumor effectiveness and decreases toxicity towards healthy cells, which constitutes a new paradigm in targeted bone cancer therapy.

Graphical abstract

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Understanding the structural drivers governing glass – water interactions in borosilicate based model bioactive glasses

Publication date: Available online 7 November 2017
Source:Acta Biomaterialia
Author(s): Nicholas Stone-Weiss, Eric M. Pierce, Randall E. Youngman, Ozgur Gulbiten, Nicholas J. Smith, Jincheng Du, Ashutosh Goel
The past decade has witnessed a significant upsurge in the development of borate and borosilicate based resorbable bioactive glasses owing to their faster degradation rate in comparison to their silicate counterparts. However, due to our lack of understanding about the fundamental science governing the aqueous corrosion of these glasses, most of the borate/borosilicate based bioactive glasses reported in the literature have been designed by "trial–and–error" approach. With an ever-increasing demand for their application in treating a broad spectrum of non-skeletal health problems, it is becoming increasingly difficult to design advanced glass formulations using the same conventional approach. Therefore, a paradigm shift from the "trial–and–error" approach to "materials–by–design" approach is required to develop new-generations of bioactive glasses with controlled release of functional ions tailored for specific patients and disease states, whereby material functions and properties can be predicted from first principles. Realizing this goal, however, requires a thorough understanding of the complex sequence of reactions that control the dissolution kinetics of bioactive glasses and the structural drivers that govern them. While there is a considerable amount of literature published on chemical dissolution behavior and apatite-forming ability of potentially bioactive glasses, the majority of this literature has been produced on silicate glass chemistries using different experimental and measurement protocols. It follows that inter-comparison of different datasets reveals inconsistencies between experimental groups. There are also some major experimental challenges or choices that need to be carefully navigated to unearth the mechanisms governing the chemical degradation behavior and kinetics of boron-containing bioactive glasses, and to accurately determine the composition–structure–property relationships. In order to address these challenges, a simplified borosilicate based model melt-quenched bioactive glass system has been studied to depict the impact of thermal history on its molecular structure and dissolution behavior in water. It has been shown that the methodology of quenching of the glass melt impacts the dissolution rate of the studied glasses by 1.5× to 3× times depending on the changes induced in their molecular structure due to variation in thermal history. Further, a recommendation has been made to study dissolution behavior of bioactive glasses using surface area of the sample – to – volume of solution (SA/V) approach instead of the currently followed mass of sample – to – volume of solution approach. The structural and chemical dissolution data obtained from bioactive glasses following the approach presented in this paper can be used to develop the structural descriptors and potential energy functions over a broad range of bioactive glass compositions.Statement of SignificanceRealizing the goal of designing third generation bioactive glasses requires a thorough understanding of the complex sequence of reactions that control their rate of degradation (in physiological fluids) and the structural drivers that control them. In this article, we have highlighted some major experimental challenges and choices that need to be carefully navigated in order to unearth the mechanisms governing the chemical dissolution behavior of borosilicate based bioactive glasses. The proposed experimental approach allows us to gain a new level of conceptual understanding about the composition–structure–property relationships in these glass systems, and which can be applied to attain a significant leap in designing borosilicate based bioactive glasses with controlled dissolution rates tailored for specific patient and disease states.

Graphical abstract

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Mono vs multilayer Fibronectin coatings on polar/hydrophobic/ionic polyurethanes: Altering surface interactions with human monocytes

Publication date: Available online 8 November 2017
Source:Acta Biomaterialia
Author(s): Audrey Gossart, Kyle G. Battiston, Adeline Gand, Emmanuel Pauthe, J Paul Santerre
Monocyte interactions with materials that are biofunctionalized with fibronectin (Fn) are of interest because of the documented literature which associates this protein with white blood cell function at implant sites. A degradable-polar hydrophobic ionic polyurethane (D-PHI), has been reported to promote an anti-inflammatory response from human monocytes. The aim of the current work was to study the influence of intrinsic D-PHI material chemistry on Fn adsorption (mono and multi-layer structures), and to investigate the influence of such chemistry on the structural state of the Fn, as well as the latter's influence on the activity of human monocytes on the protein coated substrates. Significant differences in Fn adsorption, surface hydrophobicity and the availability of defined peptide sequences (N terminal, C terminal or Cell Binding Domain) for the Fn in mono vs multilayer structures were observed as a function of the changes in intrinsic material chemistry. A D-PHI-formulated polyurethane substrate with subtle changes in anionic and hydrophobic domain content relative to the polar non-ionic urethane/carbonate groups within the polymer matrix promoted the lowest activation of monocytes, in the presence of multi-layer Fn constructs. These results highlight the importance of chemical heterogeneity as a design parameter for biomaterial surfaces, and establishes a desired strategy for controlling human monocyte activity at the surface of devices, when these are coated with multi-layer Fn structures. The latter is an important step towards functionalizing the materials with multi-layer protein drug carriers as interventional therapeutic agents.Statement of SignificanceThe control of the behavior of monocytes, especially migration and activation, is of crucial interest to modulate the inflammatory response at the site of implanted biomaterial. Several studies report the influence of adsorbed serum proteins on the behavior of monocytes on biomaterials. However, few studies show the influence of surface chemical group distribution on the controlled adsorption and the subsequent induced conformation- of mono versus multi-layer assembled structures generated from specific proteins implicated in wound repair. The current research considered the role of Fn adsorption and conformation in thin films while interacting with the intrinsic chemistry of segmented block polyurethanes; and the influence of the former on modulation and activation of human monocytes.

Graphical abstract

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Prevalence of papular urticaria caused by flea bites and associated factors in children 1–6 years of age in Bogotá, D.C.

Papular urticaria is a chronic inflammatory disease caused by exposure to arthropod bites. The disease has been reported in children attending medical centers, but the causes as the risk factors associated wit...

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Prevalence of papular urticaria caused by flea bites and associated factors in children 1–6 years of age in Bogotá, D.C.

Papular urticaria is a chronic inflammatory disease caused by exposure to arthropod bites. The disease has been reported in children attending medical centers, but the causes as the risk factors associated wit...

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3-Dimensional inkjet printing of macro structures from silver nanoparticles

Publication date: 5 February 2018
Source:Materials & Design, Volume 139
Author(s): Jayasheelan Vaithilingam, Ehab Saleh, Lars Körner, Ricky D. Wildman, Richard J.M. Hague, Richard K. Leach, Christopher J. Tuck
The adoption of additive manufacturing technology is gaining interest for processing precious metals. In this study, the capability of inkjet printing was explored to fabricate macroscopic parts from commercial silver nanoparticle ink (AgNPs). A bespoke JETx® three dimensional (3D) inkjet printing machine was used to print and subsequently sinter up to 1000 layers of AgNPs using an infrared source. Examination of the sample using X-ray computed tomography and scanning electron microscopy revealed the existence of both micro- and nano-scale pores within the structure. Pinning effect, residual surface temperature, insufficient droplet overlap and surface defects were the key factors contributing to the voids. Elemental mapping confirmed the structure to be composed of 87% of silver along with carbon and oxygen. The 750dpi sample showed a 25% reduction in nanopores and 77% lower micro-pores compared to the 600dpi sample. In terms of hardness, the 750dpi sample was 29% harder than the 600dpi sample, showcasing samples with higher print resolution can contribute towards less voids and improved mechanical properties. Thus by demonstrating the possibility to fabricate dense parts from AgNPs using inkjet technology, this study opens a novel route for processing nano-scale particulates and precious metals in 3D.

Graphical abstract

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A highly-aligned lamellar structure of ice-templated LiFePO4 cathode for enhanced rate capability

Publication date: 5 February 2018
Source:Materials & Design, Volume 139
Author(s): Wook Ki Jung, Changyeon Baek, Joo-Hyung Kim, San Moon, Dong Seok Kim, Young Hwa Jung, Do Kyung Kim
Ice-templating has been widely investigated in various energy-related fields owing to the simple and inexpensive process of this method which results highly-ordered lamellar structures. Lamellar structures offer larger active areas for ionic conductivity and a short mean free path of electrons. Here, an ice-templated LiFePO4 cathode was introduced to achieve higher rate capability with a minimized carbon source. The fabricated highly-aligned porous structure demonstrates superior rate performance during the discharge process compared to electrodes which use conventional slurry casting. This enhanced performance is mainly attributed to the aligned porous structure, which facilitates the rapid transfer of electrons from the bulk to a current collector and also provides a good distribution of contact sites with Li ions in the electrolytes.

Graphical abstract

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The design of ultra-broadband selective near-perfect absorber based on photonic structures to achieve near-ideal daytime radiative cooling

Publication date: 5 February 2018
Source:Materials & Design, Volume 139
Author(s): Dong Wu, Chang Liu, Zenghui Xu, Yumin Liu, Zhongyuan Yu, Li Yu, Lei Chen, Ruifang Li, Rui Ma, Han Ye
Passive cooling, which cools without any electricity input, has had a great impact on global energy consumption. The recent progress on radiative cooling has many potential applications in efficient passive cooling. During the day, this strategy uses the maximized infrared emissivity via the atmospheric transparency windows for radiating heat and minimizing solar absorption. However, the realization of daytime radiative coolers with ideal selective mid-infrared emissivity is still a great challenge. Here, we firstly design and numerically demonstrate a near-ideal radiative cooler operating below the ambient temperature, achieving both broadband selective emissivity in the infrared atmospheric window and extremely low absorption in the entire solar spectrum, realizing a net cooling power exceeding 122W/m² at ambient temperature. The cooling effect can still persist under significant nonradiative heat exchange conditions. The design of multi-layer all-dielectric micropyramid structure in this work not only solves the shortcoming of poor mid-infrared selectivity in planar photonics device, but also overcomes the disadvantage of high solar absorption in metal/dielectric metamaterials. The comparisons of physics mechanism between this multi-layer all-dielectric structure and previously reported multi-layer metal/dielectric structure also are investigated clearly. Thus, this study can help pave the way for designing ideal daytime radiative coolers.

Graphical abstract

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Editorial Board

Publication date: 5 January 2018
Source:Materials & Design, Volume 137





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A Survey on Recent Medical School Graduate Comfort With the Level 1 Milestones

Publication date: Available online 7 November 2017
Source:Journal of Surgical Education
Author(s): Michael E. Petravick, J. Lawrence Marsh, Matthew D. Karam, Douglas R. Dirschl
ObjectiveThe Next Accreditation System implemented 5 levels of milestones for orthopedic surgery residents in 2013. The Level 1 milestones were noted as those "expected of an incoming resident." While the milestones were intended for assessing resident progression and readiness for independent practice, this designation can also be used to assess how well prepared graduating medical students are for beginning an orthopedic surgery residency. The primary objective of this paper is to measure recent medical school graduate comfort with the Level 1 milestones.Design, Setting, and ParticipantsIn June 2015, the program directors for the Midwest Orthopaedic Surgical Skills (MOSS) Consortium affiliated residency programs were sent an online survey for distribution to the recent medical school graduates who matched at their respective programs. The survey was about recent graduate comfort with the Level 1 milestone handles associated with 16 orthopedic milestones spanning multiple subspecialties. Responses were grouped based on comfort with individual milestone handles with orthopedic conditions (e.g., carpal tunnel) or with broader categories spanning orthopedic milestones (e.g., imaging).ResultsIn all, 66 of 112 graduates (58.9%) responded. Of 60 milestone handles surveyed, respondents were "Comfortable" with an average of 31.6 ± 14.2 handles with some conditions performing much better than others. The median "Comfortable" response rate was 31 handles. The 8 broader categories had "Comfortable" response rates between 35% and 70%. All 8 orthopedic conditions had significantly higher "Comfortable" response rates for "Evaluation & Knowledge" handles than for "Decision Making & Treatment" handles.ConclusionsMost recent medical student graduates who matched into an orthopedic surgery residencies are only comfortable with about half of the Level 1 milestone handles even though they are expected to meet the Level 1 milestones upon beginning residency. This finding suggests the development of an assessment based on the Level 1 milestones would be appropriate to better inform both graduate and undergraduate medical education in orthopedic surgery.



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Curriculum Using the In-Situ Operating Room Setting

Publication date: Available online 7 November 2017
Source:Journal of Surgical Education
Author(s): Raghavendra Rao, Robert C. Caskey, Lily Owei, Kathleen O'Connor, Elijah Riddle, Daniel T. Dempsey, Joshua Atkins, Dimitry Baranov, Gregory Motuk, Ari D. Brooks, Noel Williams, Jon Morris, Kristoffel Dumon
ObjectiveThe American College of Surgeons/Association of Program Directors in Surgery is a comprehensive, simulation-based curriculum for General Surgery residents which exists in 3 phases. While phases 1 and 2 deal with core skills and advanced procedures respectively, phase 3 targets team-based skills. To date, the 3rd phase of this curriculum has not seen wide scale implementation. This is a pilot study to verify the feasibility of implementing the phase 3 curriculum in the in-situ setting.DesignIn our initial attempt to implement Phase 3 at our institution, we chose to perform the training in an in-situ setting within an operating room (OR) at our main hospital, despite our having a separate simulation center. By choosing the in-situ OR environment for this training we were able to minimize concerns regarding resident and faculty availability and able to successfully complete 8 separate sessions during the academic year. During 7 sessions, 2 separate scenarios were performed while a single scenario was performed in 1 session. This single session was excluded from analysis, leaving a total of 14 scenarios to evaluate. The unique scenarios included laparoscopic crisis, postoperative myocardial infarction, anaphylaxis, and postoperative hypotension. All sessions were audiovisually recorded. In order to evaluate the effect of the training, the videos were viewed by 3 independent reviewers and all surgery, anesthesia and nursing participants were rated using the NOTECHs II scale. Degree of inter-rater agreement was established. The difference between the first and second simulations on the same day was then assessed. In addition, participant opinions of the simulations were assessed through electronic surveys following the training.SettingTertiary Care University Hospital.ParticipantsWe performed a total of 8 sessions, for a total of 15 scenarios. Eight surgery residents at the postgraduate year 1 (PGY1)-PGY3 level, 16 anesthesia residents at the PGY3-PGY4 level, 16 nurses and 13 ancillary staff participated.ResultsFrom the first to the second scenario, the total team NOTECHs II score increased from 69.4 ± 1.4 to 77.3 ± 0.5 (p = 0.007). The NOTECHs II scores for each subteam also improved, from 24.2 ± 0.6 to 26.4 ± 0.5 (p = 0.007) for surgery residents, 23.7 ± 0.9 to 26.7 ± 0.4 (p = 0.03) for anesthesia, and 21.6 ± 0.3 to 24.3 ± 0.5 (p = 0.01) for nursing. The inter-rater reliability as measured by Kendall's coefficient of concordance was modest for the whole team score. Most of the participant responses were either favorable or strongly favorable.ConclusionThe in-situ OR environment is both a unique and effective setting to perform team-based training. Furthermore, training in the in-situ setting minimizes or removes many of the logistic issues involved in designing and implementing team-based training curricula for general surgery residency programs. However, we found that administrative and departmental (surgery, anesthesia, and nursing) "buy in" as well as protected faculty time for education were all necessary for in-situ training to be successful. NOTECHs II is an established scale for the evaluation of teams in this simulation setting and appears to be a valid tool based on the results of this study. However, further assessment of inter-rater reliability as well as improved training of evaluators are necessary to determine if inter-rater reliability can improve.



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The Educational Opportunities Provided by a Pediatric Orthopedic Urgent Case Review Conference: Keep Score to Provide a Better Experience

Publication date: Available online 7 November 2017
Source:Journal of Surgical Education
Author(s): Eric D. Shirley, Radu Gheorghe, Kevin M. Neal, Gary Kiebzak, Steven L. Frick
ObjectiveTo evaluate the distribution of conditions presented at a case conference to assess resident educational exposure to acute pediatric orthopedic conditions.DesignRetrospective review of emergency department and inpatient consultations presented at a daily pediatric orthopedic case conference over a 3-year period. Consultations were divided into 3-month resident rotation blocks for analysis.SettingTertiary children's hospital in the southern United States which host residents from 2 orthopedic surgery residency programs.ParticipantsThe case conference is attended by pediatric orthopedic surgeons, 1 pediatric orthopedic fellow, and 4 PGY III/IV residents.ResultsA total of 1762 consultations were presented at the conference. The consultations were obtained for traumatic injuries, 86.5% (1524/1762); infections, 7.7% (136/1762); and congenital/other problems, 5.8% (102/1762). The 3 most common consultations per rotation were fractures: both-bone forearm (mean, 46.1; range: 24-64), supracondylar humerus (mean, 23.8; range: 17-31), and distal radius (mean, 13.8; range: 7-33). Less common consultations per rotation were septic arthritis (mean, 1.6; range: 0-5), child abuse (mean, 1.3; range: 0-5), Monteggia fracture (mean, 0.3; range: 0-1), compartment syndrome (mean, 0.2; range: 0-1) and patella sleeve fracture (mean, 0.1; range: 0-1).ConclusionsThere was a large disparity between conditions in the number of times presented and reviewed within a 3-month rotation at the daily case conference, with some important conditions not being discussed at all in each rotation. This finding documents a disadvantage of case conferences based on limiting discussion to current patients, and highlights an opportunity for educational improvement.



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A shared decision-making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Objectives/Hypothesis

Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy.

Study Design

Prospective, single-blind, randomized controlled trial.

Methods

We enrolled consecutive patients meeting inclusion criteria who were referred to our multidisciplinary upper airway center. Study patients used a shared decision-making tool whereas controls did not. Measures of decisional conflict (SURE [Sure of myself, Understanding information, Risk benefit ratio, Encouragement], CollaboRATE, and the Decisional Conflict Scale [DCS]) were obtained pre- and postvisit.

Results

We assessed 50 families (study group = 24, controls = 26). The mean age was 8.8 ± 6.6 years, 44% were female, 86% were white, and the mean obstructive apnea-hypopnea index was 12.7 ± 15.6 events/hour. The previsit mean DCS score was similar for controls (42.7) and study patients (40.8) (P = .38). The postvisit mean DCS score for controls was 13.3 and for study patients 6.1 (P = .034). Improvement in this score was greater in the study group (P = .03). At previsit evaluation, 63% of controls and 58% of study patients were unsure about their options. Postvisit, this improved to 4.1% and 0%, respectively.

Conclusions

Families counseled regarding treatment options using shared decision-making tools had significantly less decisional conflict than those who did not use these tools. These positive outcomes suggest that clinicians should consider integrating this approach into clinical practice.

Level of Evidence

1b Laryngoscope, 2017

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Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings

Objectives/Hypothesis

Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF).

Study Design

Anatomical cadaver and radiological study plus case study.

Methods

Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair.

Results

Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm²). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm² to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications.

Conclusions

Radio-anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2rnx

Three-dimensional endoscopy for endoscopic salvage nasopharyngectomy: Preliminary report of experience

Background

Prospective, observational study to assess the efficacy of salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma (NPC) via the endoscopic endonasal approach using a three-dimensional (3D) high-definition endoscopic system.

Methods

Between 2016 and 2017, 30 patients with recurrent NPC were recruited. Patient demographics, tumor characteristics, and perioperative data were recorded. Instrument ergonomics and perceived advantages were assessed by the operating, assisting, and observing surgeons.

Results

The majority (70%) of patients received radiotherapy alone as the initial treatment for NPC, and tumor recurred after a mean interval of 16.8 months. The tumor (T) classifications of the recurrent (R) tumors were: RT1: 46.7%; RT2: 33.3%; and RT3: 20.0%. The mean operative time was 293.3 minutes, and no conversion to open approach was necessary. Internal carotid artery dissection was required in nine patients, and the resection and repair of dura was required in six patients. The most common method of reconstruction was free vastus lateralis flap (46.7%). Microscopically clear resection margins were achieved in 73.3% of patients. The mean hospital stay was 6.8 days. There was no hospital mortality. One patient developed minor secondary hemorrhage, whereas the other developed transient contralateral vocal cord paralysis. On quantitative assessment, surgeons noticed a significant advantage of the 3D system with regard to depth and size perception, anatomy identification, and hand–eye coordination, whereas there was no significant difference in terms of strain sensation and dizziness.

Conclusion

The 3D high-definition endoscopic system improves the precision of endoscopic nasopharyngectomy, particularly when dissection of the internal carotid artery and dura is required.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2hSi66R

Telemedicine in laryngology: Remote evaluation of voice disorders-setup and initial experience

http://ift.tt/2AiDVDp

The contribution of cochlear implants to postural stability

Objectives

To determine whether spatial auditory cues provided by cochlear implants can improve postural balance in adults with severe deafness.

Methods

In the presence of spatial white noise, 13 adult cochlear implantees wore head and lumbar-mounted inertial sensors while standing in the dark for 30 seconds in two auditory conditions: hearing assistive devices on and off.

Results

Stability was improved with implants on (aided condition) compared to off (unaided condition) with respect to differences in mean head velocity (Cohen's d = 0.912, P = 0.006) as well as to root mean square (RMS) acceleration (Cohen's d = 0.456, P = 0.048). This was particularly evident in measures of anteroposterior accelerations (mean difference = 0.034 m/s²; Cohen's d = 0.612; P = 0.011).

Conclusion

The decrease in RMS head acceleration and velocity while wearing cochlear implants suggests that they could be recognized as balance implants in addition to auditory implants. The clinical importance of this finding in various patient populations remains to be determined.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2hRHLfO

When should therapeutic anticoagulation be restarted following major head and neck surgery?

http://ift.tt/2Ak2nEj

In reference to intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

http://ift.tt/2hRLVV5

Proton density–weighted laryngeal magnetic resonance imaging in systemically dehydrated rats

Objectives/Hypothesis

Dehydrated vocal folds are inefficient sound generators. Although systemic dehydration of the body is believed to induce vocal fold dehydration, this causative relationship has not been demonstrated in vivo. Here we investigate the feasibility of using in vivo proton density (PD)–weighted magnetic resonance imaging (MRI) to demonstrate hydration changes in vocal fold tissue following systemic dehydration in rats.

Study Design

Animal study.

Methods

Sprague-Dawley rats (n = 10) were imaged at baseline and following a 10% reduction in body weight secondary to withholding water. In vivo, high-field (7 T), PD-weighted MRI was used to successfully resolve vocal fold and salivary gland tissue structures.

Results

Normalized signal intensities within the vocal fold decreased postdehydration by an average of 11.38% ± 3.95% (mean ± standard error of the mean [SEM], P = .0098) as compared to predehydration levels. The salivary glands experienced a similar decrease in normalized signal intensity by an average of 10.74% ± 4.14% (mean ± SEM, P = .0195) following dehydration. The correlation coefficient (percent change from dehydration) between vocal folds and salivary glands was 0.7145 (P = .0202).

Conclusions

Ten percent systemic dehydration induced vocal fold dehydration as assessed by PD-weighted MRI. Changes in the hydration state of vocal fold tissue were highly correlated with that of the salivary glands in dehydrated rats in vivo. These preliminary findings demonstrate the feasibility of using PD-weighted MRI to quantify hydration states of the vocal folds and lay the foundation for further studies that explore more routine and realistic magnitudes of systemic dehydration and rehydration.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2kZ9

Development and external validation of a risk-prediction model to predict 5-year overall survival in advanced larynx cancer

Objectives/Hypothesis

TNM-classification inadequately estimates patient-specific overall survival (OS). We aimed to improve this by developing a risk-prediction model for patients with advanced larynx cancer.

Study Design

Cohort study.

Methods

We developed a risk prediction model to estimate the 5-year OS rate based on a cohort of 3,442 patients with T3T4N0N+M0 larynx cancer. The model was internally validated using bootstrapping samples and externally validated on patient data from five external centers (n = 770). The main outcome was performance of the model as tested by discrimination, calibration, and the ability to distinguish risk groups based on tertiles from the derivation dataset. The model performance was compared to a model based on T and N classification only.

Results

We included age, gender, T and N classification, and subsite as prognostic variables in the standard model. After external validation, the standard model had a significantly better fit than a model based on T and N classification alone (C statistic, 0.59 vs. 0.55, P < .001). The model was able to distinguish well among three risk groups based on tertiles of the risk score. Adding treatment modality to the model did not decrease the predictive power. As a post hoc analysis, we tested the added value of comorbidity as scored by American Society of Anesthesiologists score in a subsample, which increased the C statistic to 0.68.

Conclusions

A risk prediction model for patients with advanced larynx cancer, consisting of readily available clinical variables, gives more accurate estimations of the estimated 5-year survival rate when compared to a model based on T and N classification alone.

Level of Evidence

2c Laryngoscope, 2017

http://ift.tt/2hRLUjZ

Cricothyroid joint type as predictor for vocal fold elongation in professional singers

Objective

Vocal fold (VF) elongation vocal folds depends on two factors: the activity of the laryngeal muscles and the cricothyroid joint (CTJ). The aim of the study was to show the influence of the CTJ on VF elongation while singing a sustained vowel at different pitches.

Study Design

Prospective study.

Methods

Forty-nine female professional singers (25 sopranos, 24 altos) were recruited. Three-dimensional images of the larynx derived from high-resolution computed tomography scanning were obtained at the mean speaking fundamental frequency (F0) and one (F1) and two octaves (F2) above this pitch.

Results

From F0 to F1, all three CTJ types showed equal elongation of the VF (type A: 14%, type B/C: 13%). From F1 to F2, VF elongation was 8% in singers with type A and 4% in those with type B/C (P < 0.0001).

Conclusion

The stability of the CTJ directly influences VF during singing. This is the first study to show this relationship in vivo.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2AiDQj5

Lack of long-term add-on effect by montelukast in postoperative chronic rhinosinusitis patients with nasal polyps

Objectives/Hypothesis

Eosinophils and mast cells are among the key cells in inflammatory diseases like chronic rhinosinusitis (CRS) and asthma. Leukotriene antagonists have proven to be effective in the treatment of asthma, but data about their efficacy in CRS are scarce, whereas data on montelukast as an add-on treatment to intranasal corticosteroids (INCS) in a postoperative setting are completely lacking.

Study Design

Prospective, randomized, open-label trial.

Methods

In this trial with long-term follow-up, we evaluated the efficacy of montelukast as an add-on treatment to INCS in postoperative CRS with nasal polyp (CRSwNP) patients. CRSwNP patients (N = 72) undergoing endoscopic sinus surgery were randomized in two arms for the postoperative treatment. One group (N = 36) received INCS in monotherapy, whereas the other group (N = 36) received INCS in association with montelukast for 1 year. The efficacy of montelukast with INCS was evaluated by assessing both subjective (total five-symptom score [T5SS]) and objective (nasal polyp score [NPS], Lund-Mackay [LMK] score, and subjective olfactometry [Barcelona Smell Test 24]) outcome parameters and compared with the gold standard of INCS in monotherapy.

Results

After 1 year of surgery, T5SS, NPS, and LMK score were significantly reduced in patients treated with either INCS or INCS plus montelukast, without significant differences between the two treatment arms. Improvement of smell loss by olfactometry was also observed with no differences between arms. Similar findings were observed at 3 and 6 months.

Conclusions

These results suggest that the addition of montelukast to INCS should not be recommended in the treatment of postoperative CRSwNP patients.

Level of Evidence

1b Laryngoscope, 2017

http://ift.tt/2hRLRVl

Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors

Objective

Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by the primary disease process. The relationship between expiratory function, cough, and aspiration is less clear in head and neck cancer (HNC) survivors for whom the disease process does not directly impact the lower respiratory system. Our objective was to compare mechanisms of airway clearance (expiratory force and cough) with aspiration status in postradiated HNC survivors.

Study Design

Cross-sectional study.

Methods

One hundred and three disease-free HNC survivors ≥ 3-months postradiotherapy referred for modified barium swallow studies were prospectively enrolled regardless of dysphagia status. Maximum expiratory pressures (MEPs) and peak cough flow (PCF) measures were taken at enrollment and examined as a function of aspiration status using generalized linear regression methods.

Results

Thirty-four (33%) patients aspirated. Maximum expiratory pressure and PCF demonstrated a moderate positive correlation (Pearson's r = 0.35). Adjusting for sex and age, MEPs were on average 19.2% lower (21.1 cm H₂O, 95% confidence interval [CI] 5.3, 36.8) among aspirators. Peak cough flow was also 14.9% lower (59.6 L/minute, 95% CI 15.8, 103.3) among aspirators after adjusting for age and sex.

Conclusion

Expiratory functions were depressed in postradiated HNC aspirators relative to nonaspirators, suggesting that airway protection impairments may extend beyond disrupted laryngopharyngeal mechanisms in the local treatment field. Exercises to strengthen subglottic expiratory force-generating capacity may offer an adjunctive therapeutic target to improve airway protection in chronic aspirators after head and neck radiotherapy.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2Ak2hMX

Examination of olfactory training effectiveness in relation to its complexity and the cause of olfactory loss

Objective

Although the effectiveness of olfactory training (OT) had already been documented, the optimal regimen for such training remains unexplored. We examined whether the complexity of OT, namely alteration of odor quantity and quality, increases its effectiveness.

Design

One-hundred eight patients (M_age = 60.1 ± 1) with postinfectious (n = 57) or idiopathic (n = 51) olfactory dysfunction underwent OT preceded and followed by examination of olfactory function.

Methods

Subjects were randomly assigned to one of the three experimental conditions: 1) simple training comprising four basic, single-molecule substances; 2) complex training involving four odor mixtures; and 3) odor-altering training in which patients changed sets of mixtures every 2 months.

Results

The analysis of variance revealed that the benefit seen in this sample was not affected by the complexity of OT with regard to odor mixtures or alteration of odor type. The highest increase of the Sniffin' Sticks (Burghardt GmbH; Wedel, Germany) threshold, discrimination, and identification (and overall TDI) score was observed in postinfectious patients.

Conclusion

We conclude that the outcomes of OT are not strongly influenced by the training regimen. However, further investigation of OT regimens is required, particularly with regard to training duration.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2hRLPgb

ABO Blood Group and Cochlear Status: Otoacoustic Emission Markers.

Objectives: There are an increasing number of research studies examining the effects of ABO blood group on susceptibility to disease. However, little is known regarding the potential relationship between blood group and hearing. Higher risk of noise-induced hearing loss was linked to blood group O in several occupational health studies. Based on this finding, a recent study of cochlear status was conducted with normal-hearing female participants representing equal numbers of the four blood groups in the ABO blood group system. ABO blood group was associated with cochlear characteristics, including the prevalence of spontaneous otoacoustic emissions (SOAEs) and the amplitudes of transient-evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs). Females with blood group O showed significantly lower amplitudes of DPOAEs at some frequencies and lower prevalence of SOAEs compared with participants with blood group B. There was a general trend of reduced TEOAE and DPOAE amplitudes in blood group O individuals compared with participants with non-O blood groups. Following from this finding, and based on known sex differences in otoacoustic emission characteristics, the present study examined the possible effects of blood group on otoacoustic emission status in males. Design: Sixty clinically normal-hearing males aged between 18 and 26 years, with equal numbers of participants in each of the ABO blood groups, were recruited by purposive sampling. SOAE, DPOAE, and linear and nonlinear TEOAE recordings were collected from all participants, as well as tympanometric data related to external and middle ear characteristics. Results: The male blood group O participants exhibited significantly lower SOAE prevalence and reduced amplitudes of DPOAEs on average, and in the midfrequency range, than participants with blood group B, and lower nonlinear and linear TEOAE amplitudes at a number of frequencies when compared with participants with blood groups A and B. A consistent trend of lower TEOAE and DPOAE response amplitudes was observed in participants with blood group O. No significant difference was noted among blood groups for outer or middle ear characteristics. Conclusions: These results were consistent with previous findings of reduced otoacoustic emission responses in female blood group O individuals. Results support the hypothesis that blood group O individuals may be at increased risk of cochlear damage from noise exposure. Further investigation on the potential link between ABO blood group and auditory status, including potentially differential effects of noise exposure on cochlear function, is needed. The possible effects of ABO blood group on other aspects of audition, such as hearing sensitivity, speech understanding, and auditory processing, should be evaluated. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2hkSzpK

Speech in Noise Perception as a Marker of Cognitive Impairment in HIV Infection.

Objectives: Human immunodeficiency virus positive (HIV+) individuals report hearing difficulties, but standard audiological tests show no, or small, changes in peripheral hearing ability. The hearing complaints may reflect central nervous system (CNS) auditory processing deficits, rather than middle or inner ear problems, and may result from CNS damage due to HIV infection or treatment. If central auditory task performance and cognitive deficits in HIV+ individuals are shown to be related, then central auditory tests might serve as a "window" into CNS function in these patients. Design: We measured cognitive performance (Mandarin Montreal Cognitive Assessment [MoCA]) and speech in noise perception (Mandarin hearing-in-noise test [HINT]) in 166 normal-hearing HIV+ individuals (158 men, 8 women, average age 36 years) at the Shanghai Public Health Clinical Center in Shanghai, China. Data collection included audiometry, tympanometry, and the Amsterdam Inventory of Auditory Handicap (AIAH), which assesses the subjective ability to understand speech and localize sound. Results: Subjects had no middle ear disease and met criteria for normal-hearing sensitivity (all thresholds 20 dB HL or less). A significant negative relationship between speech reception thresholds (SRT) and MoCA scores (r2 = 0.15, F = 28.2, p

http://ift.tt/2zoHXgO

A shared decision-making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Objectives/Hypothesis

Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy.

Study Design

Prospective, single-blind, randomized controlled trial.

Methods

We enrolled consecutive patients meeting inclusion criteria who were referred to our multidisciplinary upper airway center. Study patients used a shared decision-making tool whereas controls did not. Measures of decisional conflict (SURE [Sure of myself, Understanding information, Risk benefit ratio, Encouragement], CollaboRATE, and the Decisional Conflict Scale [DCS]) were obtained pre- and postvisit.

Results

We assessed 50 families (study group = 24, controls = 26). The mean age was 8.8 ± 6.6 years, 44% were female, 86% were white, and the mean obstructive apnea-hypopnea index was 12.7 ± 15.6 events/hour. The previsit mean DCS score was similar for controls (42.7) and study patients (40.8) (P = .38). The postvisit mean DCS score for controls was 13.3 and for study patients 6.1 (P = .034). Improvement in this score was greater in the study group (P = .03). At previsit evaluation, 63% of controls and 58% of study patients were unsure about their options. Postvisit, this improved to 4.1% and 0%, respectively.

Conclusions

Families counseled regarding treatment options using shared decision-making tools had significantly less decisional conflict than those who did not use these tools. These positive outcomes suggest that clinicians should consider integrating this approach into clinical practice.

Level of Evidence

1b Laryngoscope, 2017

http://ift.tt/2hRM0YT

Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings

Objectives/Hypothesis

Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF).

Study Design

Anatomical cadaver and radiological study plus case study.

Methods

Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair.

Results

Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm²). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm² to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications.

Conclusions

Radio-anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2rnx

Three-dimensional endoscopy for endoscopic salvage nasopharyngectomy: Preliminary report of experience

Background

Prospective, observational study to assess the efficacy of salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma (NPC) via the endoscopic endonasal approach using a three-dimensional (3D) high-definition endoscopic system.

Methods

Between 2016 and 2017, 30 patients with recurrent NPC were recruited. Patient demographics, tumor characteristics, and perioperative data were recorded. Instrument ergonomics and perceived advantages were assessed by the operating, assisting, and observing surgeons.

Results

The majority (70%) of patients received radiotherapy alone as the initial treatment for NPC, and tumor recurred after a mean interval of 16.8 months. The tumor (T) classifications of the recurrent (R) tumors were: RT1: 46.7%; RT2: 33.3%; and RT3: 20.0%. The mean operative time was 293.3 minutes, and no conversion to open approach was necessary. Internal carotid artery dissection was required in nine patients, and the resection and repair of dura was required in six patients. The most common method of reconstruction was free vastus lateralis flap (46.7%). Microscopically clear resection margins were achieved in 73.3% of patients. The mean hospital stay was 6.8 days. There was no hospital mortality. One patient developed minor secondary hemorrhage, whereas the other developed transient contralateral vocal cord paralysis. On quantitative assessment, surgeons noticed a significant advantage of the 3D system with regard to depth and size perception, anatomy identification, and hand–eye coordination, whereas there was no significant difference in terms of strain sensation and dizziness.

Conclusion

The 3D high-definition endoscopic system improves the precision of endoscopic nasopharyngectomy, particularly when dissection of the internal carotid artery and dura is required.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2hSi66R

Telemedicine in laryngology: Remote evaluation of voice disorders-setup and initial experience

http://ift.tt/2AiDVDp

The contribution of cochlear implants to postural stability

Objectives

To determine whether spatial auditory cues provided by cochlear implants can improve postural balance in adults with severe deafness.

Methods

In the presence of spatial white noise, 13 adult cochlear implantees wore head and lumbar-mounted inertial sensors while standing in the dark for 30 seconds in two auditory conditions: hearing assistive devices on and off.

Results

Stability was improved with implants on (aided condition) compared to off (unaided condition) with respect to differences in mean head velocity (Cohen's d = 0.912, P = 0.006) as well as to root mean square (RMS) acceleration (Cohen's d = 0.456, P = 0.048). This was particularly evident in measures of anteroposterior accelerations (mean difference = 0.034 m/s²; Cohen's d = 0.612; P = 0.011).

Conclusion

The decrease in RMS head acceleration and velocity while wearing cochlear implants suggests that they could be recognized as balance implants in addition to auditory implants. The clinical importance of this finding in various patient populations remains to be determined.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2hRHLfO

When should therapeutic anticoagulation be restarted following major head and neck surgery?

http://ift.tt/2Ak2nEj

In reference to intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

http://ift.tt/2hRLVV5

Proton density–weighted laryngeal magnetic resonance imaging in systemically dehydrated rats

Objectives/Hypothesis

Dehydrated vocal folds are inefficient sound generators. Although systemic dehydration of the body is believed to induce vocal fold dehydration, this causative relationship has not been demonstrated in vivo. Here we investigate the feasibility of using in vivo proton density (PD)–weighted magnetic resonance imaging (MRI) to demonstrate hydration changes in vocal fold tissue following systemic dehydration in rats.

Study Design

Animal study.

Methods

Sprague-Dawley rats (n = 10) were imaged at baseline and following a 10% reduction in body weight secondary to withholding water. In vivo, high-field (7 T), PD-weighted MRI was used to successfully resolve vocal fold and salivary gland tissue structures.

Results

Normalized signal intensities within the vocal fold decreased postdehydration by an average of 11.38% ± 3.95% (mean ± standard error of the mean [SEM], P = .0098) as compared to predehydration levels. The salivary glands experienced a similar decrease in normalized signal intensity by an average of 10.74% ± 4.14% (mean ± SEM, P = .0195) following dehydration. The correlation coefficient (percent change from dehydration) between vocal folds and salivary glands was 0.7145 (P = .0202).

Conclusions

Ten percent systemic dehydration induced vocal fold dehydration as assessed by PD-weighted MRI. Changes in the hydration state of vocal fold tissue were highly correlated with that of the salivary glands in dehydrated rats in vivo. These preliminary findings demonstrate the feasibility of using PD-weighted MRI to quantify hydration states of the vocal folds and lay the foundation for further studies that explore more routine and realistic magnitudes of systemic dehydration and rehydration.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2kZ9

Development and external validation of a risk-prediction model to predict 5-year overall survival in advanced larynx cancer

Objectives/Hypothesis

TNM-classification inadequately estimates patient-specific overall survival (OS). We aimed to improve this by developing a risk-prediction model for patients with advanced larynx cancer.

Study Design

Cohort study.

Methods

We developed a risk prediction model to estimate the 5-year OS rate based on a cohort of 3,442 patients with T3T4N0N+M0 larynx cancer. The model was internally validated using bootstrapping samples and externally validated on patient data from five external centers (n = 770). The main outcome was performance of the model as tested by discrimination, calibration, and the ability to distinguish risk groups based on tertiles from the derivation dataset. The model performance was compared to a model based on T and N classification only.

Results

We included age, gender, T and N classification, and subsite as prognostic variables in the standard model. After external validation, the standard model had a significantly better fit than a model based on T and N classification alone (C statistic, 0.59 vs. 0.55, P < .001). The model was able to distinguish well among three risk groups based on tertiles of the risk score. Adding treatment modality to the model did not decrease the predictive power. As a post hoc analysis, we tested the added value of comorbidity as scored by American Society of Anesthesiologists score in a subsample, which increased the C statistic to 0.68.

Conclusions

A risk prediction model for patients with advanced larynx cancer, consisting of readily available clinical variables, gives more accurate estimations of the estimated 5-year survival rate when compared to a model based on T and N classification alone.

Level of Evidence

2c Laryngoscope, 2017

http://ift.tt/2hRLUjZ

Cricothyroid joint type as predictor for vocal fold elongation in professional singers

Objective

Vocal fold (VF) elongation vocal folds depends on two factors: the activity of the laryngeal muscles and the cricothyroid joint (CTJ). The aim of the study was to show the influence of the CTJ on VF elongation while singing a sustained vowel at different pitches.

Study Design

Prospective study.

Methods

Forty-nine female professional singers (25 sopranos, 24 altos) were recruited. Three-dimensional images of the larynx derived from high-resolution computed tomography scanning were obtained at the mean speaking fundamental frequency (F0) and one (F1) and two octaves (F2) above this pitch.

Results

From F0 to F1, all three CTJ types showed equal elongation of the VF (type A: 14%, type B/C: 13%). From F1 to F2, VF elongation was 8% in singers with type A and 4% in those with type B/C (P < 0.0001).

Conclusion

The stability of the CTJ directly influences VF during singing. This is the first study to show this relationship in vivo.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2AiDQj5

Lack of long-term add-on effect by montelukast in postoperative chronic rhinosinusitis patients with nasal polyps

Objectives/Hypothesis

Eosinophils and mast cells are among the key cells in inflammatory diseases like chronic rhinosinusitis (CRS) and asthma. Leukotriene antagonists have proven to be effective in the treatment of asthma, but data about their efficacy in CRS are scarce, whereas data on montelukast as an add-on treatment to intranasal corticosteroids (INCS) in a postoperative setting are completely lacking.

Study Design

Prospective, randomized, open-label trial.

Methods

In this trial with long-term follow-up, we evaluated the efficacy of montelukast as an add-on treatment to INCS in postoperative CRS with nasal polyp (CRSwNP) patients. CRSwNP patients (N = 72) undergoing endoscopic sinus surgery were randomized in two arms for the postoperative treatment. One group (N = 36) received INCS in monotherapy, whereas the other group (N = 36) received INCS in association with montelukast for 1 year. The efficacy of montelukast with INCS was evaluated by assessing both subjective (total five-symptom score [T5SS]) and objective (nasal polyp score [NPS], Lund-Mackay [LMK] score, and subjective olfactometry [Barcelona Smell Test 24]) outcome parameters and compared with the gold standard of INCS in monotherapy.

Results

After 1 year of surgery, T5SS, NPS, and LMK score were significantly reduced in patients treated with either INCS or INCS plus montelukast, without significant differences between the two treatment arms. Improvement of smell loss by olfactometry was also observed with no differences between arms. Similar findings were observed at 3 and 6 months.

Conclusions

These results suggest that the addition of montelukast to INCS should not be recommended in the treatment of postoperative CRSwNP patients.

Level of Evidence

1b Laryngoscope, 2017

http://ift.tt/2hRLRVl

Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors

Objective

Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by the primary disease process. The relationship between expiratory function, cough, and aspiration is less clear in head and neck cancer (HNC) survivors for whom the disease process does not directly impact the lower respiratory system. Our objective was to compare mechanisms of airway clearance (expiratory force and cough) with aspiration status in postradiated HNC survivors.

Study Design

Cross-sectional study.

Methods

One hundred and three disease-free HNC survivors ≥ 3-months postradiotherapy referred for modified barium swallow studies were prospectively enrolled regardless of dysphagia status. Maximum expiratory pressures (MEPs) and peak cough flow (PCF) measures were taken at enrollment and examined as a function of aspiration status using generalized linear regression methods.

Results

Thirty-four (33%) patients aspirated. Maximum expiratory pressure and PCF demonstrated a moderate positive correlation (Pearson's r = 0.35). Adjusting for sex and age, MEPs were on average 19.2% lower (21.1 cm H₂O, 95% confidence interval [CI] 5.3, 36.8) among aspirators. Peak cough flow was also 14.9% lower (59.6 L/minute, 95% CI 15.8, 103.3) among aspirators after adjusting for age and sex.

Conclusion

Expiratory functions were depressed in postradiated HNC aspirators relative to nonaspirators, suggesting that airway protection impairments may extend beyond disrupted laryngopharyngeal mechanisms in the local treatment field. Exercises to strengthen subglottic expiratory force-generating capacity may offer an adjunctive therapeutic target to improve airway protection in chronic aspirators after head and neck radiotherapy.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2Ak2hMX

Examination of olfactory training effectiveness in relation to its complexity and the cause of olfactory loss

Objective

Although the effectiveness of olfactory training (OT) had already been documented, the optimal regimen for such training remains unexplored. We examined whether the complexity of OT, namely alteration of odor quantity and quality, increases its effectiveness.

Design

One-hundred eight patients (M_age = 60.1 ± 1) with postinfectious (n = 57) or idiopathic (n = 51) olfactory dysfunction underwent OT preceded and followed by examination of olfactory function.

Methods

Subjects were randomly assigned to one of the three experimental conditions: 1) simple training comprising four basic, single-molecule substances; 2) complex training involving four odor mixtures; and 3) odor-altering training in which patients changed sets of mixtures every 2 months.

Results

The analysis of variance revealed that the benefit seen in this sample was not affected by the complexity of OT with regard to odor mixtures or alteration of odor type. The highest increase of the Sniffin' Sticks (Burghardt GmbH; Wedel, Germany) threshold, discrimination, and identification (and overall TDI) score was observed in postinfectious patients.

Conclusion

We conclude that the outcomes of OT are not strongly influenced by the training regimen. However, further investigation of OT regimens is required, particularly with regard to training duration.

Level of Evidence

2b. Laryngoscope, 2017

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Harnessing designed nanoparticles: Current strategies and future perspectives in cancer immunotherapy

Publication date: Available online 6 November 2017
Source:Nano Today
Author(s): Sung Duk Jo, Gi-Hoon Nam, Gijung Kwak, Yoosoo Yang, Ick Chan Kwon
Although cancer immunotherapy, represented by chimeric antigen receptor (CAR) T-cell therapy and immune checkpoint-blockade therapies, has shown durable outcomes, the percentage of patients that respond to these approaches remains modest to date. However, encouraging recent advances suggest that nanotechnology has the potential to enhance the efficacy of such immunotherapies by improving the delivery, biodistribution, and release-kinetics of immunostimulatory small molecules and biologics in targeted tissues. A variety of synthetic nanoparticles, including polymeric nanoparticles, liposomes and inorganic nanoparticles, can be engineered according to their intended uses in cancer immunotherapy. Notably, nature-derived nanoparticles have emerged as a new class of immunotherapeutics. In this review, we describe state-of-the-art strategies for cancer immunotherapy using designed nanoparticles. We also highlight key translational challenges and opportunities in this rapidly growing field.

Graphical abstract

http://ift.tt/2yHEZnQ

Graphene heterojunctions from the bottom up

Publication date: Available online 6 November 2017
Source:Nano Today





http://ift.tt/2yH3vpb

Nano additive unlocks 3d printing of alloys

Publication date: Available online 7 November 2017
Source:Nano Today





http://ift.tt/2m2JVhp

Recipe for a Successful Hybrid Academic-Community Radiology Practice

Publication date: Available online 7 November 2017
Source:Academic Radiology
Author(s): Kaela L. Gusenbauer, Michael N. Patlas, Ania Z. Kielar, Douglas S. Katz




http://ift.tt/2hPKZ3A

From bench to clinical trials the EORTC experience in biology-based clinical cancer research

Publication date: Available online 6 November 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Konstantinos Tryfonidis, Katherine Hartmann, Marie Morfouace, Denis Lacombe
For over 50years the European Organization for Research and Treatment of Cancer (EORTC) has delivered major advances in cancer clinical research and cancer therapeutics. The introduction of molecularly targeted agents has led to significant improvements in outcome for patients with specific tumor types; however conventional chemotherapy remains the mainstay of treatment for the majority of patients. Due to increasing knowledge about the diversity of molecular pathways driving malignant progression, strategies to integrate biology into clinical research and development are continuously evolving. The challenges and the experience of the EORTC regarding how translational research is to be an indispensable component of the clinical research environment, which aims to deliver more sophisticated treatment approaches will be discussed in this perspective article.



http://ift.tt/2jaVnXh

Maspin expression and subcellular localization in invasive ductal carcinoma of the breast: Prognostic significance and relation to microvessel density

Publication date: Available online 7 November 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Duaa S. Helal, Dina M. El-Guindy
Maspin (Mammary serine protease inhibitor) is a tumor suppressor serine. Its clinical significance and role in breast carcinoma are contradictory and inconclusive. Researches demonstrated that the function of maspin differs according to its subcellular localization. This study was conducted to investigate the expression of maspin in invasive ductal carcinoma (IDC) of the breast with special emphasis on its subcellular localization and to evaluate its prognostic role in relation to clinicopathological parameters and microvessel density (MVD) of the tumor. The expression of maspin was evaluated immunohistochemically in 45 IDC cases. The positive rate of maspin expression was 73.3%. Maspin positivity was significantly related to higher tumor grade (p value = 0.041), nodal metastasis (p value = 0.044), perineural invasion (p value = 0.047), and high CD34+MVD (p value = 0.002). Nuclear maspin was detected in 36.6% whereas cytoplasmic maspin was detected in 63.4% of maspin positive cases. A significant inverse relationship was observed between nuclear maspin and high tumor grade (p value = 0.016), and nodal metastasis (p value = 0.047). These results suggest that maspin expression has a prognostic role in breast cancer. Maspin expression is related to increased angiogenesis. Subcellular localization of maspin can strongly affect cancer prognosis. Cytoplasmic maspin relates to poor prognostic parameters whereas nuclear maspin relates to good prognostic ones.



http://ift.tt/2ArLCrP

Enhancement of CO2 reduction activity under visible light irradiation over Zn-based metal sulfides by combination with Ru-complex catalysts

Publication date: May 2018
Source:Applied Catalysis B: Environmental, Volume 224
Author(s): Tomiko M. Suzuki, Tomoaki Takayama, Shunsuke Sato, Akihide Iwase, Akihiko Kudo, Takeshi Morikawa
Hybrid photocatalysts composed of metal sulfide semiconductors combined with various Ru-complex catalysts were synthesized for use during visible light-driven CO2 reduction with powder suspension systems. A variety of Zn-based sulfides, including Ni-doped ZnS, (CuGa)0.8Zn0.4S2 and (AgIn)0.22Zn1.56S2, were adopted by conducting the CO2 reduction reaction in acetonitrile containing an electron donor. The photocatalytic activities were found to be largely dependent on the basic characteristics of the Ru-complex and the metal sulfide. The results demonstrate that several of these sulfide semiconductors improve the CO2 reduction selectivity when employed in the semiconductor/metal-complex system, and that (AgIn)0.22Zn1.56S2 or Ni (0.2mol%)-doped ZnS combined with a neutral Ru-complex incorporating a phosphonate ligand [Ru(4,4′-diphosphonate-2,2′-bipyridine)(CO)2Cl2] exhibit the highest CO2 photoconversion activity when synthesizing formic acid, with a turnover number above 100, which catalysts were stable for 16h irradiation. These results suggest that metal sulfides are potential candidates for use in powdered semiconductor/metal-complex systems for selective CO2 photoreduction.

Graphical abstract

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Photocatalytic CO2 conversion on highly ordered mesoporous materials: Comparisons of metal oxides and compound semiconductors

Publication date: May 2018
Source:Applied Catalysis B: Environmental, Volume 224
Author(s): Yoon Yun Lee, Han Sol Jung, Ji Man Kim, Yong Tae Kang
In this study, the ordered mesoporous metal oxides (TiO2 and SnO2) and compound semiconductors (ZnS, ZnSe, CdS, and CdSe) are manufactured and they exhibit several micrometers (μm) of particle size, and high surface area of about 100m²g⁻¹. Well-developed crystallinities are prepared via simple nano-replication method by using a 3-D bicontinuous cubic Ia3d meso-structured ordered mesoporous silica KIT-6 as a hard-template. The visible-light-driven photocatalytic CO2 conversion into CH4 is carried out in the presence of H2O over various mesoporous materials. Prepared mesoporous materials show different light absorption behaviors and photocatalytic activities for conversion of CO2. The mesoporous compound semiconductors show higher CO yield rates than the mesoporous metal oxides, while mesoporous metal oxides show higher CH4 yield rates than the mesoporous compound semiconductors. Compared to the commercial TiO2 material (P25, Degussa), the mesoporous metal oxides (TiO2, SnO2) show 9 to 10 times higher yields of CH4 and 2 to 3 times higher yields of CO owing to their high surface area. Especially, the mesoporous ZnS shows the highest CH4 yield rate (3.620μmolgcat⁻¹h⁻¹) and the mesoporous CdSe shows the highest CO yield rate (5.884μmolgcat⁻¹h⁻¹) out of all photocatalysts considered in the present study. Although mesoporous CdS and ZnSe have great visible light absorption properties, they show relatively low CH4 yield rates.

Graphical abstract

http://ift.tt/2ArEBXX

Room temperature Zinc-metallation of cationic porphyrin at graphene surface and enhanced photoelectrocatalytic activity

Publication date: 15 March 2018
Source:Applied Surface Science, Volume 434
Author(s): Rongjin Zeng, Guoliang Chen, Chungang Xiong, Gengxian Li, Yinzhi Zheng, Jian Chen, Yunfei Long, Shu Chen
A stable zincporphyrin functionalized graphene nanocomposite was prepared by using positively charged cationic porphyrin (5,10,15,20-tetra(4-propyl pyridinio) porphyrin, TPPyP) and successive reduced graphene oxide (rGO) with tuned negative charge. The nanocomposite preparation was accompanied first by distinct electrostatic interactions and π-π stacking between TPPyP and rGO, and followed by fast Zinc-metallation at room temperature. In contrast to free TPPyP with Zn²⁺, the incorporation reaction is very slow at room temperature and heating or reflux conditions are required to increase the metallation rate. While at the surface of rGO nanosheet, the Zinc-metallation of TPPyP was greatly accelerated to 30min at 25°C in aqueous solution. The interaction process and composites formation were fully revealed by significant variations in UV–vis absorption spectra, X-ray photoelectron spectra (XPS) measurements, atomic force microscope (AFM) images, and fluorescence spectra. Furthermore, photoelectrochemical activity of resultant rGO/TPPyP-Zn nanocomposites was evaluated under visible-light irradiation, and enhancement of the photoelectrocatalytic reduction of CO2 was achieved.

Graphical abstract

http://ift.tt/2ArEzPP

A comparative study on laser induced shock cleaning of radioactive contaminants in air and water

Publication date: 1 March 2018
Source:Optics & Laser Technology, Volume 100
Author(s): Aniruddha Kumar, Manisha Prasad, R.B. Bhatt, P.G. Behere, D.J. Biswas
Efficient removal of Uranium-di-oxide (UO2) particulates from stainless steel surface was effected by Nd-YAG laser induced plasma shock waves in air as well as in water environment. The propagation velocity of the generated shock wave was measured by employing the photo-acoustic probe deflection method. Monitoring of the alpha activity of the sample with a ZnS (Ag) scintillation detector before and after the laser exposure allowed the estimation of decontamination efficiency defined as the percentage removal of the initial activity. Experiments were carried out to study the effect of laser pulse energy, number of laser exposures, orientation of the sample, the separation between the substrate surface and the onset point of the shock wave on the de-contamination efficiency. The most optimised cleaning was found to occur when the laser beam impinged normally on the sample that was immersed in water and placed at a distance of ∼0.7 mm from the laser focal spot. Analysis of the cleaned surface by optical microscopes established that laser induced shock cleaning in no way altered the surface property. The shock force generated in both air and water has been estimated theoretically and has been found to exceed the Van der Waal's binding force for spherical contaminant particulate.



http://ift.tt/2ArExaF

Dependence of nonlinear optical properties of Ag2S@ZnS core-shells on Zinc precursor and capping agent

Publication date: 1 March 2018
Source:Optics & Laser Technology, Volume 100
Author(s): M. Dehghanipour, M. Khanzadeh, M. Karimipour, M. Molaei
In this research, four different types of Ag2S@ZnS core-shells were synthesized and their nonlinear optical (NLO) properties were investigated using a Z-scan technique by a 532 nm laser diode. Here, Ag2S and ZnS nanoparticles were also synthesized and their NLO properties were compared with Ag2S@ZnS core-shells. It was observed that the NLO properties of Ag2S@ZnS quantum dots significantly increased by increasing the values of Zn(NO3)2 and thioglycolic acid (TGA). It was also observed that the NLO properties of Ag2S@ZnS core-shells for 0.1 g of Zn(NO3)2 and 7000 μl TGA is higher than sole Ag2S and ZnS nanoparticles. In open aperture Z-scan curve of ZnS sample, a saturable absorption peak was observed and this peak was seen also in type of Ag2S@ZnS nanoparticles which the value of Zn(NO3)2 much more.



http://ift.tt/2jbo8D3

Visibility of mammographically occult breast cancer on diffusion-weighted MRI versus ultrasound

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Nita Amornsiripanitch, Habib Rahbar, Averi E. Kitsch, Diana L. Lam, Brett Weitzel, Savannah C. Partridge
PurposeTo investigate the visibility of mammographically occult breast cancers on diffusion-weighted MRI (DWI) versus ultrasound.Materials and methodsMammographically occult breast cancers (n=60) initially detected on contrast-enhanced MRI that underwent pre-biopsy targeted ultrasound were retrospectively evaluated for visibility on DWI and ultrasound.ResultsMore cancers were visible on DWI than ultrasound (78% vs. 63%; p=0.049), with 32 (53%) visible on both and 7 (12%) not visible on either. Visibility differences were more significant in larger lesions (92% vs. 68%, p=0.006).ConclusionDWI may detect more mammographically occult cancers than ultrasound, warranting further investigation as an alternative supplemental screening technique.



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3-O-Glyceryl-2-O-hexyl ascorbate suppresses melanogenesis by interfering with intracellular melanosome transport and suppressing tyrosinase protein synthesis

Summary

Background

Ascorbic acid (AsA) has multifunctional benefits on skin beauty, such as the reduction in oxidative stress and the induction of collagen production. Among them, the prevention and improvement of skin pigmentation by AsA is a most important benefit for people. However, it is well known that AsA not only is quite unstable in formulations but it also has a low capability of skin penetration due to its hydrophilic property. In addition, existing water-soluble AsA derivatives that were developed to improve its stability also have low skin penetration.

Aim

To investigate the potential of a newly synthesized amphiphilic derivative of AsA, 3-O-Glyceryl-2-O-hexyl ascorbate (VC-HG), which has an added glyceryl group and a hexyl group, on skin beauty focusing on its skin lightening/whitening effects.

Methods

DNA microarray analysis and real-time PCR were used to clarify the effects of VC-HG on melanogenesis using B16 mouse melanoma cells. The effects of VC-HG on melanin synthesis, tyrosinase protein levels, and the inhibition of tyrosinase activity were evaluated.

Results

DNA microarray analysis revealed that treatment with VC-HG downregulated the expression of genes encoding tyrosinase and MyosinVa. Further, real-time PCR analysis showed the downregulation of tyrosinase, MyosinVa, Rab27a, and Kinesin mRNAs following VC-HG treatment. In addition, VC-HG caused decreases in tyrosinase protein levels and melanin synthesis.

Conclusion

We conclude that VC-HG has an impact on skin lightening/whitening by inhibiting tyrosinase protein synthesis and interfering with intracellular melanosome transport.

http://ift.tt/2AqhQnc

3-O-Glyceryl-2-O-hexyl ascorbate suppresses melanogenesis by interfering with intracellular melanosome transport and suppressing tyrosinase protein synthesis

Summary

Background

Ascorbic acid (AsA) has multifunctional benefits on skin beauty, such as the reduction in oxidative stress and the induction of collagen production. Among them, the prevention and improvement of skin pigmentation by AsA is a most important benefit for people. However, it is well known that AsA not only is quite unstable in formulations but it also has a low capability of skin penetration due to its hydrophilic property. In addition, existing water-soluble AsA derivatives that were developed to improve its stability also have low skin penetration.

Aim

To investigate the potential of a newly synthesized amphiphilic derivative of AsA, 3-O-Glyceryl-2-O-hexyl ascorbate (VC-HG), which has an added glyceryl group and a hexyl group, on skin beauty focusing on its skin lightening/whitening effects.

Methods

DNA microarray analysis and real-time PCR were used to clarify the effects of VC-HG on melanogenesis using B16 mouse melanoma cells. The effects of VC-HG on melanin synthesis, tyrosinase protein levels, and the inhibition of tyrosinase activity were evaluated.

Results

DNA microarray analysis revealed that treatment with VC-HG downregulated the expression of genes encoding tyrosinase and MyosinVa. Further, real-time PCR analysis showed the downregulation of tyrosinase, MyosinVa, Rab27a, and Kinesin mRNAs following VC-HG treatment. In addition, VC-HG caused decreases in tyrosinase protein levels and melanin synthesis.

Conclusion

We conclude that VC-HG has an impact on skin lightening/whitening by inhibiting tyrosinase protein synthesis and interfering with intracellular melanosome transport.

http://ift.tt/2AqhQnc

A critical role for very long-chain fatty acid elongases in oleic acid-mediated Saccharomyces cerevisiae cytotoxicity

Publication date: Available online 6 November 2017
Source:Microbiological Research
Author(s): Qiao Wang, Xiuxiu Du, Ke Ma, Ping Shi, Wenbin Liu, Jing Sun, Min Peng, Zhiwei Huang
Elongases FEN1/ELO2 and SUR4/ELO3 are important enzymes involved in the elongation of long-chain fatty acids (LCFAs) to very long-chain fatty acids (VLCFAs) in Saccharomyces cerevisiae. The molecular mechanism of the involvement of these elongases in lipotoxicity is unclear. In the present study, we investigated the role of VLCFA elongases in oleic acid-mediated yeast cytotoxicity. The spot test showed that yeast strains with the deletion of ELO2 or ELO3 were strikingly sensitive to oleic acid, while there was no change on the growth of strain with deleted ELO1 which was involved in the elongation of C14 fatty acid (FA) to C16 FA. By using GC-MS, the unsaturation index was increased in elo2△ and elo3△ mutants after treatment with oleic acid (OLA). However, the proportion of VLCFAs was increased in response to OLA in the wild-type strain. The growth inhibition of elo2△ and elo3△ could be partially rescued by two commonly used antioxidant agents N-acetyl cysteine (NAC) and Ascorbic acid (VC). The further study showed that exposure to excess OLA led to an increase in the levels of reactive oxygen species (ROS) and thiobarbituric acid reactive substances (TBARS), and a decline in the quantity of reduced glutathione (GSH) in both the wild type and mutant strains. However, the antioxidant enzyme activities of superoxide dismutase (SOD) and catalase (CAT) were increased in the wild type and elo1△ strains, while they were significantly decreased in the mutants of elo2△ and elo3△ after treated with excess OLA. Thus, oxidative damage mainly contributed to the cell death induced by OLA in ole2△ and ole3△. Taken together, although disruption of ELO2 or ELO3 did not affect the cellular lipid unsaturation, they altered the distribution and propotion of cellular VLCFAs, leading to the cell membrane impairment, which augmented the ability of OLA to permeabilize the plasma membrane. The data suggest that the very long-chain fatty acids elongases ELO2 and ELO3 play important roles in lipotoxic cell death induced by OLA through maintaining a balanced FA composition in plasma membrane.



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5-hydroxymethyl-2-furaldehyde from marine bacterium Bacillus subtilis inhibits biofilm and virulence of Candida albicans

Publication date: Available online 8 November 2017
Source:Microbiological Research
Author(s): Ganapathy Ashwinkumar Subramenium, Thirukannamangai Krishnan Swetha, Prasanth Mani Iyer, Krishnaswamy Balamurugan, Shunmugiah Karutha Pandian
Candida albicans is considered as the primary etiologic agent of candidiasis, a very common fungal infection in human. The yeast to hyphal transition and ability to form hypoxic biofilm on medical devices is well allied with virulence and antifungal resistance of C. albicans. Antagonistic agents that inhibit biofilm formation and alter susceptibility of C. albicans to conventional antifungals is of profound need. The present study explores the antibiofilm efficacy of Bacillus subtilis, a marine bacterial isolate from Palk Bay against C. albicans. Mass spectrometric analysis of ethyl acetate extract of B. subtilis unveiled 5-hydroxymethyl-2-furaldehyde (5HM2F) as one of its major components. 5HM2F demonstrated concentration dependent biofilm inhibition, which was also corroborated through microscopic analysis. Furthermore, 5HM2F was effective in inhibiting other virulence factors of C. albicans such as morphological transition and secreted hydrolases production. Fourier transform infrared spectroscopic analysis showed alteration in amide bond region. The reduction in ergosterol content and increased antifungal susceptibility was well allied with real time PCR result, which showed down regulation of genes involved in drug resistance mechanisms. In vivo study using Caenorhabditis elegans also substantiated the antivirulence efficacy of 5HM2F at in vivo condition. Thus, the present study reports the therapeutic potential of 5HM2F against C. albicans infections.

Graphical abstract

http://ift.tt/2j9mj9K