Head and Neck Diseases by Alexandros G.Sfakianakis: 01/01/18

Δευτέρα 1 Ιανουαρίου 2018

Smartphone apps for skin cancer diagnosis: Implications for patients and practitioners

Abstract

A research team at Stanford recently reported that their deep convolutional neural network had learned to classify skin cancer with a level of competence equivalent to that of board-certified dermatologists. It is possible that in time, and using larger datasets, such software may surpass the average doctor in diagnostic ability, and that highly accurate technology may be available to both clinicians and patients via smartphones. This technology is poised to change the landscape of skin cancer diagnosis for both physicians and patients, but whether such changes are beneficial will depend on how they are regulated and implemented.

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Giant tumour on the foot

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Comparison of skin cancers in liver and renal transplant recipients: Results of a prospective study in an Australian tertiary referral centre

Abstract

Background/Objectives

Organ transplant recipients (OTR) have an increased risk of skin cancers compared with the general population.

Methods

A prospective study of renal (RTR) and liver transplant recipients (LTR) was conducted in a single New South Wales tertiary referral centre over 60 months. Initial and subsequent visit data were recorded in our transplant database. Only patients with a minimum of 11 months follow up were included.

Results

Altogether 142 RTR and 88 LTR were included in the analysis. Compared with RTR, the median age of liver transplant recipients was higher (64 vs 57 years), more men were patients (73 vs 60%) and there were higher rates of high-risk skin types (54 vs 33%) and heavy sun exposure (43 vs 30%). RTR developed 304 non-melanoma skin cancers (NMSC) with a squamous cell carcinoma:basal cell carcinoma ratio of 1.7:1. LTR developed 205 NMSC with a squamous cell carcinoma:basal cell carcinoma ratio of 1.6:1. The odds ratio of developing NMSC in LTR:RTR was 1.8:1 (95% CI: 1.02–3.11, P = 0.044) on univariate analysis but there was no difference on multivariate analysis. A previous history of NMSC, age, time from transplant from first visit, skin phenotype and previous sun exposure were significant risk factors for developing NMSC.

Conclusions

Liver transplant recipients are not at a lower risk of NMSC than RTR. Our study supports routine and regular post-transplant skin surveillance of all LTR, like other OTR.

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Safety assessment of standardized aqueous Brucea javanica extract in rats

Publication date: 6 April 2018
Source:Journal of Ethnopharmacology, Volume 215
Author(s): Farahdina Man, Chee-Yan Choo
Ethnopharmacological relevanceThe seeds of Brucea javanica and its aqueous decoction is a traditional medicine consumed by diabetic patients in Malaysia. The daily consumption of B. javanica seeds and it's aqueous decoction causes much concern as the quassinoids and its glycosides from the seeds exhibited various pharmacological activity at low doses.Aims of studyThe aim of the present study is to evaluate the repeated dose toxicity of the standardized aqueous extract administered daily for 30 days through oral administration at its effective hypoglycemia doses.Materials and methodsThe seeds were dried, ground and extracted in deionized water. A HPLC-photodiode array method was developed and validated for the standardization of both the hypoglycemia agents, namely bruceine D and E in aqueous extract. Both normoglycemia and streptozotocin (STZ)-induced diabetic rats were fed orally with 15, 30 and 60mg/kg body weight of standardized aqueous extract. The blood glucose was measured at 0–8h. In repeated dose toxicity, similar doses were administered orally to rats for 30 days. At the end of 30 days, the blood was withdrawn and subjected to biochemical and haematology analysis while organs were harvested for histology analysis.ResultsOral administration of standardized aqueous extract exhibited a dose-response relationship in both the normoglycemia and STZ-induced diabetic rats. Daily oral administration of 15, 30 and 60mg/kg standardized aqueous extract for 30 days to rats did not show signs to toxicity in its biochemical, haematology and histology analysis.ConclusionIn conclusion, although the seeds were reported to contain compounds with various pharmacological activity, the daily oral administration to rats for 30 days do not showed signs of toxicity at its effective hypoglycemia doses.

Graphical abstract

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Inhibitory effects of Aconiti Lateralis Radix Preparata on chronic intermittent cold-induced inflammation in the mouse hypothalamus

Publication date: 6 April 2018
Source:Journal of Ethnopharmacology, Volume 215
Author(s): Wonnam Kim, Wonil Lee, Jin Gyu Choi, In Gyoung Ju, Yun-Kyung Kim, Tae Hee Lee, Myung Sook Oh
Ethnopharmacological relevanceAconiti Lateralis Radix Preparata (AR) is the most frequently used herb to generate heat and treat symptoms associated with coldness in Asia.Aims of the studyThe hypothalamus is one of the master regulators to maintain constant core body temperature. Chronic exposure to cold stress disturbs homeostatic regulation, gradually resulting in hypothalamic inflammation. This study investigate the effects of AR, on the chronic intermittent cold (CIC)-induced release of pro-inflammatory signaling molecules in the mouse hypothalamus.Materials and methodsAconiti Lateralis Radix Preparata extract (ARE) were solubilized in distilled water and diluted with saline before administration. Male ICR mice (7 weeks old, 30–32g) were divided randomly into 6 groups: (1) control, (2) cold stress, (3) ARE 30, (4) ARE 100, (5) ARE 300, and (6) ARE 1000mg/kg groups. Groups (2)-(6) were exposed to CIC stress once a day for 14 days. CIC stress was achieved by exposing the mice to 4°C and 60 ± 10% humidity for 120min once a day. Rectal temperature was measured after terminating cold stress. Cortisol levels were measured from serum. Hypothalamus tissue was used for western blot analysis, and IL-9, IL-13, PGE1, and PGE2 levels were assessed.ResultsARE treatment prevented the CIC-induced decrease in rectal temperature and increase in serum cortisol level. ARE-treated CIC-exposed mice demonstrated decrease in nuclear c-Fos levels dose-dependently compared to CIC-exposed mice. Nuclear NF-kB expression showed significant increase in CIC-exposed mice. ARE treatment significantly blunted the increase in nuclear NF-kB expression. CIC-exposed mice had significantly increased levels of both IL-9 and IL-13. Treatment with ARE suppressed the elevated IL-9 and IL-13 levels. Between control and CIC-exposed mice PGE1 levels showed no difference. However ARE (1000mg/kg)-treated CIC-exposed mice had a significant increase in PGE1 level compared to CIC-exposed mice. PGE2 levels were significantly higher in CIC-exposed mice compared to control mice. ARE treatment significantly attenuated the increase in PGE2 levels.ConclusionsOur findings suggest CIC stress disturbs the anti-inflammatory effect of cortisol and maintenance of the body temperature. Thus AR contributes to suppress the activated proinflammatory factors, IL-9, IL-13, and PGE-2, and to increase the heat production.

Graphical abstract

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Cerebral Embolism Following Transcarotid Transcatheter Aortic Valve Replacement

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Silent Myocardial Infarction: Listen to the Evidence

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Silent Myocardial Infarction and Long-Term Risk of Heart Failure: The ARIC Study

AbstractBackground

Although silent myocardial infarction (SMI) accounts for about one-half of the total number of myocardial infarctions (MIs), the risk of heart failure (HF) among patients with SMI is not well established.

Objectives

The purpose of this study was to examine the association of SMI and clinically manifested myocardial infarction (CMI) with HF, as compared with patients with no MI.

Methods

This analysis included 9,243 participants from the ARIC (Atherosclerosis Risk In Communities) study who were free of cardiovascular disease at baseline (ARIC visit 1: 1987 to 1989). SMI was defined as electrocardiographic evidence of MI without CMI after the baseline until ARIC visit 4 (1996 to 1998). HF events were ascertained starting from ARIC visit 4 until 2010 in individuals free of HF before that visit.

Results

Between ARIC visits 1 and 4, 305 SMIs and 331 CMIs occurred. After ARIC visit 4 and during a median follow-up of 13.0 years, 976 HF events occurred. The incidence rate of HF was higher in both CMI and SMI participants than in those without MI (incidence rates per 1,000 person-years were 30.4, 16.2, and 7.8, respectively; p < 0.001). In a model adjusted for demographics and HF risk factors, both SMI (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.02 to 1.78) and CMI (HR: 2.85; 95% CI: 2.31 to 3.51) were associated with increased risk of HF compared with no MI. These associations were consistent in subgroups of participants stratified by several HF risk predictors. However, the risk of HF associated with SMI was stronger in those younger than the median age (53 years) (HR: 1.66; 95% CI: 1.00 to 2.75 vs. HR: 1.19; 95% CI: 0.85 to 1.66, respectively; overall interaction p by MI type <0.001).

Conclusions

SMI is associated with an increased risk of HF. Future research is needed to examine the cost effectiveness of screening for SMI as part of HF risk assessment, and to identify preventive therapies to improve the risk of HF among patients with SMI.

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Early Experience With New Transcatheter Mitral Valve Replacement

AbstractBackground

Transcatheter mitral valve replacement (TMVR) is a potential therapy for patients with symptomatic, severe mitral regurgitation (MR). The feasibility of this therapy remains to be defined.

Objectives

The authors report their early experience with TMVR using a new valve system.

Methods

The valve is a self-expanding, nitinol valve with bovine pericardial leaflets that is placed using a transapical delivery system. Patients with symptomatic MR who were deemed high or extreme risk by the local heart teams were enrolled in a global pilot study at 14 sites (United States, Australia, and Europe).

Results

Fifty consecutively enrolled patients (mean age: 73 ± 9 years; 58.0% men; 84% secondary MR) underwent TMVR with the valve. The mean Society for Thoracic Surgery score was 6.4 ± 5.5%; 86% of patients were New York Heart Association functional class III or IV, and the mean left ventricular ejection fraction was 43 ± 12%. Device implant was successful in 48 patients with a median deployment time of 14 min (interquartile range: 12 to 17 min). The 30-day mortality was 14%, with no disabling strokes, or repeat interventions. Median follow-up was 173 days (interquartile range: 54 to 342 days). At latest follow-up, echocardiography confirmed mild or no residual MR in all patients who received implants. Improvements in symptom class (79% in New York Heart Association functional class I or II at follow-up; p < 0.0001 vs. baseline) and Minnesota Heart Failure Questionnaire scores (56.2 ± 26.8 vs. 31.7 ± 22.1; p = 0.011) were observed.

Conclusions

TMVR with the valve was feasible in a study group at high or extreme risk for conventional mitral valve replacement. These results inform trial design of TMVR in lower-risk patients with severe mitral valve regurgitation (Evaluation of the Safety and Performance of the Twelve Intrepid Transcatheter Mitral Valve Replacement System in High Risk Patients with Severe, Symptomatic Mitral Regurgitation – The Twelve Intrepid TMVR Pilot Study; NCT02322840)

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Reply: An Incomplete Story

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JACC Instructions for Authors

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Sham-Controlled Trials for Coronary Interventions: Ethically Acceptable and Ethically Important

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Transcatheter Mitral Valve Replacement: First Steps on a Long Road

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An Incomplete Story

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Beating-Heart Mitral Valve Repair Using a Novel ePTFE Cordal Implantation Device: A Prospective Trial

AbstractBackground

Conventional mitral valve (MV) operations allow direct anatomic assessment and repair on an arrested heart, but require cardiopulmonary bypass, aortic cross-clamping, sternotomy or thoracotomy, and cardioplegic cardiac arrest, and are associated with significant perioperative disability, and risks of morbidity and mortality.

Objectives

This study evaluated safety and performance of a transesophageal echocardiographic-guided device designed to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on mitral leaflets in the beating heart.

Methods

In a prospective multicenter study, 30 consecutive patients with severe degenerative mitral regurgitation (MR) were treated with a mitral valve repair system (MVRS) via small left thoracotomy. The primary (30-day) endpoint was successful implantation of cords with MR reduction to moderate or less.

Results

The primary endpoint was met in 27 of 30 patients (90%). Three patients required conversion to open mitral surgery. There were no deaths, strokes, or permanent pacemaker implantations. At 1 month, MR was mild or less in 89% (24 of 27) and was moderate in 11% (3 of 27). At 6 months, MR was mild or less in 85 % (22 of 26), moderate in 8% (2 of 26), and severe in 8% (2 of 26). Favorable cardiac remodeling at 6 months included decreases in end-diastolic (161 ± 36 ml to 122 ± 30 ml; p < 0.001) and left atrial volumes (106 ± 36 ml to 69 ± 24 ml; p < 0.001). The anterior-posterior mitral annular dimension decreased from 34.7 ± 5.8 mm to 28.2 ± 5.1 mm; p < 0.001 as did the mitral annular area (10.0 ± 2.7 cm² vs. 6.9 ± 2.0 cm²; p < 0.0001).

Conclusions

MVRS ePTFE cordal implantation can reduce the invasiveness and morbidity of conventional MV surgery. The device's safety profile is promising and prospective trials comparing the outcomes of the MVRS to conventional MV repair surgery are warranted. (CE Mark Study for the Harpoon Medical Device [TRACER]; NCT02768870)

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Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Analysis by Subgroups

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TMVR With Artificial Cords in the Treatment of Mitral Regurgitation: More Questions Than Answers

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Primary Prevention With Statins in the Elderly

Abstract

The burden of atherosclerotic cardiovascular disease (ASCVD) in high-income countries is mostly borne by the elderly. With increasing life expectancy, clear guidance on sensible use of statin therapy to prevent a first and potentially devastating ASCVD event is critically important to ensure a healthy aging population. Since 2013, 5 major North American and European guidelines on statin use in primary prevention of ASCVD have been released by the American College of Cardiology/American Heart Association, the UK National Institute for Health and Care Excellence, the Canadian Cardiovascular Society, U.S. Preventive Services Task Force, and the European Society of Cardiology/European Atherosclerosis Society. Guidance on using statin therapy in primary ASCVD prevention in the growing elderly population (>65 years of age) differs markedly. The authors discuss the discrepant recommendations, place them into the context of available evidence, and identify circumstances in which uncertainty may hamper the appropriate use of statins in the elderly.

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Temporal Trends of De Novo Malignancy Development After Heart Transplantation

AbstractBackground

Malignancy is a concern in cardiac transplant recipients, but the temporal trends of de novo malignancy development are unknown.

Objectives

The goal of this study was to describe the temporal trends of the incidence, types, and predictors of de novo malignancy in cardiac transplant recipients.

Methods

The authors analyzed the temporal trends of post-transplant incidence, types, and predictors of malignancy using 17,587 primary adult heart-only transplant recipients from the International Society for Heart and Lung Transplantation registry. The main study outcomes included the incidence of, types of, and time to de novo malignancy.

Results

The risk of any de novo solid malignancy between years 1 and 5 after transplantation was 10.7%. The cumulative incidence by malignancy type was: skin cancer (7.0%), non-skin solid cancer (4.0%), and lymphoproliferative disorders (0.9%). There was no temporal difference in the time to development according to malignancy type. However, the cumulative incidence of de novo solid malignancy increased from 2000 to 2005 vs. 2006 to 2011 (10.0% vs. 12.4%; p < 0.0001). Survival in patients after de novo malignancy was markedly lower than in patients without malignancy (p < 0.0001). Older recipients and patients who underwent transplantation in the recent era had a higher risk of de novo malignancy.

Conclusions

More than 10% of adult heart transplant recipients developed de novo malignancy between years 1 and 5 after transplantation, and this outcome was associated with increased mortality. The incidence of post-transplant de novo solid malignancy increased temporally, with the largest increase in skin cancer. Individualized immunosuppression strategies and enhanced cancer screening should be studied to determine whether they can reduce the adverse outcomes of post-transplantation malignancy.

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New Beginnings, New Transitions: A Bold Vision for the Journals Fellows-in-Training and Early Career Page

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Malignancy Post Heart Transplantation: No Free Lunch

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Effects of Direct Oral Anticoagulants at the Peak Phase, Trough Phase, and After Vascular Injury

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Platelet-Derived MRP-14 Induces Monocyte Activation in Patients With Symptomatic Peripheral Artery Disease

AbstractBackground

Peripheral artery disease (PAD), a diffuse manifestation of atherothrombosis, is a major cardiovascular threat. Although platelets are primary mediators of atherothrombosis, their role in the pathogenesis of PAD remains unclear.

Objectives

The authors sought to investigate the role of platelets in a cohort of symptomatic PAD.

Methods

The authors profiled platelet activity, mRNA, and effector roles in patients with symptomatic PAD and in healthy controls. Patients with PAD and carotid artery stenosis were recruited into ongoing studies (NCT02106429 and NCT01897103) investigating platelet activity, platelet RNA, and cardiovascular disease.

Results

Platelet RNA sequence profiling mapped a robust up-regulation of myeloid-related protein (MRP)-14 mRNA, a potent calcium binding protein heterodimer, in PAD. Circulating activated platelets were enriched with MRP-14 protein, which augmented the expression of the adhesion mediator, P-selectin, thereby promoting monocyte–platelet aggregates. Electron microscopy confirmed the firm interaction of platelets with monocytes in vitro and colocalization of macrophages with MRP-14 confirmed their cross talk in atherosclerotic manifestations of PAD in vivo. Platelet-derived MRP-14 was channeled to monocytes, thereby fueling their expression of key PAD lesional hallmarks and increasing their directed locomotion, which were both suppressed in the presence of antibody-mediated blockade. Circulating MRP-14 was heightened in the setting of PAD, significantly correlated with PAD severity, and was associated with incident limb events.

Conclusions

The authors identified a heightened platelet activity profile and unraveled a novel immunomodulatory effector role of platelet-derived MRP-14 in reprograming monocyte activation in symptomatic PAD. (Platelet Activity in Vascular Surgery and Cardiovascular Events [PACE]; NCT02106429; and Platelet Activity in Vascular Surgery for Thrombosis and Bleeding [PIVOTAL]; NCT01897103)

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Transcatheter Versus Surgical Aortic Valve Replacement: Unneglectable Concomitant Coronary Artery Disease

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MRP-14 Preach the Worse for Platelets and Monocytes Union in Peripheral Artery Disease

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A Vascular Endothelial Growth Factor-Dependent Sprouting Angiogenesis Assay Based on an In Vitro Human Blood Vessel Model for the Study of Anti-Angiogenic Drugs.

A Vascular Endothelial Growth Factor-Dependent Sprouting Angiogenesis Assay Based on an In Vitro Human Blood Vessel Model for the Study of Anti-Angiogenic Drugs.

EBioMedicine. 2017 Dec 20;:

Authors: Pauty J, Usuba R, Cheng IG, Hespel L, Takahashi H, Kato K, Kobayashi M, Nakajima H, Lee E, Yger F, Soncin F, Matsunaga YT

Abstract
Angiogenesis is the formation of new capillaries from pre-existing blood vessels and participates in proper vasculature development. In pathological conditions such as cancer, abnormal angiogenesis takes place. Angiogenesis is primarily carried out by endothelial cells, the innermost layer of blood vessels. The vascular endothelial growth factor-A (VEGF-A) and its receptor-2 (VEGFR-2) trigger most of the mechanisms activating and regulating angiogenesis, and have been the targets for the development of drugs. However, most experimental assays assessing angiogenesis rely on animal models. We report an in vitro model using a microvessel-on-a-chip. It mimics an effective endothelial sprouting angiogenesis event triggered from an initial microvessel using a single angiogenic factor, VEGF-A. The angiogenic sprouting in this model is depends on the Notch signaling, as observed in vivo. This model enables the study of anti-angiogenic drugs which target a specific factor/receptor pathway, as demonstrated by the use of the clinically approved sorafenib and sunitinib for targeting the VEGF-A/VEGFR-2 pathway. Furthermore, this model allows testing simultaneously angiogenesis and permeability. It demonstrates that sorafenib impairs the endothelial barrier function, while sunitinib does not. Such in vitro human model provides a significant complimentary approach to animal models for the development of effective therapies.

PMID: 29289530 [PubMed - as supplied by publisher]

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Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study.

Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study.

Surg Radiol Anat. 2017 Dec 30;:

Authors: Morel F, Crampon F, Adnot J, Litzler PY, Duparc F, Trost O

Abstract
PURPOSE: Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions.
METHODS: We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured.
RESULTS: In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm.
CONCLUSION: Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.

PMID: 29289988 [PubMed - as supplied by publisher]

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A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients.

A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients.

J Plast Reconstr Aesthet Surg. 2017 Nov 28;:

Authors: Walker ME, Tsay C, Broer PN, Zhu VZ, Sturrock T, Ng R, Scoutt LM, Thomson JG, Kwei SL

PMID: 29289501 [PubMed - as supplied by publisher]

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Perforator mapping reduces the operative time of DIEP flap breast reconstruction: A systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography.

Perforator mapping reduces the operative time of DIEP flap breast reconstruction: A systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography.

J Plast Reconstr Aesthet Surg. 2017 Dec 12;:

Authors: Wade RG, Watford J, Wormald JCR, Bramhall RJ, Figus A

Abstract
BACKGROUND: Prior to DIEP flap breast reconstruction, mapping the perforators of the lower abdominal wall using ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) reduces the risk of flap failure. This review aimed to investigate the additional potential benefit of a reduction in operating time.
METHODS: We systematically searched the literature for studies concerning adult women undergoing DIEP flap breast reconstruction, which directly compared the operating times and adverse outcomes for those with and without preoperative perforator mapping by ultrasound, CTA or MRA. Outcomes were extracted, data meta-analysed and the quality of the evidence appraised.
RESULTS: Fourteen articles were included. Preoperative perforator mapping by CTA or MRA significantly reduced operating time (mean reduction of 54 minutes [95% CI 3, 105], p = 0.04), when directly compared to DIEP flap breast reconstruction with no perforator mapping. Further, perforator mapping by CTA was superior to ultrasound, as CTA saved more time in theatre (mean reduction of 58 minutes [95% CI 25, 91], p < 0.001) and was associated with a lower risk of partial flap failure (RR 0.15 [95% CI 0.04, 0.6], p = 0.007). All studies were at risk of methodological bias and the quality of the evidence was very low.
CONCLUSIONS: The quality of research regarding perforator mapping prior to DIEP flap breast reconstruction is poor and although preoperative angiography appears save operative time, reduce morbidity and confer cost savings, higher quality research is needed.
REGISTRATION: PROSPERO ID CRD42017065012.

PMID: 29289500 [PubMed - as supplied by publisher]

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Founder mutation in IKBKAP gene causes vestibular impairment in familial dysautonomia.

Founder mutation in IKBKAP gene causes vestibular impairment in familial dysautonomia.

Clin Neurophysiol. 2017 Nov 26;129(2):390-396

Authors: Gutiérrez JV, Kaufmann H, Palma JA, Mendoza-Santiesteban C, Macefield VG, Norcliffe-Kaufmann L

Abstract
OBJECTIVE: To assess vestibular function in patients with familial dysautonomia (FD), a hereditary sensory and autonomic neuropathy - caused by a mutation in the IKBKAP gene (c.2204 + 6 T>C) - and characterized by marked gait ataxia.
METHODS: Cervical and vestibular evoked myogenic potentials (cVEMPs and oVEMPs) were recorded from the sternocleidomastoid (SCM) and extraocular muscles in 14 homozygous patients, 2 heterozygous patients, and 15 healthy controls during percussion of the forehead.
RESULTS: cVEMP and oVEMP amplitudes were significantly lower, and peak latencies significantly delayed, in the FD patients. There were no differences in overall EMG during attempted maximal voluntary contractions of the SCM muscle, suggesting intact efferent function. The two heterozygotes with a minor haplotype missense (R696P) mutation in exon 19 of the IKBKAP gene had cVEMP responses less affected than the homozygous.
CONCLUSIONS: The founder mutation in the IKBKAP gene affects the development of vestibular afferent pathways, leading to attenuated cVEMPs.
SIGNIFICANCE: Vestibular abnormalities may contribute to the gait ataxia in FD.

PMID: 29289840 [PubMed - as supplied by publisher]

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Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea.

Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea.

World J Surg. 2017 Dec 31;:

Authors: Hwang K, Kwon J, Cho J, Heo Y, Lee JC, Jung K

Abstract
BACKGROUND: This study evaluated the effectiveness and clinical outcomes of the implementation of a trauma center and massive transfusion protocol (TCMTP) in a developing country without a well-established trauma system.
METHODS: We included patients (1) aged >15 years, (2) with an Injury Severity Score >15, (3) who received ≥10 units of packed red blood cells (PRBCs) within 24 h, (4) who directly visited our institution from 2010 to 2016, and (5) who survived for ≥24 h. Patients treated during the post-TCMTP period (2015-2016) were compared with historical groups treated pre-TCMTP (2010-2012) and interim-TCMTP (2013-2014). Demographics, transfusion and fluid therapy performance, and clinical outcomes were compared between the three groups.
RESULTS: Overall, 190 patients were included: 64, 64, and 62 patients in the pre-TCMTP, interim-TCMTP, and post-TCMTP groups, respectively. Comparison between the three groups revealed significant differences in the fresh-frozen plasma/PRBC ratio (p = 0.001) and crystalloid infusion (p = 0.007); these variables gradually increased from pre- to post-TCMTP. Conversely, colloid infusion showed a reduction post-TCMTP (p < 0.001). Kaplan-Meier curves revealed that the 90-day survival rate was significantly higher in the post-TCMTP group (pre-TCMTP: 45.3 vs. 75.8%, p = 0.001; interim-TCMTP: 56.3 vs. 75.8%, p = 0.027). In Cox regression hierarchical survival analysis, TCMTP showed a hazard ratio for mortality of 0.380 after adjusting for all potentially confounding factors.
CONCLUSIONS: Our results suggest that building trauma centers and establishing a massive transfusion protocol according to the specific situations of a country will help improve outcomes for major trauma patients, even in developing countries without a well-established trauma system.

PMID: 29290073 [PubMed - as supplied by publisher]

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Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo.

Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo.

World J Surg. 2017 Dec 31;:

Authors: Kalisya LM, Bake JF, Bigabwa R, Rothstein DH, Cairo SB

Abstract
INTRODUCTION: Surgery is an essential component of a functional health system, with surgical conditions accounting for nearly 11-15% of world disability. While communicable diseases continue to burden low- and low-middle-income countries, non-communicable diseases, such as cancer, are an important cause of morbidity and mortality worldwide. Preliminary data on malignancies in low- and middle-income countries, specifically in Africa, suggest a higher mortality compared to other regions of the world, a difference partially explained by limited availability of screening and early detection systems as well as poorer access to treatment.
OBJECTIVE: To evaluate the diagnosed tumor burden in the Eastern Democratic Republic of Congo (DRC) and review literature on existing and suspected barriers to accessing appropriate oncologic care.
METHODS: This is a retrospective study carried out at Healthcare, Education, community Action, and Leadership development Africa, a 197-bed tertiary referral hospital, in the Province of North Kivu, along the eastern border of the DRC from 2012 to 2015. Patient charts were reviewed for diagnoses of presumed malignancy with biopsy results.
RESULTS: A total of 252 cases of suspected cancer were reviewed during the study period; 39.7% were men. The average age of patients was 43 years. Amongst adult patients, the most common presenting condition involved breast lesions with 5.8% diagnosis of fibrocystic breast changes and 2.9% invasive ductal carcinoma of the breast. 37.3% of female patients had lesions involving the cervix or uterus. The most common diagnosis amongst male adults was prostate disease (16.7% of men). For pediatric patients, the most common diagnoses involved bone and/or cartilage (27.3%) followed by skin and soft tissue lesions (20.0%). All patients underwent surgical resection of lesions; some patients were advised to travel out of country for chemotherapy and radiation for which follow-up data are unavailable.
CONCLUSION: Adequate and timely treatment of malignancy in the DRC faces a multitude of challenges. Access to surgical services for diagnosis and management as well as chemotherapeutic agents is prohibitively limited. Increased collaboration with local clinicians and remote specialist consultants is needed to deliver subspecialty care in resource-poor settings.

PMID: 29290072 [PubMed - as supplied by publisher]

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Hakim Mohammad: A Persian Military Surgeon in Safavid Era (1501-1736 CE).

Hakim Mohammad: A Persian Military Surgeon in Safavid Era (1501-1736 CE).

World J Surg. 2017 Dec 31;:

Authors: Khodaie SA, Ghaffari F, Zargaran A, Naseri M

Abstract
BACKGROUND: Wars and injuries have accompanied mankind throughout history. Physicians and surgeons from various civilizations made difficult attempts to manage wounds and injuries. Among various civilizations, the Persian Empires had great armies which were well equipped. One of the most important organizations in Persian troops was the military surgery.
METHODS: This study presents a brief biography of Hakim Mohammad (a military surgeon in Safavid era) and introduces his book, Dhakhira-yi-Kamilah.
RESULTS AND DISCUSSION: Safavid kings (1501-1736 CE) with unifying all of Persian regions and provinces reconstructed the Persian Empire. Great scholars and physicians were raised in this era. It seems that Persian physicians and surgeons were well trained in Safavid era and many of them were even employed by other countries like Ottoman Empire and India. Hakim Mohammad as a military surgeon was one of such physicians who served in Ottoman Empire for some time. He gathered his surgical experiences and others in the book of Dhakhira-yi-Kamilah. This book was written in Persian. He has mainly written about the management of wounds and practical techniques. Later, he came back to his homeland and dedicated his book to the king of Persia.

PMID: 29290071 [PubMed - as supplied by publisher]

http://ift.tt/2DJjMIe

One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy.

One-Hour Postoperative Parathyroid Hormone Levels Do Not Reliably Predict Hypocalcemia After Thyroidectomy.

World J Surg. 2017 Dec 31;:

Authors: Sahli Z, Najafian A, Kahan S, Schneider EB, Zeiger MA, Mathur A

Abstract
INTRODUCTION: Hypocalcemia is a well-known complication after total thyroidectomy. Studies have indicated that the presence of low postoperative parathyroid hormone (PTH) levels can predict hypocalcemia. However, definitive study designs are lacking. The aim of this study was to determine whether postoperative PTH alone can accurately predict postoperative biochemical hypocalcemia.
METHODS: Under IRB approval, a prospective study of 218 consecutive patients who underwent total or completion thyroidectomy by two surgeons between June 2014 and June 2016 was performed. Biochemical hypocalcemia was defined as ionized calcium <1.13 mmol/L or serum calcium <8.4 mg/dL at any time postoperatively. Three PTH thresholds, <10, <20 pg/mL, and >50% drop in PTH 1 h postoperatively from baseline were examined.
RESULTS: Postoperative PTH < 10 pg/mL had a sensitivity of 36.5% (95% CI 27.4-46.3%) and a specificity of 89.2% (95% CI 81.9-94.3%). Postoperative PTH < 20 pg/mL had a sensitivity of 66.4% (95% CI 56.6-75.2%) and a specificity of 67.6% (95% CI 58.0-76.2%). Postoperative PTH decrease >50% had a sensitivity of 63.4% (95% CI 53.2-72.7%) and a specificity of 72.5% (95% CI 62.5-81.0%). Across all PTH thresholds, the false-negative rate was 33.6-63.5% indicating that up to 64% of patients with a normal PTH level could have been discharged without appropriate calcium supplementation. The false-positive rate was 10.8-32.4% indicating that up to 32.4% of patients with low PTH could have been treated with calcium supplementation unnecessarily.
CONCLUSION: Following total thyroidectomy, PTH levels are unreliable in predicting hypocalcemia. Additional prospective studies are needed to understand the true utility of PTH levels post-thyroidectomy.

PMID: 29290070 [PubMed - as supplied by publisher]

http://ift.tt/2DJjCR8

Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma.

Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma.

World J Surg. 2017 Dec 31;:

Authors: Hirahara N, Tajima Y, Fujii Y, Kaji S, Yamamoto T, Hyakudomi R, Taniura T, Miyazaki Y, Kishi T, Kawabata Y

Abstract
BACKGROUND: The purpose of the present study is to investigate the utility of prognostic nutritional index (PNI) as a simple and readily available marker in esophageal squamous cell carcinoma (ESCC).
METHODS: We retrospectively analyzed 169 patients who underwent potentially curative esophagectomy, for histologically verified ESCC. We decided to set the optimal cutoff value for preoperative PNI levels at 49.2, based on the cancer-specific survival (CSS) and the overall survival (OS) by receiver operating characteristic curve analysis.
RESULTS: Multivariate logistic regression analysis identified that TNM pStage III [hazard ratio (HR) 3.261, p < 0.0001] and PNI < 49.2 (HR 3.887, p < 0.0001) were confirmed as independent poor predictive factors for CSS, and age >70 (HR 2.024, p < 0.0042), TNM pStage III (HR 2.510, p = 0.0002), and PNI < 49.2 (HR 2.248, p = 0.0013) were confirmed as independent poor predictive factors for OS. In non-elderly patients, TNM pStage III (CSS; HR 3.488, p < 0.0001, OS; HR 2.615, p = 0.0007) and PNI < 49.2 (CSS; HR 3.849, p < 0.0001, OS; HR 2.275, p = 0.001) were confirmed as independent poor predictive factors for CSS, and OS when multivariate logistic regression analysis was applied. But in elderly patients, univariate analyses demonstrated that the TNM pStage III was the only significant risk factor for CSS (HR 3.701, p = 0.0057) and OS (HR 1.974, p = 0.0224).
CONCLUSIONS: The PNI was a significant and independent predictor of CSS and OS of ESCC patients after curative esophagectomy. The PNI was cost-effective and readily available, and it could act as a marker of survival.

PMID: 29290069 [PubMed - as supplied by publisher]

http://ift.tt/2CwHVTd

Topical Minoxidil Versus Topical Diltiazem for Chemical Sphincterotomy of Chronic Anal Fissure: A Prospective, Randomized, Double-Blind, Clinical Trial.

Topical Minoxidil Versus Topical Diltiazem for Chemical Sphincterotomy of Chronic Anal Fissure: A Prospective, Randomized, Double-Blind, Clinical Trial.

World J Surg. 2017 Dec 31;:

Authors: Alvandipour M, Ala S, Khalvati M, Yazdanicharati J, Koulaeinejad N

Abstract
BACKGROUND: Anal fissure is a common anorectal problem causing severe pain and discomfort to the patients. Chemical sphincterotomy has emerged as a noninvasive alternative to the surgical methods of fissure treatment. The objective of this study was evaluation of the efficacy and the adverse effects of topically applied minoxidil in chemical sphincterotomy of chronic anal fissure in comparison with topical diltiazem.
METHODS: A total of 88 patients with chronic anal fissure aged between 15 and 65 years were included in this double-blind, randomized clinical trial and were randomly assigned to either 0.5% minoxidil cream or 2% diltiazem cream twice daily for 2 weeks. The pain intensity, bleeding, wound healing, itching, headache, dizziness, significant drop in blood pressure, allergy and fissure relapse were assessed on a monthly basis for 2 months.
RESULTS: Both diltiazem and minoxidil reduced the pain, bleeding and improved fissure healing with no significant difference. There were no between-groups differences in the frequencies of adverse effects, except for itching which was slightly higher with minoxidil during the first month. Allergy occurred in two patients in the minoxidil group, which was not severe and did not lead to discontinuation of the trial.
CONCLUSION: Topically administered minoxidil is of equal efficacy as diltiazem in the treatment of chronic anal fissure with low frequency of adverse effects. Thus, it can be considered as an agent for chemical sphincterotomy of anal fissure, but the itching at the beginning of the treatment can affect the adherence of the patient to treatment. Trial registration number IRCT2015041414483N6 (the full trial protocol could be accessed online at www.irct.ir ).

PMID: 29290068 [PubMed - as supplied by publisher]

http://ift.tt/2DHIzMR

[Hodgkin lymphoma: Current and future therapeutic strategies].

[Hodgkin lymphoma: Current and future therapeutic strategies].

Bull Cancer. 2017 Dec 27;:

Authors: Turpin A, Michot JM, Kempf E, Mazeron R, Dartigues P, Boros A, Bonnetier S, Castilla-Llorente C, Coman T, Danu A, Ghez D, Pilorge S, Arfi-Rouche J, Dercle L, Soria JC, Carde P, Ribrag V, Fermé C, Lazarovici J

Abstract
Hodgkin lymphoma (HL) is a cancer that mostly affects young people, in which modern therapeutic strategies using chemotherapy and radiotherapy result in a cure rate exceeding 80%. Survivors are exposed to long-term consequences of treatments, such as secondary malignancies and cardiovascular diseases, whose mortality exceeds the one of the disease itself, with long-term follow-up. The current therapeutic strategy in HL, based on the assessment of initial risk factors, is the result of large clinical trials led by the main international cooperating groups. More recently, several groups have tried to develop treatment strategies adapted to the response to chemotherapy, evaluated by interim PET/CT scan. However to date, the combined treatment with chemotherapy followed by radiation therapy remains a standard in most of the above-diaphragmatic localized forms. Immune checkpoint inhibitors, and especially anti-PD1 antibodies, have shown dramatic results in some serious forms of relapsed or refractory HL, with limited toxicity, and may contribute in the future to reduce the toxicities of treatments.

PMID: 29289336 [PubMed - as supplied by publisher]

http://ift.tt/2DHbFMk

Avoiding the ingestion of cytotoxic concentrations of ethanol may reduce the risk of cancer associated with alcohol consumption.

Avoiding the ingestion of cytotoxic concentrations of ethanol may reduce the risk of cancer associated with alcohol consumption.

Drug Alcohol Depend. 2017 Dec 27;183:201-204

Authors: Guillén-Mancina E, Calderón-Montaño JM, López-Lázaro M

Abstract
Alcohol consumption is a known risk factor for cancer. Almost 6% of all cancers worldwide are attributable to alcohol use. Approximately half of them occur in tissues highly exposed to ethanol, such as the oral cavity, pharynx, upper larynx and esophagus. However, since ethanol is not mutagenic and the mutagenic metabolite of ethanol (acetaldehyde) is mainly produced in the liver, it is unclear why alcohol consumption preferentially exerts a local carcinogenic effect. Recent findings indicate that the risk of cancer in a tissue is strongly correlated with the number of stem cell divisions accumulated by the tissue; the accumulation of stem cell divisions leads to the accumulation of cancer-promoting errors such as mutations occurring during DNA replication. Since cell death activates the division of stem cells, we recently proposed that the possible cytotoxicity of ethanol on the cells lining the tissues in direct contact with alcoholic beverages could explain the local carcinogenic effect of alcohol. Here we report that short-term exposures (2-3 s) to ethanol concentrations between 10% and 15% start to cause a marked cytotoxic effect on human epithelial keratinocytes in a concentration-dependent manner. We propose that choosing alcoholic beverages containing non-cytotoxic concentrations of ethanol, or diluting ethanol to non-cytotoxic concentrations, may be a simple and effective way to reduce the risk of cancers of the oral cavity, pharynx, larynx and esophagus in alcohol users. This preventive strategy may also reduce the known synergistic effect of alcohol drinking and tobacco smoking on the risk of these cancers.

PMID: 29289868 [PubMed - as supplied by publisher]

http://ift.tt/2DHbYGY

The Effectiveness of the EASE Scale in the Development of a Vocal Warm-up Program for an Amateur Choir.

The Effectiveness of the EASE Scale in the Development of a Vocal Warm-up Program for an Amateur Choir.

J Voice. 2017 Dec 28;:

Authors: Marchand DLP, Kavaliunas FS, Cassol M

Abstract
OBJECTIVES: This study aims to assess the effectiveness of the EASE-BR (Evaluation of the Ability to Sing Easily for Brazil) protocol in the development of a vocal warm-up program for members of an amateur choir.
STUDY DESIGN: This is a prospective cross-sectional study measuring pre- and postintervention results at two moments.
METHODS: Forty-four subjects filled out a questionnaire to characterize the sample and underwent two major applications of the EASE-BR scale-the first to determine the group's vocal requirements and the second to assess the performance after the application of a customized vocal warm-up routine.
RESULTS: Overall reduction of the scores in the postintervention moment has been determined. The score of 16 of the questions (72.7%) showed a statistically relevant reduction after the intervention.
CONCLUSIONS: The EASE-BR scale proved a valuable assessment tool and its use may help develop customized vocal warm-up programs for different types of singers.

PMID: 29289412 [PubMed - as supplied by publisher]

http://ift.tt/2q89cc7

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis.

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis.

Eur Arch Otorhinolaryngol. 2017 Dec 30;:

Authors: Jokela J, Haapaniemi A, Mäkitie A, Saarinen R

Abstract
OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented.
METHODS: Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure.
RESULTS: The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups.
CONLUSION: Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.

PMID: 29290052 [PubMed - as supplied by publisher]

http://ift.tt/2zWZlW3

Rotavirus Infection as a Frequent Cause of Neonatal Fever.

Rotavirus Infection as a Frequent Cause of Neonatal Fever.

Pediatr Int. 2017 Dec 31;:

Authors: Kang HN, Park HK, Lee HJ, Moon JH, Oh JW, Kim CR

Abstract
BACKGROUND: Fever rather than diarrhea or vomiting was the most common symptom of neonatal rotavirus(RV) infection in our previous study. We investigated if RV infection is a major cause of neonatal fever and we compared the clinical characteristics of bacterial infections, viral infections and unknown causes of neonatal fever.
METHOD: We reviewed the electronic medical records of 48 newborns of ≤ 28 days who were admitted to the Special Care Nursery of Hanyang University Guri Hospital for fever (≥ 38°C) from 2005 to 2009. All the newborns underwent CBC, urinalysis, C-reactive protein, cultures of blood, urine, and CSF as well as stool RV ELISA. Respiratory virus PCR for cough or rhinorrhea, and stool culture for diarrhea were also done.
RESULTS: All the babies were term, mean age 13±8 days and peak body temperature 38.5±0.5°C. The causes of neonatal fever were viral (44%), bacterial (10%) and unknown (46%). The viral infections included RV (n=12), enterovirus (n=6), respiratory syncytial virus (n=2), and rhinovirus (n=1). All the rotavirus genotypes were G4P[6]. Only 3 of 12 RV-infected febrile newborns had diarrhea. The bacterial infections included 3 urinary tract infections (2 Escherichia coli and 1 Klebsiella pneumoniae), and 2 sepsis and meningitis (all Streptococcus agalactiae).
CONCLUSIONS: RV infection is the most common single cause of neonatal fever. It may be necessary to include stool RV tests for febrile newborns.

PMID: 29290098 [PubMed - as supplied by publisher]

http://ift.tt/2C3s11n

Contemporary Patterns of Multidisciplinary Care in Patients With Muscle-invasive Bladder Cancer.

Contemporary Patterns of Multidisciplinary Care in Patients With Muscle-invasive Bladder Cancer.

Clin Genitourin Cancer. 2017 Dec 06;:

Authors: Harshman LC, Tripathi A, Kaag M, Efstathiou JA, Apolo AB, Hoffman-Censits JH, Stadler WM, Yu EY, Bochner BH, Skinner EC, Downs T, Kiltie AE, Bajorin DF, Guru K, Shipley WU, Steinberg GD, Hahn NM, Sridhar SS

Abstract
BACKGROUND: Multidisciplinary clinics integrate the expertise of several specialties to provide effective treatment to patients. This exposure is especially relevant in the management of muscle-invasive bladder cancer (MIBC), which requires critical input from urology, radiation oncology, and medical oncology, among other supportive specialties.
MATERIALS AND METHODS: In the present study, we sought to catalog the different styles of multidisciplinary care models used in the management of MIBC and to identify barriers to their implementation. We surveyed providers from academic and community practices regarding their currently implemented multidisciplinary care models, available resources, and perceived barriers using the Bladder Cancer Advocacy Network and the Genitourinary Medical Oncologists of Canada e-mail databases.
RESULTS: Of the 101 responding providers, most practiced at academic institutions in the United States (61%) or Canada (29%), and only 7% were from community practices. The most frequently used model was sequential visits on different days (57%), followed by sequential same-day (39%) and concurrent (1 visit with all providers; 22%) models. However, most practitioners preferred a multidisciplinary clinic involving sequential same-day (41%) or concurrent (26%) visits. The lack of clinic space (58%), funding (41%), staff (40%), and time (32%) were the most common barriers to implementing a multidisciplinary clinic.
CONCLUSION: Most surveyed practitioners at academic centers use some form of a multidisciplinary care model for patients with MIBC. The major barriers to more integrated multidisciplinary clinics were limited time and resources rather than a lack of provider enthusiasm. Future studies should incorporate patient preferences, further evaluate practice patterns in community settings, and assess their effects on patient outcomes.

PMID: 29289519 [PubMed - as supplied by publisher]

http://ift.tt/2DJuaQt

Comparing Uniplanar and Multiaxial Pedicle Screws in the Derotation of Apical Vertebrae for Lenke V Adolescent Idiopathic Scoliosis (AIS): A Case Controlled Study.

Comparing Uniplanar and Multiaxial Pedicle Screws in the Derotation of Apical Vertebrae for Lenke V Adolescent Idiopathic Scoliosis (AIS): A Case Controlled Study.

World Neurosurg. 2017 Dec 28;:

Authors: Lin T, Li T, Jiang H, Ma J, Zhou X

Abstract
OBJECTION: To compare the use of uniplanar and multiaxial pedicle screws in terms of their effects on the apical vertebral derotation efficiency in Lenke V AIS patients.
METHODS: A retrospective study was performed, and Lenke V AIS patients with uniplanar pedicle screws (Group I) and multiaxial pedicle screws (Group II) were collected from Jan 2013 to Dec 2015. The grade of the apical vertebral rotation was evaluated before and after surgery using the Nash-Moe and Upasani methods, respectively. The SRS-22 scale was also used to evaluate the satisfaction of the patients.
RESULTS: There were no significant differences in terms of age, duration of follow up, correction ratio, and preoperative level of apical rotation between both groups (p<0.05). Group I indicated better apical vertebral derotation than Group II (0 level: 10.5% versus 2.3%, I level: 71.1% versus 38.6%, II level: 18.4% versus 59.1%; p=0.001). The progression group showed lower bone maturity (p<0.0001, OR=52.0, 95%CI: 6.3∼430.7) in Group I, and similar results were observed in Group II (p=0.057, OR=12.3, 95%CI: 1.3∼121.3). Patients from Group I showed better satisfaction than those from Group II based on the SRS-22 scores (p<0.05).
CONCLUSION: Both types of pedicle screws could provide effective correction, but the uniplanar pedicle screw was better for derotation of vertebrae and provided patients with better satisfaction. Skeleton immaturity was positively correlated with the progression of vertebral rotation after surgery.

PMID: 29289805 [PubMed - as supplied by publisher]

http://ift.tt/2CzVfpT

Endovascular Management of Multiple Dysplastic Aneurysms in a Young Male With an Unknown Underlying Etiology: A Case Report and Review of the Literature.

Endovascular Management of Multiple Dysplastic Aneurysms in a Young Male With an Unknown Underlying Etiology: A Case Report and Review of the Literature.

World Neurosurg. 2017 Dec 28;:

Authors: Scullen T, Mathkour M, Lockwood J, Ott L, Medel R, Dumont AS, Amenta PS

Abstract
BACKGROUND: Intracranial aneurysms (IA) are the leading cause of non-traumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and management of a 27-year-old male with concurrent bilateral A1-2 junction aneurysms and fusiform intraorbital ophthalmic artery (OA) aneurysms.
CASE DESCRIPTION: A 27-year-old male with no past medical history presented with three months of headaches. Imaging reveled a large dysplastic left A1-2 junction aneurysm and a smaller saccular right A1-2 junction aneurysm, with potentially adherent domes. Two fusiform aneurysms of the intraorbital segment of the left OA were also identified. The patient underwent coil-assisted Pipeline embolization of the left A1-A2 aneurysm, with complete obliteration and reconstitution of the normal parent vessel. The patient underwent coil embolization of the right A1-2 aneurysm 3 weeks later, and was found to have grown significantly at the time of treatment. Three-month follow-up demonstrated spontaneous resolution of the OA aneurysms, persistent obliteration of the left aneurysm and significant recurrence of the right aneurysm, which was treated with stent-assisted coil embolization. A second recurrence three months later was successfully treated with repeat coiling. At the time of this treatment, the patient was also found to have two de novo distal middle cerebral artery (MCA) and ACA dysplastic aneurysms which were not treated. Follow up angiography 6 weeks later demonstrated stable complete obliteration of the right A1-2 aneurysm and interval complete resolution of the dysplastic MCA aneurysm. The distal ACA aneurysm was observed to have minimally increased in size, however, the parent vessel showed signs of interval partial thrombosis with contrast stasis within the aneurysm. This final aneurysm is currently being followed with serial imaging. The patient remains neurologically intact with complete resolution of his headaches.
CONCLUSION: We present a young male with no past medical history who presented with multiple dysplastic aneurysms. Successful staged endovascular intervention resulted in obliteration of aneurysms with spontaneous obliteration of the intraorbital OA aneurysms observed at three months. We present this case to review the multiple challenges of managing complex ACA aneurysms and to highlight the utility of endovascular intervention in their treatment.

PMID: 29289804 [PubMed - as supplied by publisher]

http://ift.tt/2DJfWyK

Application of a rubber band with hooks on both ends for vagus nerve stimulator implantation.

Application of a rubber band with hooks on both ends for vagus nerve stimulator implantation.

World Neurosurg. 2017 Dec 28;:

Authors: Hosoyama H, Hanaya R, Otsubo T, Sato M, Kashida Y, Sugata S, Katagiri M, Iida K, Arita K

Abstract
BACKGROUND: Vagus nerve stimulation (VNS) is a valuable therapeutic option for many types of drug-resistant epilepsy. Muscle hooks and carotid endarterectomy rings have been used for cervical delamination preceding the implantation of stimulation electrodes. The attachment on both sides of a rubber band of Kamiyama-style hanging needles, as are used for scalp and dural retraction during craniotomy, yields a useful tool for VNS implantation. Here we report our experience with this method.
METHODS: We present our method using a rubber band-plus-hooks and a review of 21 consecutive patients who underwent VNS implantation using our rubber band-plus-hooks method.
RESULTS: None of the 21 patients experienced intra- or perioperative complications. Hooks placed in connective tissue around the common carotid artery and jugular vein raised the vagus nerve by elevating the carotid sheath. A single surgeon was able to perform all cervical manipulations under a surgical microscope; the average operation time in this series of 21 patients was 137 min.
CONCLUSIONS: The use of hooks attached to both sides of a rubber band rendered VNS implantation safer by lifting the vagus nerve and standardizing the procedure.

PMID: 29289803 [PubMed - as supplied by publisher]

http://ift.tt/2CzV9P3

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis.

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis.

Eur Arch Otorhinolaryngol. 2017 Dec 30;:

Authors: Jokela J, Haapaniemi A, Mäkitie A, Saarinen R

PMID: 29290052 [PubMed - as supplied by publisher]

http://ift.tt/2zWZlW3

Decreased plasma DEK Oncogene Levels Correlate with p16-Negative Disease and Advanced Tumor Stage in a Case-Control Study of Patients with Head and Neck Squamous Cell Carcinoma.

Decreased plasma DEK Oncogene Levels Correlate with p16-Negative Disease and Advanced Tumor Stage in a Case-Control Study of Patients with Head and Neck Squamous Cell Carcinoma.

Transl Oncol. 2017 Dec 28;11(1):168-174

Authors: Wise-Draper T, Sendilnathan A, Palackdharry S, Pease N, Qualtieri J, Butler R, Sadraei NH, Morris JC, Patil Y, Wilson K, Mark J, Casper K, Takiar V, Lane A, Privette Vinnedge L

Abstract
Head and neck cancer (HNC) remains the sixth most common malignancy worldwide and survival upon recurrence and/or metastasis remains poor. HNSCC has traditionally been associated with alcohol and nicotine use, but more recently the Human Papilloma Virus (HPV) has emerged as a favorable prognostic risk factor for oropharyngeal HNSCC. However, further stratification with additional biomarkers to predict patient outcome continues to be essential. One candidate biomarker is the DEK oncogenic protein, which was previously detected in the urine of patients with bladder cancer and is known to be secreted by immune cells such as macrophages. Here, we investigated if DEK could be detected in human plasma and if DEK levels correlated with clinical and pathological variables of HNSCC. Plasma was separated from the peripheral blood of newly diagnosed, untreated HNSCC patients or age-matched normal healthy controls and analyzed for DEK protein using ELISA. Plasma concentrations of DEK protein were lower in p16-negative tumors compared to both normal controls and patients with p16-positive tumors. Patients with lower plasma concentrations of DEK were also more likely to have late stage tumors and a lower white blood cell count. Contrary to previously published work demonstrating a poor prognosis with high intratumoral DEK levels, we show for the first time that decreased concentrations of DEK in patient plasma correlates with poor prognostic factors, including HPV-negative status as determined by negative p16 expression and advanced tumor stage.

PMID: 29289845 [PubMed - as supplied by publisher]

http://ift.tt/2CsR7ds

Zinc Deficiency via a Splice Switch in Zinc Importer ZIP2/SLC39A2 Causes Cystic Fibrosis-Associated MUC5AC Hypersecretion in Airway Epithelial Cells.

Zinc Deficiency via a Splice Switch in Zinc Importer ZIP2/SLC39A2 Causes Cystic Fibrosis-Associated MUC5AC Hypersecretion in Airway Epithelial Cells.

EBioMedicine. 2017 Dec 20;:

Authors: Kamei S, Fujikawa H, Nohara H, Ueno-Shuto K, Maruta K, Nakashima R, Kawakami T, Matsumoto C, Sakaguchi Y, Ono T, Suico MA, Boucher RC, Gruenert DC, Takeo T, Nakagata N, Li JD, Kai H, Shuto T

Abstract
Airway mucus hyperproduction and fluid imbalance are important hallmarks of cystic fibrosis (CF), the most common life-shortening genetic disorder in Caucasians. Dysregulated expression and/or function of airway ion transporters, including cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC), have been implicated as causes of CF-associated mucus hypersecretory phenotype. However, the contributory roles of other substances and transporters in the regulation of CF airway pathogenesis remain unelucidated. Here, we identified a novel connection between CFTR/ENaC expression and the intracellular Zn2+ concentration in the regulation of MUC5AC, a major secreted mucin that is highly expressed in CF airway. CFTR-defective and ENaC-hyperactive airway epithelial cells specifically and highly expressed a unique, alternative splice isoform of the zinc importer ZIP2/SLC39A2 (ΔC-ZIP2), which lacks the C-terminal domain. Importantly, ΔC-ZIP2 levels correlated inversely with wild-type ZIP2 and intracellular Zn2+ levels. Moreover, the splice switch to ΔC-ZIP2 as well as decreased expression of other ZIPs caused zinc deficiency, which is sufficient for induction of MUC5AC; while ΔC-ZIP2 expression per se induced ENaC expression and function. Thus, our findings demonstrate that the novel splicing switch contributes to CF lung pathology via the novel interplay of CFTR, ENaC, and ZIP2 transporters.

PMID: 29289532 [PubMed - as supplied by publisher]

http://ift.tt/2Cn6e92

On the studies of time periods in head and neck cancer diagnosis and treatment.

On the studies of time periods in head and neck cancer diagnosis and treatment.

Oral Oncol. 2017 Dec 27;:

Authors: Varela-Centelles P, García-Martín JM, Seoane-Romero J

PMID: 29289443 [PubMed - as supplied by publisher]

http://ift.tt/2DFTFCg

Effect of carrier bandwidth on integration of simulations of acoustic and electric hearing within or across ears.

Effect of carrier bandwidth on integration of simulations of acoustic and electric hearing within or across ears.

J Acoust Soc Am. 2017 Dec;142(6):EL561

Authors: Fu QJ, Galvin JJ, Wang X

Abstract
Differences in current spread and/or spread of excitation may differently affect integration of acoustic and electric hearing within (electric-acoustic stimulation, or EAS) or across ears (bimodal). In this study, vowel recognition was measured in normal-hearing subjects listening to simulations of cochlear implant (CI), EAS, and bimodal listening. Residual acoustic hearing was limited between 0.1 and 0.6 kHz. The carrier bandwidth in the CI simulations was varied across carriers: broad-band noise, narrow-band noise, and sine waves. Results showed that reducing the bandwidth (and the inherent noise fluctuations) in the CI simulations significantly affected CI-only and bimodal performance, but not EAS performance.

PMID: 29289073 [PubMed - in process]

http://ift.tt/2zXP6Rb

Integrating coaches into the national training programme: A modern approach to surgical supervision.

Integrating coaches into the national training programme: A modern approach to surgical supervision.

Int J Surg. 2017 Dec 28;:

Authors: Ahmed F, Sheriff IHN, Al-Alusi M, Ahmed N, Lasoye T

PMID: 29289678 [PubMed - as supplied by publisher]

http://ift.tt/2DJyejD

Why should neuroscientists worry about iron? The emerging role of ferroptosis in the pathophysiology of neuroprogressive diseases.

Why should neuroscientists worry about iron? The emerging role of ferroptosis in the pathophysiology of neuroprogressive diseases.

Behav Brain Res. 2017 Dec 28;:

Authors: Morris G, Berk M, Carvalho AF, Maes M, Walker AJ, Puri BK

Abstract
Ferroptosis is a unique form of programmed death, characterised by cytosolic accumulation of iron, lipid hydroperoxides and their metabolites, and effected by the fatal peroxidation of polyunsaturated fatty acids in the plasma membrane. It is a major driver of cell death in neurodegenerative neurological diseases. Moreover, cascades underpinning ferroptosis could be active drivers of neuropathology in major psychiatric disorders. Oxidative and nitrosative stress can adversely affect mechanisms and proteins governing cellular iron homeostasis, such as the iron regulatory protein/iron response element system, and can ultimately be a source of abnormally high levels of iron and a source of lethal levels of lipid membrane peroxidation. Furthermore, neuroinflammation leads to the upregulation of divalent metal transporter-1 on the surface of astrocytes, microglia and neurones, making them highly sensitive to iron overload in the presence of high levels of non-transferrin-bound iron, thereby affording such levels a dominant role in respect of the induction of iron-mediated neuropathology. Mechanisms governing systemic and cellular iron homeostasis, and the related roles of ferritin and mitochondria are detailed, as are mechanisms explaining the negative regulation of ferroptosis by glutathione, glutathione peroxidase 4, the cysteine/glutamate antiporter system, heat shock protein 27 and nuclear factor erythroid 2-related factor 2. The potential role of DJ-1 inactivation in the precipitation of ferroptosis and the assessment of lipid peroxidation are described. Finally, a rational approach to therapy is considered, with a discussion on the roles of coenzyme Q10, iron chelation therapy, in the form of deferiprone, deferoxamine (desferrioxamine) and deferasirox, and N-acetylcysteine.

PMID: 29289598 [PubMed - as supplied by publisher]

http://ift.tt/2C3UFzF

Evaluation of the Supraglottic and Subglottic Activities Including Acoustic Assessment of the Opera-Chant Singers.

Evaluation of the Supraglottic and Subglottic Activities Including Acoustic Assessment of the Opera-Chant Singers.

J Voice. 2017 Dec 28;:

Authors: Petekkaya E, Yücel AH, Sürmelioğlu Ö

Abstract
Opera and chant singers learn to effectively use aerodynamic components by breathing exercises during their education. Aerodynamic components, including subglottic air pressure and airflow, deteriorate in voice disorders. This study aimed to evaluate the changes in aerodynamic parameters and supraglottic structures of men and women with different vocal registers who are in an opera and chant education program. Vocal acoustic characteristics, aerodynamic components, and supraglottic structures were evaluated in 40 opera and chant art branch students. The majority of female students were sopranos, and the male students were baritone or tenor vocalists. The acoustic analyses revealed that the mean fundamental frequency was 152.33 Hz in the males and 218.77 Hz in the females. The estimated mean subglottal pressures were similar in females (14.99 cmH2O) and in males (14.48 cmH2O). Estimated mean airflow rates were also similar in both groups. The supraglottic structure compression analyses revealed partial anterior-posterior compressions in 2 tenors and 2 sopranos, and false vocal fold compression in 2 sopranos. Opera music is sung in high-pitched sounds. Attempts to sing high-pitched notes and frequently using register transitions overstrain the vocal structures. This intense muscular effort eventually traumatizes the vocal structures and causes supraglottic activity.

PMID: 29289411 [PubMed - as supplied by publisher]

http://ift.tt/2lwTVgi

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Δευτέρα 1 Ιανουαρίου 2018

Abstract

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Graphical abstract

Graphical abstract

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