Head and Neck Diseases by Alexandros G.Sfakianakis: 01/21/18

Κυριακή 21 Ιανουαρίου 2018

Influence of the oscillation frequency of different side-to-side toothbrushes on noncontact biofilm removal

Abstract

Objectives

The objective of this study was to investigate the influence of different oscillation frequencies of three powered toothbrushes with side-to-side action for noncontact biofilm removal in an artificial interdental space model.

Materials and methods

A three-species biofilm (Porphyromonas gingivalis, Fusobacterium nucleatum and Streptococcus sanguinis) was formed in vitro on protein-coated titanium disks using a flow chamber system combined with a static biofilm growth model. The oscillation frequencies of three commercial side-to-side toothbrushes were evaluated by means of a dose response. The frequency was decreased in steps (100, 85, 70, 55, and 40%). Subsequently, the biofilm-coated substrates were exposed to the side-to-side toothbrushes. The biofilm volumes were measured using volumetric analyses (Imaris 8.1.2) with confocal laser scanning microscope images (Zeiss LSM700).

Results

Compared to maximum oscillation frequency (100%), lower oscillation frequencies (up to 40%) resulted in reduced median percentages of biofilm reduction (median biofilm reduction up to 53% for maximum oscillation frequency, and up to 13% for 40% oscillation frequency) (p ≥ 0.03). In addition, decreasing the oscillation frequencies of the side-to-side toothbrushes showed an enhanced variety in the results of repeated experiments.

Conclusions

The oscillation frequency of the tested side-to-side toothbrushes affected the biofilm reduction in an interdental space model.

Clinical relevance

Within a toothbrush, higher oscillation frequencies may lead to beneficial effects on interdental biofilm removal by noncontact brushing.

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Alternatives to animal testing in basic and preclinical research of atopic dermatitis

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease of increasing prevalence, especially in industrialized countries. Roughly 25% of the children and 1-3% of adults are affected. Although significant progress has been made in the understanding of the pathogenesis of AD, many aspects remain poorly understood. Moreover, there is a pressing need for improved therapeutic options. Studies to elucidate the pathophysiological pathways of AD and to identify novel therapeutic targets over the last few decades have been conducted almost exclusively in animal models. However, in vitro approaches such as 3D skin disease models have recently emerged due to an increasing awareness of distinct inter-species related differences that hamper the effective translation of results from animal models to humans. In addition, there is growing political and social pressure to develop alternatives to animal models according to the 3Rs principle (reduction, refinement and replacement of animal models). In this review, we briefly summarize commonly used animal models of AD and discuss the advancements and limitations of human-based in vitro models in AD research. Moreover, we address aspects where further improvements are urgently required.

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Tracking actinic keratosis of face and scalp treated with 0.015% ingenol mebutate to identify clinical and dermoscopic predictors of treatment response

Abstract

Background

Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non-hyperkeratotic non-hypertrophic actinic keratosis (AKs) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non-surgical therapies for AK has not been fully defined.

Objectives

Our study aims to determine if some dermoscopic features of AK of the face and scalp areas, may independently predict the response to IngMeb therapy.

Methods

Clinical and dermoscopic responses, one month after 0.015% IngMeb therapy, were retrospectively evaluated using a per-patient and per-lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response.

Results

Fifty-five patients with 245 AKs were enrolled. Clinically, per-patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per-lesion approach to 66 (26.9%) and 179 (73.1%) AKs respectively. Dermoscopy re-classified 14 patients in the per-patient and 48 AKs in the per-lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy; while microerosions were negative predictors.

Conclusion

Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face.

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Clinicopathological features and course of cutaneous protothecosis

Abstract

Background

Protothecosis is an uncommon infection caused by the achlorophyllic algae found more commonly in tropical areas. Only a limited number of cases have been reported.

Objective

We aimed to evaluate the clinicopathological features and treatment outcomes of cutaneous protothecosis.

Methods

We retrospectively identified 20 pathology-confirmed cases of cutaneous protothecosis based on skin biopsies in two tertiary medical centers in Taiwan from 1997 to 2015.

Results

The age of the patients at the time of diagnosis ranged from 48 to 85 years (mean age of 74 years). All lesions developed on the limbs. Twelve (60%) patients had adrenal insufficiency, but no patients had active malignancy at diagnosis. Interestingly, 4 (20%) patients had concurrent scabies infestation. Clinically, most lesions were erythematous plaques studded with punctate ulcers. Microscopically, the most common finding was granulomatous inflammation. Nineteen (95%) cases were successfully treated with itraconazole for 14 to 148 days with only one case of recurrence. Concomitant scabies should be suspected if pruritus is recalcitrant despite itraconazole treatment.

Conclusion

Despite its rarity, cutaneous protothecosis has become more significant due to an increased prevalence of immunocompromised individuals. Steroid overuse or iatrogenic adrenal insufficiency predisposes individuals to high-risk infections. Neglecting the disease leads to a chronic and incurable state. Protothecosis should be suspected in chronic eczematous and ulcerative plaques on the limbs refractory to conventional antibacterial and antiviral treatments, especially in patients with adrenal insufficiency. Clinical suspicion should be confirmed by skin biopsies, and confirmed cases can be successfully treated with itraconazole.

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T-cell papulosis associated with B-cell malignancy: a distinctive clinicopathologic entity

Abstract

Background

A distinctive eruption referred to as "insect bite-like reaction", or "eosinophilic dermatosis of hematologic malignancy" has been described during the course of hematological B-cell malignancies (BCM). However, its clinical evolution, histopathological features and pathogenesis remain unclear.

Objectives

To characterize this eruption and to investigate its pathogenesis and relationship with the underlying BCM.

Methods

In this multicenter retrospective study of the French Study Group on Cutaneous Lymphomas, 37 patients with a BCM and a cutaneous eruption consisting in chronic and/or recurrent papules, papulo-vesicles and/or nodules were included. Clinical, histopathological, immunohistochemical and molecular data were reviewed.

Results

No significant insect bite history or seasonal predominance was recorded. Patients had pruritic papules (81%), papulo-vesicles (43%) and nodules (38%), often predominated in the head and neck region (84%), without complete remission periods in most cases (57%). The predominant associated BCM was chronic lymphocytic leukemia (73%). Histological and immunohistochemical review showed: a dense dermal lymphocytic infiltrate predominantly composed of T lymphocytes (100%), with frequent eosinophils (77.6%); a perivascular and periadnexial (most often pilotropic) pattern (77.6%), sometimes suggestive of a pilotropic mycosis fungoides; clusters of tumor B-cells were identified in 47% of cases using appropriate phenotyping markers. In 10/14 cases (71.4%) tested for B-cell IgH gene rearrangement, a B-cell clone was identified in skin lesions (identical to the blood clone in 9 cases), whereas no T-cell clone was present.

Conclusion

We propose the denomination "T-cell papulosis associated with B-cell malignancy" (TCP-BCM) for this distinctive eruption. Although resulting in various histopathological pictures, it can be easily recognized by clinicians, and may be identified by informed pathologists relying on some key features. An extravasation of tumor B-cells with skin-homing properties associated with a secondary, predominant, T-cell immune reaction could explain the clinico-pathologic aspect and the prolonged regressive and recurrent course of the disease.

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Marked pseudoepitheliomatous hyperplasia secondary to a red-pigmented tattoo: a case report

Abstract

Tattooing is gaining increasing popularity in developed countries in recent years. Adverse cutaneous reactions of many different types against coumponds in tattoo inks are being reported more and more often in medical literature,especially against red-pigmented tattoo. Delayed immune-mediated reactions can manifest in several ways and different histological patterns have been described

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Cutaneous melioidosis: two cases of chronic primary forms

Abstract

Melioidosis is a bacterial infection due to Burkholderia pseudomallei. Systemic forms are well described and characterized by a high lethality rate up to 40% (1). In contrast cutaneous melioidosis (CM) is rarely described. CM can be primary and present either as acute or chronic forms, or secondary in case of generalized disease.

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A multicenter, prospective, observational study examining the impact of risk factors, such as BMI and waist circumference, on quality of life improvement and clinical response in moderate-to-severe plaque-type psoriasis patients treated with infliximab in routine care settings of Greece

Abstract

Background

Obesity has been associated with moderate-to-severe plaque psoriasis severity and PASI 75 response attainment of biologic therapies, but findings are inconsistent.

Objective

This study aimed to examine the association of body mass index (BMI) and waist circumference (WC) on disease severity, to identify potential patient characteristics associated with response attainment, and to assess the impact of infliximab on the patients' health-related quality of life (HRQoL) among infliximab-treated patients in the routine care setting of Greece.

Methods

This was a multicenter, prospective, observational study of adult moderate-to-severe plaque psoriasis patients who had initiated treatment with originator infliximab within 2 weeks prior to enrollment. Post-enrollment visits occurred at 14±4, 30±4 and 54±4 weeks following treatment onset.

Results

Between October-2012 and June-2014, 136 eligible patients (62.5% males) with a median age of 48.6 years, BMI of 29.6 kg/m² and WC of 107.0 cm at enrollment, were recruited by 21 dermatology hospital/private offices. All patients had received prior psoriasis treatment(s); 62.5% were biologic-naïve. Mean baseline psoriasis area severity index (PASI) and Dermatology Quality of Life Index (DLQI) scores were 23.4±13.6 and 15.0±8.3, respectively. A low correlation was observed between WC at enrollment and baseline PASI [rho=0.324 (p<0.001)]. Over a median 48.4 weeks of infliximab exposure, 89.3% of the per protocol set achieved a PASI 75 response. At 14-, 30-, and 54-weeks, the PASI 75 attainment rate was 66.4%, 74.8% and 76.6%, respectively; the clinically meaningful DLQI improvement (≥5 point decrease) rate was 68.9%, 75.7%, and 69.8%, respectively. BMI category and abdominal obesity at enrollment did not impact PASI 75 or DLQI improvement rate attainment.

Conclusion

In the routine care of Greece, infliximab reduced disease activity and improved the quality of life of moderate-to-severe psoriasis patients through one year of treatment, independent of their BMI and WC.

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Severe adverse cutaneous drug reactions to antiepileptic drugs: 18 years of experience in a tertiary referral dermatology clinic in Turkey

Abstract

Antiepileptic drugs (AEDs) are the mainstay of treatment for 1% of the human population suffering from epilepsy.¹ They are also increasingly used for several non-epileptic neurological conditions, such as trigeminal neuralgia, neuropathic pain syndromes, migraine and psychiatric disorders.² Three percent of patients who receive AEDs experience adverse cutaneous drug reactions (ACDR),³ which can range across a wide spectrum from mild to moderate eruptions, such as maculopapular rash and, urticaria, to severe and life-threatening conditions, such as drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).^1,4-5

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Epidemiologie ausgewählter endokriner Tumoren in Deutschland

Zusammenfassung

Der vorliegende Beitrag gibt einen Überblick über die Inzidenz- und Überlebensraten bösartiger Tumoren der Schilddrüse, Nebennierenrinde und neuroendokriner Tumoren in Deutschland. Die Ergebnisse beruhen auf den Daten der epidemiologischen Krebsregister der Bundesländer. In den Jahren 2012 bis 2014 wurden demnach in Deutschland jährlich etwa 7700 neuroendokrine Tumoren, 6160 bösartige Tumoren der Schilddrüse und 120 Nebennierenrindenkarzinome diagnostiziert. Ähnlich wie in vielen anderen industrialisierten Ländern war Mitte der 2000er Jahre ein deutlicher Anstieg des prognostisch günstigen papillären Schilddrüsenkarzinoms zu beobachten; die Inzidenzraten haben sich zuletzt jedoch stabilisiert. Von den neuroendokrinen Karzinomen treten etwas mehr als die Hälfte der Fälle im Verdauungstrakt auf. Von diesen sind wiederum 50 % der Tumoren gut differenziert (NET Grad 1 und 2) mit entsprechend hohen relativen Fünfjahresüberlebensraten zwischen 70 % und 90 % je nach Lokalisation. Bei den übrigen Formen sind die Überlebenschancen teilweise deutlich geringer mit Ausnahme der neuroendokrinen Karzinome (NEC) von Dünndarm und Appendix, deren Überlebensraten nur geringfügig niedriger liegen als bei den NET. Auffallend sind durchgehend höhere Überlebensraten für Frauen, die nicht alleine durch eine etwas günstigere Verteilung der histologischen Formen erklärt werden können.

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Assessment of the efficacy and tolerance of an innovative regenerative serum on cutaneous regeneration, following fractional laser procedure using Erbium:YAG

Summary

Introduction

Cutaneous regeneration, fractional laser, medical device, cellular proliferation cutaneous changes linked to photoaging are currently treated with physical treatments, such as fractional laser, which may induce epidermal alteration.

Objective

To determine the efficacy and safety of a regenerative serum (Matricium^®, Laboratoire Bioderma, France) after laser procedure.

Methods

Prospective, double-blind, controlled, and randomized study in subjects with photoaged skin. The regenerative serum of treatment was used after a fractional laser session twice daily for 2 months on 1 side of the face and the placebo on the other side. The main variable to determine efficacy was the improvement of clinical signs and histological and immunological results.

Results

A superior quality of epidermal regeneration on the treated side compared to the placebo side was observed. Likewise, a superior and faster clinical improvement on static wrinkles was observed on the hemiface on which the regenerative serum was used. After 60 days, the investigator and the subjects observed a moderate to significant improvement of the skin on the treated side and a mild to moderate improvement on the placebo side.

Histological examinations showed a superior thickness of epidermis and higher cellular proliferation rate (Ki67 markers) as well as a superior thickness of dermis with higher increase in elastin density with the regenerative serum compared to placebo.

Conclusion

The use of the regenerative serum after fractional laser on the face accelerated and improved the cutaneous regeneration on both the clinical and histological level and maximized the benefits of the laser procedure.

http://ift.tt/2EZyDiE

Assessment of the efficacy and tolerance of an innovative regenerative serum on cutaneous regeneration, following fractional laser procedure using Erbium:YAG

Summary

Introduction

Objective

To determine the efficacy and safety of a regenerative serum (Matricium^®, Laboratoire Bioderma, France) after laser procedure.

Methods

Results

Conclusion

http://ift.tt/2EZyDiE

Luigi Porta’s contribution to anesthesia in Europe in the 1800s

Abstract

Luigi Porta (1800–1875), an Italian physician who was well known in the field of surgery, played an important role in spreading ethereal anesthesia in Europe. Moreover, he proposed an original method to administer ethereal anesthesia, the Italian method "of the bladder of pig". This paper reminds us of the important role that this physician played in Anesthesiology.

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Japanese case of xeroderma pigmentosum complementation group C with a novel mutation

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Increased risk of psoriasis following scabies infection: A nationwide population-based matched-cohort study

Abstract

Both scabies and psoriasis are pruritic inflammatory skin diseases. The clinical manifestations are similar and provocation of psoriasis by mite bite was reported. The association between scabies and psoriasis was not investigated before. We conducted this nationwide population-based matched-cohort study to describe if patients with a diagnosis of scabies have a different risk of developing new psoriasis. From the National Health Insurance Research Database of Taiwan, patients with scabies (n = 5137) were identified and matched for age and sex with non-scabies controls (n = 19 142). We tracked them for a 7-year period to identify the incidence of psoriasis. One hundred and ninety (0.8%) patients with newly diagnosed psoriasis were identified; 91 (1.8%) from the scabies group and 99 (0.5%) from the control group. Patients with scabies had a higher risk of subsequent psoriasis, with a crude hazard ratio of 3.45 and an adjusted hazard ratio (aHR) of 3.03 (95% confidence interval, 2.24–4.11). An increased risk for psoriasis among patients with scabies was observed (aHR, 3.03). Immunopathology involving the T-helper 17 cell-mediated inflammatory pathway may contribute to this association. Physicians may consider implementing assessments of psoriatic symptoms in patients with scabies.

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Assessment of medication adherence and treatment satisfaction in Japanese patients with psoriasis of various severities

Abstract

Psoriasis is a chronic, relapsing, inflammatory keratotic skin disease. To elucidate the medication adherence and treatment satisfaction, we performed a questionnaire survey using the eight-item Morisky Medication Adherence Scale (MMAS-8) and nine-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) of 163 psoriatic patients who regularly visited hospitals or clinics. To assess the relationship between the MMAS-8/TSQM-9 outcomes and severity of psoriasis, two different clinical severity indices were used: the Psoriasis Area and the Severity Index (PASI) for disease severity and the Psoriasis Disability Index (PDI) for quality of life (QOL) impairment. The MMAS-8 score for oral medication was significantly higher than that for topical medication. The oral and topical MMAS-8 scores were significantly correlated with the PDI score, but not with the PASI score, indicating that QOL impairment lowered treatment motivation. All of the TSQM-9 domain scores (effectiveness, convenience and global satisfaction) were significantly correlated with both the PASI and PDI scores, suggesting that patients whose skin and QOL conditions were under good control had high satisfaction with treatment. Patients treated with biologics had higher satisfaction than those treated with non-biologics.

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Successful management of steroid-resistant vascular tumors associated with the Kasabach–Merritt phenomenon using sirolimus

Abstract

Vascular tumors associated with Kasabach–Merritt phenomenon (KMP) are life-threatening and the mortality is as high as 10–30%. Steroids are considered the primary choice for drug therapy. However, there are many steroid-resistant cases. In the present study, analyzed data are presented to support the use of sirolimus in clinical practise for the treatment of corticosteroid-resistant vascular tumors with KMP in eight infants between June 2015 and April 2017 in a single hospital. The time to initial response was 6.8 ± 2.7 days. The average stabilization time for the platelet count was 19.1 ± 8.5 days. At the time of publication, the average duration of sirolimus treatment was 14.1 ± 4.0 months, and the average time for sirolimus treatment as a single agent was 12.6 ± 4.2 months. The side-effects were tolerable and included oral ulcer, fever, pain, skin rash and transient ascension of serum transaminase and cholesterol. Our study indicated that sirolimus therapy is an effective and safe method for the treatment of corticosteroid resistant vascular tumors associated with KMP in infants.

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Deformable image registration–based contour propagation yields clinically acceptable plans for MRI-based cervical cancer brachytherapy planning

Publication date: Available online 10 January 2018
Source:Brachytherapy
Author(s): Christina Hunter Chapman, Daniel Polan, Karen Vineberg, Shruti Jolly, Katherine E. Maturen, Kristy K. Brock, Joann I. Prisciandaro
PurposeTo study the dosimetric impact of deformable image registration–based contour propagation on MRI-based cervical cancer brachytherapy planning.Methods and MaterialsHigh-risk clinical target volume (HRCTV) and organ-at-risk (OAR) contours were delineated on MR images of 10 patients who underwent ring and tandem brachytherapy. A second set of contours were propagated using a commercially available deformable registration algorithm. "Manual-contour" and "propagated-contour" plans were optimized to achieve a maximum dose to the most minimally exposed 90% of the volume (D90) (%) of 6 Gy/fraction, respecting minimum dose to the most exposed 2cc of the volume (D2cc) OAR constraints of 5.25 Gy and 4.2 Gy/fraction for bladder and rectum/sigmoid (86.5 and 73.4 Gy equivalent dose in 2 Gy fractions [EQD2] for external beam radiotherapy [EBRT] + brachytherapy, respectively). Plans were compared using geometric and dosimetric (total dose [EQD2] EBRT + brachytherapy) parameters.ResultsThe differences between the manual- and propagated-contour plans with respect to the HRCTV D90 and bladder, rectum, and sigmoid D2cc were not statistically significant (per-fraction basis). For the EBRT + brachytherapy course, the D2cc delivered to the manually contoured OARs by the propagated-contour plans ranging 98–107%, 95–105%, and 92–108% of the dose delivered by the manual-contour plans (max 90.4, 70.3, and 75.4 Gy for the bladder, rectum, and sigmoid, respectively). The HRCTV dose in the propagated-contour plans was 97–103% of the dose in the manual-contour plans (maximum difference 2.92 Gy). Increased bladder filling resulted in increased bladder dose in manual- and propagated-contour plans.ConclusionsWhen deformable image registration–propagated contours are used for cervical brachytherapy planning, the HRCTV dose is similar to the dose delivered by manual-contour plans and the doses delivered to the OARs are clinically acceptable, suggesting that our algorithm can replace manual contouring for appropriately selected cases that lack major interfractional anatomical changes.

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Comments on “Low-dose-rate prostate brachytherapy: 4–8 week postimplant prostate-specific antigen a novel predictor of biochemical failure-free survival”

Publication date: Available online 10 January 2018
Source:Brachytherapy
Author(s): Kamyar Mansori, Erfan Ayubi, Saeid Safiri

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Validation of MRI to TRUS registration for high-dose-rate prostate brachytherapy

Publication date: Available online 10 January 2018
Source:Brachytherapy
Author(s): Eric Poulin, Karim Boudam, Csaba Pinter, Samuel Kadoury, Andras Lasso, Gabor Fichtinger, Cynthia Ménard
PurposeThe objective of this study was to develop and validate an open-source module for MRI to transrectal ultrasound (TRUS) registration to support tumor-targeted prostate brachytherapy.Methods and MaterialsIn this study, 15 patients with prostate cancer lesions visible on multiparametric MRI were selected for the validation. T2-weighted images with 1-mm isotropic voxel size and diffusion weighted images were acquired on a 1.5T Siemens imager. Three-dimensional (3D) TRUS images with 0.5-mm slice thickness were acquired. The investigated registration module was incorporated in the open-source 3D Slicer platform, which can compute rigid and deformable transformations. An extension of 3D Slicer, SlicerRT, allows import of and export to DICOM-RT formats. For validation, similarity indices, prostate volumes, and centroid positions were determined in addition to registration errors for common 3D points identified by an experienced radiation oncologist.ResultsThe average time to compute the registration was 35 ± 3 s. For the rigid and deformable registration, respectively, Dice similarity coefficients were 0.87 ± 0.05 and 0.93 ± 0.01 while the 95% Hausdorff distances were 4.2 ± 1.0 and 2.2 ± 0.3 mm. MRI volumes obtained after the rigid and deformable registration were not statistically different (p > 0.05) from reference TRUS volumes. For the rigid and deformable registration, respectively, 3D distance errors between reference and registered centroid positions were 2.1 ± 1.0 and 0.4 ± 0.1 mm while registration errors between common points were 3.5 ± 3.2 and 2.3 ± 1.1 mm. Deformable registration was found significantly better (p < 0.05) than rigid registration for all parameters.ConclusionsAn open-source MRI to TRUS registration platform was validated for integration in the brachytherapy workflow.

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A Medicare cost analysis of MRI- versus CT-based high-dose-rate brachytherapy of the cervix: Can MRI-based planning be less costly?

Publication date: Available online 10 January 2018
Source:Brachytherapy
Author(s): Amishi Bajaj, Grant Harmon, John Weaver, Brendan Martin, Michael Mysz, Murat Surucu, John C. Roeske, Andre A. Konski, William Small, Matthew M. Harkenrider
PurposeWhile some institutions deliver multiple fractions per implant for MRI-based planning, it is common for only one fraction to be delivered per implant with CT-based cervical brachytherapy. The purpose of this study was to compare physician costs, hospital costs, and overall costs for cervical cancer patients treated with either CT-based or MRI-based high-dose-rate (HDR) cervical brachytherapy to determine if MRI-based brachytherapy as described can be financially feasible.Methods and MaterialsWe identified 40 consecutive patients treated with curative intent cervical brachytherapy. Twenty patients underwent CT-based HDR brachytherapy with five fractions delivered in five implants on nonconsecutive days in an outpatient setting with the first implant placed with a Smit sleeve under general anesthesia. Twenty patients received MRI-based HDR brachytherapy with four fractions delivered in two implants, each with MRI-based planning, performed 1–2 weeks apart with an overnight hospital admission for each implant. We used Medicare reimbursements to assess physician costs, hospital costs, and overall cost.ResultsThe median cost of MRI-based brachytherapy was $14,248.75 (interquartile range [IQR]: $13,421.32–$15,539.74), making it less costly than CT-based brachytherapy with conscious sedation (i.e., $18,278.85; IQR: $17,323.13–$19,863.03, p < 0.0001) and CT-based brachytherapy with deep sedation induced by an anesthesiologist (i.e., $27,673.44; IQR: $26,935.14–$29,511.16, p < 0.0001). CT-based brachytherapy with conscious sedation was more costly than CT-based brachytherapy with deep sedation (p < 0.001).ConclusionsMRI-based brachytherapy using the described treatment course was less costly than both methods of CT-based brachytherapy. Cost does not need to be a barrier for MRI-based cervical brachytherapy, especially when delivering multiple fractions with the same application.

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Assessment of a source position checking tool for the quality assurance of transfer tubes used in HDR 192Ir brachytherapy treatments

Publication date: Available online 17 January 2018
Source:Brachytherapy
Author(s): O.A. Awunor
PurposeThe determination of source positions before treatment is an essential part of the quality assurance (QA) associated with high dose rate brachytherapy treatments. The purpose of this study was to design and commission a tool to allow the quantification of source positions across multiple transfer tube types.Methods and MaterialsA bespoke flexi-adapter jig, three transfer tube adapters, and a film piercing pointer were designed and built for source position QA across three transfer tube types—the standard, 6 French, and gynae transfer tubes. The jig was calibrated against a manufacturer source position check tool, and intratube and intertube source position variations investigated across a total of 40 transfer tubes, using strips of Gafchromic film irradiated at multiple positions 20 mm apart with a microSelectron V3 afterloader (Elekta, Holland). The performance of the jig in localizing the nominal dwell positions relative to the manufacturer check tool was assessed. Associated expanded uncertainties were quantified in line with the International Organization for Standardization Guidelines.ResultsThe mean expanded uncertainty associated with the use of the jig was 0.4 ± 0.0 mm (k = 1). The performance of the jig was 0.3 ± 0.0 mm, while the intratube and intertube source positional variations were observed to be within ±1.0 mm across most transfer tubes.ConclusionsA bespoke flexi-adapter jig capable of allowing source position measurements to be carried out on various transfer tube types has been designed. Measurement results highlight the need for routine QA of all transfer tubes in clinical use.

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Hidradenitis suppurativa, a review of pathogenesis, associations and management. Part 1

Abstract

Hidradenitis suppurativa is a chronic, painful, autoinflammatory condition resulting in nodules, abscesses and sinus tracts. We present an evidence-based review providing new understanding of the pathogenesis of hidradenitis suppurativa and associated comorbidities. By the nature of their speciality, dermatologists are uniquely positioned to investigate and treat patients with this condition. Data collected from a subspecialty hidradenitis suppurativa clinic (N = 106) and experiences thereof are discussed in this review.

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Hidradenitis suppurativa, a review of pathogenesis, associations and management. Part 1

Abstract

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Oil mixing behavior after an oil spill: identification conflicts of different fingerprints

Abstract

Clearing up whether spilled oil is mixed or not can strengthen the accuracy of oil spill identification. In the present study, the biomarkers in spilled oil samples were detected. The weathering modes of different types of diagnostic ratio and carbon isotope values of individual n-alkanes were also analyzed. The results showed that the diagnostic ratios of steroids, terpenes and aromatics, and weathering characteristics of carbon isotope composition (δ¹³C) of individual n-alkanes supported the idea that Dalian oil spill emerged from a single oil source. Furthermore, commonly used diagnostic ratios of n-alkanes indicated that the Dalian oil spill had undergone the oil mixing process. The different identifying outcomes indicate that some kinds of n-alkane-rich substance (such as oil dispersants) were mixed in the Dalian spilled oil and interfered with the routine diagnosis ratios of n-alkanes.

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Surgical treatment of enterovirus D68 brainstem encephalitis-induced dysphagia

Cluster of acute flaccid paralysis and cranial nerve dysfunction was associated with a 2014 outbreak of enterovirus D68 (EV-D68) respiratory illness in US. We describe a 33 year-old male patient of refractory dysphagia due to EV-D68-induced brainstem encephalitis successfully treated by surgery. Following acute upper respiratory tract infection, he developed dysphagia and bilateral facial paralysis. A coughing reflex was readily produced when the laryngopharyngeal fiberscope touched the epiglottis, however, water infusion induced only very weak and slow swallowing reflex, suggesting that only motor component was impaired but sensory function was preserved during swallowing.

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Twenty-seven mutations with three novel pathologenic variants causing biotinidase deficiency: a report of 203 patients from the southeastern part of Turkey

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Response to growth hormone treatment in very young patients with growth hormone deficiencies and mini-puberty

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Growth, sexual and bone development in a boy with bilateral anorchia under testosterone treatment guided by the development of his monozygotic twin

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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Examination of the skin barrier repair/wound healing process using a living skin equivalent (LSE) model and matrix-assisted laser desorption-ionization-mass spectrometry imaging (MALDI-MSI)

Abstract

Objective

Examination of the skin barrier repair/wound healing process using a living skin equivalent (LSE) model and matrix-assisted laser desorption/ionization-mass spectrometry imaging (MALDI-MSI) to identify lipids directly involved as potential biomarkers. These biomarkers may be used to determine whether an in vivo wound is going to heal for example if infected.

Methods

An in vitro LSE model was wounded with a scalpel blade and assessed at day 4 post wounding by histology and MALDI-MSI. Samples were sectioned at wound site and were either formalin fixed paraffin embedded (FFPE) for histology or snapped frozen (FF) for MSI analysis.

Results

The combination of using an in vitro wounded skin model with MSI allowed the identification of lipids involved in the skin barrier repair/wound healing process. The technique was able to highlight lipids directly in the wound site and distinguish differences in lipid distribution between the epidermis and wound site.

Conclusion

This novel method of coupling an in vitro LSE with MSI allowed in depth molecular analysis of the skin barrier repair/wound healing process. The technique allowed the identification of lipids directly involved in the skin barrier repair/wound healing process, indicating these biomarkers may be potentially be used within clinic. These biomarkers will help determine, which stage of the skin barrier repair/wound healing process the wound is in to provide the best treatment.

http://ift.tt/2G4yxaQ

Lysosomal Acid Lipase Deficiency: Report of Five Cases across the Age Spectrum

Lysosomal acid lipase (LAL) deficiency is an autosomal recessive lysosomal storage disorder caused by mutations in the LIPA gene that leads to premature organ damage and mortality. We present retrospective data from medical records of 5 Brazilian patients, showing the broad clinical spectrum of the disease.

http://ift.tt/2DTU9WD

Biochemical Evaluation of Male Androgen Status: Beyond Total Testosterone

Abstract

Male hypogonadism is a clinical diagnosis confirmed by consistent biochemical findings. Clinical guidelines agree that the initial diagnostic test to confirm clinically suspected androgen deficiency should be a fasting morning total testosterone concentration by a reliable assay. They also agree that a diagnosis of androgen deficiency should only be made in men with consistent symptoms and signs, and unequivocally and repeatedly low serum testosterone concentrations.

http://ift.tt/2DU7mP6

Resting-state quantitative EEG characteristics of insomniac patients with depression

Publication date: February 2018
Source:International Journal of Psychophysiology, Volume 124
Author(s): Yunna Kwan, Chorom Baek, Sunhye Chung, Tae Hui Kim, Sungwon Choi
Insomnia is known to show hyperarousal in the central nervous system. However, depression that often coexists with insomnia exhibits hypo-activity in the frontal lobe, which is very different from insomnia. In the present study, we examined wake resting state EEG of insomniac patients with depression to investigate whether they could be conceptualized as spectrum of insomnia or significantly different from insomnia. We compared the absolute power values of EEG spectra of three groups: 15 insomniacs with comorbid depression (CD), age- and sex-matched 15 comorbid-free insomniacs (CFI), and 15 good sleep controls (GSC). As a result, CD and CFI showed no significant difference in the EEG power spectrum analysis. Compared with GSC, however, both CD and CFI groups showed increased high frequency EEG amplitude. From these results, we have confirmed that CD shows cortical hyperarousal similar to insomnia in the daytime resting state. In conclusion, it would be reasonable to understood insomniac patients experiencing depression as a continuum of insomnia patients.

http://ift.tt/2Dz43iI

Cue and context conditioning to respiratory threat: Effects of suffocation fear and implications for the etiology of panic disorder

Publication date: February 2018
Source:International Journal of Psychophysiology, Volume 124
Author(s): Christoph Benke, Manuela G. Alius, Alfons O. Hamm, Christiane A. Pané-Farré
Interoceptive threats play a crucial role in the etiology of panic disorder (PD). While body sensations may become conditioned stimuli (CS) when paired with such interoceptive threats (cue conditioning), the environment in which such interoceptive threats occur may also be learned as a predictor of threat (context conditioning). Suffocation fear (SF) might facilitate these associative learning processes if threats of suffocation become relevant as unconditioned stimuli (US). To investigate whether SF affects associative learning during such respiratory threat, we used mild dyspnea as CS that predicted the occurrence of strong dyspnea (US) in one context (predictable), was not related to the occurrence of the US in another context (unpredictable) or was presented in a different context (safe) in which no US was delivered. Startle eyeblink responses and subjective reports were assessed in 34 participants during learning. Individuals reporting high SF showed a clear potentiation of the startle response during the interoceptive CS predicting the occurrence of interoceptive threat (US). Such startle potentiation was not observed when the CS remained unpaired (safe or unpredictable context). Moreover, high SF persons also showed a significant startle potentiation to the threatening context, when the CS did not predict the onset of the US. No such learning effects were observed for low SF individuals. The data support the view that defensive response mobilization can be triggered by cues but also by contexts that predict the occurrence of interoceptive threats if these threats are relevant for the individuals, supporting learning accounts for the development of PD.

http://ift.tt/2F2qtWO

Developmental changes in the feedback related negativity from 8 to 14 years

Publication date: Available online 10 January 2018
Source:International Journal of Psychophysiology
Author(s): Yael Arbel, Kayleigh N. McCarty, Mark Goldman, Emanuel Donchin, Ty Brumback
The study examined age related changes in the magnitude of the Feedback Related Negativity (FRN) in 8–14 year old children performing a variation of a Go/No-Go task. Participants were presented with four stimuli and tasked with mapping each of them either to a response or to a "no response" by trial and error guided by feedback. Feedback was valid for two stimuli (Go and No-Go) and invalid (.5 positive; .5 negative feedback) for the other two stimuli. The amplitude of the FRN was evaluated as a function of age separately for Go and No-Go trials. The results indicated that while performance on valid Go trials improved with age, accuracy on valid No-Go trials remained stable with age. FRN amplitude was found to be inversely related to age such that smaller FRN amplitudes were observed in older children even after controlling for variance in learning. Additionally, the FRN was found as a predictor of post-learning performance on Go trials but not on No-Go trials, regardless of age. These results do not provide support to the link between the FRN and inhibition control as measured by No-Go performance, but do suggest a link with other executive control abilities called for by the Go condition.

http://ift.tt/2Dz4t8M

Electrophysiological brain indices of risk behavior modification induced by contingent feedback

Publication date: Available online 9 January 2018
Source:International Journal of Psychophysiology
Author(s): Alberto Megías, Miguel Angel Torres, Andrés Catena, Antonio Cándido, Antonio Maldonado
The main aim of this research was to study the effects of response feedback on risk behavior and the neural and cognitive mechanisms involved, as a function of the feedback contingency. Sixty drivers were randomly assigned to one of three feedback groups: contingent, non-contingent and no feedback. The participants' task consisted of braking or not when confronted with a set of risky driving situations, while their electroencephalographic activity was continuously recorded. We observed that contingent feedback, as opposed to non-contingent feedback, promoted changes in the response bias towards safer decisions. This behavioral modification implied a higher demand on cognitive control, reflected in a larger amplitude of the N400 component. Moreover, the contingent feedback, being predictable and entailing more informative value, gave rise to smaller SPN and larger FRN scores when compared with non-contingent feedback. Taken together, these findings provide a new and complex insight into the neurophysiological basis of the influence of feedback contingency on the processing of decision-making under risk. We suggest that response feedback, when contingent upon the risky behavior, appears to improve the functionality of the brain mechanism involved in decision-making and can be a powerful tool for reducing the tendency to choose risky options in risk-prone individuals.

http://ift.tt/2F2qn1o

Lost connections: Oxytocin and the neural, physiological and behavioral consequences of disrupted relationships

Publication date: Available online 9 January 2018
Source:International Journal of Psychophysiology
Author(s): Tobias T. Pohl, Larry J. Young, Oliver J. Bosch
In humans and rodent animal models, the brain oxytocin system is paramount for facilitating social bonds, from the formation and consequences of early-life parent-infant bonds to adult pair bond relationships. In social species, oxytocin also mediates the positive effects of healthy social bonds on the partners' well-being. However, new evidence suggests that the negative consequences of early neglect or partner loss may be mediated by disruptions in the oxytocin system as well. With a focus on oxytocin and its receptor, we review studies from humans and animal models, i.e. mainly from the biparental, socially monogamous prairie vole (Microtus ochrogaster), on the beneficial effects of positive social relationships both between offspring and parents and in adult partners. The abundance of social bonds and benevolent social relationships, in general, are associated with protective effects against psycho- and physiopathology not only in the developing infant, but also during adulthood. Furthermore, we discuss the negative effects on well-being, emotionality and behaviour, when these bonds are diminished in quality or are disrupted, for example through parental neglect of the young or the loss of the partner in adulthood. Strikingly, in prairie voles, oxytocinergic signalling plays an important developmental role in the ability to form bonds later in life in the face of early-life neglect, while disruption of oxytocin signalling following partner loss results in the emergence of depressive-like behaviour and physiology. This review demonstrates the translational value of animal models for investigating the oxytocinergic mechanisms that underlie the detrimental effects of developmental parental neglect and pair bond disruption, encouraging future translationally relevant studies on this topic that is so central to our daily lives.

http://ift.tt/2DxFmDa

Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis

Abstract

Purpose

This study examined direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity, and activity impairment based on psoriasis severity and symptoms.

Methods

Analyses were based on data from the CLEAR study. Structural equation modelling (SEM) examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area Severity Index (PASI) severity and symptoms (pain, itching, and scaling) as potential mediators. Analyses were conducted primarily for patients achieving PASI 90 response (indicating a 90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75, and 100.

Results

Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by PASI 90 response and by improvements in itching and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching, and scaling were correlated (r = 0.51 to 0.68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab.

Conclusion

The results underscore the important role of both PASI response and reduction in symptoms on improvements in health-related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab.

http://ift.tt/2BhpRdv

How should minimally important change (MIC) scores for the Patient Oriented Eczema Measure (POEM) be interpreted? A validation using varied methods

Summary

Background

The Patient Oriented Eczema Measure (POEM), scored 0-28, is the core outcome instrument recommended for measuring patient-reported atopic eczema symptoms in clinical trials. To date, two published studies have broadly concurred that the MIC of the POEM is 3 points. Further assessment of the minimally important change (MIC) of POEM in different populations, and using a variety of methods, will improve interpretability of the POEM in research and clinical practice.

Objectives

To calculate the smallest detectable change in the POEM and estimate the MIC of the POEM using a variety of methods in a trial dataset of children with moderate to severe atopic eczema.

Methods

This study used distribution-based and anchor-based methods to calculate the MIC of the POEM in children with moderate to severe eczema.

Results

Data was collected from 300 children. The smallest detectable change was 2.12. The MIC estimates were 1.07 (0.2 SD) and 2.68 (0.5 SD) based on distribution-based methods, were 3.09 to 6.13 based on patient-reported anchor-based methods, and were 3.23 to 5.38 based on investigator-reported anchor-based methods.

Conclusions

We recommend the following thresholds are used to interpret changes in POEM scores: ≤ 2, unlikely to be a change beyond measurement error; 2.1 to 2.9, a small change detected that is likely to be beyond measurement error but may not be clinically important; 3 to 3.9, probably a clinically important change; 4+, very likely to be a clinically important change.

http://ift.tt/2mY74j6

In vivo dermoscopic and confocal microscopy multi-step algorithm to detect in situ melanomas

Summary

Background

Although several dermoscopic features of in situ melanoma (MIS) have been identified, data on confocal features for MIS are still lacking.

Objectives

To identify RCM (reflectance confocal microscopy) features of MIS and to develop a diagnostic score for MIS while combining dermoscopy and RCM.

Methods

120 MIS and 213 nevi (test set) were retrospectively analysed to assess the presence of dermoscopic and RCM criteria. Facial and acral lesions have been excluded. Spearman's correlation, univariate and multivariate regression models were performed to find features significantly correlated with MIS diagnosis. Multivariate results on the test set allowed the development of a multi-step algorithm, that was tested on a validation set counting 100 lesions.

Results

Dermoscopic atypical network and regression resulted as independent predicting factors for MIS diagnosis (OR=3.437, 95%CI=1.696-6.966 and OR=4.168, 95%CI=1.930-9.002 respectively). Significant confocal predictors for malignancy were epidermal pagetoid spread (OR=2.829, 95%CI=1.324-6.043) and junctional cytological atypia (OR=3.390, 95%CI=1.383-8.305 if focal, OR=8.439, 95%CI=3.213-22.165 if widespread). A multi-step diagnostic algorithm able to predict MIS with a sensitivity of 92.5% and a specificity of 61% was developed. The validation set confirmed the high diagnostic value (sensitivity 92%, specificity 58%).

Conclusions

An easy and reproducible multi-step algorithm for MIS detection is suggested, that can be routinely used in tertiary centres.

http://ift.tt/2BiFt0j

Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis

Abstract

Purpose

This study examined direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity, and activity impairment based on psoriasis severity and symptoms.

Methods

Results

Conclusion

http://ift.tt/2BhpRdv

How should minimally important change (MIC) scores for the Patient Oriented Eczema Measure (POEM) be interpreted? A validation using varied methods

Summary

Background

Objectives

To calculate the smallest detectable change in the POEM and estimate the MIC of the POEM using a variety of methods in a trial dataset of children with moderate to severe atopic eczema.

Methods

This study used distribution-based and anchor-based methods to calculate the MIC of the POEM in children with moderate to severe eczema.

Results

Conclusions

http://ift.tt/2mY74j6

In vivo dermoscopic and confocal microscopy multi-step algorithm to detect in situ melanomas

Summary

Background

Although several dermoscopic features of in situ melanoma (MIS) have been identified, data on confocal features for MIS are still lacking.

Objectives

To identify RCM (reflectance confocal microscopy) features of MIS and to develop a diagnostic score for MIS while combining dermoscopy and RCM.

Methods

Results

Conclusions

An easy and reproducible multi-step algorithm for MIS detection is suggested, that can be routinely used in tertiary centres.

http://ift.tt/2BiFt0j

Analysis of the skin mycobiome in adult patients with atopic dermatitis

Abstract

With the recent availability of culture-independent sequencing methods, studies have been conducted to analyze skin microorganisms present in patients with atopic dermatitis (AD). However, the database on the skin fungal communities, "mycobiome," has been relatively restrictive compared with the bacterial world. We aimed to comparatively analyze the overall skin mycobiome between patients with AD and healthy individuals in the Korean population. We analyzed skin swab samples obtained from the antecubital fossae of 8 patients with AD and 8 healthy controls. Using sequencing method followed by direct DNA extraction and molecular PCR, taxonomic compositions of fungi at stepwise level ranks were analyzed. The phylogenic marker used was internal transcribed spacer 2 regions of DNA. We observed the tendency of higher intra- and inter-personal taxonomic diversity at genus and species levels in AD samples. Non-Malassezia fungal diversity was also noticeable in the patient group compared with healthy controls. Malassezia globosa and Malassezia restricta were prevalent in all samples across both study groups, and some Malassezia species, including Malassezia sloofiae and dermatis characterized AD. Our data might provide a new insight into the mycobiome of adult AD, which contributes to building a systemic mycobiome database in AD.

http://ift.tt/2F0tOpg

Seasonal changes in epidermal ceramides are linked to impaired barrier function in acne patients

Abstract

Acne skin demonstrates increased transepidermal water loss (TEWL) compared with healthy skin, which may be due, in part, to altered ceramide levels. We analysed ceramides in the stratum corneum of healthy and acne skin, and studied seasonal variation over the course of a year. Using ultraperformance liquid chromatography with electrospray ionisation and tandem mass spectrometry (UPLC/ESI-MS/MS), we identified 283 ceramides. Acne-affected skin demonstrated overall lower levels of ceramides, with notable reductions in CER[NH] and CER[AH] ceramides, as well as the acylceramides CER[EOS] and CER[EOH]; these differences were more apparent in the winter months. Lower ceramide levels reflected an increase in TEWL in acne, compared with healthy skin, which partly resolves in the summer. Individual ceramide species with 18-carbon 6-hydroxysphingosine (H) bases (including CER[N(24)H(18)], CER[N(26)H(18)], CER[A(24)H(18)], CER[A(26)H(18)]) were significantly reduced in acne skin, suggesting that CER[NH] and CER[AH] species may be particularly important in a healthy skin barrier.

http://ift.tt/2DAkn2H

Pantoea agglomerans Infections in Children: Report of Two Cases

Introduction. Pantoea agglomerans, primarily an environmental and agricultural organism has been reported as both commensal and pathogen of humans. We present two case reports of P. agglomerans infections in children that involved the meninges and bloodstream. Case Presentations. A 6-month-old female baby, diagnosed as congenital hydrocephalus secondary to aqueduct stenosis with ventriculoperitoneal shunt in situ, operated 14 days back was brought to the pediatric emergency with a two-day history of high fever associated with vomiting, irritability, excessive crying, and decreased feeding. Postoperative meningitis was confirmed as cerebrospinal fluid culture revealed P. agglomerans. She responded well with a 14-day intravenous (IV) course of ceftriaxone. Also, we report a case of a 3-year-old male child referred to our center with a provisional diagnosis of UTI with chickenpox for further evaluation. During his 24-hour stay at the local hospital, he had received oral antibiotics and urinary catherization. Urine culture of catheter clamp urine was sterile. P. agglomerans was grown in blood culture. He was treated successfully with IV ceftriaxone and amikacin. Conclusion. P. agglomerans can cause postsurgical meningitis and bloodstream infection in children. The clinical course of infection was mild and timely administration of proper antibiotic resulted in a favorable outcome.

http://ift.tt/2Bj3lAL

The role of extracellular matrix components in angiogenesis and fibrosis: Possible implication for systemic sclerosis.

The role of extracellular matrix components in angiogenesis and fibrosis: Possible implication for systemic sclerosis.

Mod Rheumatol. 2018 Jan 19;:1-27

Authors: Liakouli V, Cipriani P, Di Benedetto P, Ruscitti P, Carubbi F, Berardicurti O, Panzera N, Giacomelli R

Abstract
Extracellular matrix (ECM) plays a crucial role in the regulation of both physiological and pathological angiogenesis. ECM homeostasis and function is ensuring by the tightly regulation of the different ECM components including, collagens, proteoglycans and a variety of different glycoproteins. An altered expression of the above ECM molecules as well as an imbalance between the action of matrix remodeling enzymes and their tissue inhibitors is known to be responsible for impaired angiogenesis and fibrosis. Systemic Sclerosis (SSc) is an autoimmune disease characterized by micro-angiopathy, failure of reparative angiogenesis and excessive fibrosis of the skin and various internal organs, dues to an increased production of ECM. A comprehensive search through Medline/PubMed and Scopus was performed for English-language original papers, using the keywords related to ECM components and SSc. This review will analyze the role played by ECM components in the deregulation of angiogenic mechanisms and in the persistence of a pro-fibrotic phenotype, during SSc. A better knowledge of these processes might provide information about molecules, which could be considered targets for future pro-angiogenic and/or anti-fibrotic therapies.

PMID: 29351724 [PubMed - as supplied by publisher]

http://ift.tt/2DwxEZV

Effect of Time to Operation on Value of Care in Acute Care Surgery.

Effect of Time to Operation on Value of Care in Acute Care Surgery.

World J Surg. 2018 Jan 19;:

Authors: Loftus TJ, Rosenthal MD, Croft CA, Stephen Smith R, Efron PA, Moore FA, Mohr AM, Brakenridge SC

Abstract
BACKGROUND: As reimbursement models evolve, there is increasing emphasis on maximizing value-based care for inpatient conditions. We hypothesized that longer intervals between admission and surgery would be associated with worse outcomes and increased costs for acute care surgery patients, and that these associations would be strongest among patients with high-risk conditions.
METHODS: We performed a 5-year retrospective analysis of three risk cohorts: appendectomy (low-risk for morbidity and mortality, n = 618), urgent hernia repair (intermediate-risk, n = 80), and laparotomy for intra-abdominal sepsis with temporary abdominal closure (sTAC; high-risk, n = 102). Associations between the interval from admission to surgery and outcomes including infectious complications, mortality, length of stay, and hospital charges were assessed by regression modeling.
RESULTS: Median intervals between admission and surgery for appendectomy, hernia repair, and sTAC were 9.3, 13.5, and 8.1 h, respectively, and did not significantly impact infectious complications or mortality. For appendectomy, each 1 h increase from admission to surgery was associated with increased hospital LOS by 1.1 h (p = 0.002) and increased intensive care unit (ICU) LOS by 0.3 h (p = 0.011). For hernia repair, each 1 h increase from admission to surgery was associated with increased antibiotic duration by 1.6 h (p = 0.007), increased hospital LOS by 3.3 h (p = 0.002), increased ICU LOS by 1.5 h (p = 0.001), and increased hospital charges by $1918 (p < 0.001). For sTAC, each 1 h increase from admission to surgery was associated with increased antibiotic duration by 5.0 h (p = 0.006), increased hospital LOS by 3.9 h (p = 0.046), increased ICU LOS by 3.5 h (p = 0.040), and increased hospital charges by $3919 (p = 0.002).
CONCLUSIONS: Longer intervals from admission to surgery were associated with prolonged antibiotic administration, longer hospital and ICU length of stay, and increased hospital charges, with strongest effects among high-risk patients. To improve value of care for acute care surgery patients, operations should proceed as soon as resuscitation is complete.

PMID: 29352339 [PubMed - as supplied by publisher]

http://ift.tt/2mZDR6G

Predictive Factors for Lymph Node Metastasis in Submucosal Invasive Colorectal Carcinoma: A New Proposal of Depth of Invasion for Radical Surgery.

Predictive Factors for Lymph Node Metastasis in Submucosal Invasive Colorectal Carcinoma: A New Proposal of Depth of Invasion for Radical Surgery.

World J Surg. 2018 Jan 19;:

Authors: Han J, Hur H, Min BS, Lee KY, Kim NK

Abstract
BACKGROUND: Patients with lymph node metastasis (LNM) in submucosal invasive colorectal carcinoma (SM cancer) require additional surgical treatment after endoscopic dissection. However, because additional radical resection after endoscopic local resection may be unnecessary for cases without LNM, more specific criteria are required in order to diminish the incidence of further radical resection after endoscopic dissection.
METHODS: A total of 492 patients with biopsy-proven SM cancer who underwent curative surgery between January 2008 and December 2012 were collected and were divided into LNM group and no LNM group. The cutoff value for the depth of submucosal invasion was analyzed by a receiver operating characteristic (ROC) curve. In this retrospective study, the association between LNM and clinicopathologic factors was analyzed by logistic regression analysis.
RESULTS: The depth of submucosal invasion of 1900 μm was determined as the cutoff value by ROC curve. Significant, independent predictive factors for LNM included the depth of submucosal invasion >1900 μm (odds ratio [OR] 7.5; 95% confidence interval [CI] 3.1-18.3; p < 0.001), venous invasion (OR 2.4; 95% CI 1.1-5.5; p = 0.03), and poorly differentiated/mucinous adenocarcinoma (OR 6.3; 95% CI 1.3-30.8; p = 0.02).
CONCLUSIONS: Our study demonstrates that the depth of submucosal invasion (>1900 μm), vascular invasion and poorly differentiated/mucinous carcinoma were predictive factors of LNM in patients with SM cancer. These predictors may help to reduce the incidence of unnecessary surgery after endoscopic resection.

PMID: 29352338 [PubMed - as supplied by publisher]

http://ift.tt/2Du3ibq

Impact of Hepatitis B Carrier Status on the Outcomes of Surgical Treatment of Colorectal Liver Metastases.

Impact of Hepatitis B Carrier Status on the Outcomes of Surgical Treatment of Colorectal Liver Metastases.

World J Surg. 2018 Jan 19;:

Authors: Au KP, Chok KSH, Chan ACY, Dai WC, Cheung TT, Lo CM

Abstract
BACKGROUND: Chronic hepatitis B virus (HBV) infection is associated with a lower incidence of colorectal liver metastases. We explored the impact of HBV carrier status on outcomes of surgical treatment of colorectal liver metastases.
METHODS: A retrospective analysis was conducted for consecutive patients undergoing liver resection for colorectal liver metastases from 2000 to 2016. HBV carriers were matched with controls by propensity scoring.
RESULTS: 304 patients with known HBV carrier status who underwent resection of colorectal liver metastases were studied. From the 21 (6.9%) hepatitis B carriers, a more prolonged prothrombin time (12.1 vs. 11.3 s, OR 1.42, p = 0.027) was observed, and fewer major resections were performed (19.0 vs. 47.3%, OR 0.262, p = 0.018). After 1:5 propensity score matching, they were compared with 105 controls with similar liver function, tumour status and receiving similar treatments. Patients with chronic hepatitis B enjoyed better median disease-free survival (15.8 vs. 9.20 month, p = 0.032). Overall survivals (50.0 vs. 43.6 month, p = 0.15) were similar. Operating time (227 vs. 240 min, OR 1.00, p = 0.33), blood loss (0.50 vs. 0.37 L, OR 1.15, p = 0.62), hospital stay (6 vs. 6 day, OR 1.02, p = 0.48), operative morbidity (9.5 vs. 16.2%, OR 0.545, p = 0.44) and mortality (0 vs. 1.0%, OR 1.62, p = 0.77) were comparable. The use of antiviral agents did not affect survival of HBV carriers.
CONCLUSIONS: Chronic HBV infection confers oncological benefit to surgical treatment of colorectal liver metastases. Given satisfactory liver reserve, HBV carrier status did not affect operative morbidity or mortality.

PMID: 29352337 [PubMed - as supplied by publisher]

http://ift.tt/2mZDN6W

Who was Dr. William C. Baum?

Who was Dr. William C. Baum?

World J Surg. 2018 Jan 19;:

Authors: Ladd MR, Zeiger MA

Abstract
The first discovery of primary hyperaldosteronism secondary to an aldosterone-secreting adrenal adenoma has been credited solely to Dr. Jerome Conn, an endocrinologist at the University of Michigan and for whom, Conn syndrome was named. Dr. William Baum, a urologist at the University of Michigan, however, was instrumental in the appropriate operation and historical aldosteronoma resection. Despite Dr. Baum's important role in this discovery, he was never included as an author in any of the subsequent papers describing Conn syndrome and, few today would recognize his name. So, who was Dr. Baum and what happened? This historical article aims to revisit the history surrounding the discovery of aldosteronoma as a cause of Conn's syndrome and to catalog the life and involvement of Dr. William C. Baum in that discovery.

PMID: 29352336 [PubMed - as supplied by publisher]

http://ift.tt/2Dx7wyQ

Important Research Elements in Aiding Training: Reply.

Important Research Elements in Aiding Training: Reply.

World J Surg. 2018 Jan 19;:

Authors: Waalewijn BP, van Duinen A, Koroma AP, Rijken MJ, Elhassein M, Bolkan HA

PMID: 29352335 [PubMed - as supplied by publisher]

http://ift.tt/2mZDLvQ

Long-Term Follow-Up of Retromuscular Incisional Hernia Repairs: Recurrence and Quality of Life: Reply.

Long-Term Follow-Up of Retromuscular Incisional Hernia Repairs: Recurrence and Quality of Life: Reply.

World J Surg. 2018 Jan 19;:

Authors: Rogmark P, Montgomery A

PMID: 29352334 [PubMed - as supplied by publisher]

http://ift.tt/2DwRF3y

Roflumilast, type 4 phosphodiesterase inhibitor, attenuates inflammation in rats with ulcerative colitis via down-regulation of iNOS and elevation of cAMP

Publication date: March 2018
Source:International Immunopharmacology, Volume 56
Author(s): Nahla E. El-Ashmawy, Naglaa F. Khedr, Hoda A. El-Bahrawy, Samar A. El-Adawy
BackgroundRoflumilast (Rof), a phosphodiesterase 4 (PDE4) inhibitor, has been shown to be an effective agent in inflammatory diseases and marketed for chronic obstructive pulmonary disease.ObjectiveThis study was conducted to examine the potential anti-inflammatory effects of Rof in dextran sulphate sodium (DSS)–induced ulcerative colitis (UC) in rats and to investigate the molecular mechanisms underlying these effects.MethodsForty male Wistar rats were divided into four groups: normal control, colitis group (rats received 5% DSS in their drinking water continuously for 7 days), Rof group, and sulfasalazine (SLZ) group. The Rof (5 mg/kg) and SLZ (500 mg/kg) groups underwent pretreatment with DSS one week ahead of DSS challenge and parallel with DSS. Colitis was determined by assessing colon length, weight loss, histologic colon score, quantifying the concentration of tumor necrosis factor alpha (TNF-α), nitric oxide (NO), cyclic adenosine monophosphate (cAMP), myeloperoxidase (MPO) activity and inducible nitric oxide synthase (iNOS) gene expression in colon tissue.ResultsRof attenuated the severity of colitis as evidenced by increased colon length, prevention of body weight loss, and improved colon histologic score compared to DSS group. Rof also suppressed the inflammatory response induced in DSS colitis group by decreasing colon concentration of TNF-α, NO and MPO activity and down- regulation of iNOS gene expression. The level of cAMP was increased by Rof compared to DSS group. The obtained results of Rof were comparable to those exerted by SLZ.ConclusionThese findings revealed the beneficial effects of Rof in alleviating inflammation in DSS colitis.

http://ift.tt/2DpcmtV

Predicting the Hearing Outcome in Sudden Sensorineural Hearing Loss via Machine Learning Models

Abstract

Objective

Sudden sensorineural hearing loss (SSHL) is a multifactorial disorder with high heterogeneity, thus the outcomes vary widely. The present study aimed to develop predictive models based on four machine learning methods for SSHL, identifying the best performer for clinical application.

Design

Single-center retrospective study.

Setting

Chinese People's liberation army (PLA) hospital, Beijing, China.

Participants

1220 in-patient SSHL patients were enrolled between June 2008 and December 2015.

Main outcome measures

An advanced deep learning technique, deep belief network (DBN), together with the conventional logistic regression (LR), support vector machine (SVM) and multilayer perceptron (MLP) were developed to predict the dichotomized hearing outcome of SSHL by inputting six feature collections derived from 149 potential predictors. Accuracy, precision, recall, F-score and the area under the receiver operator characteristic curves (ROC-AUC) were exploited to compare the prediction performance of different models.

Results

Overall the best predictive ability was provided by the DBN model when tested in the raw dataset with 149 variables, achieving an accuracy of 77.58% and AUC of 0.84. Nevertheless DBN yielded inferior performance after feature pruning. In contrast, the LR, SVM and MLP models demonstrated opposite trend as the greatest individual prediction powers were obtained when included merely three variables, with the ROC-AUC ranging from 0.79 to 0.81, and then decreased with the increasing size of input features combinations.

Conclusions

With the input of enough features, DBN can be a robust prediction tool for SSHL. But LR is more practical for early prediction in routine clinical application by using three readily available variables, i.e. time elapse between symptom onset and study entry, initial hearing level and audiogram.

http://ift.tt/2n1mEKL

Repeated Domperidone treatment modulates pulmonary cytokines in LPS-induced acute lung injury in mice

Publication date: March 2018
Source:International Immunopharmacology, Volume 56
Author(s): Talita Rossetto Barreto, Carolina Costola-de-Souza, Rafael Oliveira Margatho, Nicolle Queiroz-Hazarbassanov, Sandra Campos Rodrigues, Luciano Freitas Felício, João Palermo-Neto, Adriano Zager
The dopaminergic antagonist drug Domperidone has immunomodulatory effects. We investigated the effects of repeated Domperidone treatment in a model of Lypopolyssacharide (LPS)-induced acute lung inflammation. Adult C57BL/6J mice were treated with either Vehicle or Domperidone for 5days, and challenged intranasally with LPS in the following day. The behavior of mice was analyzed in the open field and elevated plus-maze test before and 24h after LPS challenge. The bronchoalveolar lavage fluid, blood and lung tissue were collected 24h and 48h after LPS challenge. Domperidone treatment increased LPS-induced tumor necrosis factor (TNF) and interleukin (IL)-6 production in the bronchoalveolar lavage fluid, without altering tissue damage and the number of immune cells in the lungs and circulation. Locomotor and anxiety-like behavior were unchanged after Domperidone and/or LPS treatment. Cytokine data indicate that Domperidone promotes a change in activity of other cell types, likely alveolar epithelial cells, without affecting immune cell migration in the present model. Due to the role of these cytokines in progression of inflammation, Domperidone treatment may exacerbate a subsequent inflammatory injury.

Graphical abstract

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Teenage-onset progressive myoclonic epilepsy due to a familial C9orf72 repeat expansion.

Teenage-onset progressive myoclonic epilepsy due to a familial C9orf72 repeat expansion.

Neurology. 2018 Jan 19;:

Authors: van den Ameele J, Jedlickova I, Pristoupilova A, Sieben A, Van Mossevelde S, Ceuterick-de Groote C, Hůlková H, Matej R, Meurs A, Van Broeckhoven C, Berkovic SF, Santens P, Kmoch S, Dermaut B

Abstract
BACKGROUND: The progressive myoclonic epilepsies (PME) are a heterogeneous group of disorders in which a specific diagnosis cannot be made in a subset of patients, despite exhaustive investigation. C9orf72 repeat expansions are emerging as an important causal factor in several adult-onset neurodegenerative disorders, in particular frontotemporal lobar degeneration and amyotrophic lateral sclerosis. An association with PME has not been reported previously.
OBJECTIVE: To identify the causative mutation in a Belgian family where the proband had genetically unexplained PME.
RESULTS: We report a 33-year old woman who had epilepsy since the age of 15 and then developed progressive cognitive deterioration and multifocal myoclonus at the age of 18. The family history suggested autosomal dominant inheritance of psychiatric disorders, epilepsy, and dementia. Thorough workup for PME including whole exome sequencing did not reveal an underlying cause, but a C9orf72 repeat expansion was found in our patient and affected relatives. Brain biopsy confirmed the presence of characteristic p62-positive neuronal cytoplasmic inclusions.
CONCLUSION: C9orf72 mutation analysis should be considered in patients with PME and psychiatric disorders or dementia, even when the onset is in late childhood or adolescence.

PMID: 29352102 [PubMed - as supplied by publisher]

http://ift.tt/2rtlLzn

Aberrant expression of miR-21, miR-376c and miR-145 and their target host genes in Merkel cell polyomavirus-positive non-small cell lung cancer.

Aberrant expression of miR-21, miR-376c and miR-145 and their target host genes in Merkel cell polyomavirus-positive non-small cell lung cancer.

Oncotarget. 2017 Dec 22;8(68):112371-112383

Authors: Lasithiotaki I, Tsitoura E, Koutsopoulos A, Lagoudaki E, Koutoulaki C, Pitsidianakis G, Spandidos DA, Siafakas NM, Sourvinos G, Antoniou KM

Abstract
Merkel Cell Polyoma Virus (MCPyV) infection has been associated with non-small cell lung cancer (NSCLC). Viruses can manipulate cellular miRNAs or have a profound impact on cellular miRNA expression to control host regulatory pathways. In this study, we evaluated the expression profiles of cancer-associated and virally affected host microRNAs miR-21, miR-145, miR-146a, miR-155, miR-302c, miR-367 and miR-376c in a series of NSCLC tissue samples as well as in samples from "healthy" sites, distant from the tumour region that were either positive or negative for MCPyV DNA. miR-21 and miR-376c were significantly upregulated whereas miR-145 was significantly downregulated in the MCPyV+ve samples compared to the MCPyV-ve tumour samples. Overall, miR-21 and miR-376c expression was higher in tumour compared to healthy tissue samples. No association was observed between the miR-155, miR-146a, miR-302c and miR-367 levels and the presence of MCPyV. The expression of miR-21 target genes (Pten, Bcl-2, Daxx, Pkr, Timp3), miR-376c (Grb2, Alk7, Mmp9) and miR-145 (Oct-4, Sox2, Fascin1) and their associated pathways (Braf, Akt-1, Akt-2, Bax, Hif1a, p53) was altered between MCPyV+ve tumor samples and their corresponding controls. These results show a novel association between miR-21, miR-376c and miR-145 and their host target genes with the presence of MCPyV, suggesting a mechanism of virus-specific microRNA signature in NSCLC.

PMID: 29348831 [PubMed]

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The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature

Publication date: Available online 20 January 2018
Source:The Journal of Emergency Medicine
Author(s): Michael Gottlieb, Brit Long, Alex Koyfman
BackgroundToxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately.ObjectiveThis review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS.DiscussionThe most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid.ConclusionTSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.

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An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature

Publication date: Available online 20 January 2018
Source:The Journal of Emergency Medicine
Author(s): Lane C. Thaut, Andrew S. Murtha, Anthony E. Johnson, Jamie L. Roper
BackgroundThe management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices.Case ReportA 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department.Why Should an Emergency Physician Be Aware of This?Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients.

http://ift.tt/2EZpHJR

How to Perform a Systematic Review and Meta-analysis of Diagnostic Imaging Studies

Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Paul Cronin, Aine Marie Kelly, Duaa Altaee, Bradley Foerster, Myria Petrou, Ben A. Dwamena
A systematic review is a comprehensive search, critical evaluation, and synthesis of all the relevant studies on a specific (clinical) topic that can be applied to the evaluation of diagnostic and screening imaging studies. It can be a qualitative or a quantitative (meta-analysis) review of available literature. A meta-analysis uses statistical methods to combine and summarize the results of several studies. In this review, a 12-step approach to performing a systematic review (and meta-analysis) is outlined under the four domains: (1) Problem Formulation and Data Acquisition, (2) Quality Appraisal of Eligible Studies, (3) Statistical Analysis of Quantitative Data, and (4) Clinical Interpretation of the Evidence. This review is specifically geared toward the performance of a systematic review and meta-analysis of diagnostic test accuracy (imaging) studies.

http://ift.tt/2mXHsSq

Best Practices From the APDR

Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Daryl T. Goldman, Gail L. Peters, Aaron M. Fischman, George G. Vatakencherry, Peter R. Bream, Jonathan G. Martin, Janice M. Newsome, Zachary L. Bercu, Michael A. Schacht, Karen S. Johnson, James M. Milburn, Seng Ong, Vivek Kalia, Eric England, Darel E. Heitkamp

http://ift.tt/2DsJ0yT

Virtual Computed Tomography Colonography

Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Hannes Seuss, Rolf Janka, Matthias Hammon, Alexander Cavallaro, Michael Uder, Peter Dankerl
Rationale and ObjectivesTo evaluate two- and three-dimensional (2D and 3D) image quality of sub-milliSievert (mSv) computed tomography (CT) colonography utilizing a third-generation dual source CT scanner featuring a tin filter.MethodsWe retrospectively evaluated 26 consecutive patients who underwent third-generation dual source CT colonography, nine with the standard-dose clinical-scan protocol (SDP) and 17 with a low-dose protocol (LDP) featuring a tin filter. Radiation dose was evaluated by volume computed tomography dose index (CTDIvol), dose length product (DLP), effective dose (E), and size-specific dose estimate. Objective image quality was evaluated utilizing signal-to-noise ratio (SNR) derived from standardized placed regions of interest on the transverse 2D images and the ratio of SNR/CTDIvol (normalized SNR). Two radiologists in consensus assessed subjective image quality of the virtual 3D images.ResultsThere were no significant differences in subjective image quality (P = .661). All examinations were rated "excellent" or "good" for diagnostic confidence. The mean total for DLP/E was 143.4 ± 29.8 mGy/3.00 ± 0.40 mSv in the SDP and therefore significantly higher than in the LDP with 36.9 ± 8.7 mGy/0.75 ± 0.16 mSv (P < .001). The SNR was 8.9 ± 2.1 in the SDP and 4.9 ± 0.8 in the LDP.ConclusionsThird-generation dual source CT featuring a tin filter enables consistent sub-mSv colonography without substantially impairing image quality.

http://ift.tt/2mSCB54

Coregistration of Preoperative MRI with Ex Vivo Mesorectal Pathology Specimens to Spatially Map Post-treatment Changes in Rectal Cancer Onto In Vivo Imaging

Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Jacob Antunes, Satish Viswanath, Justin T. Brady, Benjamin Crawshaw, Pablo Ros, Scott Steele, Conor P. Delaney, Raj Paspulati, Joseph Willis, Anant Madabhushi
Rationale and ObjectivesThe objective of this study was to develop and quantitatively evaluate a radiology-pathology fusion method for spatially mapping tissue regions corresponding to different chemoradiation therapy-related effects from surgically excised whole-mount rectal cancer histopathology onto preoperative magnetic resonance imaging (MRI).Materials and MethodsThis study included six subjects with rectal cancer treated with chemoradiation therapy who were then imaged with a 3-T T2-weighted MRI sequence, before undergoing mesorectal excision surgery. Excised rectal specimens were sectioned, stained, and digitized as two-dimensional (2D) whole-mount slides. Annotations of residual disease, ulceration, fibrosis, muscularis propria, mucosa, fat, inflammation, and pools of mucin were made by an expert pathologist on digitized slide images. An expert radiologist and pathologist jointly established corresponding 2D sections between MRI and pathology images, as well as identified a total of 10 corresponding landmarks per case (based on visually similar structures) on both modalities (five for driving registration and five for evaluating alignment). We spatially fused the in vivo MRI and ex vivo pathology images using landmark-based registration. This allowed us to spatially map detailed annotations from 2D pathology slides onto corresponding 2D MRI sections.ResultsQuantitative assessment of coregistered pathology and MRI sections revealed excellent structural alignment, with an overall deviation of 1.50 ± 0.63 mm across five expert-selected anatomic landmarks (in-plane misalignment of two to three pixels at 0.67- to 1.00-mm spatial resolution). Moreover, the T2-weighted intensity distributions were distinctly different when comparing fibrotic tissue to perirectal fat (as expected), but showed a marked overlap when comparing fibrotic tissue and residual rectal cancer.ConclusionsOur fusion methodology enabled successful and accurate localization of post-treatment effects on in vivo MRI.

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The determinants of reduced dietary intake in hospitalised colorectal cancer patients.

The determinants of reduced dietary intake in hospitalised colorectal cancer patients.

Support Care Cancer. 2018 Jan 19;:

Authors: van der Werf A, Arthey K, Hiesmayr M, Sulz I, Schindler K, Laviano A, Langius J, de van der Schueren M

Abstract
PURPOSE: Patients with colorectal cancer (CRC) often experience malnutrition and weight loss, largely resulting from reduced dietary intake. The aim of this study was to identify determinants of reduced dietary intake in order to facilitate early recognition of malnutrition and optimise nutritional treatment.
METHODS: Data from nutritionDay, an international 1-day survey investigating patient, disease and food profiles, were used. To identify determinants of dietary intake, defined as normal vs. reduced in the last week, univariate and multivariate logistic regressions were performed.
RESULTS: Of 1131 hospitalised CRC patients, 54% reported reduced dietary intake. Patient- and disease-related characteristics significantly associated with reduced dietary intake were female gender (odds ratio (OR) 1.38), cancer stage III (OR 1.52) or IV (OR 1.70) vs. I, performance status 2 (OR 1.56), 3 (OR 2.37) or 4 (OR 4.15) vs. 0, duration since hospital admission of ≥ 4 days (OR 4-7 days, 1.91; 8-21 days, 1.97; > 21 days, 1.92) vs. < 4 days, and unintentional weight loss (OR 2.56). Additionally, higher symptom scores of pain, weakness, depression, tiredness and lack of appetite were associated with reduced intake.
CONCLUSIONS: Patient- and disease-related determinants for reduced dietary intake were being female, higher cancer stage, worse performance status, duration since hospital admission ≥ 4 days and unintentional weight loss. Furthermore, multiple symptoms were associated with a reduced dietary intake. Future trials should assess whether early recognition of patients at risk of malnutrition and the combination of treating symptoms and dietary advice result in improved intake and treatment-related outcomes.

PMID: 29352452 [PubMed - as supplied by publisher]

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Handheld magnetic probe with permanent magnet and Hall sensor for identifying sentinel lymph nodes in breast cancer patients.

Handheld magnetic probe with permanent magnet and Hall sensor for identifying sentinel lymph nodes in breast cancer patients.

Sci Rep. 2018 Jan 19;8(1):1195

Authors: Sekino M, Kuwahata A, Ookubo T, Shiozawa M, Ohashi K, Kaneko M, Saito I, Inoue Y, Ohsaki H, Takei H, Kusakabe M

Abstract
The newly developed radioisotope-free technique based on magnetic nanoparticle detection using a magnetic probe is a promising method for sentinel lymph node biopsy. In this study, a novel handheld magnetic probe with a permanent magnet and magnetic sensor is developed to detect the sentinel lymph nodes in breast cancer patients. An outstanding feature of the probe is the precise positioning of the sensor at the magnetic null point of the magnet, leading to highly sensitive measurements unaffected by the strong ambient magnetic fields of the magnet. Numerical and experimental results show that the longitudinal detection length is approximately 10 mm, for 140 μg of iron. Clinical tests were performed, for the first time, using magnetic and blue dye tracers-without radioisotopes-in breast cancer patients to demonstrate the performance of the probe. The nodes were identified through transcutaneous and ex-vivo measurements, and the iron accumulation in the nodes was quantitatively revealed. These results show that the handheld magnetic probe is useful in sentinel lymph node biopsy and that magnetic techniques are widely being accepted as future standard methods in medical institutions lacking nuclear medicine facilities.

PMID: 29352214 [PubMed - in process]

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Κυριακή 21 Ιανουαρίου 2018

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