CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck

Abstract

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.

https://ift.tt/2JPRNL6

Thyroid Dysfunction Following Management of Non-thyroid Head and Neck Cancers

Abstract

Head and neck cancers are one of the commonest malignancies in India. Majority of cases of head and neck malignancy undergo chemoradiation with or without surgery. Thyroid bears the brunt in terms of either excision or the gland tends to get irradiated and fibrosed. In either scenario the functionality of gland is lost leading to hypothyroidism and other clinical manifestations. It tends to get subclinical and goes unnoticed. To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine use of thyroid function tests during follow up. It was a prospective non randomized control study of 100 patients of head and neck cancer receiving radiotherapy for duration of 1 year. Thyroid stimulating hormone and T3 and T4 estimations were done at baseline and at 3 and 9 months following radiotherapy. Out of 100 patients, 72 (72%) were males and 28 (28%) were females. All the patients received radiation to the neck to a dose of > 30 Gy. 35 patients received concurrent chemotherapy. 11 patients were found to have subclinical hypothyroidism while 32 patients developed significant clinical hypothyroidism (P value of 0.001). Thus a total of 43 patients developed radiation induced hypothyroidism. 20 of the 32 patients who developed clinical hypothyroidism were in the age group of 41–50 years. 11 of 32 patients who developed clinical hypothyroidism received chemoradiation while rest 21 received radiotherapy alone. Mean period for developing radiation induced hypothyroidism was 4.5 months. Hypothyrodism (clinical or subclinical) is an under recognised morbidity of external radiation to the neck which is seen following a minimum dose of 30 Gy to the neck. Recognising hypothyroidism (clinical or subclinical) early and treating it prevents thyroid dysfunction related complications. Hence, thyroid function tests should be made routine during follow up in all patients undergoing radiotherapy.

https://ift.tt/2EMHX8Y

The Reliability of Polyvinylidene Fluoride Sensor for Intra- and Intersession Measurements

Abstract

A new nasal sensor has been designed using Polyvinylidene fluoride (PVDF) film using its piezoelectric property to measure nasal patency. The aim of this study is to determine the intra- and intersession reliability of the new PVDF nasal sensor measurement of unilateral and combined nasal parameters in a group of healthy subjects. Two identical nasal sensors: for right nostril (RN) and left nostril (LN) were designed using piezoelectric natured PVDF films. Twenty subjects were studied. To evaluate the repeatability, total three sets of PVDF sensor measurements were recorded, two sets were taken 5 min apart during same session without repositioning the PVDF nasal sensors and two more sets were taken during 1 h apart successively, by repositioning the PVDF nasal sensor. Intraclass correlation coefficients (ICC) of PVDF sensor measurements for intra- and intersession showed a high and greater repeatability over time for all the combined (mean) and unilateral (RN and LN) values. In both healthy and patients, ICC values for both intra- and intersession measurements were ≥ 0.80 confirming strong reliability and also almost all of the coefficients of variation for the same parameters were low (below 10%). PVDF sensor measurements showed good intra- and intersession repeatability and can be recommended for the objective monitoring of nasal patency during diagnosis and follow-up of conditions.

https://ift.tt/2JNzztz

A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis

Abstract

To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.

https://ift.tt/2viqQMz

Upgradation of chemical, fuel, thermal, and structural properties of rice husk through microwave-assisted hydrothermal carbonization

Abstract

The process parameters of microwave hydrothermal carbonization (MHTC) have significant effect on yield of hydrochar. This study discusses the effect of process parameters on hydrochar yield produced from MHTC of rice husk. Results revealed that, over the ranges tested, a lower temperature, lower reaction time, lower biomass to water ratio, and higher particle size produce more hydrochar. Maximum hydrochar yield of 62.8% was obtained at 1000 W, 220 °C, and 5 min. The higher heating value (HHV) was improved significantly from 6.80 MJ/kg of rice husk to 16.10 MJ/kg of hydrochar. Elemental analysis results showed that the carbon content increased and oxygen content decreased in hydrochar from 25.9 to 47.2% and 68.5 to 47.0%, respectively, improving the energy and combustion properties. SEM analysis exhibited modification in structure of rice husk and improvement in porosity after MHTC, which was further confirmed from BET surface analysis. The BET surface area increased from 25.0656 m²/g (rice husk) to 92.6832 m²/g (hydrochar). Thermal stability of hydrochar was improved from 340 °C for rice husk to 370 °C for hydrochar.

https://ift.tt/2qAAupg

Production of mycotoxins by filamentous fungi in untreated surface water

Abstract

Several research studies reported that mycotoxins and other metabolites can be produced by fungi in certain matrices such as food. In recent years, attention has been drawn to the wide occurrence and identification of fungi in drinking water sources. Due to the large demand of water for drinking, watering, or food production purposes, it is imperative that further research is conducted to investigate if mycotoxins may be produced in water matrices. This paper describes the results obtained when a validated analytical method was applied to detect and quantify the presence of mycotoxins as a result of fungi inoculation and growth in untreated surface water. Aflatoxins B1 and B2, fumonisin B3, and ochratoxin A were detected at concentrations up to 35 ng/L. These results show that fungi can produce mycotoxins in water matrices in a non-negligible quantity and, as such, attention must be given to the presence of fungi in water.

https://ift.tt/2qA3BJm

A system dynamics model of China’s electric power structure adjustment with constraints of PM10 emission reduction

Abstract

Recently, Chinese state environmental protection administration has brought out several PM10 reduction policies to control the coal consumption strictly and promote the adjustment of power structure. Under this new policy environment, a suitable analysis method is required to simulate the upcoming major shift of China's electric power structure. Firstly, a complete system dynamics model is built to simulate China's evolution path of power structure with constraints of PM10 reduction considering both technical and economical factors. Secondly, scenario analyses are conducted under different clean-power capacity growth rates to seek applicable policy guidance for PM10 reduction. The results suggest the following conclusions. (1) The proportion of thermal power installed capacity will decrease to 67% in 2018 with a dropping speed, and there will be an accelerated decline in 2023–2032. (2) The system dynamics model can effectively simulate the implementation of the policy, for example, the proportion of coal consumption in the forecast model is 63.3% (the accuracy rate is 95.2%), below policy target 65% in 2017. (3) China should promote clean power generation such as nuclear power to meet PM10 reduction target.

https://ift.tt/2EPxqcX

CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck

Abstract

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.

https://ift.tt/2JPRNL6

Thyroid Dysfunction Following Management of Non-thyroid Head and Neck Cancers

Abstract

Head and neck cancers are one of the commonest malignancies in India. Majority of cases of head and neck malignancy undergo chemoradiation with or without surgery. Thyroid bears the brunt in terms of either excision or the gland tends to get irradiated and fibrosed. In either scenario the functionality of gland is lost leading to hypothyroidism and other clinical manifestations. It tends to get subclinical and goes unnoticed. To identify the occurrence of clinical and subclinical hypothyroidism among head and neck cancer patients receiving radiation to the neck and to justify routine use of thyroid function tests during follow up. It was a prospective non randomized control study of 100 patients of head and neck cancer receiving radiotherapy for duration of 1 year. Thyroid stimulating hormone and T3 and T4 estimations were done at baseline and at 3 and 9 months following radiotherapy. Out of 100 patients, 72 (72%) were males and 28 (28%) were females. All the patients received radiation to the neck to a dose of > 30 Gy. 35 patients received concurrent chemotherapy. 11 patients were found to have subclinical hypothyroidism while 32 patients developed significant clinical hypothyroidism (P value of 0.001). Thus a total of 43 patients developed radiation induced hypothyroidism. 20 of the 32 patients who developed clinical hypothyroidism were in the age group of 41–50 years. 11 of 32 patients who developed clinical hypothyroidism received chemoradiation while rest 21 received radiotherapy alone. Mean period for developing radiation induced hypothyroidism was 4.5 months. Hypothyrodism (clinical or subclinical) is an under recognised morbidity of external radiation to the neck which is seen following a minimum dose of 30 Gy to the neck. Recognising hypothyroidism (clinical or subclinical) early and treating it prevents thyroid dysfunction related complications. Hence, thyroid function tests should be made routine during follow up in all patients undergoing radiotherapy.

https://ift.tt/2EMHX8Y

The Reliability of Polyvinylidene Fluoride Sensor for Intra- and Intersession Measurements

Abstract

A new nasal sensor has been designed using Polyvinylidene fluoride (PVDF) film using its piezoelectric property to measure nasal patency. The aim of this study is to determine the intra- and intersession reliability of the new PVDF nasal sensor measurement of unilateral and combined nasal parameters in a group of healthy subjects. Two identical nasal sensors: for right nostril (RN) and left nostril (LN) were designed using piezoelectric natured PVDF films. Twenty subjects were studied. To evaluate the repeatability, total three sets of PVDF sensor measurements were recorded, two sets were taken 5 min apart during same session without repositioning the PVDF nasal sensors and two more sets were taken during 1 h apart successively, by repositioning the PVDF nasal sensor. Intraclass correlation coefficients (ICC) of PVDF sensor measurements for intra- and intersession showed a high and greater repeatability over time for all the combined (mean) and unilateral (RN and LN) values. In both healthy and patients, ICC values for both intra- and intersession measurements were ≥ 0.80 confirming strong reliability and also almost all of the coefficients of variation for the same parameters were low (below 10%). PVDF sensor measurements showed good intra- and intersession repeatability and can be recommended for the objective monitoring of nasal patency during diagnosis and follow-up of conditions.

https://ift.tt/2JNzztz

A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis

Abstract

To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.

https://ift.tt/2viqQMz

Effect of mono and divalent salts on the conformation and composition of a humic acid and on atrazine adsorption

Abstract

We investigated the effects of sodium and calcium chlorides on the conformation and composition of a purified Aldrich humic acid (PAHA), as well as on the adsorption of atrazine. The PAHA was treated with 1, 10, and 100 mM NaCl, CaCl₂, or a mixture of NaCl and CaCl₂ (molar ratio 5:1) at pH 7.5 and 8.5. The conformation of treated PAHA was characterized by atomic force microscopy (AFM) and transmission electron microscopy (TEM) and spectral changes of functional groups of PAHA by Fourier transform infrared spectroscopy (FTIR). AFM and TEM images showed an increase in the aggregation of the PAHA as salinity increased. FTIR spectra revealed that changes in the aggregation of the PAHA were principally due to the formation of bridged interactions between calcium and carboxylate groups in the PAHA. The adsorption of atrazine on > 0.45 μm PAHA decreased as salt concentrations and pH increased. This reduction of atrazine adsorption was explained by the decrease in available adsorption sites due to agglomeration of PAHA.

https://ift.tt/2HDuKT4

Effect of photobiomodulation therapy on postoperative pain after endodontic treatment: a randomized, controlled, clinical study

Abstract

Objective

The aim of this prospective, randomized, clinical study was to assess the effect of photobiomodulation therapy (PBM) with low-level laser irradiation (LLLI) on postoperative pain after endodontic treatment.

Materials and methods

Sixty patients, diagnosed with irreversible pulpitis in lower molar teeth, participated in the study. All treatments were performed by a single operator. Participants were randomly divided into two groups: in the experimental group (EG), endodontic treatment was performed with a reciprocating system, immediately followed by PBM with LLLI; and only endodontic treatment was performed in the control group (CG). Postoperative pain was assessed by a second examiner, who was blinded, using two scales: verbal rating scale (VRS) and numerical rating scale (NRS). Assessment was carried out at 6, 12, and 24 h after treatment. Data were analyzed using chi-squared, Fisher's exact, Mann-Whitney tests, ordinal, and non-parametric regression analyses.

Results

For the prevalence of pain, the difference between the groups was significant for the evaluations performed after 6 h (p = 0.04) and 24 h (p = 0.02). The difference after 24 h remained significant after stratification by sex and extrusion of filling material. Increased pain intensity was associated with extrusion of root canal filling material to the periapical region in the two scales used.

Conclusion

The effect of PBM therapy after endodontic treatment showed a significant decreasein prevalence of postoperative pain.

Clinical relevance

The PBM reduces the prevalence of postoperative pain and may benefit patients who need endodontic treatment.

https://ift.tt/2JPg6Zl

Nine prophylactic polishing pastes: impact on discoloration, gloss, and surface properties of a CAD/CAM resin composite

Abstract

Objectives

To investigate discoloration reduction and changes of surface properties of a CAD/CAM resin composite after 14 days´ storage in red wine and polishing with nine different prophylactic polishing pastes (PPPs).

Materials and methods

Rectangular discs (N = 172) were fabricated and polished (P4000) using GC Cerasmart (GC Europe) to investigate different polishing protocols with 1–4 related descending PPPs (22 in total): Cleanic/CLE-Kerr, CleanJoy/CLJ-Voco, Clean Polish/Super Polish/SPO-Kerr, Clinpro Prophy Paste/CPP-3M, Détartrine/DET-Septodont, Nupro/NUP-Dentsply Sirona, Prophy Paste CCS/CCS-Directa, Proxyt/PXT-Ivoclar Vivadent, and Zircate/ZIR Prophy Paste-Dentsply Sirona. Surface properties (roughness values (RV)/Ra, Rz, Rv, surface free energy (SFE), surface gloss (G), and discoloration (ΔE)) were analyzed before and after storage and additional polishing. Data were examined using Kolmogorov-Smirnov test, three-way ANOVA followed by Tukey-B post hoc, Mann-Whitney U, and Kruskal-Wallis H tests (α < 0.05).

Results

Regarding RV, CLE, followed by CCS, and CPP showed the highest values; the lowest presented SPO and DET (p < 0.001). No impact of PPP was observed on ΔE values (p = 0.160). The lowest SFE presented DET, followed by SPO; highest showed CCS followed by NUP and CPP (p < 0.001). Within G, lowest values were observed for CLE and NUP, followed by CCS, ZIP, and CLJ (p < 0.001); the highest presented SPO (p < 0.001). Polishing showed generally a positive impact on SFE values (p < 0.001–p = 0.007), except ZIP (p = 0.322) and CLE (p = 0.083). G increased and RV decreased after polishing (p < 0.001), except SPO, with no significant change for G (p = 0.786).

Conclusions

Polishing with PPPs improves the surface properties and is generally recommended. The choice of PPP has a minor role in removing discolorations. Multi-step systems should be carried out conscientiously.

Clinical relevance

The proper selection of PPP is essential for the clinical outcome of surface properties of prosthetic restorations. Not every polishing paste leads to the same final surface quality.

https://ift.tt/2EPhsj9

Durable response to bevacizumab in adults with recurrent pilocytic astrocytoma.

Related Articles

Durable response to bevacizumab in adults with recurrent pilocytic astrocytoma.

CNS Oncol. 2018 Apr 09;:

Authors: Wasilewski A, Mohile N

Abstract
BACKGROUND: Adult pilocytic astrocytomas are rare and highly vascular tumors.
AIM: We hypothesized that they may be uniquely responsive to bevacizumab (BEV).
PATIENTS: We present four adult patients with pathologically diagnosed WHO grade I pilocytic astrocytoma who had robust and durable responses to BEV at time of recurrence. Three patients developed radiographic changes on MRI, consistent with progressive disease based on response assessment in neuro-oncology criteria. Median time to recurrence was 8.5 months.
METHODS: All patients were treated with six cycles of BEV for recurrence.
RESULTS: At the end of treatment, all patients had achieved a clinical and radiographic response. Median follow-up time after BEV is 20.5 months.
CONCLUSION: This suggests that BEV may have true antitumor activity in adult pilocytic astrocytomas and may be important for achieving durable disease control.

PMID: 29629823 [PubMed - as supplied by publisher]

https://ift.tt/2qz6kBS

The effect of simulated acid rain on the stabilization of cadmium in contaminated agricultural soils treated with stabilizing agents

Abstract

Stabilization technology is one of widely used remediation technologies for cadmium (Cd)-contaminated agricultural soils, but stabilized Cd in soil may be activated again when external conditions such as acid rain occurred. Therefore, it is necessary to study the effect of acid rain on the performance of different stabilizing agents on Cd-polluted agriculture soils. In this study, Cd-contaminated soils were treated with mono-calcium phosphate (MCP), mono-ammonium phosphate (MAP), and artificial zeolite (AZ) respectively and incubated 3 months. These treatments were followed by two types of simulated acid rain (sulfuric acid rain and mixed acid rain) with three levels of acidity (pH = 3.0, 4.0, and 5.6). The chemical forms of Cd in the soils were determined by Tessier's sequential extraction procedure, and the leaching toxicities of Cd in the soils were assessed by toxicity characteristic leaching procedure (TCLP). The results show that the three stabilizing agents could decrease the mobility of Cd in soil to some degree with or without simulated acid rain (SAR) treatment. The stabilization performances followed the order of AZ < MAP < MCP. Acid rain soaking promoted the activation of Cd in stabilized soil, and both anion composition and pH of acid rain were two important factors that influenced the stabilization effect of Cd.

https://ift.tt/2IZXTal

Zebrafish extracellular matrix improves neuronal viability and network formation in a 3-dimensional culture

Publication date: July 2018
Source:Biomaterials, Volume 170
Author(s): Sung-Min Kim, Daniel Ward Long, Michael Wai Kok Tsang, Yadong Wang
Mammalian central nervous system (CNS) has limited capacity for regeneration. CNS injuries cause life-long debilitation and lead to $50 billion in healthcare costs in U.S. alone each year. Despite numerous efforts in the last few decades, CNS-related injuries remain as detrimental as they were 50 years ago. Some functional recovery can occur, but most regeneration are limited by an extracellular matrix (ECM) that actively inhibits axonal repair and promotes glial scarring. In most tissues, the ECM is an architectural foundation that plays an active role in supporting cellular development and regenerative response after injury. In mammalian CNS, however, this is not the case - its composition is not conducive for regeneration, with various molecules restricting plasticity and neuronal growth. In fact, the CNS ECM alters its composition dramatically following injury to restrict regeneration and to prioritize containment of injury as well as preservation of intact neural circuitry. This leads us to hypothesize that the inhibitory extracellular environment needs be modified or supplemented to be more regeneration-permissive for significant CNS regeneration. Mammalian nervous tissue cannot provide such ECM, and synthesizing it in a laboratory is beyond current technology. Evolutionarily lower species possess remarkably regenerative neural tissue. For example, small fresh-water dwelling zebrafish (Danio rerio) can regenerate severed spinal cord, re-gaining full motor function in a week. We believe their ECM contributes to its regenerative capability and that it can be harnessed to induce more regeneration in mammalian CNS. This study shows that ECM derived from zebrafish brains promotes more neuronal survival and axonal network formation than the widely studied and available ECM derived from mammalian tissues such as porcine brains, porcine urinary bladder, and rat brains. We believe its regenerative potential, combined with its affordability, easy handling, and fast reproduction, will make zebrafish an excellent candidate as a novel ECM source.



https://ift.tt/2quef4j

Corrigendum to“Effects of compatibility of deproteinized antler cancellous bone with various bioactive factors on their osteogenic potential” [Biomaterials 34 (2013) 9103-9114]

Publication date: July 2018
Source:Biomaterials, Volume 170
Author(s): Xuehui Zhang, Mingming Xu, Lin Song, Yan Wei, Yuanhua Lin, Wentao Liu, Boon C. Heng, Hui Peng, Ying Wang, Xuliang Deng




https://ift.tt/2EObhvG

Editorial Board

Publication date: April 2018
Source:Cancer Genetics, Volumes 222–223





https://ift.tt/2H0TdQR

Suprathreshold Stochastic Resonance behind Cancer

Publication date: Available online 14 April 2018
Source:Trends in Biochemical Sciences
Author(s): Guillermo Rodrigo, Nigel G. Stocks
Noise in gene expression is pervasive and, in some cases, even fulfills a functional role. Cancer cell populations exploit noise to increase heterogeneity as a defense against therapies. What lies behind this picture is a phenomenon of stochastic resonance led by the collective, rather than by individual cells.



https://ift.tt/2H2M6r4

Challenges of managing patients with symptomatic large traumatic cervical pseudomeningoceles.

Challenges of managing patients with symptomatic large traumatic cervical pseudomeningoceles.

World Neurosurg. 2018 Apr 11;:

Authors: Ganaha S, Lara-Velazquez M, Yoon JW, Akinduro OO, Clendenen SR, Murray PM, Pichelmann MA, Quinones-Hinojosa A, Deen HG

Abstract
BACKGROUND: Traumatic cervical pseudomeningoceles (TCP) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases, because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of cases of large TCPs ("large" defined as ≥ 6cm in greatest diameter), and there is no established guideline for the management of such lesions.
CASE DESCRIPTIONS: We describe the cases of two young men in their 20's who were involved in a motor vehicle accident. Both patients suffered a brachial plexus injury and developed large TCPs. Patient #1 was treated surgically for TCP using a combined intra-/extradural approach using a fascia lata graft. Patient #2 was ultimately treated non-surgically, because a spontaneous resolution of the pseudomingocele was achieved over the period of 7 months following the accident. Both patients underwent brachial plexus repair surgery consisting of spinal accessory nerve transfer to the suprascapular nerve, and intercostal nerve transfer to the musculocutaneous nerve.
CONCLUSIONS: Disease progression of TCPs is a dynamic process, and even large lesions may spontaneously resolve without surgical intervention. When surgery is indicated, a definitive dural repair using a fascia lata graft to cover the dural tear intra- and extradurally is an effective method. Surgery must be planned carefully on a case-by-case basis, and close follow-up with thorough physical examination and serial imaging and is critical to monitor disease progression.

PMID: 29654960 [PubMed - as supplied by publisher]

https://ift.tt/2IXBL0a

A small Glossopharyngeal schwannoma presenting with intractable vomiting: case presentation and literature review.

A small Glossopharyngeal schwannoma presenting with intractable vomiting: case presentation and literature review.

World Neurosurg. 2018 Apr 11;:

Authors: Darwish H, Adada B

Abstract
BACKGROUND: Glossopharyngeal schwannomas are rare tumors. Clinical and radiological presentation closely resembles those of vestibular schwannomas. Their clinical presentation varies from vestibulocochlear dysfunction to glossopharyngeal and vagal nerve dysfunction.
CASE: We report a case of a small glossopharyngeal schwannoma presenting with intractable recurrent sudden episodes of vomiting that subsided after tumor resection. This is the only case in the literature of glossopharyngeal schwannoma presenting with nerve irritation in the form of intractable emesis.
CONCLUSION: Small Glossopharyngeal Schwannomas can present with irritative symptoms of the ninth cranial nerve causing vomiting refractory to medical treatment. Intracranial imaging should be considered in the investigation of unexplained intractable vomiting even if the gross neurological exam is normal.

PMID: 29654959 [PubMed - as supplied by publisher]

https://ift.tt/2qz3Ioi

The survival effect of repeat surgery at glioblastoma recurrence and its trend: A systematic review and meta-analysis.

The survival effect of repeat surgery at glioblastoma recurrence and its trend: A systematic review and meta-analysis.

World Neurosurg. 2018 Apr 11;:

Authors: Lu VM, Jue TR, McDonald KL, Rovin RA

Abstract
BACKGROUND: Glioblastoma (GBM) is a dismal disease managed in the first instance by surgical resection, temozolomide and radiation. The role of repeat surgery at recurrence remains ill defined. This study aims to quantify the effect of repeat surgery in recurrent GBM on overall survival (OS) and determine if a trend in reported effect over time exists.
METHODS: Searches of seven electronic databases from inception to January 2018 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 2692 articles identified for screening. Prognostic hazard ratios (HRs) derived from multivariate regression analysis were extracted, and analyzed using meta-analysis of proportions and linear regression.
RESULTS: Eight observational studies reporting prognostic HRs in 10 cohorts were included. They described 1906 recurrent GBM diagnoses, managed by surgery at primary diagnosis, with 709 (37%) undergoing further, repeat surgery at recurrence. Repeat surgery was shown to confer a statistically significant survival advantage compared to no surgery at recurrence in the pooled cohort (HR, 0.722; p<0.001). Newer studies trended towards a more superior prognostic advantage of repeat surgery when compared to earlier studies (effect coefficient, 0.856; p=0.012).
CONCLUSIONS: This meta-analysis is of contemporary literature suggests repeat surgery at GBM recurrence in select patients confers a significant, prognostic OS advantage independent of other prognostic factors. Furthermore, newer studies are significantly more likely to suggest greater benefit than older studies. The main limitation is the selection bias inherent in the cohorts pooled for analysis. Larger prospective, randomized controlled studies are needed to validate the findings of this study, and provide stratification for such benefit justified by quality of life metrics..

PMID: 29654958 [PubMed - as supplied by publisher]

https://ift.tt/2IY2GsS

Cerebral Microbleeds Could be Independently Associated with the Intracranial Aneurysm Rupture: A Cross-Sectional Population-Based Study.

Cerebral Microbleeds Could be Independently Associated with the Intracranial Aneurysm Rupture: A Cross-Sectional Population-Based Study.

World Neurosurg. 2018 Apr 11;:

Authors: Zhang X, Yao ZQ, Karuna T, Duan CZ, Wang XM, Li XF, Yin JH, He XY, Guo SQ, Chen YC, Liu WC

Abstract
OBJECTIVE: The article aims to determine whether the presence of cerebral microbleeds (CMBs) is independently associated with the intracranial aneurysm rupture. It also intends to identify the incubation period of CMBs related intracranial aneurysm rupture.
METHODS: A total of 1847 patients with unruptured and ruptured intracranial aneurysm from January 2010 to November 2017 were included in this cross-sectional study. Their clinical records and images, including the preoperative presence of CMBs identified by T2-weighted gradient-recalled-echo sequence on magnetic resonance imaging (MRI) were evaluated. Univariate analysis and multivariate logistic regression were done to determine which parameters are independent factors for aneurysm rupture. The incubation period of CMBs related intracranial aneurysm rupture was also evaluated.
RESULTS: CMBs confirmed by MRI were present in 142 patients, with 7.7% incidence rate (142/1847). Of the total 142 patients with CMBs, 56 patients (including 17 ruptured anrueysms) received endovascular treatment, and other 86 consecutive patients who did not receive emobilization or surgery due to various reasons were followed for 3-49 months. The incidence of CMBs related intracranial aneurysm rupture was 27.9% (24/86) during the follow-up. The incubation period of CMBs related intracranial aneurysm rupture varies from 3 to 27 months (median month, 9.5 months). Multivariate analyses showed CMBs is significantly correlated with the intracranial aneurysm rupture (OR 1.6, 95%C.I. 1.1 to 2.4, P=0.010).
CONCLUSIONS: CMBs is independently associated with the intracranial aneurysm rupture. Patient with CMBs has the increased 60% risk of aneurysm rupture than those without.

PMID: 29654957 [PubMed - as supplied by publisher]

https://ift.tt/2qzEQfw

Comparison of Zero-profile Device versus Plate and Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion.

Comparison of Zero-profile Device versus Plate and Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion.

World Neurosurg. 2018 Apr 11;:

Authors: Shen Y, Du W, Wang LF, Dong Z, Wang F

Abstract
OBJECTIVE: The purpose of this study was to compare the clinical efficacy of ACDF with Zero-profile device (Zero-p) and traditional cervical plate and cage implant in the treatment of symptomatic ASD and determine the optimal reoperation procedure.
METHODS: This was a retrospective study of 58 patients with symptomatic ASD after an initial ACDF surgery, which had undergone a reoperation by ACDF with Zero-p (n=27) and cervical plate and cage (n=31) at our medical center between January 2010 and December 2015.
RESULTS: The JOA score, NDI score, VAS score, C2-C7 Cobb angle and DHI demonstrated significant improvements compared with the preoperative in both Zero-p and plate and cage groups (P<0.05). However, there were no differences between the two groups (P>0.05). The reoperation time of Zero-p group [(83.4±18.9) min] was less than plate and cage group [(96.5±20.1) min], with significant differences (P<0.05). A total of 5 (8.6%) patients had cage subsidence and 14 (24.1%) patients had dysphagia after the reoperation. There was no statistical significance in the difference between two groups in cage subsidence (P>0.05). However, the incidence of dysphagia in plate and cage group (38.7%) was higher than Zero-p group (7.4%), with significant difference (P<0.05).
CONCLUSION: ACDF with Zero-p obtaining the same surgical efficacy, compared with traditional cervical plate and cage can significantly shorten the reoperation time, and reduce the incidence of postoperative dysphagia. It may be a preferred option for symptomatic ASD patients qualifying for the anterior approach with regard to biomechanics and surgical outcomes.

PMID: 29654956 [PubMed - as supplied by publisher]

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Histologic Features and Prognosis of Spinal Intradural Extramedullary Ewing Sarcoma: Case Report, Literature Review, and Analysis of Prognosis.

Histologic Features and Prognosis of Spinal Intradural Extramedullary Ewing Sarcoma: Case Report, Literature Review, and Analysis of Prognosis.

World Neurosurg. 2018 Apr 11;:

Authors: Takami H, Kumar R, Brown DA, Krauss WE

Abstract
Ewing sarcoma is a malignant neoplasm that primarily involves extremity long bones, pelvis and soft tissues of children. The intradural extramedullary space is an uncommon location for Ewing sarcoma and there is thus a paucity of information regarding the features and natural history of this particular presentation. There is controversy regarding preoperative diagnosis, surgical management and postoperative care and there are no accepted standards. Herein we present a 61-year-old male with an L1-3 intradural extramedullary Ewing sarcoma who underwent gross total resection of the tumor via laminectomy. Pathologic analysis revealed a diagnosis of Ewing sarcoma based on the characteristic immunohistochemistry and the presence of EWSR1-FLI1 fusion transcript by reverse-transcription polymerase chain reaction. There have been 28 cases of intradural extramedullary Ewing sarcoma reported in the past literature. Out of 29 cases including the current case, 18 cases (62.1 %) were male and median/mean age was 32 and 34.0 years old, respectively, with the peak age group of 10-20. Twenty-two of 29 (72.4%) cases involved the lumbar spine, followed by the cervical spine (7 cases, 24.1 %). Long-term prognosis was poor, with 1-, 2-, 3-, and 5-year progression-free survival rate are 75.0, 56.3, 37.5 and 18.8 %, respectively. The 1-, 2-, 3-, and 5-year overall survival rate was 89.5, 80.5, 80.5, and 43.0 %, respectively. Herein, we present imaging and pathological findings of the case with review of the literature.

PMID: 29654955 [PubMed - as supplied by publisher]

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A new minimally invasive technique for primary unstable C2 Spondylolysis in an 8-year-old child: A case report and review of the literature.

A new minimally invasive technique for primary unstable C2 Spondylolysis in an 8-year-old child: A case report and review of the literature.

World Neurosurg. 2018 Apr 11;:

Authors: Farah K, Pech-Gourg G, Graillon T, Scavarda D, Fuentes S

PMID: 29654954 [PubMed - as supplied by publisher]

https://ift.tt/2ITXvdx

Effect of subthalamic deep brain stimulation on upper limb dexterity in patients with Parkinson's disease.

Effect of subthalamic deep brain stimulation on upper limb dexterity in patients with Parkinson's disease.

World Neurosurg. 2018 Apr 11;:

Authors: Nozaki T, Asakawa T, Sugiyama K, Koda Y, Shimoda A, Mizushima T, Sameshima T, Namba H

Abstract
OBJECTIVE: The efficacy of deep brain stimulation of the subthalamic nucleus (STN-DBS) on dexterity remains controversial despite its recognition as an effective strategy for Parkinson's disease (PD). The present study investigated the efficacy of STN-DBS for ameliorating bradykinesia and dexterity in comparison to dopaminergic medications.
METHODS: Part III of the unified Parkinson's disease rating scale was employed for the evaluation of bradykinesia while the Purdue Pegboard Test and the Box and Block test were selected for dexterity.
RESULTS: Our findings indicate that bradykinesia is significantly improved with both DBS and dopaminergic medication, whereas dexterity is improved only with DBS. Dopaminergic medication did not exhibit a satisfactory efficacy on dexterity, and there was little synergistic effect of dopaminergic medication and STN-DBS for improving dexterity associated with PD.
CONCLUSIONS: Our results suggest that DBS is potentially more effective than dopaminergic medications for improving dexterity. The disparities in efficacy for bradykinesia and dexterity between DBS and dopaminergic medication hint at the potential mechanisms of STN-DBS. We speculate that DBS follows at least two different mechanisms for improving Parkinsonian symptoms: 1) the dopaminergic system, primarily for the improvement of bradykinesia; and 2) the non-dopaminergic system, for the improvement of dexterity. This hypothesis requires further verification and investigation.

PMID: 29654953 [PubMed - as supplied by publisher]

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Zebrafish extracellular matrix improves neuronal viability and network formation in a 3-dimensional culture

Publication date: July 2018
Source:Biomaterials, Volume 170
Author(s): Sung-Min Kim, Daniel Ward Long, Michael Wai Kok Tsang, Yadong Wang
Mammalian central nervous system (CNS) has limited capacity for regeneration. CNS injuries cause life-long debilitation and lead to $50 billion in healthcare costs in U.S. alone each year. Despite numerous efforts in the last few decades, CNS-related injuries remain as detrimental as they were 50 years ago. Some functional recovery can occur, but most regeneration are limited by an extracellular matrix (ECM) that actively inhibits axonal repair and promotes glial scarring. In most tissues, the ECM is an architectural foundation that plays an active role in supporting cellular development and regenerative response after injury. In mammalian CNS, however, this is not the case - its composition is not conducive for regeneration, with various molecules restricting plasticity and neuronal growth. In fact, the CNS ECM alters its composition dramatically following injury to restrict regeneration and to prioritize containment of injury as well as preservation of intact neural circuitry. This leads us to hypothesize that the inhibitory extracellular environment needs be modified or supplemented to be more regeneration-permissive for significant CNS regeneration. Mammalian nervous tissue cannot provide such ECM, and synthesizing it in a laboratory is beyond current technology. Evolutionarily lower species possess remarkably regenerative neural tissue. For example, small fresh-water dwelling zebrafish (Danio rerio) can regenerate severed spinal cord, re-gaining full motor function in a week. We believe their ECM contributes to its regenerative capability and that it can be harnessed to induce more regeneration in mammalian CNS. This study shows that ECM derived from zebrafish brains promotes more neuronal survival and axonal network formation than the widely studied and available ECM derived from mammalian tissues such as porcine brains, porcine urinary bladder, and rat brains. We believe its regenerative potential, combined with its affordability, easy handling, and fast reproduction, will make zebrafish an excellent candidate as a novel ECM source.



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Corrigendum to“Effects of compatibility of deproteinized antler cancellous bone with various bioactive factors on their osteogenic potential” [Biomaterials 34 (2013) 9103-9114]

Publication date: July 2018
Source:Biomaterials, Volume 170
Author(s): Xuehui Zhang, Mingming Xu, Lin Song, Yan Wei, Yuanhua Lin, Wentao Liu, Boon C. Heng, Hui Peng, Ying Wang, Xuliang Deng




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Prevention and Treatment of Type 2 Diabetes: A Pathophysiological-Based Approach

Publication date: Available online 14 April 2018
Source:Trends in Endocrinology & Metabolism
Author(s): Dorit Samocha-Bonet, Sophie Debs, Jerry R. Greenfield
Prediabetes affects approximately 40% of American adults. Randomized trials report that a proportion of individuals with prediabetes develop diabetes despite caloric restriction, physical activity, and/or when treated with metformin, the first-line medication for patients with type 2 diabetes mellitus (T2DM). Currently, there are no valid predictors of the effectiveness of these measures in determining who will and who will not progress to the T2DM state. Few studies have examined the clinical and phenotypic predictors of better and worse glycemic response to lifestyle interventions and metformin in prediabetes and diabetes. Further studies incorporating 'omic' approaches to discover novel markers of phenotypes and treatment effectiveness may pave the way to personalizing the treatment of prediabetes and diabetes.



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Spontaneous posterior rectus sheath hernia: a case report

Hernias of the posterior rectus sheath are very rare abdominal wall hernias with only a handful of cases reported in the literature to date. As an uncommon disease, it is important to recognize and report this...

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Adenoid cystic carcinoma of head and neck: A retrospective clinical analysis of a single institution.

Related Articles

Adenoid cystic carcinoma of head and neck: A retrospective clinical analysis of a single institution.

Auris Nasus Larynx. 2018 Apr 10;:

Authors: Chang CF, Hsieh MY, Chen MK, Chou MC

PMID: 29653784 [PubMed - as supplied by publisher]

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AAC Services for Multilingual Populations: South African Service Provider Perspectives

Publication date: Available online 14 April 2018
Source:Journal of Communication Disorders
Author(s): Kerstin M Tönsing, Karin van Niekerk, Georg I Schlünz, Ilana Wilken
BackgroundIn South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these.AimsThe study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds.Methods & ProceduresFifteen AAC service providers were purposefully chosen to participate in one of three focus groups – two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data.Outcomes & ResultsFour overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services.Conclusions & ImplicationsAlthough service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics.



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Acute prediction of outcome and cognitive-communication impairments following traumatic brain injury: the influence of age, education and site of lesion

Publication date: Available online 14 April 2018
Source:Journal of Communication Disorders
Author(s): Sandra Gauthier, Joanne LeBlanc, Alena Seresova, Andréanne Laberge-Poirier, José A Correa, Abdulrahman Y Alturki, Judith Marcoux, Mohammed Maleki, Mitra Feyz, Elaine de Guise
BackgroundCommunication impairment following a traumatic brain injury (TBI) has been well documented, yet information regarding communication skills in the acute period following the injury is limited in the literature. Also, little is known about the influence of TBI severity (mild, moderate or severe) on cognitive-communication impairments and how these impairments are related to short-term functional outcome. The goal of this study was to assess the performance of adults with mild, moderate and severe TBI on different language tests and to determine how this performance is related to functional capacity. We also aimed to explore which variables among age, sex, education, TBI severity and site of cerebral damage would predict initial language impairments.MethodsSeveral language tests were administered to a sample of 145 adult patients with TBI of a range of severities admitted to an acute care service and to 113 healthy participants from the community.ResultsTBI patients of a range of severities performed poorly on all language tests in comparison to the healthy controls. In addition, patients with mild TBI performed better than the moderate and severe groups, except on the reading test and on the semantic naming test. In addition, their performance on verbal fluency, conversational discourse and procedural discourse tasks predicted acute functional outcome. Finally, age, education and TBI severity and site of lesion predicted some language performance. A left temporal lesion was associated with poorer performance in conversational discourse and auditory comprehension tasks, a left frontal lesion with a decrease in the verbal fluency results and a right parietal lesion with decreased auditory comprehension and reasoning skills.ConclusionHealth care professionals working in the acute care setting should be aware of the possible presence of cognitive-communication impairments in patients with TBI, even for those with mild TBI. These deficits can lead to functional communication problems and assistance may be required for tasks frequently encountered in acute care requiring intact comprehension and expression.



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A Novel Technique of Ultrasound-Guided Selective Mandibular Nerve Block With a Lateral Pterygoid Plate Approach: A Cadaveric Study

Background and Objectives We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. Methods Ten soft cadavers were studied. A curved array ultrasound transducer was applied over 1 side of the face of the cadaver, in an open-mouth position. The transducer was placed transversely below the zygomatic arch and tilted in the caudal-to-cranial direction to identify the boundary of the LPP. The needle was inserted in-plane, in an anterior-to-posterior direction, into the posterior border of the uppermost part of the LPP, and 3 mL of methylene blue was injected. Results Mandibular nerve block was successfully performed in all 10 cadavers using an LPP approach under ultrasound guidance. The mandibular nerve and its branches were seen to be stained with methylene blue in all cadaveric specimens. No accidental injection into the facial nerve or maxillary artery was observed. Conclusions This cadaveric study suggests that this novel technique, using an LPP approach under ultrasound guidance, is helpful for selective mandibular nerve block, with high accuracy and feasibility. Further studies are required to establish its safety and efficacy for clinical application. Clinical Trial Registration This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004. Accepted for publication November 20, 2017. Address correspondence to: Wirinaree Kampitak, MD, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, 1873, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand (e-mail: nutong127@yahoo.com). No external funding was received. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies

Background and Objectives Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31–0.54; P

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Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial

Background and Objectives This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. Methods One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. Results During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. Conclusions Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02415088. Accepted for publication December 30, 2017. Address correspondence to: Björn Stessel, MD, PhD, Department of Anesthesiology and Pain Treatment, Jessa Hospital, Virga-Jesse Campus, Stadsomvaart 11, 3500 Hasselt, Belgium (e-mail: bjornstessel@hotmail.com). This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Province of Limburg, Flemish Government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The authors declare no conflict of interest. Authors' contributions: A.N. was responsible for the study design, data collection, and writing of the paper. B.S. was responsible for the study design, data interpretation, table creation, and writing of the paper. P.F.W. was responsible for the data interpretation and writing of the paper. C.D. was responsible for the study design and the writing of the paper. W.C. provided statistical expertise and was responsible for the statistical analyses and figure creation. J.-P.O., I.A., L.J., and J.D. were responsible for the writing of the paper. D.S. conceived of the study and was responsible for the study design, the literature search, execution of all regional blocks, and writing of the paper. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Clotting-Factor Concentrations 5 Days After Discontinuation of Warfarin

Background The American Society of Regional Anesthesia and Pain Medicine guidelines recommend discontinuation of warfarin and an international normalized ratio (INR) of 1.2 or less before a neuraxial injection. The European and Scandinavian guidelines accept an INR of 1.4 or less. We evaluated INR and levels of clotting factors (CFs) II, VII, IX, and X 5 days after discontinuation of warfarin. Methods Patients who discontinued warfarin for 5 days and had an INR of 1.4 or less had activities of factors II, VII, IX, and X measured. The primary outcome was the frequency of subjects with CF activities of less than 40%. Results Twenty-three patients were studied; 21 (91%) had an INR of 1.2 or less. In these 21 patients, the median (interquartile range) activities of factors II, VII, IX, and X were 66% (52%–80%), 114% (95%–132%), 101% (84%–121%), and 55% (46%–63%), respectively. Ninety-five percent (99% confidence interval, 69%–99%) had CF activities of greater than 40%. The patient who did not CF activities greater than 40% had end-stage renal disease. Two subjects had an INR of greater than 1.2; the activities of factor II, VII, IX, and X were 37% and 46%, 89% and 105%, 66% and 78%, and 20% and 36%, respectively. Neither patient had CF activities of greater than 40%. Conclusions Based on 40% activity of CFs, patients with INRs of 1.2 or less can be considered to have adequate CFs to undergo neuraxial injections. The number of patients with an INR of 1.3 and 1.4 is too small to make conclusions. Accepted for publication January 30, 2018. Address correspondence to: Honorio T. Benzon, MD, Department of Anesthesiology, 251 E. Huron, St, Feinberg Pavilion, 5–704, Chicago, IL 60611 (e-mail: h-benzon@northwestern.edu). L.V. is retired. This work is attributed to the Departments of Anesthesiology and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Funding support for this study was provided by the Department of Anesthesiology, Northwestern University Feinberg School of Medicine (departmental sources only). The study was presented at Anesthesiology 2016, the annual meeting of the American Society of Anesthesiologists, October 22 to 25, 2016, Chicago, IL. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Adults with Autism Tend to Undermine the Hidden Environmental Structure: Evidence from a Visual Associative Learning Task.

Related Articles

Adults with Autism Tend to Undermine the Hidden Environmental Structure: Evidence from a Visual Associative Learning Task.

J Autism Dev Disord. 2018 Apr 13;:

Authors: Sapey-Triomphe LA, Sonié S, Hénaff MA, Mattout J, Schmitz C

Abstract
The learning-style theory of Autism Spectrum Disorders (ASD) (Qian, Lipkin, Frontiers in Human Neuroscience 5:77, 2011) states that ASD individuals differ from neurotypics in the way they learn and store information about the environment and its structure. ASD would rather adopt a lookup-table strategy (LUT: memorizing each experience), while neurotypics would favor an interpolation style (INT: extracting regularities to generalize). In a series of visual behavioral tasks, we tested this hypothesis in 20 neurotypical and 20 ASD adults. ASD participants had difficulties using the INT style when instructions were hidden but not when instructions were revealed. Rather than an inability to use rules, ASD would be characterized by a disinclination to generalize and infer such rules.

PMID: 29654451 [PubMed - as supplied by publisher]

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Dermatology Surgery and Reconstruction Photograph Booklet as a Tool to Improve Informed Consent Before Skin Surgery

BACKGROUND Skin surgery is a high-risk area of litigation and tools to improve consent are welcomed. OBJECTIVE This project aimed to strengthen the consenting process for dermatological surgery by introducing a photograph booklet. MATERIALS AND METHODS The authors designed a booklet containing skin surgery images. Patients attending surgery completed an anonymous questionnaire immediately after their procedures before the booklet introduction (Group 1). The questionnaire was then repeated (Group 2) with the introduction of the photograph booklet during consent. The authors looked for changes in the following: understanding of procedure, scar, and postoperative care as well as addressing of patients' concerns using a subjective scale of 1 to 5 (1 = poor, 2 = fair, 3 = okay, 4 = good, and 5 = great). RESULTS Results indicated greater patient satisfaction among patients in Group 2 who had been shown relevant surgical images compared with Group 1, with improvements from ratings of 3 and 4 on the scale to 5. The difference in the 2 groups for the highest ratings of 5/5 was significant (p

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Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures

BACKGROUND Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments. OBJECTIVE To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators. METHODS Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale. RESULTS Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment. CONCLUSION Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures. Address correspondence and reprint requests to: Joseph F. Sobanko, MD, Mohs & Reconstructive Surgery, Division of Dermatologic Surgery, Dermatology, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, or e-mail: joseph.sobanko@uphs.upenn.edu J.F. Sobanko is supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery and a University of Pennsylvania Center for Human Appearance Grant. J.M. Gelfand is supported by NIH/NIAMS grant K24AR064310. In the previous 12 months, J.M. Gelfand served as a consultant for Coherus (DSMB), Dermira, Janssen Biologics, Merck (DSMB), Novartis, Corp., Regeneron, Sanofi, and Pfizer, Inc., receiving honoraria and receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis, Corp., Regeneron, Sanofi, Celgene, and Pfizer, Inc., and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Abbvie. J.M. Gelfand is a copatent holder of resiquimod for the treatment of cutaneous T-cell lymphoma. D.B. Sarwer has consulting relationships with Allergan, BARONova, Ethicon, and Novo Nordisk. He also serves on the Board of Directors for the American Board of Plastic Surgery and the American Society for Aesthetic Plastic Surgery Research Foundation. I. Percedc is a consultant for Galderma. The remaining authors have indicated no significant interest with commercial supporters. This study was approved by the institutional review board of the University of Pennsylvania. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types

BACKGROUND The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery. OBJECTIVE To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III–V. METHODS Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment. RESULTS Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator–assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted. CONCLUSION The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III–V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ. Address correspondence and reprint requests to: Monique J. Vanaman Wilson, MD, California Skin Institute, 603 S. Knickerbocker Drive, Sunnyvale, CA 94087, or e-mail: moniquewilsonmd@gmail.com Supported by Valeant Pharmaceuticals North America LLC, Bridgewater, NJ. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Topical Botulinum Toxin Type A Liposomal Cream for Primary Axillary Hyperhidrosis: A Double-Blind, Randomized, Split-Site, Vehicle-Controlled Study

BACKGROUND Despite its effectiveness in treating primary axillary hyperhidrosis (PAH), topical botulinum toxin type A (BTX-A) is highly resistant to transdermal absorption. Topical BTX-A liposomal cream is recommended as a novel, noninvasive modality to enhance skin penetration. OBJECTIVE To evaluate the efficacy and safety of topical BTX-A liposomal cream in comparison with liposomal vehicle cream alone in the treatment of PAH. MATERIALS AND METHODS A prospective, randomized, double-blinded, split-site study was conducted in 20 subjects, aged 18 to 50 years, all of whom had symmetrical axillary sweating with Hyperhidrosis Disease Severity Scale scores between 2 to 4. All subjects were double-blinded to treatment regimens and randomly given 2 bottles, one containing topical BTX-A liposomal cream and one containing the vehicle cream without BTX-A, to be applied consistently to the same axilla nightly for 7 consecutive days. Clinical improvement and adverse reactions were evaluated at every follow-up visit. RESULTS Axillary skin treated with topical BTX-A demonstrated superior sweat reduction and patient satisfaction to vehicle cream–treated axillary skin, with clinical and statistical significance, at baseline, weeks 2, 4, 6, and 8 of follow-up, without adverse effects. CONCLUSION Topical BTX-A liposomal cream pharmaceutically enhances drug delivery, is painless, cost-effective, and overall an innovative treatment of PAH. Address correspondence and reprint requests to: Suparuj Lueangarun, MD, MSc, Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, 99 Moo 18 Phahonyothin Rd Klonglung, Pathum Thani, Thailand 12120, or e-mail: saoraya180@gmail.com The authors have indicated no significant interest with commercial supporters. S. Lueangarun and C. Sermsilp were responsible for the initiation, execution, data collection, analysis, and drafting of the paper. S. Lueangarun and T. Tempark were responsible for the critical revision of the manuscript as well as the review and approval of the final paper. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Trends in Dermatologic Surgery: Results of the American Society for Dermatologic Surgery Procedure and Consumer Surveys

No abstract available

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Pseudohalo Basal Cell Carcinoma

No abstract available

https://ift.tt/2JM3get

Liposarcoma Preoperatively Diagnosed as Lipoma: 10-Year Experience at a Single Institution

BACKGROUND On rare occasions, a lesion preoperatively diagnosed as a lipoma is ultimately diagnosed as a liposarcoma. It is important to differentiate liposarcomas from lipomas preoperatively. OBJECTIVE To examine characteristic features of liposarcomas preoperatively diagnosed as lipomas. METHODS Patients (n = 637) who underwent resection of tumors preoperatively diagnosed as lipomas from January 2006 to October 2016 were retrospectively reviewed. RESULTS Based on pathological examination, 8 of 637 lesions were diagnosed as liposarcomas postoperatively. All the liposarcomas were well-differentiated liposarcomas. The rate of male patients was higher (87.5% vs 38.9%) and the size of tumors was larger (8.75 vs 4.64 cm) in these cases than in accurately diagnosed lipoma cases. On imaging, nonfatty septa were more frequently observed (71.4% vs 20.0%) and were thicker (2.22 vs 1.33 mm) than in true lipoma cases. CONCLUSION If the patient with a lipomatous tumor is male and the tumor is large, we should consider the possibility of it being a liposarcoma. A thick internal septum in the image findings is a good predictor of malignancy. Address correspondence and reprint requests to: Hirotaka Suga, MD, Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan, or e-mail: sugah-tky@umin.ac.jp The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2vc5Ozg

In Vivo Degradation of Crosslinked Hyaluronic Acid Fillers by Exogenous Hyaluronidases

BACKGROUND An advantage of hyaluronic acid (HA)-based fillers is reversibility. OBJECTIVE To evaluate the ability of 2 hyaluronidases to degrade 3 HA-based fillers using a novel in vivo model. MATERIALS AND METHODS Rats were injected with 3 HA fillers (HYC-24L+, VYC-20L, and RES-L) to create a projecting bolus. After 4 days, recombinant human hyaluronidase (HX) or ovine hyaluronidase (VIT) was administered at (1) varying doses (5 U, 10 U, or 30 U per 0.1 mL filler) or (2) different dilutions (10 U diluted 3-fold). The impact of tissue integration was assessed by administering 10 U/0.1 mL filler 4 weeks after filler injection. Three-dimensional images quantified projection loss over 72 hours. RESULTS Complete loss of projection was achieved for all fillers with the highest HX and VIT doses; lower doses achieved less degradation. No difference in degradation was observed between HYC-24L+ and VYC-20L using HX or VIT. RES-L was slightly more degraded with 10 U VIT but not with 10 U HX. Enzyme dilution resulted in less degradation. Tissue integration did not impact the degree of degradation. CONCLUSION This model incorporates the biological system while controlling variables including filler depth and volume and location of hyaluronidase delivery. Hyaluronic acid filler degradation by exogenous hyaluronidase was not hindered by differences among fillers. Address correspondence and reprint requests to: Christopher K. Hee, PhD, Allergan plc, 2525 Dupont Dr, Irvine, CA or e-mail: hee_charlie@Allergan.com This study was sponsored by Allergan plc, Dublin, Ireland. Writing and editorial assistance was provided to the authors by Peloton Advantage, Parsippany, NJ, and was funded by Allergan plc. Neither honoraria nor other forms of payment were made for authorship. C. K. Hee, G. T. Shumate, and D. J. Messina are employees of Allergan, plc. R. Chopra has received honoraria from Allergan plc and Galderma, research funding from Galderma, serves as a consultant for Allergan plc, and is a stockholder of Allergan plc. D. Jones has received research grants from and serves as a consultant for Allergan plc, Lithera, and Merz. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2JM3fap

Features of Irradiated Skeletal Muscle on Mohs Frozen Section Examination

No abstract available

https://ift.tt/2JMApqh

Dosage form modification and oral drug delivery in older people

Publication date: Available online 13 April 2018
Source:Advanced Drug Delivery Reviews
Author(s): Esther T.L. Lau, Kathryn J. Steadman, Julie A.Y. Cichero, Lisa M. Nissen
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.

Graphical abstract

https://ift.tt/2HoeQOw

Impact of aging, Alzheimer's disease and Parkinson's disease on the blood-brain barrier transport of therapeutics

Publication date: Available online 14 April 2018
Source:Advanced Drug Delivery Reviews
Author(s): Yijun Pan, Joseph A. Nicolazzo
Older people are at greater risk of medicine-induced toxicities resulting from either increased drug sensitivity or age-related pharmacokinetic changes. The scenario is further complicated with the two most prevalent age-related neurodegenerative diseases, Alzheimer's disease (AD) and Parkinson's disease (PD). With aging, AD and PD, there is growing evidence of altered structure and function of the blood-brain barrier (BBB), including modifications to tight junctions and efflux transporters, such as P-glycoprotein. The subsequent impact on CNS drug exposure and risk of neurotoxicity from systemically-acting medicines is less well characterized. The purpose of this review, therefore, is to provide an overview of the multiple changes that occur to the BBB as a result of aging, AD and PD, and the impact that such changes have on CNS exposure of drugs, based on studies conducted in aged rodents or rodent models of disease, and in elderly people with and without AD or PD.

Graphical abstract

https://ift.tt/2vjqaqs

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review.

Related Articles

An Unusual Manifestation of Calcineurin Inhibitor-Induced Pain Syndrome in Kidney Transplantation: A Case Report and Literature Review.

Am J Case Rep. 2018 Apr 14;19:442-446

Authors: Udomkarnjananun S, Townamchai N, Virojanawat M, Avihingsanon Y, Praditpornsilpa K

Abstract
BACKGROUND Calcineurin inhibitors (CNI) are the mainstay immunosuppressive drugs for kidney transplantation. Although they provide excellent allograft and patient outcomes, adverse effects are frequently encountered. Calcineurin inhibitor-induced pain syndrome (CIPS) is a rare adverse effect of CNI. Previous case reports with CIPS diagnosis involved incapacitating pain in the lower extremities. CASE REPORT In this article, we report the first case of CIPS with severe back pain as the presenting symptom, which was correlated with a high tacrolimus trough concentration due to a drug interaction with clotrimazole troche. Magnetic resonance imaging (MRI) of the spine showed bone marrow edema, which is consistent with previous case reports. The patient's symptoms resolved within 3 weeks of the onset of pain. Treatments were symptomatic care and lowering the tacrolimus trough concentration. Pain was improved significantly with pregabalin but not with nifedipine. CONCLUSIONS We reviewed the literature of kidney transplant cohorts with CIPS to ascertain prevalence, pain characteristics, and treatment outcomes. Apart from our case, all patients experienced lower extremities pain and were pain-free during the follow-up period, without any residual abnormalities. CIPS is a benign but adverse effect of CNI. Counselling patients about the disease's natural history and supportive care remain the best treatment.

PMID: 29654227 [PubMed - in process]

https://ift.tt/2GZxIUz

Blood Cell Disruption to Significantly Improve the Borrelia Pcr Detection Sensitivity in Borreliosis in Humans

Publication date: Available online 15 April 2018
Source:Medical Hypotheses
Author(s): Alexis Lacout, Yves Mone, Michel Franck, Pierre-Yves Marcy, Marie Mas, Francisco Veas, Christian Perronne
Lyme disease is the most frequently reported zoonotic tick-borne disease worldwide, and the number of infected humans is increasing. Lyme disease (or Lyme borreliosis) is an affection caused by the spirochete Borrelia burgdorferi, sensu lato. Lyme disease is also reported as a variety of misleading clinical symptomatologies. Infected patient's blood serology is the most currently test used for its diagnosis. However, serology has a low sensitivity, which ranges from 34 % to 70%.Thus, there are numerous subsequent false-negative diagnoses despite an active clinical infection profile. Therefore, alternative and more sensitive techniques are required to detect the antigens or nucleic acids of Borrelia. Actually, the most appropriate methodological approach seems to be the polymerase chain reaction (PCR). However, PCR will detect the only "visible" part available of the targeted DNA presence in the blood of the infected patients. Consequently PCR alone will not be conclusive enough to reach the final diagnosis. Considering the ability of Borrelia to invade host cells, we hypothesize that a selective lysis of all blood cells should improve the diagnostic sensitivity of the detection of Borrelia by PCR in whole blood, and subsequently reduce the false-negative diagnostic rate, thus improving the patient's diagnosis and therapeutic management.



https://ift.tt/2qzsGmW

Minimizing Post-operative Complications of Groin Dissection Using Modified Skin Bridge Technique: A Single-Centre Descriptive Study Showing Post-operative and Early Oncological Outcomes.

Related Articles

Minimizing Post-operative Complications of Groin Dissection Using Modified Skin Bridge Technique: A Single-Centre Descriptive Study Showing Post-operative and Early Oncological Outcomes.

World J Surg. 2018 Apr 13;:

Authors: Ray MD, Jakhetiya A, Kumar S, Mishra A, Singh S, Shukla NK

Abstract
INTRODUCTION: Historically, groin dissections are associated with high morbidity. Various modifications have been described in the literature with inconsistent outcomes. The aim of this paper is to highlight modified skin bridge technique to minimize all post-operative complications of groin dissection without compromising early oncological outcomes.
METHODS: A retrospective descriptive study of the computerized cancer database was performed to retrieve details of all the cancer patients who had undergone groin dissections during January 2012 to September 2016. Data pertaining to clinical profile including demographics, clinical and histopathological details, treatment profile, procedure-related morbidity and relapse patterns were extracted and analysed.
RESULTS: A total of 75 patients underwent 105 groin dissections during this period. Out of 105 groin dissections, 43 were inguinal lymph node dissection (ILND) and 62 were combined ilio-inguinal lymph node dissection (IILND). The most common diagnosis was carcinoma penis (25%) followed by malignant melanoma (14.6%) and squamous cell carcinoma (13.33%) of lower extremities. Overall, the most common complications were seroma (14.28%) and skin edge necrosis (7.61%) followed by surgical site infection (4.76%). After a median follow-up of 17.64 months (IQR 5-61.53), a total of 18 patients (24%) developed recurrence.
CONCLUSION: Groin dissection still remains an important diagnostic as well as therapeutic procedure justifying its potential of morbidity. Modified skin bridge technique is a very effective method to minimize all post-operative complications with optimal early oncological outcomes.

PMID: 29654358 [PubMed - as supplied by publisher]

https://ift.tt/2ELeNHi

An ulcer on the ventral tip of tongue.

Related Articles

An ulcer on the ventral tip of tongue.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 09;:

Authors: Pontes HAR, de Souza LL, Costa AMPE, da Silva AA, Gonçalves FLN, Fonseca FP, Pontes FSC

PMID: 29653816 [PubMed - as supplied by publisher]

https://ift.tt/2vexRy1

Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients.

Related Articles

Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 09;:

Authors: Undt G, Jahl M, Pohl S, Marlovits S, Moser D, Yoon HH, Frank J, Lang S, Czerny C, Klima G, Gentleman E, Ewers R

Abstract
OBJECTIVE: Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ).
STUDY DESIGN: We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis.
RESULTS: Six of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage-not typical for the TMJ-was present.
CONCLUSIONS: We conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.

PMID: 29653815 [PubMed - as supplied by publisher]

https://ift.tt/2JMsUQ9

Epigenomic biomarkers for prognostication and diagnosis of gastrointestinal cancers

Publication date: Available online 14 April 2018
Source:Seminars in Cancer Biology
Author(s): Chi Chun Wong, Weilin Li, Bertina Chan, Jun Yu
Altered epigenetic regulation is central to many human diseases, including cancer. Over the past two decade, major advances have been made in our understanding of the role of epigenetic alterations in carcinogenesis, particularly for DNA methylation, histone modifications and non-coding RNAs. Aberrant hypermethylation of DNA at CpG islands is a well-established phenomenon that mediates transcriptional silencing of tumor suppressor genes, and it is an early event integral to gastrointestinal cancer development. As such, detection of aberrant DNA methylation is being developed as biomarkers for prognostic and diagnostic purposes in gastrointestinal cancers. Diverse tissue types are suitable for the analyses of methylated DNA, such as tumor tissues, blood, plasma, and stool, and some of these markers are already utilized in the clinical setting. Recent advances in the genome-wide epigenomic approaches are enabling the comprehensive mapping of the cancer methylome, thus providing new avenues for mining novel biomarkers for disease prognosis and diagnosis. Here, we review the current knowledge on DNA methylation biomarkers for the prognostication and non-invasive diagnosis of gastrointestinal cancers and highlight their clinical application.



https://ift.tt/2HrtHrK

Cosmetics, Vol. 5, Pages 27: Analysis of Lipids in the Medulla of Japanese Hair and Their Function

Cosmetics, Vol. 5, Pages 27: Analysis of Lipids in the Medulla of Japanese Hair and Their Function

Cosmetics doi: 10.3390/cosmetics5020027

Authors: Jun Ymazaki Kazuhisa Maeda

The hair is composed of the cuticle (the outermost surface), cortex (its major part), and medulla (in the hair center). The lipid content of the medulla of Caucasian hair is relatively higher than that of African-American hair. However, the types of lipids therein remain unidentified. The aim of the current study was to analyze the constituent lipids of the medulla of Japanese hair, and to identify their function. A lipid peroxidase fluorescent reagent was used to investigate region-specific differences in the lipid content of the medulla (the tip, middle, and root portions). Since the medulla is important for the hair's glossiness, we also investigated the relationship between the lipid content and hair glossiness. The lipid content of hair, based on the absence or presence of lipid species in the medulla, was investigated using thin-layer chromatography (TLC). Micro-attenuated total reflectance Fourier-transform infrared spectrophotometry (micro-ATR FTIR) was used to analyze the similarities between the standard and medulla lipids, focusing on the methylene/methyl stretching vibration region. The data indicated that the medulla contained unsaturated lipids, the content of which decreased from the root to the tip of the hair. Hair glossiness was reduced with the decreasing lipid content, suggesting that unsaturated lipids of the medulla play a role in glossiness. The TLC analysis revealed differences in the type and amount of hair lipids in the medulla. While squalene and oleic acid spots were detected in hair with a continuously maintained medulla, these compounds were not detected in hair in which the medulla was not maintained. The medulla constituents similar to oleic acid and squalene were also identified by the micro-ATR FTIR spectrum analysis and the previous report. The findings indicate that the medulla is composed of at least squalene and oleic acid.

https://ift.tt/2H1lZVO

Assessing associations of anaemia with morbidity and mortality following liver transplantation.

Assessing associations of anaemia with morbidity and mortality following liver transplantation.

Int J Surg. 2018 Apr 11;:

Authors: Liu YY, Xue FS, Liu Q

PMID: 29654969 [PubMed - as supplied by publisher]

https://ift.tt/2veworv

Mini-incision versus hand-assisted laparoscopic donor nephrectomy in living-donor kidney transplantation: A retrospective cohort study.

Mini-incision versus hand-assisted laparoscopic donor nephrectomy in living-donor kidney transplantation: A retrospective cohort study.

Int J Surg. 2018 Apr 11;:

Authors: Subramanian T, Dageforde LA, Vachharajani N, Wellen J, Doyle M, Lin Y, Khan A, Senter-Zapata M, Chapman W, Shenoy S

Abstract
BACKGROUND: Increasing use of Living Donor Kidney Transplantation (LDKT) would decrease the discrepancy between patients awaiting transplantation and organ availability. Minimally invasive surgical approaches attempt to improve outcomes and foster living donation. This report compares outcomes of open minimal incision nephrectomy (Mini N) and a hand assisted laparoscopic nephrectomy (HALN).
METHODS: This is a retrospective analysis of a prospectively maintained clinical database of LDKT using HALN or Mini N at a single institution between July 2007 and December 2015. Donor and recipient demographics, relevant pre-, intra- and post-operative factors, outcomes such as patient and graft survival rates, and complications were evaluated.
RESULTS: Four hundred and fifty-four adult LDKT (243 Mini N, 211 HALN) were performed during the study period. Recipient and donor demographics were comparable except for higher BMI (p = 0.027) in HALN donors. One-, 3- and 5-year patient and graft survival rates were comparable. Six HALN donors experienced infectious wound complications or superficial skin dehiscence; none did in the Mini N group (p = 0.009). Eight HALN donors and one Mini N donor required an incisional hernia repair (p = 0.014). Recipients had similar warm ischemia times (33 v. 35 min, p = 0.491), but recipient surgeons of HALN nephrectomies subjectively noted higher anastomotic difficulty (10.4% v. 4.5%, p = 0.0183). Other parameters were similar between groups.
CONCLUSION: Both Mini N and HALN provide similar long term recipient and donor outcomes. Offering techniques such as Mini N and HALN for living donor kidney procurement facilitates the opportunity to provide living donors safer and better tolerated nephrectomy procedures.

PMID: 29654968 [PubMed - as supplied by publisher]

https://ift.tt/2JNkSH4

Conversion surgery for gastric cancer: A cohort study from a western center.

Conversion surgery for gastric cancer: A cohort study from a western center.

Int J Surg. 2018 Apr 11;:

Authors: Morgagni P, Solaini L, Framarini M, Vittimberga G, Gardini A, Tringali D, Valgiusti M, Monti M, Ercolani G

Abstract
BACKGROUND: Advanced unresectable gastric cancer has a dismal prognosis. The aim of this study was to evaluate the short- and long-term outcomes of patients who underwent induction chemotherapy ± gastrectomy for advanced gastric cancer.
MATERIAL AND METHODS: All patients referred to our center with a clinical diagnosis of unresectable locally advanced or stage IV gastric adenocarcinoma between April 2005 and August 2016 were included in the study. Cox regression was performed to find independent prognostic factor among the considered variable.
RESULTS: The cohort included 73 patients: 16 had best supportive care, 35 chemotherapy alone and 22 chemotherapy plus radical surgery. Thirty-three patients underwent surgery after chemotherapy. Twenty-two patients had R0 surgery, while the remaining 11 had only an exploratory procedure. Nine patients (40.9%) underwent gastrectomy plus hyperthermic intraperitoneal chemotherapy. Three patients out of 22 developed postoperative complications with a Clavien-Dindo grade above 2. Median survival was 50 months for patients who had chemotherapy plus surgery while it was 14 and 3 for those who had chemotherapy alone and best supportive care, respectively (p < 0.0001). Cox regression analysis performed on the whole cohort identified only radical conversion surgery as an independent factor positively associated with survival (HR 0.12, 95% CI 0.05-0.29, p < 0.0001).
CONCLUSION: Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment.

PMID: 29654967 [PubMed - as supplied by publisher]

https://ift.tt/2vof43F

Reply letter to: Letter to the editor on the article " Adjuvant systemic therapy and postoperative outcomes after resection of node positive gallbladder cancer".

Reply letter to: Letter to the editor on the article " Adjuvant systemic therapy and postoperative outcomes after resection of node positive gallbladder cancer".

Int J Surg. 2018 Apr 11;:

Authors:

PMID: 29654966 [PubMed - as supplied by publisher]

https://ift.tt/2JNkNDg

Endothelial nitric oxide synthase gene polymorphisms and risk of erectile dysfunction: An updated meta-analysis of genetic association studies.

Endothelial nitric oxide synthase gene polymorphisms and risk of erectile dysfunction: An updated meta-analysis of genetic association studies.

Int J Surg. 2018 Apr 11;:

Authors: Yao HX, Ma FZ, Tan YY, Liu LY

Abstract
PURPOSE: Endothelial nitric oxide synthase (eNOS) polymorphisms have been implicated as risk factors for erectile dysfunction (ED), but the results of genetic association studies are inconclusive. We performed a meta-analysis of published studies investigating the association between ED and three eNOS polymorphisms, intron 4 VNTR, G894T and T786C in humans.
METHODS: The PubMed, Web of Science, CNKI and Google Scholar databases were searched for relevant studies published up to November 2017. Association studies with case-control design were included. For each study with genotype information we calculated odds ratios (OR) and 95% confidence intervals (CI).
RESULTS: The search identified 13 eligible studies. The G894T and T786C polymorphisms showed a significant association with ED risk in Caucasians (GT + TT versus GG for G894T: OR = 2.13, 95% CI = 1.08-4.19; CC versus CT + TT for T786C: OR = 3.29, 95% CI = 2.30-4.72) and Asians (GT + TT versus GG for G894T: OR = 2.08, 95% CI = 1.53-2.84; CC + CT versus TT for T786C: OR = 3.13, 95% CI = 1.35-7.25). In addition, the intron 4 VNTR polymorphism was associated with ED risk only among Caucasian subjects (aa versus bb + ab: OR = 2.38, 95% CI = 1.15-4.93). We found no evidence of publication bias. The robustness of overall analyses was ensured in sensitivity analyses excluding studies deviating from Hardy-Weinberg equilibrium.
CONCLUSION: Our findings suggest that common genetic polymorphisms in the eNOS gene contribute to risk of ED, presumably by effects on eNOS activity and NO availability.

PMID: 29654965 [PubMed - as supplied by publisher]

https://ift.tt/2vglKAK

Adjuvant systemic therapy and postoperative outcomes after resection of node positive gallbladder cancer.

Adjuvant systemic therapy and postoperative outcomes after resection of node positive gallbladder cancer.

Int J Surg. 2018 Apr 11;:

Authors: Yu JJ, Xu XF, Yang T

PMID: 29654964 [PubMed - as supplied by publisher]

https://ift.tt/2JLTlWh

The pretreatment thrombocytosis as one of prognostic factors for gastric cancer: A systematic review and meta-analysis.

The pretreatment thrombocytosis as one of prognostic factors for gastric cancer: A systematic review and meta-analysis.

Int J Surg. 2018 Apr 11;:

Authors: Wang YH, Kang JK, Zhi YF, Zhang Y, Wang ZQ, Zhou Q, Niu WY, Ma MJ

Abstract
BACKGROUND & AIMS: At present, increasing reports have shown that pretreatment platelet count was associated with the prognosis of many types of cancer. We performed rounded analysis to comprehensively analyze and evaluate the prognostic significance of pretreatment thrombocytosis for patients with gastric cancer.
METHODS: We identified relevant studies by searching database including PubMed, Embase, Cochrane Library and Web of Science. The relative risk (RR) with its 95% confidence interval (CI) was used to assess the correlation between thrombocytosis and overall survival (OS) of gastric cancer patients. We also conducted subgroup analysis and sensitivity analysis for the prognostic effect of thrombocytosis on OS. The analysis was performed and assessed using Review Manager 5.2.
RESULTS: A total of nine studies including 7158 participants were included in this systematic review. Analysis results showed that pretreatment thrombocytosis had a close relationship with 1, 3 and 5 years survival of gastric cancer, with the pooled RRs being 0.80 (95% CI 0.71-0.90; P = 0.0004), 0.65 (95% CI 0.45-0.92; P = 0.02) and 0.64 (95% CI 0.47-0.87; P = 0.004) respectively.
CONCLUSIONS: The present rounded analysis suggests that pretreatment thrombocytosis may have significant association with poor survival of patients with gastric cancer.

PMID: 29654963 [PubMed - as supplied by publisher]

https://ift.tt/2ENw96n