Head and Neck Diseases by Alexandros G.Sfakianakis: 04/17/18

Τρίτη 17 Απριλίου 2018

Effects of single- and double-layered resorbable membranes and platelet-rich fibrin on bone healing

Abstract

Objectives

Research has been ongoing on achieving optimum bone healing in the reconstruction of bone loss. Clinically, soft tissue migration into the already existing bone defects is the leading cause of unfavourable bone healing. Platelet-rich fibrin, a recent material that is used to promote bone healing, was compared with single- and double-layered resorbable collagen membranes to determine whether a healing protocol which increases patient comfort is possible.

Materials and methods

Sixty adult female Sprague-Dawley rats were used. The rats were divided into five main groups as a sacrification group, a control group, and three experimental groups. The bone defects experimental group 1 were covered with a single-layer collagen membrane, and experimental group 2 were covered with the double-layered collagen membrane. Defects on the experimental group 3 were covered with platelet-rich fibrin membranes which were derived from the sacrification group. The animals in the main groups were also divided into eight subgroups arranged by sacrification periods on day 7 and day 28.

Results

Statistical analysis of our study revealed that new bone formation in experimental group 3 was significantly higher than in other groups. Fibrosis was found to be lower in experimental group 3 than in any other group. No significant differences were found between experimental group 1 and the control group.

Conclusion

Platelet-rich fibrin, which can be used as an autologous membrane which promotes bone healing, yields better clinical result compared to collagen membranes.

Clinical relevance

Histopathologic evaluation has been carried out regarding the effect of platelet-rich fibrin and collagen membranes applied on bone recovery. Our objective is to contribute to barrier membrane studies that continue to guide and accelerate bone recovery.

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Effect of bleaching agent extracts on murine macrophages

Abstract

Objectives

The aim of this study was to evaluate the cytotoxicity and the influence of bleaching agents on immunologically cell surface antigens of murine macrophages in vitro.

Materials and methods

RAW 264.7 cells were exposed to bleaching gel extracts (40% hydrogen peroxide or 20% carbamide peroxide) and different H₂O₂ concentrations after 1 and 24-h exposure periods and 1-h exposure and 23-h recovery. Tests were performed with and without N-acetyl cysteine (NAC) and buthionine sulfoximine (BSO). Cell viability was determined by MTT assay. The expression of surface markers CD14, CD40, and CD54 with and without LPS stimulation was detected by flow cytometry, while the production of TNF-α was measured by ELISA. Statistical analysis was performed using the Mann-Whitney U test (α = 0.05).

Results

Extracts of bleaching agents were cytotoxic for cells after a 1-h exposure; cells could not recover after 24 h. This effect can be mitigated by the antioxidant NAC and increased by BSO, an inhibitor of glutathione (GSH) synthesis. LPS stimulated expression of all surface markers and TNF-α production. Exposure to bleaching agent extracts and H₂O₂ leads to a reduction of TNF-α, CD14, and CD40 expression, while the expression of CD54 was upregulated at non-cytotoxic concentrations. Whereas NAC reduced this effect, it was increased in the presence of BSO.

Conclusions

Extracts of bleaching agents were irreversibly cytotoxic to macrophages after a 1-h exposure. Only the expression of CD54 was upregulated. The reactions are mediated by the non-enzymatic antioxidant GSH.

Clinical relevance

The addition of an antioxidant can downregulate unfavorable effects of dental bleaching.

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Lack of association between ENAM gene polymorphism and dental caries in primary and permanent teeth in Czech children

Abstract

Objectives

The enamelin gene (ENAM) polymorphism (rs12640848) was recently associated with dental caries in primary teeth in Polish children. The aims of the present study were to prove this association in primary dentition and to find a possible effect of this variant on caries development in permanent dentition in Czech children.

Materials and methods

This study comprised 905 Czech children. Totally, 187 children aged 2–6 years with primary dentition [78 healthy subjects (with decayed/missing/filled teeth, dmft = 0) and 109 patients with early childhood caries (ECC; dmft ≥ 1)] were included in this case-control study. In addition, 177 subjects aged 13–15 years without caries (DMFT = 0) and 541 children with dental caries (DMFT ≥ 1) in permanent dentition were selected from the ELSPAC study. Genotype determination of the ENAM polymorphism (rs12640848) was based on the TaqMan method.

Results

No significant differences in the allele or genotype frequencies between the caries-free children and those affected by dental caries were observed in both primary and permanent dentitions.

Conclusions

Lack of association between the ENAM polymorphism (rs12640848) and dental caries in Czech children was detected.

Clinical relevance

Although ENAM is considered as a candidate gene for dental caries, the presence of the ENAM variant (rs12640848) cannot be used as a risk factor of this multifactorial disease in the Czech population.

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Evaluation of the interface between gutta-percha and two types of sealers using scanning electron microscopy (SEM)

Abstract

Objectives

The aim of the present study was to evaluate the adaptation of a calcium silicate bioceramic (BC) sealer with either BC or conventional gutta-percha compared with that of AH Plus sealer in different root canal sections.

Materials and methods

Seventy-two extracted mandibular premolars were divided randomly into six groups. After standardised chemomechanical preparation, four groups were obturated with the BC sealer and BC gutta-percha or conventional gutta-percha, and the other two groups were obturated with AH Plus sealer and conventional gutta-percha either in lateral compaction or in a single cone technique. Each root was sectioned into three sections. An impression was made from each section, and replicas were then made for scanning electron microscopy (SEM) analysis. Areas and interfacial gaps were identified using image analysis software. In addition to descriptive and explorative data analyses, linear regression analysis was performed.

Results

All specimens had measurable interfacial gaps. Significantly fewer gaps were found between conventional gutta-percha and sealer compared to those observed when using the BC gutta-percha (p < 0.001). However, minor interfacial gaps between sealer and dentin were observed with the BC sealer (p = 0.04). The technique of obturation in different root canal sections did not significantly affect the sealer adaptability.

Conclusion

The type of gutta-percha as well as the sealer had a noticeable impact on the adaptability.

Clinical relevance

Different obturation techniques will result in similar outcomes. However, within the limitations of the study, there seems to be no advantage in using the BC gutta-percha.

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Prevention of coronal discoloration induced by regenerative endodontic treatment in an ex vivo model

Abstract

Objectives

The aim of this study was to assess the effect of sealing the pulp chamber walls with a dentin-bonding agent (DBA) on prevention of discoloration induced by regenerative endodontic procedures (REPs) in an ex vivo model.

Materials and methods

Ninety-six bovine incisors were prepared and randomly divided into two groups. In one group, the pulp chamber walls were sealed with DBA before placement of triple antibiotic paste (TAP) containing minocycline inside the root canals, but in the other group, DBA was not applied. After 4 weeks, the root canals were filled with human blood and each group was then randomly divided into four subgroups (n = 12) according to the endodontic cements placed over the blood clot (ProRoot MTA, OrthoMTA, RetroMTA, or Biodentine). The color changes (∆E) were measured at different steps. The data were analyzed using t test and two-way ANOVA.

Results

The specimens in which dentinal walls of pulp chamber were sealed with DBA showed significantly less coronal discoloration at each step of regenerative treatment (p < 0.001). However, application of DBA did not completely prevent the clinically perceptible coronal color change. Sealing the blood clot with different endodontic cements did not result in significant difference in coronal discoloration (p > 0.05).

Conclusions

Sealing the pulp chamber walls before insertion of TAP decreased coronal discoloration following REP using different endodontic cements but did not prevent it.

Clinical relevance

Discoloration of teeth undergoing REPs is an unfavorable outcome. Considering the significant contribution of TAP containing minocycline to the coronal tooth discoloration even after sealing the pulp chamber walls, the revision of current guidelines in relation to the use of TAP with minocycline might need to be revised.

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Oral cancer radiotherapy affects enamel microhardness and associated indentation pattern morphology

Abstract

Objectives

The aim of this study is to determine the effects of in vitro and in vivo high-dose radiotherapy on microhardness and associated indentation pattern morphology of enamel.

Materials and methods

The inner, middle, and outer microhardness of enamel was evaluated using three experimental groups: control (non-radiated); in vitro irradiated; in vivo irradiated. In vitro specimens were exposed to simulated radiotherapy, and in vivo specimens were extracted teeth from oral cancer patients previously treated with radiotherapy. Indentations were measured via SEM images to calculate microhardness values and to assess the mechanomorphological properties of enamel before and after radiotherapy.

Results

Middle and outer regions of enamel demonstrated a significant decrease in microhardness after in vitro and in vivo irradiation compared to the control group (p < 0.05). Two indentation patterns were observed: pattern A—presence of microcracks around indent periphery, which represents local dissipation of deformation energy; pattern B—clean, sharp indents. The percentage of clean microindentation patterns, compared to controls, was significantly higher following in vitro and in vivo irradiation in all enamel regions. The highest percentage of clean microindentations (65%) was observed in the in vivo irradiated group in the inner region of enamel near the dentin-enamel junction.

Conclusions

For the first time, this study shows that in vitro and in vivo irradiation alters enamel microhardness. Likewise, the indentation pattern differences suggest that enamel may become more brittle following in vitro and in vivo irradiation.

Clinical relevance

The mechanomorphological property changes of enamel following radiation may be a contributory component of pathologic enamel delamination following oral cancer radiotherapy.

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Development of a novel bioactive glass for air-abrasion to selectively remove orthodontic adhesives

Abstract

Objectives

To develop a novel, bioactive glass for removing residual orthodontic adhesive via air-abrasion, following bracket debonding, and to evaluate its effectiveness against a proprietary bioactive glass 45S5(Sylc™)-air-abrasion, and a slow-speed tungsten carbide (TC) bur.

Materials and methods

Three glasses were prepared and their bioactivity was proved. One novel glass (QMAT3) was selected due to its appropriate hardness, lower than that of enamel/45S5(Sylc™). Sixty extracted human premolars were randomly assigned to adhesive removal using: (a) QMAT3-air-abrasion, (b) 45S5(Sylc™)-air-abrasion, and (c) TC bur, which were further subdivided (n = 10) based on the adhesive used (Transbond XT™ or Fuji Ortho LC™). Enamel roughness was assessed using scanning electron microscopy (SEM) and non-contact profilometry before bracket bonding, after removing residual adhesive following bracket debonding and after polishing.

Results

QMAT3 formed apatite faster (6 h) than 45S5(Sylc™) (24 h) in Tris solution. QMAT3-air-abrasion gave the lowest enamel roughness (Ra) after removing the adhesives. SEM images showed a pitted, roughened enamel surface in the TC bur group and to a lesser extent with 45S5(Sylc™), while a virtually smooth surface without any damage was observed in the QMAT3-air-abrasion group. The time taken for adhesive removal with QMAT3 was comparable to 45S5(Sylc™) but was twice as long with the TC bur.

Conclusions

QMAT3-air-abrasion is a promising technique for selective removal of adhesives without inducing tangible enamel damage.

Clinical relevance

A novel bioactive glass has been developed as an alternative to the use of TC burs for orthodontic adhesive removal.

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Chemokine Receptor 5 Has No Major Role in the Severity of Hepatitis C Virus-Related Liver Damage

Viral Immunology, Ahead of Print.

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Building a Better Flu Vaccine

Viral Immunology, Ahead of Print.

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Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers

Abstract

DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.

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Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India

Abstract

Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006–2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.

https://ift.tt/2qHaOq5

Sternocleidomastoid Flap in Parotid Surgery: A Case Series

Abstract

Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.

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LncRNA LINC00152 promoted glioblastoma progression through targeting the miR-107 expression

Abstract

Long non-coding RNAs (lncRNAs) LINC00152 plays important roles in the progression of some tumors. However, the role of LINC00152 in human l glioblastoma is still unknown. In this study, we indicated that LINC00152 expression level was upregulated in glioblastoma tissues and cell lines. Overexpression of LINC00152 promoted the U87 and LN229 cell proliferation and invasion. Moreover, overexpression of LINC00152 suppressed the E-cadherin expression, where ectopic expression of LINC00152 promoted the N-cadherin, Vimentin, and Snail expression. These results suggested that LINC00152 enhanced epithelial-to-mesenchymal transition (EMT) program in the glioblastoma cell. Overexpression of LINC00152 suppressed the miR-107 expression in the U87 cell and enhanced the HMGA2 expression, which is a direct target gene of miR-107. In addition, we showed that the miR-107 expression was downregulated in the glioblastoma tissues and cell lines. Interesting, the expression of LINC00152 was negatively related with miR-107 expression in the glioblastoma tissues. Furthermore, LINC00152 promoted the glioblastoma cell proliferation and invasion through inhibiting miR-107 expression. These data suggested that LINC00152 acted as oncogene roles in the glioblastoma cell partly through targeting the miR-107 expression.

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Sternocleidomastoid Flap in Parotid Surgery: A Case Series

Abstract

https://ift.tt/2qCN6eG

Issue Information

Journal of Cutaneous Pathology, Volume 45, Issue 5, May 2018.

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Singlet oxygen evolution from layered transition metal oxide cathode materials and its implications for lithium-ion batteries

Publication date: Available online 17 April 2018
Source:Materials Today
Author(s): Johannes Wandt, Anna T.S. Freiberg, Alexander Ogrodnik, Hubert A. Gasteiger
For achieving higher energy density lithium-ion batteries, the improvement of cathode active materials is crucial. The most promising cathode materials are nickel-rich layered oxides LiNixCoyMnzO2 (NCM) and over lithiated NCM (often called HE-NCM). Unfortunately, the full capacity of NCM cannot be utilized due to its limited cycle-life at high state-of-charge (SOC), while HE-NCM requires high voltages. By operando emission spectroscopy, we show for the first time that highly reactive singlet oxygen is released when charging NCM and HE-NCM to an SOC beyond ≈80%. In addition, on-line mass-spectrometry reveals the evolution of CO and CO2 once singlet oxygen is detected, providing significant evidence for the reaction between singlet oxygen and electrolyte to be a chemical reaction. It is controlled by the SOC rather than by potential, as would be the case for a purely electrochemical electrolyte oxidation. Singlet oxygen formation therefore imposes a severe challenge to the development of high-energy batteries based on layered oxide cathodes, shifting the focus of research from electrochemically stable 5 V-electrolytes to chemical stability toward singlet oxygen.

Graphical abstract

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Microfluidic generation of transient cell volume exchange for convectively driven intracellular delivery of large macromolecules

Publication date: Available online 17 April 2018
Source:Materials Today
Author(s): Anna Liu, Muhymin Islam, Nicholas Stone, Vikram Varadarajan, Jenny Jeong, Samuel Bowie, Peng Qiu, Edmund K. Waller, Alexander Alexeev, Todd Sulchek
Efficient intracellular delivery of target macromolecules remains a major obstacle in cell engineering and other biomedical applications. We discovered a unique cell biophysical phenomenon of transient cell volume exchange using microfluidics to rapidly and repeatedly compress cells. This behavior consists of brief, mechanically induced cell volume loss followed by rapid volume recovery. We harness this behavior for high-throughput, convective intracellular delivery of large polysaccharides (2000 kDa), particles (100 nm), and plasmids while maintaining high cell viability. Successful proof of concept experiments in transfection and intracellular labeling demonstrated potential to overcome the most prohibitive challenges in intracellular delivery for cell engineering.

Graphical abstract

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Association Between Voice Handicap Index and Praat Voice Analysis in Patients with Benign Vocal Cord Lesion Before and After Microscopic Laryngeal Surgery

Abstract

Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson's correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p < 0.05). We found no correlation between VHI score and Praat voice analysis in patients with benign vocal cord lesion before and after surgery, except correlation between VHI functional subscale with HNR and VHI total score with jitter.

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Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients

Abstract

Nasopharyngeal carcinoma (NPC) is a malignant disease derived from nasopharyngeal epithelial cells that have a higher tendency for invasion and metastasis to the cervical lymph nodes than other head–neck malignancies. NPC patients with the same stages often show different progressions and prognoses. This suggests that clinical stages are not sufficient to predict progressivity, so biomarkers are required to provide better progression predictions. Some literature shows that the development and progression of NPC is a complex mechanism involving various components of signal paths, it plays a role in regulating the process of proliferation, angiogenesis and apoptosis. One of the most studied is β-catenin protein that is a key component of the canonical Wnt signal pathway. The β-catenin protein is reported to have roles in increasing the proliferative pathway of c-Myc and cyclin D1, increasing the expression of IL-8 proangiogenesis factor, decreasing expression of RASSF1A tumor suppressor and inhibiting apoptosis through the barriers of caspace-9 activity. To determine the association of β-catenin expression and staging in nasopharyngeal carcinoma patients. The research design used was analytic observational research with cross sectional approach. Samples were enrolled using consecutive sampling. The β-catenin expression was examined from the NPC tissue paraffin block with the immunohistochemical cracking technique, using an anti-β-catenin rabbit polyclonal antibody from Boster Biotechnology, California, USA. The β-catenin expression was assessed visually using a binocular light microscope and a scoring method according to the Allred scale index by an Anatomical Pathology consultant. Statistical analysis was performed using Spearman's test to determine the association between β-catenin expression and staging in NPC patients. The significance level was α = 0.05. The study was conducted from May to December 2015 at Otolaryngology Unit of Dr. Soetomo General Soetomo, Surabaya. There were 40 patients who fulfilled the inclusion criteria. Spearman test results obtained p value = 0.060. The correlation of β-catenin expression with staging in NPC patients was found to be non-significant (p > 0.05). There was no correlation between β-catenin expression and staging in NPC patients.

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Chronic respiratory rhinitis

Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): R. Jankowski, P. Gallet, D.T. Nguyen, C. Rumeau
The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.

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Maxillofacial brown tumours: Series of 5 cases

Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Antin, D. Bakhos, F. Jegoux, M. Merkouza, L. Laccourreye
ObjectivesBrown tumours are benign bone tumours secondary to hyperparathyroidism. The authors describe the various clinical features, diagnostic methods and treatment modalities for maxillofacial brown tumours.Material and methodsThis multicentre retrospective study comprised 5 patients (four women and one man, between the ages of 29 and 70 years) with one or several maxillofacial brown tumours observed over a 16-year period from January 2000 to December 2016.ResultsFour patients presented secondary hyperparathyroidism in a context of chronic renal failure, one patient presented primary hyperparathyroidism due to parathyroid adenoma. Three patients presented a mandibular brown tumour, and two patients presented a maxillary brown tumour. The diagnosis was based on histological examination and laboratory tests. Brown tumours were treated either surgically or conservatively. A favourable outcome was observed in all cases.ConclusionBrown tumours are rare lesions. This diagnosis must be considered in a context of giant cell tumour associated with hyperparathyroidism. Brown tumours should be treated conservatively.

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Correction to: Formation of brominated and chlorinated dioxins and its prevention during a pilot test of mechanochemical treatment of PCB and PBDE contaminated soil

Abstract

The destruction of persistent organic pollutants(POPs) is a large challenge in particular in developing and emerging economies.

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Comparison of different advanced degradation processes for the removal of the pharmaceutical compounds diclofenac and carbamazepine from liquid solutions

Abstract

Carbamazepine and diclofenac are two examples of drugs with widespread geographical and environmental media proliferation that are poorly removed by traditional wastewater treatment processes. Advanced oxidation processes (AOPs) have been proposed as alternative methods to remove these compounds in solution. AOPs are based on a wide class of powerful technologies, including UV radiation, ozone, hydrogen peroxide, Fenton process, catalytic wet peroxide oxidation, heterogeneous photocatalysis, electrochemical oxidation and their combinations, sonolysis, and microwaves applicable to both water and wastewater. Moreover, processes rely on the production of oxidizing radicals (•OH and others) in a solution to decompose present pollutants. Water radiolysis-based processes, which are an alternative to the former, involve the use of concentrated energy (beams of accelerated electrons or γ-rays) to split water molecules, generating strong oxidants and reductants (radicals) at the same time. In this paper, the degradation of carbamazepine and diclofenac by means of all these processes is discussed and compared. Energy and byproduct generation issues are also addressed.

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Allocating on coal consumption and CO 2 emission from fair and efficient perspective: empirical analysis on provincial panel data of China

Abstract

This paper considers a problem of how to allocate resource effectively and equitably among provinces. To address the problem, a total factor resource input-oriented data envelopment analysis (DEA) model is used to evaluate the energy and environmental efficiency for 30 provinces in China during 2009–2013 in this paper. Based on the evaluation results, from efficient and fair perspective, a revised DEA-based resource allocation model is established. It is worth pointing out that the model takes the input orientation and output orientation into account at the same time and can be used to allocate coal consumption and carbon emission by 2020 for 30 provinces in China. Results indicate that if the Chinese government wants to fulfill the CO₂ emission reduction targets of 40–45% by 2020, and coal consumption intensity reduction target during 13th Five-Year Plan, inefficient provinces will undertake more coal consumption and carbon emission intensity reduction obligation share. And provinces with historical high coal consumption and high CO₂ emission intensity will have greater potential of coal consumption and carbon emission intensity reduction. In addition, this paper set several scenarios of gross domestic product (GDP) growth rate, under the scenarios analysis, finds the growth rate of GDP has negative effect on reduction of coal consumption and carbon dioxide emissions intensity. This research provides more realistic practical significance for achieving sustainable economic development.

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Association Between Voice Handicap Index and Praat Voice Analysis in Patients with Benign Vocal Cord Lesion Before and After Microscopic Laryngeal Surgery

Abstract

https://ift.tt/2HbM3xe

Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients

Abstract

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Towards tailored management of malignant brain tumors with nanotheranostics

Publication date: Available online 17 April 2018
Source:Acta Biomaterialia
Author(s): Juan Aparicio-Blanco, Ana-Isabel Torres-Suárez
Malignant brain tumors still represent an unmet medical need given their rapid progression and often fatal outcome within months of diagnosis. Given their extremely heterogeneous nature, the assumption that a single therapy could be beneficial for all patients is no longer plausible. Hence, early feedback on drug accumulation at the tumor site and on tumor response to treatment would help tailor therapies to each patient's individual needs for personalized medicine. In this context, at the intersection between imaging and therapy, theranostic nanomedicine is a promising new technique for individualized management of malignant brain tumors. Although brain nanotheranostics has yet to be translated into clinical practice, this field is now a research hotspot due to the growing demand for personalized therapies. In this review, the barriers to the clinical implementation of theranostic nanomedicine for tracking tumor responses to treatment and for guiding stimulus-activated therapies and surgical resection of malignant brain tumors are discussed. Likewise, the criteria that nanotheranostic systems need to fulfil to become clinically relevant formulations are analyzed in depth, focusing on theranostic agents already tested in vivo. Currently, magnetic nanoparticles exploiting brain targeting strategies represent the first generation of preclinical theranostic nanomedicines for the management of malignant brain tumors.Statement of significanceThe development of nanocarriers that can be used both in imaging studies and the treatment of brain tumors could help identify which patients are most and least likely to respond to a given treatment. This will enable clinicians to adapt the therapy to the needs of the patient and avoid overdosing non-responders. Given the many different approaches to non-invasive techniques for imaging and treating brain tumors, it is important to focus on the strategies most likely to be implemented and to design the most feasible theranostic biomaterials that will bring nanotheranostics one step closer to clinical practice.

Graphical abstract

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An asymmetric chitosan scaffold for tendon tissue engineering: in vitro and in vivo evaluation with rat tendon stem/progenitor cells

Publication date: Available online 17 April 2018
Source:Acta Biomaterialia
Author(s): Erman Chen, Ling Yang, Chenyi Ye, Wei Zhang, Jisheng Ran, Deting Xue, Zhengke Wang, Zhijun Pan, Qiaoling Hu
The poor healing capacity and typically incomplete regeneration of injured tendons has made tendon repair as a primary clinical concern. Several methods for repairing injured tendons have been developed in the last decade. Tendon regeneration using current tissue engineering techniques requires advanced biomaterials to satisfy both microstructural and mechanical criteria. In this study, a novel chitosan (CS)-based scaffold with asymmetric structure was fabricated using a self-deposition technique. The fabricated scaffolds were assessed with regard to the microstructural and mechanical demands of cell ingrowth and the prevention of peritendinous adhesion. In vitro studies showed that rat tendon stem/progenitor cells (TSPCs) seeded onto the CS scaffold displayed higher levels of tenogenic specific genes expression and protein production. Four and six weeks after the implantation of CS scaffolds on full-site Achilles tendon defects, in vivo tendon repair was evaluated by histology, immunohistochemistry, immunofluorescence, and mechanical measurements. The production of collagen I (COL1) and collagen III (COL3) demonstrated that the CS scaffolds were capable of inducing conspicuous tenogenic differentiation, higher tenomodulin (TNMD) production, and superior phenotypic maturity, compared with the empty defect group. The introduction of TSPCs into the CS scaffold resulted in a synergistic effect on tendon regeneration and yielded better-aligned collagen fibers with elongated, spindle-shaped cells. These findings indicated that the application of TSPC-seeded CS scaffolds would be a feasible approach for tendon repair.

Graphical abstract

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The role of the micro-pattern and nano-topography of hydroxyapatite bioceramics on stimulating osteogenic differentiation of mesenchymal stem cells

Publication date: Available online 18 April 2018
Source:Acta Biomaterialia
Author(s): Cancan Zhao, Xiaoya Wang, Long Gao, Linguo Jing, Quan Zhou, Jiang Chang
The micro/nano hybrid structure is considered to be a biomaterial characteristic to stimulate osteogenesis by mimicking the three-dimensional structure of the bone matrix. However, the mechanism of the hybrid structure induced osteogenic differentiation of stem cells is still unknown. For elucidating the mechanisms, one of the challenge is to directly fabricate micro/nano hybrid structure on bioceramics because of its brittleness. In this study, hydroxyapatite (HA) bioceramics with the micro/nano hybrid structure were firstly fabricated via a hydrothermal treatment and template method, and the effect of the different surface structures on the expression of integrins, BMP2 signaling pathways and cell-cell communication was investigated. Interestingly, the results suggested that the osteogenic differentiation induced by micro/nano structures was modulated first through activating integrins and then further activating BMP2 signaling pathway and cell-cell communication, while activated BMP2 could in turn activate integrins and Cx43-related cell-cell communication. Furthermore, differences in activation of integrins, BMP2 signaling pathway, and gap junction-mediated cell-cell communication were observed, in which nanorod and micropattern structures activated different integrin subunits, BMP downstream receptors and Cx43. This finding may explain the synergistic effect of the micro/nano hybrid structure on the activation of osteogenic differentiation of BMSCs. Based on our study, we concluded that the different activation mechanisms of micro- and nano-structures led to the synergistic stimulatory effect on integrin activation and osteogenesis, in which not only the direct contact of cells on micro/nano structure played an important role, but also other surface characteristics such as protein adsorption might contribute to the bioactive effect.Statement of SignificanceThe micro/nano hybrid structure has been found to have synergistic bioactivity on osteogenesis. However, it is still a challenge to fabricate the hybrid structure directly on the bioceramics, and the role of micro- and nano-structure, in particular the mechanism of the micro/nano-hybrid structure induced stem cell differentiation is still unknown. In this study, we firstly fabricated hydroxyapatite bioceramics with the micro/nano hybrid structure, and then investigated the effect of different surface structure on expression of integrins, BMP2 signaling pathways and cell-cell communication. Interestingly, we found that the osteogenic differentiation induced by structure was modulated first through activating integrins and then further activating BMP2 signaling pathway and cell-cell communication, and activated BMP2 could in turn activate some integrin subunits and Cx43-related cell-cell communication. Furthermore, differences in activation of integrins, BMP2 signaling pathway, and gap junction-mediated cell-cell communication were observed, in which nanorod and micropattern structures activated different integrin subunits, BMP downstream receptors and Cx43. This finding may explain the synergistic effect of the micro/nano hybrid structure on the activation of osteogenic differentiation of BMSCs. Based on our study, we concluded that the different activation mechanisms of micro- and nano-structures led to the synergistic stimulatory effect on integrin activation and osteogenesis, in which not only the direct contact of cells on micro/nano structure played an important role, but also other surface characteristics such as protein adsorption might contribute to the bioactive effect.

Graphical abstract

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DESPEDIDA

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Realidad nacional de los programas de detección auditiva temprana con miras a la cobertura universal

RESUMEN Introducción: El 50% de los recién nacidos hipoacúsicos no presenta ningún factor de riesgo, por lo que la pesquisa universal y temprana puede cambiar el pronóstico de estos pacientes. La detección auditiva precoz universal es la realización de un examen para descartar hipoacusia a todos los recién nacidos vivos de un centro determinado. Objetivo: Describir y analizar la presencia de programas de pesquisa auditiva universal en Chile y las características de los programas implementados. Material y método: Se identificó a los centros con programas de detección auditiva universal en Chile y se les envió una encuesta electrónica acerca de la estructuración de cada programa. Resultados: 34 hospitales cuentan con programas establecidos; 31 contestaron la encuesta; 73% inició el programa después de 2010; 46% se encuentra financiado por el Ministerio de Salud; la gran mayoría está a cargo de fonoaudiólogos y tecnólogos médicos. Los principales métodos de detección disponibles son emisiones otoacústicas por producto de distorsión y potenciales evocados auditivos de tronco cerebral auto-matizado. En cuanto al diagnóstico definitivo el 71% realiza con potenciales evocados auditivos de tronco cerebral estímulo click más impedanciometría. Conclusión: Los hospitales con detección auditiva precoz universal corresponden al 50% de los hospitales con maternidad y se encuentran principalmente en la zona central. A pesar de que existe interés y avance por parte de algunos centros hospitalarios en responder a la necesidad de estos programas, aún queda mucho por hacer, siendo el objetivo principal una cobertura universal a nivel nacional.

ABSTRACT Introduction: 50% of hearing-impared newborns do not have any associated risk factors; so early universal detection programs can change the prognosis of these patients. Universal newborn hearing screening consists in studying all newborns in a particular area, regardless of the presence of risk factors. Aim: Describe and analyze the presence of universal newborn hearing screening programs in Chile and its characteristics. Material and method: We identify establishments that have universal newborn hearing screening programs and sent them An electronic survey focusing on the structure of each program. Results: 34 hospitals have universal newborn hearing screening. Of these, 31 answered the survey. 73% begun the program after 2010. The Ministry of Health provides financing in 46%. Audiologists and medical technicians majoring in otolariyngology are in charge of the vast majority of the programs. Available screening methods are distortion product otoacoustic emissions (90%) and automated Brainsteam evoked response audiometry (67.8%). As for the definitive diagnosis, 71% use Brainsteam evoked response audiometry click plus impedanciometry. Conclusion: 50% of the hospitals with maternities have universal hearing screening; most of them are in Chile's central area. Even though some hospitals show interest and have made advances in this regard, there is still much to be done, being universal coverage the main objective.

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Cirugía endoscópica nasosinusal: ¿Un procedimiento ambulatorio?

RESUMEN Introducción: La cirugía endoscópica nasosinusal (CEN) ha aumentado progresivamente debido a que brinda un gran acceso quirúrgico mediante un abordaje mínimamente invasivo. Debido a que tiene un posoperatorio reducido y con pocas complicaciones se puede realizar como cirugía ambulatoria (CA). Esta modalidad es ampliamente aceptada a nivel internacional, sin embargo, no se ha masificado en nuestra realidad nacional. Objetivo: Describir la incidencia y causas de estadía no programada pos CEN ambulatoria en el Servicio de Otorrinolaringología del Hospital del Salvador. Material y método: Revisión retrospectiva de fichas de pacientes operados de CEN por el mismo equipo quirúrgico (Dra. Constanza J. Valdés y Dra. Paula Ruz) entre agosto 2013 y diciembre 2015. Se registraron datos demográficos, cirugías y complicaciones perioperatorias. Resultados: De un total de 75 CEN programadas para realizarse en forma ambulatoria, la incidencia de estadía no programada fue de 15%. Las principales causas fueron problemas administrativos (6 casos) seguido de complicaciones perioperatorias (5 casos). Conclusión: Excluyendo causas administrativas de estadía no programada, el 93% de los procedimientos lograron realizarse como CA. Esta modalidad es plausible y recomendable en el sistema de salud donde los recursos son escasos.

ABSTRACT Introduction: Endoscopic sinus surgery (ESS) has an increase trend because it provides wide surgical access through a minimally invasive approach. It can be performed on a day surgery basis because it has a fast postoperative recovery and a low complication rate. This method has worldwide acceptance, however it has not been established in our national practice. Aim: Describe incidence and unplanned admission causes of ESS in the Otolaryngology service of the Hospital del Salvador. Material and method: Retrospective review of patient medical records undergoing ESS by the same surgical team (Dra. Constanza J. Valdés y Dra. Paula Ruz) between August 2013 and December 2015. Patient demographic information, surgery and perioperative complications were recorded. Results: 75 ESS procedures were scheduled to be performed on an outpatient basis. The incidence of unplanned stay was 15%. Fifteen patients had an unplanned admission, due to administrative problems (6) and perioperative complications (5). Conclusions: Fifteen percent of the patients who underwent ESS on a day surgery basis had an unplanned stay; its main cause is due to administrative problems. Excluding administrative causes of unplanned admission, 93% of the procedures performed were ambulatory procedures. This mode is plausible and desirable in the health system where resources are scarce.

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Timpanoplastía endoscópica: Experiencia en el Hospital del Salvador

RESUMEN Introducción: La técnica endoscópica para la cirugía de oído ha presentado un gran avance en los últimos años, debido al avance de las ópticas de alta resolución e instrumental quirúrgico. El uso de endoscopio en timpanoplastías facilita la visualización de zonas de difícil acceso, como es el caso de pacientes con pared anterior del conducto auditivo externo prominente y perforaciones timpánicas anteriores, además permite la revisión de la caja timpánica y de las vías de ventilación del oído medio. Objetivo: Mostrar la timpanoplastía endoscópica (TE) como alternativa en pacientes con otitis media crónica y analizar el éxito anatómico y funcional. Material y método: Revisión de fichas clínicas de pacientes sometidos a TE en el Hospital del Salvador. Resultados: Catorce pacientes fueron operados entre octubre de 2015 y agosto de 2016. La edad promedio fue de 45 años. Todos fueron sometidos a TE unilateral. Once de 14 perforaciones comprometía alguno de los cuadrantes anteriores. De éstas, en el 82% el borde anterior de la perforación no era visible con otomicroscopía. Se realizó otoendoscopía y audiometría 2 meses poscirugía, logrando un éxito anatómico de 92,8%, y mejoría en el PTP posoperatorio en todos los pacientes. Conclusión: Los resultados obtenidos son similares a los descritos utilizando microscopio. La TE permite mejor visualización convirtiendo esta técnica en una alternativa quirúrgica y de docencia atractiva. Es necesario realizar seguimiento a estos pacientes y aumentar el número de pacientes en el futuro.

ABSTRACT Introduction: The endoscopic ear surgery technique has been a great advance in the last years due to the developments in high resolution optics and surgical instruments. The use of an endoscope provides the visualization of difficult access zones in the middle ear, such as patients with prominent anterior wall of the external auditory canal and anterior tympanic perforations. Aim: To describe the endoscopic tympanoplasty (ET) as an alternative treatment for patients who suffer from chronic otitis media, and to analyze the functional and anatomic outcome. Material and method: Clinical record review of patients submitted to a ET in Hospital del Salvador. Results: 14 patients were operated during October 2015 and August 2016. The average age was 45 years. All of them where submitted to a unilateral ET. 11 of 14 perforations compromised some of the anterior quadrants. In 82% of the latter the anterior edge of the perforation was not visible with otomicroscopy. An otomicroscopy and audiometry were performed 2 months after surgery, anatomic outcome success was of 92,8%, and PTA improved after surgery in all patients. Conclusion: The obtained results are similar to those described using microscope. ET allows improved visualization making this technique an attractive surgery and teaching choice. It is necessary to evaluate these results with a higher number of patients.

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Estudio clínico y micológico de otomicosis en diabéticos: Una serie de 17 casos

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

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Manejo endoscópico del meningoencefalocele de base de cráneo anterior

RESUMEN La fístula de líquido cefalorraquídeo (LCR) corresponde a una comunicación anormal entre el espacio subaracnoideo y la porción neumatizada de la base de cráneo anterior en relación con las cavidades paranasales. Fístulas persistentes requieren reparación quirúrgica por el riesgo de meningitis, abscesos cerebrales y neumoencéfalo asociado. El gold standard es el abordaje extracraneal endoscópico. Uno de los principales inconvenientes es dañar estructuras intracraneanas nobles. La ayuda de tecnologías como la cirugía guiada por imágenes, contribuye a disminuir este problema. A continuación se presentan dos casos clínicos de fístula de líquido cefalorraquídeo en base de cráneo anterior, asociado a meningoencefalocele, intervenidos por cirugía endonasal guiada por imágenes.

ABSTRACT Endoscopic management of anterior skull base meningoencephalocele. The cerebrospinal fluid leak (CSF) is an abnormal communication between the subaracnoid space and the pneumatic portion of the anterior cranial base which is related to the paranasal cavities. The persistent leak requires surgery due to the potential complications such as meningitis, cerebral abscess or pneumoencephalus. Extracranial endoscopic approach is the gold standard procedure. One of the most important risk of the surgery is to damage noble intracranial structures. This situation can be ameliorated by using image guided surgery. We present two cases of CSF in anterior cranial base associated with meningoencephalocele that were treated in our center using nasal image guided endoscopic surgery.

https://ift.tt/2EWf763

Cirugía endoscópica de oído para el manejo del colesteatoma atical

RESUMEN El colesteatoma es la presencia de epitelio plano queratinizado en zonas neumatizadas del hueso temporal, cuya ubicación más frecuente es el ático. En la década de los noventa, se inicia el desarrollo de la cirugía endoscópica de oído, ofreciendo una nueva perspectiva en el tratamiento del colesteatoma. Se presentan dos casos clínicos de pacientes con colesteatoma atical. Se realiza abordaje endoscópico transcanal con resección macroscópica completa del colesteatoma. Audiometría posoperatoria evidencia mejoría de hipoacusia de conducción.

ABSTRACT The cholesteatoma is the presence of keratinized squamous epithelium in pneumatized areas of the temporal bone, its most frequent location is the attic. In the 1990s the development of the ear endoscopic surgery begins, offering a new perspective for cholesteatoma treatment. Two clinical cases of patients who present attic cholestatoma are described. A transcanal endoscopic approach with complete macroscopic resection was accomplished. Post-surgical audiometry shows improvement of the conductive hearing loss.

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Telangiectasia hemorrágica hereditaria: A propósito de un caso clínico

RESUMEN La epistaxis, es un síntoma frecuente en la consulta de otorrinolaringología. Dentro de las causas posibles encontramos la telangiectasia hemorrágica hereditaria (síndrome de Rendu Osler Weber), que corresponde a un desorden autosómico dominante caracterizado por sangrados nasales y gastrointestinales asociados a malformaciones arteriovenosas sistémicas. Su manifestación más frecuente es la epistaxis, presentándose más frecuentemente en personas mayores de 40 años, sin predilección por género. Se presenta el caso de un paciente de sexo masculino de 46 años quien consulta por epistaxis a repetición y severa. Durante la hospitalización se efectúa el tratamiento convencional de la epistaxis, diagnóstico retroactivo del síndrome de Rendu Osler Weber y manejo multidisciplinario de la patología. Se realiza revisión de la literatura y discusión del manejo del paciente que cursa con esta enfermedad.

ABSTRACT Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.

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Dehiscencia del canal semicircular superior como causa de tinnitus pulsátil

RESUMEN El tinnitus se presenta en forma crónica en alrededor del 10% de los adultos, siendo el 4% de estos casos tinnitus pulsátil (TP). El TP se caracteriza por ser rítmico y sincrónico al latido cardiaco. Existen múltiples causas descritas, pero en un grupo importante de casos, no se logra objetivar su origen. Nuestro objetivo es presentar casos de dehiscencia del canal semicircular superior (DCSS) como causa de tinnitus pulsátil y su estudio. Se presentan dos pacientes evaluadas por tinnitus pulsátil. En ambos casos se descartan causas sistémicas, ECO doppler carotídeo sin alteración, angio TAC y RNM sin hallazgos. En reconstrucción de Pöschl se sospecha DCSS, por lo que se estudia con potenciales miogénicos evocados cVEMP y oVEMP con disminución de umbral y respuesta aumentada en oído afectado. En los casos expuestos el tinnitus aparece como síntoma único asociado a la presencia de DCSS, que fue confirmada con estudio imagenológico y VEMPs. El estudio con angio TAC permite pesquisar diversas causas asociadas. Los VEMPs confirman el diagnóstico, teniendo el oVEMP mayor sensibilidad. Como conclusión la DCSS es una entidad a tener presente como diagnóstico diferencial del tinnitus pulsátil y ante su sospecha se debe explorar con VEMPs.

ABSTRACT Tinnitus occurs chronically in about 10% of adults, being pulsatile tinnitus a 4% of these cases (TP). TP is characterized by being rythmic and sychronous to the heart beat. There are many described causes, but in a significant group of cases it is not possible to determine its origin. Our aim is present clinical cases of superior semicircular canal dehiscence (SSCD) as the cause of pulsatile tinnitus and its study. Clinical cases: Two patients present pulsatile tinnitus in her right ear. System causes were discarded, normal Carotid Doppler ultrasonography, Anglo CT scan and MRI without findings. In Pöschl reconstruction SSCD can be observed. Evoked myogenic potentials (VEMPs) by suspicion of SSCD Syndrome, cVEMP and oVEMP with a elevated amplitudes and lower thresholds ipsilateral response. In the cases exposed, tinnitus appears as a single symptom associated with the presence of SSCD which was confirmed with imaging studies and VEMPs. The AngioTAC allows to investigate several associated causes. The VEMPs confirm the diagnosis, with oVEMP having a greater sensitivity. The SSCD is an entity to have in my mind as a differential diagnosis of pulsatile tinnitus and, if suspected, should be explored with VEMPs.

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Amiloidosis laríngea: A propósito de un caso

RESUMEN La amiloidosis es una enfermedad poco frecuente, de etiología desconocida, caracterizada por la presencia de depósitos extracelulares de proteínas fibrilares en diversos órganos y tejidos, teniendo una amplia gama de manifestaciones clínicas según localización y tamaño de los depósitos. En cabeza y cuello, el sitio de presentación más frecuente es la laringe. Suele presentarse con disfonía y/o disnea progresiva, cuyo tratamiento definitivo, sin estar estandarizado, suele ser la resección quirúrgica. Se presenta a continuación el caso de un paciente de 78 años, con historia de disnea en reposo y estridor laríngeo leve de 6 meses de evolución, cuya nasofibroscopía evidenció una masa subglótica, determinando lumen crítico de vía aérea superior. Biopsia reveló amiloidosis, siendo tratado de manera exitosa con exéresis tumoral vía laringoscopía directa.

ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.

https://ift.tt/2EWeA43

Mecanismos de comunicación en pacientes laringectomizados

RESUMEN El cáncer laríngeo representa el 25% de las neoplasias de cabeza y cuello. Para los carcinomas laríngeos T1 tratados con radioterapia o cirugía láser, no existe diferencia significativa en cuanto a la calidad de voz percibida por el paciente entre ambas formas terapéuticas. La laringectomía total sigue siendo utilizada como la alternativa terapéutica en carcinomas avanzados. La pérdida de la capacidad de fonación es una consecuencia de esta cirugía, por lo que existe un variado abanico de mecanismos de comunicación que ofrecerle al paciente. Las alternativas clásicas comprenden: erigmofonación, laringe electrónica y válvula traqueoesofágica. Dentro de este escenario, han surgido nuevas alternativas en los últimos años como son conversión estadística de voz GMM (Gaussian Mixture Model), proyecto SWARA y el proyecto "Mi propia voz".

ABSTRACT Laryngeal cancer accounts for 25% of head and neck cancers. For T1 laryngeal carcinomas treated with radiotherapy or laser surgery, there is no significant difference in terms of quality of voice perceived by the patient between both therapeutic forms. The total laryngectomy is still used as the therapeutic alternative in advanced carcinomas. The loss of the phonation ability is a consequence of the surgery, so there is a diverse range of communication mechanisms to offer to the patient. Classical approaches include: esophageal speech, electrolarynx and tracheoesophageal valve. In this scenario, new alternatives have emerged: statistical voice conversion GMM (Gaussian Mixture Model), SWARA project and "Mi propia voz" project.

https://ift.tt/2vnqXGQ

Tiroides ectópica dual hiperfuncionante: Abordaje quirúrgico dual

RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.

ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.

https://ift.tt/2qFDHnD

The role of ketogenic diets in the therapeutic management of adult and paediatric gliomas: a systematic review.

The role of ketogenic diets in the therapeutic management of adult and paediatric gliomas: a systematic review.

CNS Oncol. 2018 Apr 16;:

Authors: Martin-McGill KJ, Srikandarajah N, Marson AG, Tudur Smith C, Jenkinson MD

Abstract
AIM: We performed a systematic review of the evidence for effectiveness and acceptability of different ketogenic diets (KDs) in the therapeutic management of gliomas.
METHODS: The search strategy included searches of seven electronic databases. Data extraction and quality assessment were undertaken independently by two authors.
RESULTS: No randomized clinical trials were identified. Six studies (n = 39) met the eligibility criteria for this review - all were case series or reports and therefore at high risk of bias. All studies reported overall or progression-free survival; however the effectiveness of KD interventions could not be established. Dietary acceptability was not reported.
CONCLUSION: The effectiveness and acceptability of KDs in the management of gliomas is unknown and high quality randomized controlled trials are needed.

PMID: 29658772 [PubMed - as supplied by publisher]

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Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.

Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.

Ann Ital Chir. 2018;89:70-74

Authors: Marella GL, De Dominicis E, Paliani GB, Santeusanio G, Marsella LT, Potenza S

Abstract
Necrotizing fasciitis is one of the most dangerous complication of an abscess and it is still a disease with a high mortality. In this work, we decided to consider two cases: the first one concerns a male subject, aged 66, deceased because of a fatal necrotizing fasciitis associated to a cervical descending mediastinitis, which evolved from a primary peritonsillar abscess; the second is about a 50-year-old woman with a perineal abscess, then evolved into necrotizing fasciitis associated to a fatal septis shock. After a systematic consideration of necrotizing fasciitis as pathology and an analysis of the possible related risks to a diagnostic or therapeutic delay, we analyzed the particular history of both cases to underline the possible critical issues in professional behavior of the medical staff intervened.
KEY WORDS: Abscess, Medical malpractice, Mortality, Necrotizing fasciitis, Professional liability.

PMID: 29629889 [PubMed - in process]

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Reply to: “Facial erythromelalgia?”

To the Editor: A few predominantly facial cases of potential erythromelalgia have been described, but these appear to be exceedingly rare.1-4 In 1 of the case reports, the condition was mistaken for other dermatologic conditions (rosacea and contact dermatitis) for years until the patient developed symptoms of erythromelalgia elsewhere.1 Another case report highlights the importance of keeping this in the differential diagnosis to avoid confusion with dermatologic connective tissue disorders that involve the face.

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Introducing a curriculum in ethics and professionalism for dermatology residencies

There is general agreement on what constitutes ethical reasoning and professional behavior, but standardized methods to teach these skills in dermatology residency are currently unavailable. We introduce a model curriculum designed to impart the knowledge and skills to meet the Accreditation Council for Graduate Medical Education Dermatology Milestones for Professionalism over a 3-year cycle.

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Journal Based CME Instructions and Information

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Performance of a computer-aided digital dermoscopic image analyzer for melanoma detection in 1,076 pigmented skin lesion biopsies

Digital dermoscopic image analysis of pigmented skin lesions (PSLs) has become increasingly popular, despite its unclear clinical utility. Unbiased, high-powered studies investigating the efficacy of commercially available systems are limited.

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Facial erythromelalgia?

To the Editor: I enjoyed reading the excellent reviews of the many causes of cutaneous flushing by Sadeghian et al.1,2 One cause of facial flushing mentioned is erythromelalgia. I write to suggest that the term erythromelalgia be restricted to patients with additional flushing of their feet and/or hands.

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Editorial Board

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JAAD Case Reports Article List

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Information for Readers

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CME examination

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Treatment of pincer nail deformity using dental correction principles

To the Editor: Pincer nail deformity (PND) is characterized by excessive transverse curvature of the nail plate. There is no treatment of choice. Superelastic nickel-titanium has been used to bend PND to its normal shape in previous reports, and the procedure involves drilling a hole in the nail plate or applying a hook structure to fix the material to the nail.1-3 In this study, we used dental correction methods to improve PND.

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Desquamative gingivitis

Desquamative gingivitis is a clinical finding with several potential etiologies. Among the most common are oral lichen planus, cicatricial pemphigoid, and pemphigus vulgaris, though various other differential diagnoses exist. The presence of desquamative gingivitis often results in poor oral hygiene, which can have downstream consequences, including periodontitis and tooth loss. Though certain mucosal findings may be suggestive of a particular diagnosis, a thorough history, physical examination, and appropriate dermato- and immunopathologic assessment is necessary for narrowing this broad differential diagnosis.

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Comment on “The role of the ugly duckling sign in patient education”

To the Editor: There are important caveats regarding the study by Ilyas et al regarding the role of the ugly duckling sign in patient education, both in the design and conclusions of the study itself, as well as in the premise of ugly duckling identification and melanoma recognition.1

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Desquamative gingivitis

Desquamative gingivitis is a clinical finding with several potential etiologies, and therefore histologic examination should be performed to confirm the diagnosis before the implementation of systemic therapy. The best methods for obtaining a mucosal biopsy specimen are discussed to aid the dermatologist in approaching these patients, and indications for additional testing, such as immunofluorescence studies, are reviewed. Desquamative gingivitis is uncommon, and there are no systematic guidelines to assist the physician in treatment, producing a practice gap in management.

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Answer to CME examination

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Sub-lethal ultraviolet B irradiation and Poly I:C treatment synergistically induced apoptosis of HaCaT cells through NF-κB pathway

Publication date: July 2018
Source:Molecular Immunology, Volume 99
Author(s): Wuxiyar Otkur, Weiwei Liu, Jinda Wang, Xingfan Jia, Dianchao Huang, Fang Wang, Toshihiko Hayashi, Shin-ichi Tashiro, Satoshi Onodera, Takashi Ikejima
Ultraviolet B (UVB) irradiation exerts multiple effects on skin cells, inducing apoptosis, senescence and carcinogenesis. Toll-like receptor 3, a member of pattern recognition receptors, is reported to initiate inflammation by recognizing double-strand RNA (dsRNA) released from UVB-irradiated cells. It has not been studied, however, whether apoptosis induction in UVB irradiation is attributed to TLR3 activation. Here, we report on the pro-apoptotic role of TLR3 in UVB-irradiated epidermal cells. Poly I:C, an analogue of dsRNA that activates TLR3, was used in combination with sub-lethal UVB (4.8 mJ/cm²) irradiation for investigating the effects of TLR3 activation on human immortalized keratinocyte HaCaT cells. Although sub-lethal dose of either Poly I:C or UVB alone did not induce cell death, UVB-Poly I:C co-treatment synergistically induced cell death by activation of caspase-3 and cleavages of ICAD and PARP, with apoptotic features when stained with Annexin V/PI or Hoechst 33342. Treatment with pan-caspase inhibitor, Z-VAD, attenuated UVB-Poly I:C-induced cell death. Silencing TLR3 by siRNA rescued HaCaT cells from UVB-Poly I:C-induced apoptosis. NF-κB, a major downstream component of TLR3 pathway, that usually negatively regulates the classical TLR3 apoptotic pathway, was analyzed by western blotting and immunofluorescence confocal microscopy. The results indicate to our surprise that NF-κB is translocated to nucleus in the cells co-treated with UVB-Poly I:C. The nuclear translocation of NF-κB is attenuated by TLR3 silencing. Treatment with BAY, an inhibitor of NF-κB pathway, blocked UVB-Poly I:C-induced apoptosis. Therefore, we conclude that NF-κB pathway plays a cytotoxic role in UVB-Poly I:C-treated HaCaT cells, mediating TLR3-related apoptosis.

https://ift.tt/2HHgnNx

Molecular pathways for antigenic peptide generation by ER aminopeptidase 1

Publication date: Available online 17 April 2018
Source:Molecular Immunology
Author(s): Anastasia Mpakali, Zachary Maben, Lawrence J. Stern, Efstratios Stratikos
Endoplasmic Reticulum aminopeptidase 1 (ERAP1) is an intracellular enzyme that can generate or destroy potential peptide ligands for MHC class I molecules. ERAP1 activity influences the cell-surface immunopeptidome and epitope immunodominance patterns but in complex and poorly understood manners. Two main distinct pathways have been proposed to account for ERAP1's effects on the nature and quantity of MHCI-bound peptides: i) ERAP1 trims peptides in solution, generating the correct length for binding to MHCI or overtrimming peptides so that they are too short to bind, and ii) ERAP1 trims peptides while they are partially bound onto MHCI in manner that leaves the peptide amino terminus accessible. For both pathways, once an appropriate length peptide is generated it could bind conventionally to MHCI, competing with further trimming by ERAP1. The two pathways, although not necessarily mutually exclusive, provide distinct vantage points for understanding of the rules behind the generation of the immunopeptidome. Resolution of the mechanistic details of ERAP1-mediated antigenic peptide generation can have important consequences for pharmacological efforts to regulate the immunopeptidome for therapeutic applications, and for understanding association of ERAP1 alleles with susceptibility to autoimmune disease and cancer. We review current evidence in support of these two pathways and discuss their relative importance and potential complementarity.

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Sub-lethal ultraviolet B irradiation and Poly I:C treatment synergistically induced apoptosis of HaCaT cells through NF-κB pathway

Spreading of Sn-Ag-Ti and Sn-Ag-Ti(-Al) solder droplets on the surface of porous graphite through ultrasonic vibration

Publication date: 15 July 2018
Source:Materials & Design, Volume 150
Author(s): Weiyuan Yu, Yun Liu, Xinya Liu
The spreading process of an active solder droplet on porous graphite surface was captured by using high-speed camera. The spreading characteristics of the Sn5Ag8Ti and Sn5Ag2Ti1Al active solder under ultrasonic vibrations were analysed. The results showed that applying ultrasonic waves during the soldering process enable the active solder to spread on the graphite surface at a relatively low temperature under atmospheric condition. Initially, the solder spread slowly on the graphite surface in the direction opposite to that of the ultrasonic wave transmission because of the rapid attenuation of ultrasonic amplitude on the surface of the graphite. Then graphite pores were rapidly filled with solder under the action of ultrasonic vibration, which prevented the ultrasonic attenuation. Subsequently, the solder spread out rapidly along the direction of transmission. In addition, the spreading distance and rate of Sn5Ag8Ti were significantly less than that of Sn5Ag2Ti1Al solder, which was determined by the composition and thickness of the oxide film on the surface of the active solder.

Graphical abstract

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Radiation-induced extreme elastic and inelastic interactions in concentrated solid solutions

Publication date: 15 July 2018
Source:Materials & Design, Volume 150
Author(s): Ritesh Sachan, Mohammad W. Ullah, Matthew F. Chisholm, Jie Liu, Pengfei Zhai, Daniel Schauries, Patrick Kluth, Christina Trautman, Hongbin Bei, William J. Weber, Yanwen Zhang
One of the biggest challenges in the radiation induced defect science is to understand the complex nature of ion-atom interactions under highly extreme conditions. Here, we report the irradiation induced non-equilibrium defect formation in NiCoCr single phase concentrated solid solution alloy due to (i) the extreme inelastic and (ii) the coupled inelastic and elastic ion-atom interactions. These two conditions are achieved at 5 and 30μm penetration depths along the paths of swift heavy ions (1.542GeV Bi). In general, the irradiation induced damage consists of interstitial-type dislocation loops and vacancy-type stacking fault tetrahedra (SFT). Near the surface (~5μm) where electronic energy loss is dominating (~62.5keVnm⁻¹), the atomic motion primarily results in the formation of SFT. A noticeable increase of dislocation loop formation is observed at 30μm near the maximum energy deposition from elastic interactions (~4.9keVnm⁻¹), as compared to the near surface region (~0.06keVnm⁻¹). Insights on the complex electronic and atomic correlations of extreme energy deposition and dissipation on defect dynamics and structural stability may pave the way for new design principles of radiation–tolerant structural alloys.

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The effect of laser focus shift on microstructural variation of Inconel 718 produced by selective laser melting

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Tait D. McLouth, Glenn E. Bean, David B. Witkin, Scott D. Sitzman, Paul M. Adams, Dhruv N. Patel, Woonsup Park, Jenn-Ming Yang, Rafael J. Zaldivar
Selective laser melting is gaining interest in the aerospace industry as a candidate for manufacturing flight hardware. With increasing popularity comes the need for rigorous qualification standards and a thorough understanding of how processing parameters can affect part quality. One such parameter is the laser focal shift, which moves the building plane relative to the focal plane of the laser. Changing the focal shift alters the power density while keeping the laser parameters constant, a novel method for tailoring the microstructures of parts made by SLM. In this study, samples were manufactured at different focal positions and their microstructures were characterized. Samples built at the focal plane had a finer microstructure than samples built away from it, a result of higher power density and a smaller spot size. Furthermore, samples in the heat-treated condition produced at the shifted locations exhibited coarser grains aligned parallel to the build direction, while those at the focal plane had a finer and more equiaxed microstructure. Differences originating from the as-built condition that remain through post processing may influence the final mechanical performance of SLM parts. Utilizing the focus shift to produce these changes presents a unique opportunity for microstructural tailoring and improved mechanical performance.

Graphical abstract

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Canakinumab and Lung Cancer: Intriguing, but Is It Real?

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Delayed Autoimmune Toxicity Occurring Several Months After Cessation of Anti‐PD‐1 Therapy

AbstractTreatment with anti‐programmed cell death protein 1 (PD‐1) antibodies has demonstrated clinical efficacy in a whole range of malignancies including advanced melanoma, renal cell cancer, bladder cancer, and non‐small cell lung cancer. Immune‐related adverse events are a unique side effect of checkpoint regulator therapy including anti‐PD‐1 antibodies. Treatment‐related autoimmunity can occur in any organ system, with the median onset usually within 5–15 weeks from the commencement of therapy, depending on the organ system involved. This study describes for the first time a case of delayed autoimmunity occurring 8 months after discontinuing treatment with the anti‐PD‐1 antibody nivolumab in a patient with metastatic melanoma. The case highlights the need for ongoing surveillance of patients treated with immune checkpoint inhibitors even after cessation of therapy, especially as patients increasingly stop treatment after achieving durable responses.

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Phase II Study of Everolimus in Metastatic Malignant Melanoma (NCCTG‐N0377, Alliance)

AbstractLessons Learned. Everolimus does not have sufficient activity to justify its use as single agent in metastatic melanoma.Patients treated with 10 mg per day dose were most likely to require dose reductions.Everolimus appeared to reduce the numbers of regulatory T cells in approximately half of the treated patients; unfortunately, these effects were not correlated with clinical outcomes.Background.Everolimus (RAD‐001) is an orally active rapamycin analogue shown in preclinical data to produce cytostatic cell inhibition, which may be potentially beneficial in treating melanoma. We conducted a phase II study to evaluate the efficacy and safety of everolimus in patients with unresectable metastatic melanoma (MM).Methods.This study included two cohorts; cohort 1 received 30 mg of everolimus by mouth (PO) weekly, and cohort 2 was dosed with 10 mg of everolimus PO daily. The endpoints of the study were safety, 16‐week progression‐free survival (PFS), overall survival (OS), and measures of immunomodulatory/antiangiogenic properties with therapy. Tumor samples before therapy and at week 8 of treatment were analyzed. Peripheral blood plasma or mononuclear cell isolates collected prior to therapy and at weeks 8 and 16 and at time of tumor progression were analyzed for vascular endothelial growth factor and regulatory T‐cell (Treg) measurements.Results.A total of 53 patients were enrolled in cohort 1 (n = 24) and cohort 2 (n = 29). Only 2 patients of the first 20 patients enrolled in cohort 2 had treatment responses (25%; 95% confidence interval, 8.6%–49.1%); this result did not allow full accrual to cohort 2, as the study was terminated for futility. Median OS was 12.2 months for cohort 1 versus 8.1 months in cohort 2; no PFS advantage was seen in either group (2.1 months vs. 1.8 months). Dose‐limiting toxicities included grade 4 myocardial ischemia (3.4%); grade 3 fatigue, mucositis, and hyperglycemia (10.3%); and anorexia and anemia (6.9%). Everolimus significantly reduced the number of Tregs in approximately half of the treated patients; however, these effects were not correlated with clinical outcomes.Conclusion.Everolimus does not have sufficient single‐agent activity in MM; however, we have identified evidence of biological activity to provide a potential rationale for future combination studies.

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Phase II Study to Evaluate the Efficacy and Safety of Rilotumumab and Bevacizumab in Subjects with Recurrent Malignant Glioma

AbstractLessons Learned. Due to evolving imaging criteria in brain tumors and variation in magnetic resonance imaging evaluation, it is not ideal to use response rate as a primary objective. Future studies involving antiangiogenic agents should use overall survival.Disease‐expected toxicities should be considered when defining the clinical significance of an adverse event. For example, vascular thromboembolic events are common in brain tumor patients and should not be attributed to the study drug in the safety analysis.Background.Recurrent malignant glioma (rMG) prognosis is poor, with a median patient survival of 3–11 months with bevacizumab (BEV)‐containing regimens. BEV in rMG has 6‐month progression free survival (PFS‐6) of ∼40% and an objective response rate of 21.2%. BEV‐containing regimens improve PFS‐6 to 42.6%–50.3%, indicating that BEV combination therapies may be superior to single agent. Rilotumumab, a hepatocyte growth factor (HGF) antibody, inhibits angiogenesis and expression of angiogenic autocrine factors (e.g., vascular endothelial growth factor [VEGF]) by c‐Met inhibition. Combination of rilotumumab with BEV to block vascular invasion and tumor proliferation may synergistically inhibit tumor growth.Methods.Thirty‐six BEV‐naïve rMG subjects received rilotumumab (20 mg/kg and BEV (10 mg/kg) every 2 weeks. Endpoints included objective response rate (using Response Assessment in Neuro‐Oncology [RANO] criteria), PFS‐6, overall survival (OS), and toxicity.Results.Median patient follow‐up was 65.0 months. Objective response rate was 27.8% (95% confidence interval [CI]: 15.7%–44.1%). Median OS was 11.2 months (95% CI: 7–17.5). PFS‐6 was 41.7% (95% CI: 25.6%–57.0%). Most frequent treatment‐related grade ≤2 events included weight gain, fatigue, allergic rhinitis, and voice alteration; grade ≥3 events included venous thromboembolism (four patients), including one death from pulmonary embolism.Conclusion.Rilotumumab with BEV did not significantly improve objective response compared with BEV alone, and toxicity may preclude the use of rilotumumab in combination BEV regimens.

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Editorial Board

Publication date: 1 July 2018
Source:Biosensors and Bioelectronics, Volume 110

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Fate of Lu(III) sorbed on 2-line ferrihydrite at pH 5.7 and aged for 12 years at room temperature. II: insights from STEM-EDXS and DFT calculations

Abstract

Transformation products of two-line ferrihydrite associated with Lu(III) were studied after 12 years of aging using aberration-corrected high-angle annular dark field scanning transmission electron microscopy (HAADF-STEM), high-efficiency energy-dispersive X-ray spectroscopy (EDXS), and density functional theory (DFT). The transformation products consisted of hematite nanoparticles with overgrown goethite needles. High-efficiency STEM-EDXS revealed that Lu is only associated with goethite needles, and atomic-resolution HAADF-STEM reveals structural incorporation of Lu within goethite, partially replacing structural Fe sites. This finding corroborates those recently obtained by AsFlFFF and EXAFS spectroscopy on the same sample (Finck et al. 2018). DFT calculations indicate that Lu incorporation within goethite or hematite are almost equally likely, suggesting that experimental parameters such as temperature and reaction time which affect reaction kinetics, play important roles in determining the Lu uptake. It seems likely that these results may be transferable to predict the behavior of chemically homologous trivalent actinides.

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Carbonic anhydrase 9 expression in well-differentiated pancreatic neuroendocrine neoplasms might be associated with aggressive behavior and poor survival

Abstract

Well-differentiated pancreatic neuroendocrine neoplasms/tumors (PanNETs) are rare neoplasms with diverse clinical behavior. Biomarker discovery is important for predicting clinical course and prognosis of PanNET patients. Carbonic anhydrase 9 (CA9) and vimentin are hypoxia and epithelial-mesenchymal transition-related proteins of which expression in many carcinomas has been associated with poor prognosis, but their significance in PanNET has yet to be determined. We assessed CA9 and vimentin expression in 164 PanNETs and compared this with clinicopathologic characteristics. CA9 expression was observed in normal islets, while neuroendocrine microadenomas and small (< 1 cm) PanNETs showed loss of CA9 expression. CA9 and vimentin expression was observed in 38 (23%) and 36 (22%) of PanNETs, respectively. CA9 expression was associated with larger size (p = 0.001), higher grade (p < 0.001), higher pT category (p < 0.001), lymph node (p = 0.003) and distant (p = 0.047) metastases, higher AJCC stage (p < 0.001), and lymphovascular (p < 0.001) and perineural (p = 0.002) invasion. PanNET patients with CA9 expression had a shorter recurrence-free survival (5-year survival rate 47%) than those without CA9 expression (76%) by univariate (p = 0.001) but not multivariate analysis. Vimentin expression correlated with CA9 expression (p < 0.001) but not with other clinicopathologic factors. In conclusion, CA9 expression was observed in normal islets, while neuroendocrine microadenomas and small (< 1 cm) PanNETs showed CA9 expression loss. CA9 expression gradually reappeared in larger PanNETs, and this was associated with clinical progression and decreased patient survival by univariate but not multivariate analysis.

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 17 Απριλίου 2018

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