ACKNOWLEDGEMENT

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Audiological Evaluation in Hypothyroid Patients and Effect of Thyroxine Replacement Therapy

Abstract

To do the audiological evaluation of patients with hypothyroidism and to assess status of hearing after thyroxin replacement therapy (TRT). Two groups were included: a hypothyroidism group (HG, n = 50), and a control group (CG, n = 50). Parameters studied: anominesic data, duration of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemical and hormonal exams (TSH, FT4 and FT3), pure tone audiometry, impendence audiometry and BERA as where required. Mean age of the patients in HG was 26.5 ± 10.4 years. Male/Female ratio was 2.39. All HG patients had altered TSH values and 8% had diminished T4 values. Cochleovestibular symptoms were more common in hypothyroid patients (48%) than control (20%) p value. Pure Tone Audiometric threshold was found higher in 34% of cases. Sensorineural hearing loss was most common (76.46%) compared to conductive and mixed hearing loss. BERA showed significant prolonged absolute peak latency of wave III, inter peak latency (IPL) of wave I–III and reduced amplitude of wave Ia and Va. After thyroxine replacement therapy there was statistically significant improvement in hearing threshold in 46.42% ears (p  < 0.05), (if ≥ 5 dB hearing improvement consider as significant). The significant improvement was also found in BERA, in amplitude of wave Va. Site of involvement was at several levels, middle ear, cochlear or retro-cochlear. HG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in latency of wave III, IPL of I–III and reduced Ia and Va amplitude in the BERA. After TRT improvement in hearing threshold and BERA was found.

https://ift.tt/2IjVabS

Audiological Evaluation in Hypothyroid Patients and Effect of Thyroxine Replacement Therapy

Abstract

To do the audiological evaluation of patients with hypothyroidism and to assess status of hearing after thyroxin replacement therapy (TRT). Two groups were included: a hypothyroidism group (HG, n = 50), and a control group (CG, n = 50). Parameters studied: anominesic data, duration of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemical and hormonal exams (TSH, FT4 and FT3), pure tone audiometry, impendence audiometry and BERA as where required. Mean age of the patients in HG was 26.5 ± 10.4 years. Male/Female ratio was 2.39. All HG patients had altered TSH values and 8% had diminished T4 values. Cochleovestibular symptoms were more common in hypothyroid patients (48%) than control (20%) p value. Pure Tone Audiometric threshold was found higher in 34% of cases. Sensorineural hearing loss was most common (76.46%) compared to conductive and mixed hearing loss. BERA showed significant prolonged absolute peak latency of wave III, inter peak latency (IPL) of wave I–III and reduced amplitude of wave Ia and Va. After thyroxine replacement therapy there was statistically significant improvement in hearing threshold in 46.42% ears (p  < 0.05), (if ≥ 5 dB hearing improvement consider as significant). The significant improvement was also found in BERA, in amplitude of wave Va. Site of involvement was at several levels, middle ear, cochlear or retro-cochlear. HG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in latency of wave III, IPL of I–III and reduced Ia and Va amplitude in the BERA. After TRT improvement in hearing threshold and BERA was found.

https://ift.tt/2IjVabS

Early Speech Perception Test Outcome in Children with Severe Sensorineural Hearing Loss with Unilateral Cochlear Implants Alone versus Bimodal Stimulation

Abstract

Bilateral stimulation of the auditory system has clear advantages over unilateral hearing. Hearing-impaired children are, therefore, generally fitted with hearing aids in both ears so that they can have the benefits of binaural hearing. Children who use acochlear implant in one ear and no acoustic stimulation in the opposite ear are at a definite disadvantage. This study was undertaken to determine the advantages of bimodal stimulation in pediatric population especially in terms of speech recognition. This study comprised of 30 children between 3 and 6 years of age with profound bilateral sensorineural hearing loss with cochlear implant in one ear and fitted with digital hearing aid in non-implanted ear. Speech recognition performance was compared in unilateral cochlear implant only and with bimodal hearing stimulation in the same set of children. A statistically significant difference was found between speech reception scores in children with a unilateral cochlear implant only and those with a cochlear implant in one ear and a hearing aid in the non implanted ear in quiet surroundings. It is suggested that the use of bimodal fitting be considered as an effective management method to obtain the advantage of binaural hearing in children who undergo unilateral cochlear implantation.

https://ift.tt/2wH1rx2

Early Speech Perception Test Outcome in Children with Severe Sensorineural Hearing Loss with Unilateral Cochlear Implants Alone versus Bimodal Stimulation

Abstract

Bilateral stimulation of the auditory system has clear advantages over unilateral hearing. Hearing-impaired children are, therefore, generally fitted with hearing aids in both ears so that they can have the benefits of binaural hearing. Children who use acochlear implant in one ear and no acoustic stimulation in the opposite ear are at a definite disadvantage. This study was undertaken to determine the advantages of bimodal stimulation in pediatric population especially in terms of speech recognition. This study comprised of 30 children between 3 and 6 years of age with profound bilateral sensorineural hearing loss with cochlear implant in one ear and fitted with digital hearing aid in non-implanted ear. Speech recognition performance was compared in unilateral cochlear implant only and with bimodal hearing stimulation in the same set of children. A statistically significant difference was found between speech reception scores in children with a unilateral cochlear implant only and those with a cochlear implant in one ear and a hearing aid in the non implanted ear in quiet surroundings. It is suggested that the use of bimodal fitting be considered as an effective management method to obtain the advantage of binaural hearing in children who undergo unilateral cochlear implantation.

https://ift.tt/2wH1rx2

Role of hypothetical protein YicS in the pathogenicity of Avian Pathogenic Escherichia coli in vivo and in vitro

Publication date: Available online 13 May 2018
Source:Microbiological Research
Author(s): Renu Verma, Thaís Cabrera Galvão Rojas, Renato Pariz Maluta, Janaína Luisa Leite, Gerson Nakazato, Wanderley Dias de Silveira
Avian Pathogenic Escherichia coli (APEC) strains belong to the extra-intestinal pathogenic group of E. coli (ExPEC) that causes colibacillosis in poultry. A variety of putative virulence factors of APEC are recognized as potent causes of pathogenicity, the mechanisms underlying their pathogenicity are still not fully understood. The role of yicS in the virulence of pathogenic E. coli is still unclear. Thus, yicS may be related to biofilm formation, which in some bacteria plays a role in pathogenicity. Therefore, the fact that this gene appears to be under positive selection pressure suggests that yicS may be associated with the pathogenicity of APEC. To better understand the role of yicS protein in APEC biological characteristics and pathogenicity, we deleted yicS in an APEC Swollen Head Syndrome strain (APEC strain SCI-07) and studied its effects by comparing wild type and isogenic mutants through comprehensive in vitro and in vivo assays. We demonstrated that yicS plays a role in pathogenicity of APEC. We suggest that the yicS gene, which encodes an exporter protein, has a significant role in biofilm formation, motility, invasion of CEC-32 and Hep-2 cells and APEC pathogenicity in a day-old chick model.



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A 37-year-old Nigerian woman with Apert syndrome – medical and psychosocial perspectives: a case report

Apert syndrome is a rare genetic disease that presents a diagnostic dilemma because of its similarity with other craniosynostosis syndromes. Currently, there is paucity of reports about adult patients in Afric...

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Cytoprotective, antioxidant and anti-inflammatory mechanism related to antiulcer activity of Cissampelos sympodialis Eichl. in animal models

Publication date: 10 August 2018
Source:Journal of Ethnopharmacology, Volume 222
Author(s): Igor Rafael Praxedes De Sales, Rodrigo De Oliveira Formiga, Flávia Danniele Frota Machado, Raphaela Francelino Nascimento, Matheus Marley Bezerra Pessoa, Monique Emanuela Frutuoso Xavier Barros, Giciane Carvalho Vieira, Francisco Allysson Assis Ferreira Gadelha, Alexsandro Fernandes Marinho, José Maria Barbosa Filho, Raimundo Fernandes De Araújo Júnior, Aurigena Araújo Antunes, Leônia Maria Batista
Ethnopharmacological relevanceThe leaves and roots of Cissampelos sympodialis (Menispermaceae) are used by indian tribes and in folk medicine to treat genitourinary infections, inflammation, asthma and gastrointestinal disorders.Material and methodsThe standardized ethanolic extract (Cs-EtOHE) and alkaloids total fraction (Cs-TAF) obtained from aerial parts of C. sympodialis were evaluated in several models of acute gastric ulcers. The antisecretory and/or neutralizing mechanisms of the gastric acid secretion, cytoprotective, antioxidant and immunoregulatory mechanisms were also evaluated.ResultsCs-EtOHE and Cs-TAF presented a reduction in gastric mucosa lesions against ethanol, NSAIDs, hypothermic restraint-stress and gastric juice containment induced ulcer models. This activity is related to alkaloids present in the extract, and involves the participation of sulfhydryl compounds, nitric oxide, KATP channels, prostaglandins, decreased levels of IL-1β and TNF-α and increased levels of GSH and IL-10.ConclusionThe data indicate gastroprotective activity, due to the participation of the cytoprotective, antioxidant and immunoregulatory mechanisms.

Graphical abstract

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The effects of overwintering and habitat type on body condition and locomotion of the wolf spider Pardosa alacris

Publication date: May 2018
Source:Acta Oecologica, Volume 89
Author(s): Kapilkumar Ingle, Ádám Horváth, Nikolett Gallé-Szpisjak, Levente Gellért, Enikő Csata, Róbert Gallé
Overwintering in temperate regions is a prominent mortality risk for invertebrates and may affect their behaviour and body condition. Pardosa alacris is a common ground dwelling spider in central European native and plantation forests, and habitat type and prey availability may play important roles in their overwintering. The effect of overwintering on body condition and behaviour of spiders in semi natural and exotic habitats is relatively unknown. Here we assess the effects of winter on spiders from native poplar and exotic pine plantations. The locomotory behaviour of P. alacris (distance covered and speed) was assessed by tracking their movement in a white circular plastic arena. We assessed body condition, body size, and total fat content. Forest type and sex had significant effects on body length. Fat content was significantly higher in the spring than in autumn, and spiders covered larger distances and were faster in autumn than in spring. Fat content had a significant negative effect on average speed. Spiders in native forests were smaller but grew more during the winter than in exotic plantations, possibly due to higher prey availability in native forests. Visually-hunting predators may significantly affect spiders. Fat spiders with better body condition moved less, and were thus less detectable by predators. However the low movement rate may result in a low rate of encountering prey items, thus lowering feeding efficiency.



https://ift.tt/2KlwrVb

Near-infrared light-activated red-emitting upconverting nanoplatform for T1-weighted magnetic resonance imaging and photodynamic therapy

Publication date: Available online 12 May 2018
Source:Acta Biomaterialia
Author(s): Xiang-long Tang, Jun Wu, Ben-lan Lin, Sheng Cui, Hong-mei Liu, Ru-tong Yu, Xiao-dong Shen, Ting-wei Wang, Wei Xia
Photodynamic therapy (PDT) has increasingly become an efficient and attractive cancer treatment modality based on reactive oxygen species (ROS) that can induce tumor death after irradiation with ultraviolet or visible light. Herein, to overcome the limited tissue penetration in traditional PDT, a novel near-infrared (NIR) light-activated NaScF4: 40% Yb, 2% Er@CaF2 upconversion nanoparticle (rUCNP) is successfully designed and synthesized. Chlorin e6, a photosensitizer and a chelating agent for Mn²⁺, is loaded into human serum albumin (HSA) that further conjugates onto rUCNPs. To increase the ability to target glioma tumor, an acyclic Arg–Gly–Asp peptide (cRGDyK) is linked to rUCNPs@HSA(Ce6-Mn). This nanoplatform enables efficient adsorption and conversion of NIR light (980 nm) into bright red emission (660 nm), which can trigger the photosensitizer Ce6-Mn complex for PDT and T1-weighted magnetic resonance imaging (T1-weighted MRI) for glioma diagnosis. Our in vitro and in vivo experiments demonstrate that NIR light-activated and glioma tumor-targeted PDT can generate large amounts of intracellular ROS that induce U87 cell apoptosis and suppress glioma tumor growth owing to the deep tissue penetration of irradiated light and excellent tumor-targeting ability. Thus, this nanoplatform holds potential for applications in T1-weighted MRI diagnosis and PDT of glioma for antitumor therapy.Statement of SignificanceA near-infrared (NIR) light-activated nanoplatform for photodynamic therapy (PDT) was designed and synthesized. The Red-to-Green (R/G) ratio of NaScF4: 40% Yb, 2% Er almost reached 9, a value that was much higher than that of a traditional Yb/Er-codoped upconversion nanoparticle (rUCNP). By depositing a CaF2 shell, the red-emission intensities of the rUCNPs were seven times strong as that of NaScF4: 40% Yb, 2% Er. The enhanced red-emitting rUCNPs could be applied in many fields such as bioimaging, controlled release, and real-time diagnosis. The nanoplatform had a strong active glioma-targeting ability, and all results achieved on subcutaneous glioma demonstrated that our NIR light-activated red-emitting upconverting nanoplatform was efficient for PDT. By loading Ce6-Mn complex into rUCNPs@HSA-RGD, the nanoplatform could be used as a T1-weighted magnetic resonance imaging agent for tumor diagnosis.

Graphical abstract

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Comparison of two analytical methods validated for the determination of volatile compounds in virgin olive oil: GC-FID vs GC-MS

Publication date: 1 September 2018
Source:Talanta, Volume 187
Author(s): R. Aparicio-Ruiz, D.L. García-González, M.T. Morales, A. Lobo-Prieto, I. Romero
The utility of volatile compounds to explain virgin olive oil aroma descriptors is fully accepted and demanded by the olive oil sector. However, the methodology, and particularly the kind of detector to be used, is a matter of discussion because the high number of volatiles and their different nature. The SPME-GC-MS method has recently been validated for the most relevant volatiles but SPME-GC-FID method still needs to be validated to evaluate its performance in this application. A comparison between these two GC methods in determining 26 volatiles has been carried out in terms of analytical quality parameters (repeatability, intermediate precision, calibration curves, limits of detection and quantification, linear working ranges, selectivity and sensitivity). Good selectivity, linearity and higher upper values of the working range are the main advantages of SPME-GC-FID versus low bottom values of working ranges, better sensitivity and lower limits of detection and quantification of SPME-GC-MS. The limit of blank associated to each individual volatile was also determined and it allowed perfecting the empirical limit of detection. This procedure was carried out for SPME-GC-FID, which resulted in 21 volatiles with empirical limits of detections lower than their odor thresholds, and hence they can be used as markers of virgin olive oil sensory descriptors. Finally, with all the analytical quality parameters checked, a practical example of the ability of the volatiles quantified by SPME-GC-FID to discriminate the different categories (extra-virgin, virgin and lampante) and their main aroma descriptors is also provided.

Graphical abstract

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Development and characterization of poly(ethylene terephthalate) based injection molded self-reinforced composites. Direct reinforcement by overmolding the composite inserts

Publication date: 5 September 2018
Source:Materials & Design, Volume 153
Author(s): Jacek Andrzejewski, Piotr Przyszczypkowski, Marek Szostak
This work presents the concept of using the self-reinforced inserts, suitable for overmolding during the standard injection molding procedure. The reinforcing inserts made from self-reinforced poly(ethylene terephtahalte) sheets (srPET) were overmolded by the matrix polymer. Two types of poly(ethylene terephthalate) were used as the matrix material, PET (pure bottle grade resin) and G-PET (amorphous PET based copolymer). Samples prepared under different conditions of the injection molding process were tested in terms of mechanical properties, DMA and DSC analysis. The results of mechanical tests confirmed the different fracture behavior, more favorable for G-PET samples, where the increase of tensile strength and E modulus reached 60% and 32% respectively. The most significant increase was observed for impact resistance values, for both types of polyesters the impact strength reach around 50 kJ/m², from the initial value below 5 kJ/m². The SEM microscopy was used to investigate the morphology of matrix-reinforcement interface. The observations of the bonding interface indicate the lack of delamination process and high level of adhesion between the matrix materials and reinforcing srPET insert. The presented results confirm that the proposed concept of using the overmolding technology for preparation of self-reinforced composites has the potential for industrial implementation.

Graphical abstract

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Development and evaluation of a methodology to integrate technical and sensorial properties in materials selection

Publication date: 5 September 2018
Source:Materials & Design, Volume 153
Author(s): Agnese Piselli, Weston Baxter, Michele Simonato, Barbara Del Curto, Marco Aurisicchio
In the materials selection process, the use of different tools, languages and perspectives frequently causes disagreement between engineers and industrial designers.The aim of the paper is to define an integrated method for materials selection that provides industrial designers with measurable data to support and explain aesthetic decisions on materials.A new method for materials selection consisting of multiple tools structured in a two-step framework is presented. The method is tested through a case study of professional kitchen appliances where metal components are replaced with polymers. The first step involved the application of an established technique to identify polymeric bulk solutions, based on their technical properties. The second step employed a sensory analysis test to choose suitable finishes. Thirty-seven individuals performed the test: the subjects highlighted their main perceptions of metal and metal-look polymer finishes.The research demonstrates that the proposed method is suitable for the evaluation of both technical and sensorial properties of materials. In particular, Mapping test represents a rapid, low cost and effective tool to help industrial designers justify Colour Materials and Finish (CMF) choices with quantifiable information.

Graphical abstract

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Ameliorative effects of bone marrow derived pancreatic progenitor cells on hyperglycemia and oxidative stress in diabetic rats.

Related Articles

Ameliorative effects of bone marrow derived pancreatic progenitor cells on hyperglycemia and oxidative stress in diabetic rats.

Acta Histochem. 2018 May 08;:

Authors: Rizk H, Tohamy AF, Sayed WM, Prince A

Abstract
The present study aimed to investigate the effects of Bone marrow derived pancreatic progenitor cells (BM- PPCs) in diabetic rats. It was conducted on 30 adult male Sprague-Dawley rats weighing 200-220 g. They were divided into three groups: (a) Group 1 was the control group; (b) Group 2 was the diabetic (induced diabetic by a single intraperitoneal (IP) injection of streptozotocin (STZ) (60 mg/kg) and (c) Group 3 was the treated (received injection of 2.5 X 106 BM- PPCs via the tail vein twice with a 21-day time interval). The blood glucose level was estimated weekly, the oxidative stress and insulin gene expression were evaluated at the end of the experiment. Pancreatic tissue histopathology was performed. The insulin immuno-histochemical reaction was applied to the islets. The blood glucose level was reduced in the treated group over time till reaching its acceptable level whereas it was increased in the diabetic group. The oxidative stress was decreased in the treated group compared to the diabetic one. The treated group showed increased expression of the insulin gene compared to the diabetic group. The immune-histochemical analysis of insulin showed an increased number and size of pancreatic islets in the treated group compared to the diabetic one. Thus, the twofold injection of BM- PPCs could restore the normal beta-cell morphology and function.

PMID: 29751963 [PubMed - as supplied by publisher]

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In Response

No abstract available

https://ift.tt/2rDkpzy

A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia Between 2005 and 2015

BACKGROUND: Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. METHODS: The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ2, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. RESULTS: The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005), and took longer to resolve (3.2 vs 1.3 years; P

https://ift.tt/2wCkbO4

The Perioperative Care of the Transgender Patient

An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient. Accepted for publication February 27, 2018 Funding: This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. The authors declare no conflicts of interest. All authors were substantial contributors to the conception of the article, were active participants in the drafting and revision of the article, approved the final version of the article, and agree to be accountable for all aspects of the work. Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines: This article adheres to the appropriate EQUATOR guidelines Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0. Reprints will not be available from the authors. Address correspondence to Luis Etienne Tollinche, MD, FASA, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Address e-mail to tollincl@mskcc.org. © 2018 International Anesthesia Research Society

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Effects of Intraoperative Opioid Use on Recurrence-Free and Overall Survival in Patients With Esophageal Adenocarcinoma and Squamous Cell Carcinoma

BACKGROUND: Perioperative opioid use is associated with poor survival in patients with esophageal squamous cell carcinoma. The most common histological type of esophageal cancer in western countries is adenocarcinoma. The objective of this study was to evaluate the association between intraoperative opioid consumption and survival in patients with adenocarcinoma and squamous cell carcinoma of the esophagus. METHODS: Records of patients who had undergone esophageal cancer surgery between January 2000 and January 2017 were reviewed. Comparisons were made between patients who received high versus low intraoperative doses of opioids. Groups were divided using the recursive partitioning method. Multicovariate Cox proportional hazards models were fitted to evaluate the impact of intraoperative opioid use on recurrence-free survival (RFS) and overall survival (OS). RESULTS: For patients with esophageal squamous cell carcinoma, the univariable analysis indicated that lower opioid dosages (

https://ift.tt/2KlbeuH

Misconceptions Surrounding Penicillin Allergy: Implications for Anesthesiologists

Administration of preoperative antimicrobial prophylaxis, often with a cephalosporin, is the mainstay of surgical site infection prevention guidelines. Unfortunately, due to prevalent misconceptions, patients labeled as having a penicillin allergy often receive alternate and less-effective antibiotics, placing them at risk of a variety of adverse effects including increased morbidity and higher risk of surgical site infection. The perioperative physician should ascertain the nature of previous reactions to aid in determining the probability of the prevalence of a true allergy. Penicillin allergy testing may be performed but may not be feasible in the perioperative setting. Current evidence on the structural determinants of penicillin and cephalosporin allergies refutes the misconception of cross-reactivity between penicillins and cefazolin, and there is no clear evidence of an increased risk of anaphylaxis in cefazolin-naive, penicillin-allergic patients. A clinical practice algorithm for the perioperative evaluation and management of patients reporting a history of penicillin allergy is presented, concluding that cephalosporins can be safely administered to a majority of such patients. Accepted for publication March 30, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leon Vorobeichik, MD, Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room M3-200, Toronto, ON M4N 3M5, Canada. Address e-mail to l.vorobeichik@mail.utoronto.ca. © 2018 International Anesthesia Research Society

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Classification of Foreign Body Reactions due to Industrial Silicone Injection

BACKGROUND A foreign body reaction (FBR) is a typical tissue response to a biomaterial that has been injected or implanted in human body tissue. There has been a lack of data on the classification of foreign body reaction to silicone injection, which can describe the pattern of body tissue responses to silicone. OBJECTIVE Determine the foreign body reaction to silicone injection. METHOD We modified the classification proposed by Duranti and colleagues, which has categorized a FBR to hyaluronic acid injection into a new classification of an FBR to silicone injection. A cohort study of 31 women suffering from silicone-induced granulomas on their chin was conducted. Granulomatous tissue and submental skin were stained with hematoxylin–eosin and evaluated. RESULTS Our data revealed that there were at least 7 categories of FBRs to silicone injection that could be developed. Categories 1 to 4 showed inflammatory activity, and categories 5 to 8 showed tissue repair by fibrosis. CONCLUSION Using histopathological staining, we are able to sequence the steps of body reactions to silicone injection. Initial inflammatory reaction is then replaced by fibrosis process repairing the damaged tissues. The process depends on the host immune tolerance. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address correspondence and reprint requests to: Ago Harlim, MD, MHA, PhD, Head of Dermatology and Venereology Division, Medical Faculty, Christian University of Indonesia, Fakultas Kedokteran Universitas Kristen Indonesia, Jl. Mayjen Sutoyo No. 2, RT5/RW11, Cawang, Kramatjati, Jakarta Timur, Jakarta 13630, Indonesia, or e-mail: agoharlim@yahoo.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Nail Brace Application: A Noninvasive Treatment for Ingrown Nails in Pediatric Patients

No abstract available

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Confluent Verruca Vulgaris Arising Within Bilateral Eyebrow Tattoos: Successful Treatment With Ablative Laser and Topical 5% Imiquimod Cream

No abstract available

https://ift.tt/2KWdzNu

Why Do a Fellowship in Advanced Dermatologic Surgery?

No abstract available

https://ift.tt/2rEVYky

Surgical Cadaver Curriculum

No abstract available

https://ift.tt/2KZv13N

Efficacy Using a Modified Technique for Tissue Stabilized-Guided Subcision for the Treatment of Mild-to-Moderate Cellulite of the Buttocks and Thighs

BACKGROUND Cellulite can be significantly improved using vacuum-assisted tissue stabilized-guided subcision (TS-GS). However, the treatment of shallow and linear cellulite has remained problematic. OBJECTIVE In this retrospective study, we describe a modified technique of vacuum-assisted TS-GS. The aim is to demonstrate that this new limited-release technique is an effective treatment for long ripples and interconnected shallow dimples, which are characteristic of mild-to-moderate cellulite. METHODS Patients with mild-to-moderate cellulite were treated with limited-release vacuum-assisted TS-GS. All subcisions were performed at the 6-mm depth and a minimum of 3 mm between each dimple. Using a 4-point scale, 2 raters graded cellulite improvement on evaluation of prephotographs and postphotographs. RESULTS A total of 23 female patients were included in this study. The pre- and post-treatment photographs were correctly identified in 22 of the 23 patients (95.6%). The average cellulite improvement was 2.9 of 4 for the buttocks and 2.8 of 4 for the posterior thighs. Global cellulite improvement was reported at 3.1 of 4. CONCLUSION The results demonstrate that modified, limited-release, vacuum-assisted TS-GS can be an effective and safe method for the treatment of long ripples and shallow dimples that are characteristics of mild-to-moderate cellulite. Address correspondence and reprint requests to: Omer Ibrahim, MD, 3533 N Wilton, Avenue #2, Chicago, IL 60657, or e-mail: oibrahim@chicagodermatolog.y.com M.S. Kaminer serves as a research consultant for Merz. The remaining authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2rEVSJI

BRCA1-Associated Protein-1 Tumor Predisposition Syndrome in a Patient With Numerous Basal Cell Carcinomas

No abstract available

https://ift.tt/2KZuVcr

Recent Advances in the Histopathology of Drug-Induced Liver Injury.

Related Articles

Recent Advances in the Histopathology of Drug-Induced Liver Injury.

Surg Pathol Clin. 2018 Jun;11(2):297-311

Authors: Kleiner DE

Abstract
Drug-induced liver injury (DILI) is constantly changing as new drugs are approved and as new herbals and dietary supplements (HDS) reach the market. The pathologist plays a key role in the evaluation of DILI by classifying and interpreting the histologic findings considering patients' medical history and drug exposure. The liver biopsy findings may suggest alternative explanations of the injury and additional testing that should be performed to exclude non-DILI causes. Recent reports of iatrogenic liver injury are reviewed with attention to immunomodulatory and antineoplastic agents as well as reports of injury associated with HDS use.

PMID: 29751876 [PubMed - in process]

https://ift.tt/2rG1LGj

Advances in anatomical bases for head and neck surgery.

Related Articles

Advances in anatomical bases for head and neck surgery.

Surg Radiol Anat. 2018 May 12;:

Authors: Crampon F, Duparc F, Grignon B, Trost O

PMID: 29752483 [PubMed - as supplied by publisher]

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Amyand's hernia: A case report and review of the literature.

Related Articles

Amyand's hernia: A case report and review of the literature.

Int J Surg Case Rep. 2018 May 07;47:92-96

Authors: Shaban Y, Elkbuli A, McKenney M, Boneva D

Abstract
INTRODUCTION: An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%.
PRESENTATION OF CASE: A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome.
DISCUSSION: The current generally accepted treatment algorithm for Amyand's hernia is essentially contingent on the appendix's condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand's hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation.
CONCLUSION: This case report reviews a rare entity known as an Amyand's hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand's hernia.

PMID: 29753277 [PubMed - as supplied by publisher]

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Impaction of swallowed dentures in the sigmoid colon requiring sigmoid colectomy.

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Impaction of swallowed dentures in the sigmoid colon requiring sigmoid colectomy.

Int J Surg Case Rep. 2018 May 07;47:89-91

Authors: Flanagan M, Clancy C, O Riordain MG

Abstract
INTRODUCTION: Foreign body (FB) ingestion results in perforation in 1% of cases and is associated with significant morbidity and rarely mortality. Clinical presentation is variable and can present a diagnostic challenge. We report our experience and management of a patient with a delayed presentation of a sigmoid colon foreign body as a result of ingestion of a dental plate.
PRESENTATION OF CASE: A 67 year old female attended the colorectal outpatient clinic following an incidental finding of a sigmoid mass on computed tomography (CT) abdomen. Further investigation identified a dental plate impacted in a thickened sigmoid colon. On further questioning the patient recalled losing her dentures three years previously. At surgery the dental plate had partially eroded through the sigmoid colon into the pelvic side wall. A sigmoid colectomy and hand sewn end-to-end colo-colic anastomosis was performed.
DISCUSSION: Localised perforation following ingestion of a foreign body may result in significant morbidity. Extra luminal migration and local inflammatory response resulted in the formation of a walled off collection. Delayed complications of perforation include abscess and fistula formation.
CONCLUSION: Clinicians need to exhibit a high index of suspicion when treating edentulous patients and alcohol and drug abusers who present with an acute abdomen or a sub-acute presentation with associated atypical imaging and endoscopic findings. The decision regarding intervention and management strategy in cases of perforation by foreign body depends on chronicity of the case, extent of localised or diffuse peritonitis, and size of the lesion or area of bowel involved.

PMID: 29753276 [PubMed - as supplied by publisher]

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Cervical spine fracture through a cervical disc replacement.

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Cervical spine fracture through a cervical disc replacement.

Int J Surg Case Rep. 2018 Mar 29;47:80-88

Authors: Flanagan M, Cawley DT, Cassidy N

Abstract
INTRODUCTION: We report a rare case of cervical spine trauma through a cervical disc replacement and adjacent multilevel disc fusions. Cervical disc replacement (CDR) is a viable option for the surgical treatment of degenerative disc disease however long term follow up data regarding this operative technique is poor specifically relating to traumatic complications. We know of no previous reports of bilateral cervical pedicle fractures occurring adjacent to CDR and anterior cervical spine instrumentation.
PRESENTATION OF CASE: A 46 year-old with a history of C6C7 CDR and C4-6 anterior cervical decompression and fusion was an unrestrained driver involved in a road traffic accident and suffered bilateral C7 pedicle fractures and a right C6C7 facet joint fracture-subluxation without neurological deficit. Reduction and fixation via a posterior approach achieved a satisfactory alignment and the patient made an uneventful recovery.
DISCUSSION: A significant force coupled with cervical fixation resulted in a bilateral pedicle fracture of the cervical spine with preserved neurological function.
CONCLUSION: The protective role of the CDR has not been previously demonstrated but may have played a role in this case. The authors believe the challenges encountered in the treatment of this patient provide valuable lessons in the management of complex cervical spine trauma in the setting of previous instrumentation.

PMID: 29753275 [PubMed - as supplied by publisher]

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A modified CO2/O2 Guedel airway improves capnographic accuracy compared with a CO2/O2 nasal cannula: An infant manikin study

BACKGROUND Capnography via a CO2/O2 nasal cannula is commonly used for respiratory monitoring during sedation. However, signal disturbances are frequently encountered, especially in young children. OBJECTIVE Sampling ports placed closer to the trachea have been shown to result in improved signal quality. In a manikin model of a 6-month-old infant we compared capnography from a modified Guedel airway with a CO2 port located at the tip with that from a CO2/O2 nasal cannula. DESIGN A comparison study using an artificial model of a breathing 6-month-old infant. SETTING Department of Paediatrics, Inselspital Bern, Switzerland, from March 2016 to June 2016. MATERIAL Modified CO2/O2 Guedel airway. INTERVENTIONS Capnography using a modified CO2/O2 Guedel airway or a CO2/O2 nasal cannula was performed for tidal volumes of 20 to 80 ml (in steps of 20 ml), respiratory rates of 20 to 60 min−1 (in steps of 10 min−1) and with different O2 flows (0 to 2 l min−1, in steps of 0.5 l). MAIN OUTCOME MEASURES Comparison of differences between tracheal and device CO2. Secondary outcomes included the effect of various respiratory settings and O2 flows on the CO2 difference. RESULTS The tracheal to device CO2 difference was significantly smaller when using a modified CO2/O2 Guedel airway vs. a CO2/O2 nasal cannula: Mean ± SD, 16.8 ± 4.9 vs. 24.1 ± 5.9 mmHg, P less than 0.0001. An O2 flow of 0.5 to 2 l min−1 did not influence the tracheal to device CO2 difference with the modified CO2/O2 Guedel airway in contrast to the CO2/O2 nasal cannula where there were significant differences (P 

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Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

https://ift.tt/2IdARkr

Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A prospective, double-blinded, randomised controlled trial

BACKGROUND Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN Controlled, randomised, prospective, double-blinded study. SETTING The current study was conducted in a tertiary-level hospital in Brussels (Belgium) from December 2013 to June 2014. PATIENTS Of the 132 women undergoing oocyte retrieval included, 121 completed the study. INTERVENTION After randomisation, patients received either a ketamine infusion (40 μg kg−1 min−1 over 5 min followed by 2.5 μg kg−1 min−1) or a 0.9% saline infusion in addition to the variable remifentanil TCI. MAIN OUTCOME MEASURES The primary outcome was the number of respiratory depression episodes. Effect site target remifentanil concentrations, side effects, pain score, patient satisfaction and incidence of pregnancy were also recorded. RESULTS No significant difference in the incidence of respiratory events was noted (pulse oximetry oxygen saturation 

https://ift.tt/2rEPAcW

A modified CO2/O2 Guedel airway improves capnographic accuracy compared with a CO2/O2 nasal cannula: An infant manikin study

BACKGROUND Capnography via a CO2/O2 nasal cannula is commonly used for respiratory monitoring during sedation. However, signal disturbances are frequently encountered, especially in young children. OBJECTIVE Sampling ports placed closer to the trachea have been shown to result in improved signal quality. In a manikin model of a 6-month-old infant we compared capnography from a modified Guedel airway with a CO2 port located at the tip with that from a CO2/O2 nasal cannula. DESIGN A comparison study using an artificial model of a breathing 6-month-old infant. SETTING Department of Paediatrics, Inselspital Bern, Switzerland, from March 2016 to June 2016. MATERIAL Modified CO2/O2 Guedel airway. INTERVENTIONS Capnography using a modified CO2/O2 Guedel airway or a CO2/O2 nasal cannula was performed for tidal volumes of 20 to 80 ml (in steps of 20 ml), respiratory rates of 20 to 60 min−1 (in steps of 10 min−1) and with different O2 flows (0 to 2 l min−1, in steps of 0.5 l). MAIN OUTCOME MEASURES Comparison of differences between tracheal and device CO2. Secondary outcomes included the effect of various respiratory settings and O2 flows on the CO2 difference. RESULTS The tracheal to device CO2 difference was significantly smaller when using a modified CO2/O2 Guedel airway vs. a CO2/O2 nasal cannula: Mean ± SD, 16.8 ± 4.9 vs. 24.1 ± 5.9 mmHg, P less than 0.0001. An O2 flow of 0.5 to 2 l min−1 did not influence the tracheal to device CO2 difference with the modified CO2/O2 Guedel airway in contrast to the CO2/O2 nasal cannula where there were significant differences (P 

https://ift.tt/2rFYneL

Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

https://ift.tt/2IdARkr

Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A prospective, double-blinded, randomised controlled trial

BACKGROUND Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes. DESIGN Controlled, randomised, prospective, double-blinded study. SETTING The current study was conducted in a tertiary-level hospital in Brussels (Belgium) from December 2013 to June 2014. PATIENTS Of the 132 women undergoing oocyte retrieval included, 121 completed the study. INTERVENTION After randomisation, patients received either a ketamine infusion (40 μg kg−1 min−1 over 5 min followed by 2.5 μg kg−1 min−1) or a 0.9% saline infusion in addition to the variable remifentanil TCI. MAIN OUTCOME MEASURES The primary outcome was the number of respiratory depression episodes. Effect site target remifentanil concentrations, side effects, pain score, patient satisfaction and incidence of pregnancy were also recorded. RESULTS No significant difference in the incidence of respiratory events was noted (pulse oximetry oxygen saturation 

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Replicative virus shedding in the respiratory tract of the patients with Middle East respiratory syndrome coronavirus infection.

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Replicative virus shedding in the respiratory tract of the patients with Middle East respiratory syndrome coronavirus infection.

Int J Infect Dis. 2018 May 09;:

Authors: Park WB, Poon LL, Choi SJ, Choe PG, Song KH, Bang JH, Kim ES, Kim HB, Park SW, Kim NJ, Peiris M, Oh MD

Abstract
BACKGROUND: Information on the duration of replicative Middle East respiratory syndrome coronavirus (MERS-CoV) shedding is important for infection control. Detection of MERS-CoV subgenomic mRNAs indicates the virus is replicative. We examined the duration for detecting MERS-CoV subgenomic mRNA compared with genomic RNA in diverse respiratory specimens METHODS: From upper and lower respiratory samples of 17 MERS-CoV-infected patients, MERS-CoV subgenomic mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR) and MERS-CoV genomic RNA was done by real time RT-PCR.
RESULTS: In sputum or transtracheal aspirate, subgenomic mRNA was detected up to 4 weeks after symptoms developed, which correlated with the detection of genomic RNA. In oropharyngeal or nasopharyngeal swab specimens, detection of subgenomic mRNA and genomic RNA did not correlate.
CONCLUSIONS: These findings suggest that MERS-CoV does not replicate well in the upper respiratory tract.

PMID: 29753119 [PubMed - as supplied by publisher]

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Probiotics for respiratory tract infections in children attending day care centers-a systematic review.

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Probiotics for respiratory tract infections in children attending day care centers-a systematic review.

Eur J Pediatr. 2018 May 12;:

Authors: Laursen RP, Hojsak I

Abstract
Probiotics have been suggested to have a preventive effect on respiratory tract infections (RTIs), but limited evidence exist on strain-specific effects. The main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on RTIs in children attending day care. We included 15 RCTs with 5121 children in day care settings (aged 3 months to 7 years), but due to high diversity in reported outcomes, different number of RCTs were available for evaluated outcomes. Twelve RCTs (n = 4527) reported results which could be compared in at least one outcome of the meta-analysis. Compared to placebo, Lactobacillus rhamnosus GG (LGG) significantly reduced duration of RTIs (three RCTs, n = 1295, mean difference - 0.78 days, 95% confidence interval (CI) - 1.46; - 0.09), whereas no effect was found on other evaluated outcomes. Based on the results from two studies (n = 343), Bifidobacterium animalis subsp. lactis BB-12 showed no effect on duration of RTIs or on absence from day care. Meta-analyses on other strains or their combination were not possible due to limited data and different outcome measures.
CONCLUSION: LGG is modestly effective in decreasing the duration of RTIs. More RCTs investigating specific probiotic strains or their combinations in prevention of RTIs are needed. What is known: • Previously published systematic reviews have suggested that probiotics may have a preventive effect on respiratory infections, but limited data exist on strain specific effects. What is new: • This systematic review showed that use of Lactobacillus rhamnosus GG modestly reduces the duration of respiratory tract infections.

PMID: 29752587 [PubMed - as supplied by publisher]

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Combining Magnetic Resonance Imaging (MRI) and Medical Infrared Thermography (MIT) in the pre- and per-operating management of severe Hidradenitis Suppurativa (HS)

Publication date: Available online 12 May 2018
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Stéphane Derruau, Yohann Renard, Hervé Pron, Redha Taiar, Ellie Abdi, Guillaume Polidori, Sandrine Lorimier
Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurrent skin disease. Surgical excision of wounds appears to be the only curative treatment for the prevention of recurrence of moderate to severe stages. Magnetic resonance imaging (MRI) is a standard reference examination for the detection of HS peri-anal inflammatory fistula. In this case study, the use of real-time medical infrared thermography, in combination with MRI as appropriate imaging, is proposed. The aim is to assist surgeons in the pre- and peri-surgical management of severe perianal hidradenitis suppurativa with the intent to ensure that all diseased lesions were removed during surgery and therefore to limit recurrence.The results show that medical infrared thermography (MIT), coupled with MRI, could be highly effective strategy to address thermally distinguished health tissues and inflammatory sites during excision, as characterised by differential increases in temperature. Medical infrared thermography could be used to check the total excision of inflammatory lesions as a noninvasive method that is not painful, not radiant, and is easily transportable during surgery. Ultimately, this method could be complementary with MRI in providing clinicians with objective data on the status of tissues below the perianal skin surface in the pre- and per-operating management of severe hidradenitis suppurativa.



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Antimicrobial effect of the photodynamic therapy using erythrosine/methylene blue combination on Streptococcus mutans biofilm

Publication date: Available online 12 May 2018
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Laíse Midori Tokubo, Pedro Luiz Rosalen, Janaina de Cássia Orlandi Sardi, Irlan Almeida Freires, Mitsue Fujimaki, Josely Emiko Umeda, Patricia Magalhães Barbosa, Gabriela Ortolan Tecchio, Noboru Hioka, Camila Fabiano de Freitas, Raquel Sano Suga Terada
BackgroundPhotodynamic therapy (PDT) has demonstrated promising results in the treatment of several clinical pathologies through the photochemical reaction caused by the combination of a photosensitizer and a light source. The objective of this study was to evaluate the antimicrobial effect of the combination of the photosensitizers (PSs) erythrosine/methylene blue activated by a white halogen light device on Streptococcus mutans biofilm.MethodsTwo separate experiments were conducted, the first using the PSs at the concentration of 100 μM, and the second 250 μM. The PSs were tested on S. mutans biofilms cultured for 24 hours in isolation, in combination, with and without light activation for 2 minutes fractionated in 4 periods of 30 seconds. After treatment, biofilms were diluted and plated on BHI medium and incubated for 24 hours for colony forming units (CFU) counting. The results (log10) were analyzed with ANOVA followed by Tukey test (p < 0.05).ResultsThe erythrosine/methylene blue combination activated by white halogen light at 100 and 250 μM, and erythrosine at 250 μM, methylene blue at 250 μM presented significantly reduced cell counts (3.2 log10, 5.3 log10, 4.5 log10, 4.3 log10, respectively) when compared to controls (p < 0.05).ConclusionPDT with the combination of erythrosine/methylene blue demonstrated better results that the PSs in isolation regardless of the concentration. The use of this combination at the concentration of 250 μM shows promise as an antibacterial treatment for carious lesions and should be further assessed.



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Prediction of early caries prognosis after fluoride application based on the severity of lesions: An in situ study

Publication date: Available online 12 May 2018
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Hee-Eun Kim, Baek-Il Kim
PurposeThe aim of thisin situ study was to measure baseline fluorescence loss values (ΔF(0)) using the quantitative light-induced fluorescence (QLF) technology to screen enamel lesions for effective remineralization following fluoride application.MethodsIn this single-blindedin situ study, 20 adult volunteers wore intraoral appliances containing 4 specimens of human enamel. The surfaces of the specimens were divided into 3 regions: sound, demineralized, and treated regions. After generating 80 artificial enamel lesions with varying ΔF values, all specimens were covered with 1.23% acidulated phosphate fluoride gel for 1 min. Three repeated QLF-digital measures of ΔF values were then obtained for the lesions, immediately after demineralization and at 1 and 4 weeks after fluoride application.Results and conclusionFluoride application was found to increase the ΔF values of lesions significantly over time (p < 0.001). The groups with lower ΔF(0) values showed significantly larger changes in ΔF values over time (p < 0.001). Receiver operating characteristics analysis showed that baseline lesion values of ΔF(0) = -17.50 and -25.50 would allow for lesion ΔF to recover to -10 at 1 and 4 weeks after fluoride application, respectively (p < 0.001). The findings of this study indicate that clinicians can establish prognostic criteria for early carious lesions using the QLF technology, and hence predict the efficacy of fluoride treatment and devise effective lesion-specific treatment plans.



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Immunosuppression is associated with clinical features and relapse risk of B cell posttransplant lymphoproliferative disorder: A retrospective analysis based on the prospective, international, multicenter PTLD-1 trials

Background Current guideline recommendations for immunosuppression reduction after diagnosis of posttransplant lymphoproliferative disorder (PTLD) include stopping antimetabolites, reducing calcineurin inhibitors and maintaining corticosteroids. However, the effect of immunosuppression on PTLD relapse risk after up-to-date therapy is unclear. Methods This is a retrospective analysis of immunosuppression, patient baseline characteristics and relapse risk measured as landmark time to progression (TTP) starting 1 year after start of therapy in 159 patients with B cell PTLD after solid organ transplantation treated in the prospective, international, multicenter PTLD-1 trials with either sequential treatment (rituximab followed by CHOP chemotherapy) or risk-stratified sequential treatment (rituximab followed by rituximab or R-CHOP immunochemotherapy). Results Patient baseline characteristics at diagnosis of PTLD differed significantly depending on immunosuppression before diagnosis. Compared to immunosuppression before diagnosis, significantly fewer patients received an antimetabolite or a calcineurin inhibitor (CNI) after diagnosis of PTLD. Relapse risk measured as landmark TTP was significantly higher for patients on corticosteroids compared to all others (p=0.010) as well as for patients on ciclosporin compared to those on tacrolimus (p=0.002), but similar for those on antimetabolites compared to all others (p=0.912). In a Cox regression analysis of landmark TTP, corticosteroid-containing immunosuppression after diagnosis of PTLD (p=0.002, hazard ratio (HR) 11.195) and age (p=0.001, HR 1.076/year) were identified as independent, significant risk factors for PTLD relapse. Conclusions In the prospective PTLD-1 trials, corticosteroid use after diagnosis of PTLD is associated with an increased risk of relapse whereas the use of antimetabolites is not. These findings require prospective validation. Correspondence: Ralf Ulrich Trappe, DIAKO Hospital Bremen, Department of Internal Medicine II: Hematology and Oncology, Gröpelinger Heerstr. 406-408, 28239 Bremen, Germany, e-mail: rtrappe@gwdg.de Authorship HZ and RUT designed the study. RUT is the principal investigators and takes primary responsibility for the paper. RUT, SC and DD coordinated the research. HR, NB, SC, VL, FM, DD, PM, JMZ, MD, UD, PR, GV, MS, AH, TT, EB, IAH, CT, EVDN and OG recruited significant numbers of patients. HZ and RUT collected, analyzed and interpreted the data. IA served as reference pathologists. HZ, NB, DD, MD, SC, FM, JMZ, HR, and RUT wrote the paper. All authors had full access to the final version of the manuscript and agreed to publication. Disclosures H. Zimmermann reports grants form Roche, and nonfinancial support from Celgene Amgen, and Roche, outside the submitted work. F. Morschhauser reports personal fees from Celgene, Genentech/Roche, Gilead, and Janssen, outside the submitted work. P. Mollee reports grants from Celgene and Janssen as well as advisory boards membership for Celgene, Janssen, Amgen and BMS, outside the submitted work. J.M. Zaucha reports personal fees from Roche, Amgen, and Takeda, all outside the submitted work. M. Dreyling reports grants and personal fees from Roche, outside the submitted work. P. Reinke reports personal fees or travel support from Teva, Thermo Fisher, Pfizer, Astellas, Amgen, Baxalta, MSD, Pluristem, and Novartis, outside the submitted work. U. Dührsen reports and personal fees from Roche, outside the submitted work. M. Subklewe reports institutional grants from Roche, Amgen and OBT and personal fees or travel support from Amgen, Pfizer, Seattle Genetics, Gilead and Celgene, outside the submitted work. I.A. Hauser reports nonfinancial support from Astellas and Alexion as well as personal fees from Novartis, Roche, Chiesi, Sanofi, Hexal, and Teva, outside the submitted work. V. Leblond reports personal fees from Roche, Gilead, Janssen and Novartis, outside the submitted work. S. Choquet reports grants from Roche France and Chugai during the conduct of the study. R.U. Trappe reports grants from Hoffmann-La Roche, Amgen, Chugai France and Novartis during the conduct of the study; ongoing grants from Roche, and nonfinancial support from Abbvie, Celgene, Takeda, Teva, Janssen, Roche and Gilead, all outside the submitted work. All other authors declared no conflicts of interest. Funding The PTLD-1 trials were planned and initiated in 2003 and amended in 2006 as an investigator-initiated trial by the German and French PTLD Study Groups. In 2004, F Hoffmann-La Roche, AMGEN and Chugaï France granted financial support. Novartis provided funding for an analysis of the effect of immunosuppression on PTLD outcomes. The companies were neither involved in protocol design nor in data collection, analysis or interpretation. They had no role in writing the manuscript and were not involved in the decision to submit for publication. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Novel Technique in The Treatment of Lymphoceles After Renal Transplantation: C-arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage Following Lymphangiography

Background We aimed to evaluate the efficacy of percutaneous embolization following lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele. Methods Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele following renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range: 36 to 70) years and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection. Results Lymphatic leakage was observed in 9 patients following lymphangiography and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate (NBCA) embolization. The volume of lymphatic drainage reduced to less than 10 cc in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage wasn't observed in 4 patients following lymphangiography. Of these, 3 patients showed a reduction in the amount of ymphatic drainage following the lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient didn't respond to the treatment and was treated surgically. Pre and post lymphangiography and embolization, the volume of lymphatic drainage was 113,07±21,75 ml, and 53,84±30,96 ml respectively, and statistically significant decrease was detected. (p

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Response to commentary

No abstract available

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Coagulation Defects in the Cirrhotic Patient Undergoing Liver Transplantation

Patients with cirrhosis undergoing liver transplantation have unique challenges with regard to the prevention and management of thrombosis and hemorrhage. Patients with cirrhosis have an unstable balance of the coagulation system due to defects in both prothrombotic and antithrombotic components. These changes make laboratory monitoring challenging, prophylaxis against bleeding and thrombosis controversial, and therapy for the same uncertain. When cirrhotic patients undergo liver transplantation they frequently have significant transfusion requirements. Emerging evidence may help aid in predicting which recipients will have the greatest blood product requirements, but the ideal blood product regimen to support them through the surgical procedure remains elusive. After these patients receive a liver they are at risk for both venous and arterial thrombotic complications. Unique to liver transplantation is the possibility of acquiring an inherited defect in coagulation, most commonly leading to a predisposition to thrombosis. Further high quality prospective studies focusing on the management of cirrhotic patients are needed to better guide clinicians. Correspondence: Corresponding author/reprints: Constantine J. Karvellas MD SM FRCPC, Associate Professor of Medicine, Division of Gastroenterology (Liver Unit), Division of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta T6G-2X8, Phone: (780) 248-1555, Fax: (780) 492-5643, Email: dean.karvellas@ualberta.ca Conflict of interest: None Financial support: None Authorship: Both authors contributed to writing this manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of a Predictive Model for Deceased Donor Organ Yield

No abstract available

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Determination of Minimal Hemoglobin Level Necessary for Normothermic Porcine Ex situ Liver Perfusion

Background In current studies of ex situ liver perfusion there exists considerable variability in perfusate composition, including the type of oxygen carrier. Herein we aim to clarify the minimal hemoglobin level necessary during normothermic porcine ex situ liver perfusion. Methods Livers procured from 35- 45 Kg domestic pigs were connected to our experimental ex situ circuit (n=10). In the treatment group, perfusate was sequentially diluted hourly to predetermined hemoglobin levels. At the end of each hemoglobin dilution, perfusate samples were analyzed for liver transaminases, lactate dehydrogenase, total bilirubin, and lactate levels. Liver oxygen consumption was measured. In the control group, livers were perfused continually for a duration of 24 hours at target hemoglobin levels of 30 and 20 g/L. Results Rising liver transaminases, significantly higher lactate (p

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Detection of Complement-Binding Donor-Specific Antibodies, not IgG-Antibody Strength nor C4d Status, at Antibody-Mediated Rejection Diagnosis is an Independent Predictor of Kidney Graft Failure

Background Antibody-mediated rejection (ABMR) remains associated with reduced kidney graft survival and no clear prognostic marker is available. Methods We investigated whether donor-specific antibodies (DSA) ability to bind C1q in comparison with ABMR C4d status, both indirect signs of complement activation, improve risk stratification at time of ABMR. Hence, among 467 patients in whom ≥1 graft biopsy was performed between 2008 and 2015, we included 56 with ABMR according to Banff'15 criteria. Using concurrent sera, we prospectively identified DSA by single-antigen beads (IgG and C1q) assays. Results ABMR C4d (+) (n=28) was associated with preformed DSA (P=0.007), while DSA C1q (+) (n=25) cases had stronger IgG-DSA (P

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Revascularization Time in Liver Transplantation: Independent Prediction of Inferior Short- and Long-term Outcomes by Prolonged Graft Implantation

Background Strategies for successful transplantation are much needed in the era of organ shortage and there has been a resurgence of interest on the impact of revascularization time (RT) on outcomes in liver transplantation (LT). Methods All primary LT performed in Birmingham between 2009 and 2014 (n=678) with portal reperfusion first were stratified according to RT (

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Differential impact of T-bet and IFNγ on pancreatic islet allograft rejection

Background T-cell-mediated graft rejection is mostly correlated with potent Th1 responses. However, since IFNγ-/- mice reject their graft as efficiently as wild-type (WT) mice, the exact contribution of IFNγ and its transcription factor T-bet remains a matter of debate. Here, we address this question in the context of pancreatic islet allograft to better inform the molecular pathways that hampers islet survival in vivo. Methods Pancreatic islets from BALB/c mice were transplanted in WT, IFNγ-/- or T-bet-/- C57BL/6 mice. Graft survival and the induction of effector and cytotoxic T cell responses were monitored. Results Rejection of fully mismatched islet allografts correlated with high expression of both IFNγ and T-bet in WT recipients. However, allogeneic islets were permanently accepted in T-bet-/- mice, in contrast to IFNγ-/- hosts. Long-term survival correlated with decreased CD4+ and CD8+ T cell infiltrates, drastically reduced donor-specific IFNγ and TNFα responses and very low expression of the cytotoxic markers granzyme B, perforin and FasLigand. In addition, in vitro and in vivo data pointed to an increased susceptibility of T-bet-/- CD8+ T cell to apoptosis. These observations were not reported in IFNγ-/- mice, which have set up compensatory effector mechanisms comprising an increased expression of the transcription factor Eomes and cytolytic molecules as well as TNFα- but not IL-4 nor IL-17-mediated allogeneic responses. Conclusion Anti-islet T cell responses require T-bet but not IFNγ-dependent programs. Our results provide new clues on the mechanisms dictating islet rejection and may help refining the therapeutic/immunosuppressive regimens applied in diabetic patients receiving islets or pancreas allografts. *These authors equally contributed to this work. Corresponding author: Dr. Sylvaine You, INSERM U1016 – Institut Cochin, Bâtiment Cassini, 123 Bd de Port Royal, 75014 Paris, France. E-mail: sylvaine.you@inserm.fr Authorship A.B and Z.D. designed experiments, performed experiments, analyzed and interpreted the data. T.G, F.V. and E.P. performed experiments and analyzed the data. L.C. provided critical advice and help in writing the manuscript. S. Y. designed and directed the study, analyzed the data and wrote the manuscript. Disclosure The authors declare no conflicts of interest. Funding: This work was supported by grants from the RISET consortium (Reprogramming the Immune System for the Establishment of Tolerance) from the European Commission (FP6), Institutional funding from INSERM and University Paris Descartes, the Fondation CENTAURE, and the Fondation DAY SOLVAY. A. Besançon was supported by a doctoral fellowship from INSERM by a price from the Société Française d'Endocrinologie et Diabétologie Pédiatrique (SFEDP, grant from NOVONORDISK). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Contemporary Strategies and Barriers to Transplantation Tolerance

The purpose of this review is to discuss immunologic tolerance as it applies to solid organ transplantation and to identify barriers that hinder the achievement of this long-term goal. First, the definition of tolerance and an introduction of mechanisms by which tolerance exists or can be achieved will be discussed. Next, a review of contemporary attempts at achieving transplant tolerance will be described. Finally, a discussion of the humoral barriers to transplantation tolerance and potential ways to overcome these barriers will be presented. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address all correspondence and requests for reprints to: Stuart J. Knechtle, MD, Executive Director, Duke Transplant Center, 207 Research Dr., Jones 365, Durham, NC 27710, U.S.A. Phone: 919-613-9687; Fax: 919-684-8716; E-mail: stuart.knechtle@dm.duke.edu. Jean Kwun, DVM, PhD, Duke Transplant Center, 207 Research Dr., Jones 362, Durham, NC 27710, U.S.A. Phone: 919-668-6792; Fax: 919-684-8716; E-mail: jean.kwun@duke.edu (SJK and JK share the corresponding authorship for this work) Disclosure: The authors declare no conflicts of interest. Funding: The work in this paper is supported in part by grants: NIH U19 AI051731 (S.K.), NIH 1U19AI131471 (S.K.) and AHA Enduring Hearts Foundation Research Award 15SDG25710165 (J.K.). Author Contribution B.E. conceived the idea and wrote the manuscript. P.S. conceived the idea, wrote the manuscript, and devised the figure. K.F. and J.Y. participated in manuscript cowriting and critical revision. J.K. and S.K. conceived the idea and wrote the manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Early and late hepatitis B reactivation following IFN- or DAA-based therapy of recurrent hepatitis C in anti-HBc-positive liver transplant recipients

No abstract available

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Caspase Inhibition: Optimizing Grafts for Transplantation

No abstract available

https://ift.tt/2rCGHl0

Preventing Antibody Mediated Rejection during Transplantation: the Potential of Tfr Cells

No abstract available

https://ift.tt/2KjIK4a

T follicular regulatory cells and antibody responses in transplantation

De novo donor specific antibody (DSA) formation is a major problem in transplantation, and associated with long-term graft decline and loss as well as sensitisation, limiting future transplant options. Forming high-affinity, long-lived antibody responses involves a process called the germinal center (GC) reaction, and requires interaction between several cell types, including GC B cells, T follicular helper (Tfh) and T follicular regulatory (Tfr) cells. Tfr cells are an essential component of the GC reaction, limiting its size and reducing nonspecific or self-reactive responses. An imbalance between helper function and regulatory function can lead to excessive antibody production. High proportions of Tfh cells have been associated with DSA formation in transplantation; therefore Tfr cells are likely to play an important role in limiting DSA production. Understanding the signals that govern Tfr cell development and the balance between helper and regulatory function within the GC is key to understanding how these cells might be manipulated to reduce the risk of DSA development. This review discusses the development and function of Tfr cells and their relevance to transplantation. In particular how current and future immunosuppressive strategies might allow us to skew the ratio between Tfr and Tfh cells to increase or decrease the risk of de novo DSA formation. Transplant Research Immunology Group, Nuffield Dept Surgical Sciences, Level 6 John Radcliffe Hospital, Oxford OX3 9DU. Email: lizwallin@doctors.org.uk Telephone +44 (0)1865 222508, fax +44 (0)1865 768876 EFW was supported by a Kidney Research UK/MRC Clinical Fellowship and declares no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Primary Graft Dysfunction: The Devil is in the details

No abstract available

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Live Donor Kidney Transpalntation: Altruism Alone is not Always Enough!

No abstract available

https://ift.tt/2rEWxvn

ISHLT Primary Graft Dysfunction incidence, risk factors and outcome: a UK National Study

Background Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by ISHLT established diagnostic criteria for PGD. We studied the incidence of PGD across the UK. Methods We analysed the medical records of all adult patients who underwent heart transplantation between October 2012-October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details and posttransplant complications were compared between the PGD and non PGD groups using the ISHLT definition. Multivariable analysis was performed using logistic regression. Results The incidence of ISHLT PGD was 36%. Thirty-day all-cause mortality in those with and without PGD was 31(19%) vs 13(4.5%) (p=0.0001). Donor, recipient and operative factors associated with PGD were: recipient diabetes mellitus (p=0.031), recipient preoperative BIVAD(p

https://ift.tt/2wEtNb8

Caspase inhibition during cold storage improves graft function and histology in a murine kidney transplant model

Background Prolonged cold ischemia is a risk factor for delayed graft function of kidney transplants, and is associated with caspase-3 mediated apoptotic tubular cell death. We hypothesized that treatment of tubular cells and donor kidneys during cold storage with a caspase inhibitor before transplant would reduce tubular cell apoptosis and improve kidney function after transplant. Methods Mouse tubular cells were incubated with either DMSO or Q-VD-OPh during cold storage in saline followed by rewarming in normal media. For in vivo studies, donor kidneys from C57BL/6 mice were perfused with cold saline, DMSO (vehicle), or QVD-OPh. Donor kidneys were then recovered, stored at 4°C for 60 minutes, and transplanted into syngeneic C57BL/6 recipients Results Tubular cells treated with a caspase inhibitor had significantly reduced capsase-3 protein expression, caspase-3 activity, and apoptotic cell death compared to saline or DMSO (vehicle) in a dose-dependent manner. Treatment of donor kidneys with a caspase inhibitor significantly reduced serum creatinine, and resulted in significantly less tubular cell apoptosis, brush border injury, tubular injury, cast formation, and tubule lumen dilation compared to DMSO and saline-treated kidneys. Conclusion: Caspase inhibition resulted in decreased tubular cell apoptosis and improved renal function after transplantation. Caspase inhibition may be a useful strategy to prevent cold ischemic injury of donor renal grafts. Trevor L. Nydam, MD, Robert Plenter, Swati Jain, Authors contributed equally to this work. Address for Correspondence: Alkesh Jani, University of Colorado Denver Division of Renal Diseases and Hypertension, 12700 East 19th Avenue, C281, Aurora, Colorado 80045: Email address: Alkesh.jani@ucdenver.edu Authorship TN participated in performance of the research, research design, writing the paper and data analysis; RP participated in performance of the research, writing the paper and data analysis; SJ participated in performance of the research, writing the paper and data analysis; SL participated in data analysis and AJ participated in performance of the research, research design, writing the paper and data analysis. Disclosures The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. Funding This work was supported by a T32 award 5T32DK007, in addition to a 135 VA Merit Award 1I01BX001737 to AJ and the 2014 American Society of Transplant Surgeons –Astellas Faculty Development Award to TN. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impact of Early Initiated Everolimus on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation

Background Many centers implement everolimus-based immunosuppression in liver transplant patients with hepatocellular carcinoma. We aimed to explore the potential impact of early initiated everolimus on tumor recurrence after liver transplantation. Methods This study included 192 patients with hepatocellular carcinoma undergoing liver transplantation among who 64 individuals were prospectively enrolled (2012-2015) and received early initiated everolimus (ie, started between postoperative day 15 to 21), while the remaining 128 patients acted as historical controls without everolimus. Propensity score matching was performed to ensure comparability. Multivariate Cox's regression and competing risks analysis were used to control for potential confounders. Results Patients with and without everolimus were comparable in terms of number of nodules (p=0.37), total tumor diameter (p=0.44), Milan criteria fulfillment (p=0.56) and histological differentiation (p=0.61), but there were increased microvascular invasion rates in the everolimus group (26.5% vs 13.3%; p=0.026). Tumor recurrence rates were similar with and without everolimus (10.9% vs 9.9% at 36 months respectively; p=0.18). After controlling for microvascular invasion among other potential confounders, everolimus had no significant impact on tumor recurrence, neither in the multivariate Cox regression (RR=3.23; p=0.09), nor in the competing risks analysis for tumor recurrence-death (RR=1.02; p=0.94). Patients receiving everolimus had reduced tacrolimus trough concentrations and lower serum creatinine within the first 18 months post-LT. Conclusion Everolimus may not be universally prescribed to prevent tumor recurrence in liver transplant patients with hepatocellular carcinoma. Future randomized trials should be focused on patients with histological features of increased tumor aggressiveness, in whom the potential benefit would be higher. These authors contributed equally to the present manuscript, Manuel Rodríguez-Perálvarez, PhD and Marta Guerrero, MD. CORRESPONDENCE INFORMATION: Prof. Manuel de la Mata, MD, PhD. Head of Department of Hepatology and Liver Transplantation at the Reina Sofía University Hospital, Córdoba, Spain. Address: Avda/Menéndez Pidal s/n, Postal code 14004, Córdoba, Spain. E-mail: mdelamatagarcia@gmail.com. Manuel De la Mata and Manuel Rodríguez-Perálvarez conceived the original idea and designed the study. Lydia Barrera, Gustavo Ferrín, María D. Ayllón, Gonzalo Suárez-Artacho, Carmen Bernal and Juan M. Pascasio enrolled patients and acquired the data. Manuel Rodríguez-Perálvarez, Marta Guerrero and Antonio Poyato analyzed the data. Manuel Rodríguez-Perálvarez and Marta Guerrero drafted the manuscript. Jose L. Montero, Javier Briceño, Javier Padillo, Luis M. Marín-Gómez and Manuel De la Mata critically revised the manuscript for important intellectual content. DISCLOSURE: The authors have no conflict of interest to disclose regarding the present manuscript. FUNDING: The present study was supported by the Instituto de Salud Carlos III (FIS PI11-02867 and PI14/01469) and co-funded by FEDER. Additional funding was granted by the Andalusian Society for Organ Transplantation (SATOT). M.R-P is a recipient of the Physician Scientist Fellowship awarded by the European Association for the Study of the Liver (EASL). The financial sources listed above had no vested interest in the results of the study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Renal cell carcinoma in one year: Going inside the news of 2017 - A report of the main advances in RCC cancer research.

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Renal cell carcinoma in one year: Going inside the news of 2017 - A report of the main advances in RCC cancer research.

Cancer Treat Rev. 2018 May 02;67:29-33

Authors: Mosillo C, Ciccarese C, Bimbatti D, Fantinel E, Volta AD, Bisogno I, Zampiva I, Santoni M, Massar F, Brunelli M, Montironi R, Tortora G, Iacovelli R

Abstract
Very interesting issues regarding RCC treatment have been raised during 2017. We analysed the main news that may potentially modified clinical practice. Conflicting data came from trials testing targeted therapies in the adjuvant setting, supporting the necessity of further investigations. One of the key goals of RCC research is focused on the first-line therapy, with particular interest focus on immunotherapy combinations. Redefine the standard of care with the aim of improving patients' survival represents an imperative need. Enhancing immunotherapy antitumor activity by combining immune checkpoint inhibitors with anti-angiogenetic therapies is a noteworthy research field, with promising results. In addiction, we analysed in the metastatic setting data about the role of cytoreductive nephrectomy and the possibility of delay the start of first-line therapy after an active surveillance period. Based on recent developments, the paper outlines future prospective of RCC research.

PMID: 29753244 [PubMed - as supplied by publisher]

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An interpretative phenomenological analysis of the experience of living with colorectal cancer as a chronic illness.

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An interpretative phenomenological analysis of the experience of living with colorectal cancer as a chronic illness.

J Clin Nurs. 2018 May 12;:

Authors: McGeechan GJ, McPherson KE, Roberts K

Abstract
AIMS AND OBJECTIVES: The main aim of this study was to explore the lived experiences of patients living with cancer as a chronic illness.
BACKGROUND: Due to recent advances in detection and treatment, cancer is now regarded as a chronic illness. However, living with cancer as a chronic illness can lead to a number of physical and psychosocial consequences all of which can lead to uncertainty over how patients view and plan for their future.
DESIGN: A longitudinal qualitative study.
METHODS: Individuals attending oncology follow-up clinics with their clinical nurse specialist at a hospital in the North East of England were invited to participate in two semi-structured interviews over a 6-month period. A total of six individuals consented to participate, of whom two were women. One participant could not be contacted for the second interview, resulting in 11 interviews. Interviews were audio recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
RESULTS: Two superordinate themes emerged from the analysis; physical and psychological consequences of cancer; and adapting to life after treatment.
CONCLUSION: The experience of future disorientation was common amongst participants however this was impacted on by a number of factors such as functional impairment, and fear of recurrence. Furthermore, future disorientation does not appear to be stable and may ease as patients begin to adjust to the uncertainty of living with colorectal cancer as a chronic illness. This article is protected by copyright. All rights reserved.

PMID: 29752847 [PubMed - as supplied by publisher]

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Redefining Quality Measurement in Cancer Care.

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Redefining Quality Measurement in Cancer Care.

J Natl Compr Canc Netw. 2018 May;16(5):473-478

Authors: Nardi EA, McCanney J, Winckworth-Prejsnar K, Schatz AA, Adelson K, Neubauer M, Smith ML, Walters R, Carlson RW

Abstract
Quality measurement in oncology is increasing in significance as payment schemes shift from volume to value. As demand for quality measures increases, challenges in the development of quality measures, standardization across measures, and the limitations of health information technology have become apparent. Moreover, the time and financial burden associated with developing, tracking, and reporting quality measures are substantial. Despite these challenges, best practices and leaders in the field of quality measurement in oncology have emerged. To understand the current challenges and promising practices in quality measurement and to explore future considerations for measure development and measure reporting in oncology, NCCN convened the NCCN Policy Summit: Redefining Quality Measurement in Oncology. The summit included discussion of the current quality landscape and efforts to develop quality measures, use of quality measures in various programs, patient perspective of quality, and challenges and best practices for quality reporting.

PMID: 29752321 [PubMed - in process]

https://ift.tt/2wBENGf

The impact of health insurance status on the stage of cervical cancer diagnosis at a tertiary care center in Massachusetts.

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The impact of health insurance status on the stage of cervical cancer diagnosis at a tertiary care center in Massachusetts.

Gynecol Oncol. 2018 May 08;:

Authors: Davis M, Strickland K, Easter SR, Worley M, Feltmate C, Muto M, Horowitz N, Berkowitz R, Feldman S

Abstract
OBJECTIVE: To evaluate the impact of insurance status on the stage of cervical cancer diagnosed and treated at a tertiary care center in Massachusetts and review the preceding screening history.
METHODS: An IRB approved retrospective cohort study was conducted of patients with a diagnosis of cervical cancer treated at Brigham and Women's Hospital (BWH) between January 2011 and June 2016. Clinical and demographic data was extracted from the longitudinal medical record. Statistical analysis was performed using SAS.
RESULTS: 117 cases of cervical cancer met the inclusion criteria during the study period. Most patients (76%) were diagnosed with stage I disease. On univariate analysis, compared to patients with private insurance, patients with public insurance or no documented insurance presented at older ages, were more likely to be non-white races, and present with advanced stage disease. In an adjusted model, the risk of being diagnosed with advanced stage disease persisted among women with public or no documented insurance, adjusted odds ratio (aOR) 4.13 (1.37-12.45). There was no difference in screening history among women with private vs. public insurance, p = 0.30.
CONCLUSIONS: Despite access to insurance, patients with public issued insurance had an increased risk of presenting with advanced stage cervical cancer in this cohort. These data suggest that additional barriers to screening and prevention may exist and are important for future investigation.

PMID: 29751992 [PubMed - as supplied by publisher]

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PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives.

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PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives.

Radiat Oncol. 2018 May 11;13(1):90

Authors: Zschaeck S, Lohaus F, Beck M, Habl G, Kroeze S, Zamboglou C, Koerber SA, Debus J, Hölscher T, Wust P, Ganswindt U, Baur ADJ, Zöphel K, Cihoric N, Guckenberger M, Combs SE, Grosu AL, Ghadjar P, Belka C

Abstract
68Gallium prostate specific membrane antigen (PSMA) ligand positron emission tomography (PET) is an increasingly used imaging modality in prostate cancer, especially in cases of tumor recurrence after curative intended therapy. Owed to the novelty of the PSMA-targeting tracers, clinical evidence on the value of PSMA-PET is moderate but rapidly increasing. State of the art imaging is pivotal for radiotherapy treatment planning as it may affect dose prescription, target delineation and use of concomitant therapy.This review summarizes the evidence on PSMA-PET imaging from a radiation oncologist's point of view. Additionally a short survey containing twelve examples of patients and 6 additional questions was performed in seven mayor academic centers with experience in PSMA ligand imaging and the findings are reported here.

PMID: 29751842 [PubMed - in process]

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Telomere Maintenance Mechanisms in Cancer.

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Telomere Maintenance Mechanisms in Cancer.

Genes (Basel). 2018 May 03;9(5):

Authors: Gaspar TB, Sá A, Lopes JM, Sobrinho-Simões M, Soares P, Vinagre J

Abstract
Tumour cells can adopt telomere maintenance mechanisms (TMMs) to avoid telomere shortening, an inevitable process due to successive cell divisions. In most tumour cells, telomere length (TL) is maintained by reactivation of telomerase, while a small part acquires immortality through the telomerase-independent alternative lengthening of telomeres (ALT) mechanism. In the last years, a great amount of data was generated, and different TMMs were reported and explained in detail, benefiting from genome-scale studies of major importance. In this review, we address seven different TMMs in tumour cells: mutations of the TERT promoter (TERTp), amplification of the genes TERT and TERC, polymorphic variants of the TERT gene and of its promoter, rearrangements of the TERT gene, epigenetic changes, ALT, and non-defined TMM (NDTMM). We gathered information from over fifty thousand patients reported in 288 papers in the last years. This wide data collection enabled us to portray, by organ/system and histotypes, the prevalence of TERTp mutations, TERT and TERC amplifications, and ALT in human tumours. Based on this information, we discuss the putative future clinical impact of the aforementioned mechanisms on the malignant transformation process in different setups, and provide insights for screening, prognosis, and patient management stratification.

PMID: 29751586 [PubMed]

https://ift.tt/2IEkpcq