Head and Neck Diseases by Alexandros G.Sfakianakis: 08/02/18

Πέμπτη 2 Αυγούστου 2018

Surgery of benign thyroid disease by ENT/head and neck surgeons and general surgeons: 233 cases of vocal fold paralysis in 3509 patients

Abstract

Purpose

Thyroid surgery is mainly performed by general surgeons (GS). The aim of this study is to evaluate the safety and efficiency of thyroid surgery by ENT/head and neck surgeons (ENT), especially regarding the incidence of vocal fold palsy (VFP).

Methods

We retrospectively analysed 3509 patients (69.0% female) who underwent surgery for benign thyroid diseases (56.8% nodular goitre, 18.6% inactive nodes, 14.0% thyroid autonomy, 7.0% Graves' disease). Operations were mainly performed with intraoperative neuromonitoring by GS (n = 1933) or physicians trained for head and neck surgery (n = 1576). 18.7% of the procedures were carried out by residents in training.

Results

VFP occurred in 233 subjects (6.6%); 6.2% in females and 7.6% in males. A lower rate (p < 0.001) was observed in operations performed by ENT (4.7%) than by GS (8.2%). No increased incidence of VFP was seen for surgeries performed by physicians in training (6.2%, n = 657). Prevalence of VFP was not different for minimally invasive (6.3%, n = 950) and conventional surgery (6.8%, n = 2559), but higher in total (7.2%, n = 1916) than in subtotal thyroidectomy (5.0%, n = 997). Postoperative haemorrhage (5.6 vs. 1.9%) and hypocalcaemia < 2.0 mmol/l (32.8 vs. 22.0%) were documented more frequently in patients with VFP, also substitution therapy with calcium (23.2 vs. 14.7%) and dihydrotachysterol (8.1 vs. 3.7%) had to be applied more frequently.

Conclusion

Thyroid surgery performed by surgeons specifically trained for ENT/head and neck surgery is safe and has a significantly reduced rate of VFP. VFP is associated with other complications (postoperative haemorrhaging, hypocalcaemia).

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6-mT 0–120-Hz magnetic fields differentially affect cellular ATP levels

Abstract

Adenosine triphosphate (ATP), an indispensable molecule that provides energy for essentially all cellular processes, has been shown to be affected by some magnetic fields (MFs). Although people are frequently exposed to various static and power frequency MFs in their daily lives, the exact effects of these MFs of different frequencies have not been systematically investigated. Here, we tested 6-mT MFs with 0, 50, and 120 Hz for their effects on cellular ATP levels in 11 different cell lines. We found that the 6-mT static magnetic field (SMF) either does not affect or increase cellular ATP levels, while 6-mT 50-Hz MF either does not affect or decrease cellular ATP levels. In contrast, 6-mT 120-Hz MF has variable effects. We examined the mitochondrial membrane potential (MMP) as well as reactive oxygen species (ROS) in four different cell lines, but did not find their direct correlation with ATP levels. Although none of the ATP level changes induced by these three different frequencies of 6-mT MFs are dramatic, these results may be used to explain some differential cellular responses of various cell lines to different frequency MFs.

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The clinical value of serum squamous cell carcinoma antigens 1 and 2 in head and neck squamous cell carcinoma

Publication date: Available online 2 August 2018

Source: Auris Nasus Larynx

Author(s): Ryuji Yasumatsu, Takafumi Nakano, Kazuki Hashimoto, Ryunosuke Kogo, Takahiro Wakasaki, Takashi Nakagawa

Abstract

Objective

The usefulness of pretreatment measurement of SCC antigen in patients with head and neck SCC is still controversial. Our aim of this study was to evaluate the clinical usefulness of serum SCC antigen, SCCA1 and SCCA2 in the management of patients with head and neck SCC.

Methods

Serum samples for the analysis of SCCA1, SCCA2 and SCC antigen were taken from head and neck SCC patients before treatment. Serum SCC antigen was assayed with a solid phase immunoradiometric assay. The SCCA1 and SCCA2 protein level was determined by a sandwich ELISA.

Results

Fifty-two of 96 cases (54%) showed evaluated serum SCC antigen levels above the upper limit. The serum SCCA2 level was significantly higher in the head and neck SCC patients than in control group, whereas there were no significant differences in the serum SCCA1 level between head and neck SCC patients and control group. 72% of head and neck SCC patients demonstrated SCCA2 levels higher than 0.15, whereas 68% of the control subjects had SCCA2 levels less than 0.15.

Conclusion

The serum SCCA2 levels were increased during the progression of cancer and might be a useful tool for the management of head and neck SCC.

https://ift.tt/2M02KNZ

Study the Role of Nasal Scrap Cytology in Allergic Rhinitis Patients in Rural Population

Abstract

Allergic Rhinitis is one of the gift of modern era. Condition is involving wide range of age group starting from children to old age people. In spite of latest diagnostic facility and advanced treatment, it is still a great challenge for the otorhinolaryngologist. This study was done to perform simple and cost effective test to understand the severity of Allergic Rhinitis. To investigate the patients of allergic rhinitis with specific focus on nasal scrape cytology. After applying inclusion and exclusion criterion were found suitable and hence selected for the present study. 100 patients who were clinically diagnosed on history and examination as allergic rhinitis were included as cases while control group consisted of 100 subjects having no symptoms of allergic rhinitis. These patients were a subjected to nasal scrape cytology for which Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden, was employed. Mucosal specimens were acquired by scraping the surfaces of the middle thirds of inferior turbinates with Cytobrush Plus (Medscand Cell Sampling Kit), Malmo, Sweden. The samples thus obtained were transferred onto glass slides to be fixed in 95% ethyl alcohol and stained with May Gurwald Gimesa stain to study pattern and profile of different types of cells like eosinophils, goblet cells, mast cells. The nasal eosinophils were studied under 1000 × magnification of light microscope 10-well spread, high power epithelium fields were examined and the quantitative score of nasal eosinophils was rated according to a scale described by Meltzer. In study group all 100 patients underwent nasal scrape cytology. 25 (25%) patients in study group showed grade 1 + nasal eosinophilia followed by grade ½ + in 24 (24%), grade 0 in 22 (22%) and grade 2 + in 21 (21%). In control group 80% of subjects had grade 0 nasal eosinophilia. Difference between nasal eosinophilia in the study and the control group were found to be statistically significant. In study group 54% showed grading > 0.5 + whereas 46% showed ≤ 0.5 + . The sensitivity and specificity were observed to be 54% and 100% respectively. The results thus found were statistically significant. Nasal scrape cytology which was an added dimension proved to be a more specific than sensitive test. The specificity of nasal scrape cytology in our study was 100%. Sensitivity was only 54%. 22% of the patients of allergic rhinitis showed an eosinophil count more than 300/cu mm.

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Study the Role of Nasal Scrap Cytology in Allergic Rhinitis Patients in Rural Population

Abstract

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Use of text messaging to improve patient experience and communication with pediatric tonsillectomy patients

Publication date: Available online 3 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laurie Newton, Cecille Sulman

Abstract

Objectives

The aims of this quality improvement project were to develop a text messaging service to deliver messages to pediatric tonsillectomy patients to improve communication and overall experience.

Method

Text messages were developed to deliver important information and reminders both preoperatively and postoperatively to pediatric tonsillectomy patients. After success with a small pilot program of five patients, a sample of 85 patients who underwent tonsillectomy participated in the program.

Results

Similar to the pilot program, the larger sample size had no canceled procedures and no visits to the emergency department. Approximately 25% of the participants called the ENT clinic nurse line for a question or concern postoperatively. The majority of phone calls were for concerns with pain or pain medications. Parental survey results were positive with respect to the value and overall helpfulness of the text messages. Respondents found the information useful, easy to understand, and it also helped reduce anxiety or level of worry during and after the surgery. Respondents all felt that the number of messages was just right.

Conclusion

With the explosion of technology and smartphone use, text messaging is an innovative way to provide patient/family education for surgical procedures such as tonsillectomy.

https://ift.tt/2OELxIg

Prevalence of recurrent wheezing during the first year of life in Setúbal district, Portugal

Publication date: Available online 2 August 2018

Source: Allergologia et Immunopathologia

Author(s): Cláudio D'Elia, Javier Mallol, Dirceu Solé

Abstract

Background

Recurrent wheezing during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence in Portugal.

Objective

Determine the prevalence and severity of recurrent wheezing, treatments employed and other related aspects, in infants during their first year of life in Setúbal, Portugal.

Methods

This is a cross-sectional study of a random sample of infants aged 12–15 months living in Setúbal district. It uses a validated questionnaire answered by parents/caregivers at local healthcare facilities where infants attend for growth/development monitoring and/or vaccine administration.

Results

Among the 202 infants surveyed, 44.6% (95% CI 37.7–51.4) had at least one episode of wheezing; and 18.3% (95% CI 12.9–23.6) had recurrent wheezing. There was significant morbidity associated to recurrent wheezing in terms of severe episodes (17.3%–95% CI 12–22.5), visits to the emergency department (26.2%–95% CI 20.1–32.2) and hospital admissions (5.4%–95% CI 2.2–8.5); 10.4% (95% CI 6.1–14.6) used inhaled corticosteroids and 7.9% (95% CI 4.1–11.6) used a leukotriene receptor antagonist.

Conclusions

The prevalence of recurrent wheezing in infants during the first year of life is high and is associated with significant morbidity, presenting as a relevant public health problem. An important proportion of infants' progress with a more severe condition, resulting in high use of health resources (visits to emergency department and hospitalisations). The prevalence of recurrent wheezing in this district of Portugal stays between those related in other European and Latin American Centres, suggesting that maybe some of the well-known risk factors are shared with affluent countries.

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Use of statistical experimental methods for optimization of collagenolytic protease production by Bacillus cereus strain SUK grown on fish scales

Abstract

In this study, novel and cheap sources like fish scales and molasses were used for the production of collagenolytic protease. Statistical optimization of different parameters for the production of collagenolytic protease by Bacillus cereus strain SUK has been carried out using response surface methodology (RSM). Three most significant medium components identified by Plackett-Burman (PB) were fish scales, molasses, and incubation time, which were further optimized using central composite design (CCD). The medium having fish scales 9.38 g l⁻¹, molasses 2.42 g l⁻¹, and incubation time of 67.34 h was found to be optimum for maximum collagenolytic protease production. B. cereus strain SUK has shown multiple plant growth-promoting traits, whereas degraded fish scale hydrolysates (FSHs) were having antimicrobial as well as plant growth-promoting abilities. The collagenolytic efficiency of this isolate can be exploited in an eco-friendly process of bioconversion of fish waste, representing an alternative way of waste management that could be used to produce various value-added products, such as collagenolytic protease, microbial biomass, amino acids, protein hydrolysates, and collagen peptides.

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Inoculation of plant growth-promoting bacteria Bacillus sp. YM-1 alleviates the toxicity of Pb to pakchoi

Abstract

Heavy metal accumulation in plants may imperil human health. Inoculation of plant growth-promoting bacteria can alleviate the toxicity of heavy metal and promote plant growth. In this study, Bacillus sp. YM-1, a heavy metal resistant and plant growth-promoting bacterium, was immobilized with spent substrate of mushroom and applied to alleviate the toxicity of Pb to pakchoi. The results indicated that the biomass of pakchoi in inoculation group was increased by 17.45 to 27.05% compared with that in non-inoculated group (p < 0.05). The root and shoot were lengthened by 13.45% to 39.17% and 20.23% to 42.36%, respectively. The content of Pb in root and shoot obviously reduced and that in edible part (shoot) was less than 0.2 mg kg⁻¹ in the low concentration of Pb. Other indicators such as superoxide dismutase (SOD), peroxidase (POD), chlorophyll, and protein all testified that YM-1 inoculation was conducive to the alleviation of Pb toxicity to pakchoi.

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An open-label feasibility study of nintedanib combined with docetaxel in Japanese patients with locally advanced or metastatic lung adenocarcinoma after failure of first-line chemotherapy

Abstract

Purpose

This open-label feasibility study assessed the tolerability of nintedanib 200 mg in combination with docetaxel 75 mg/m² as a starting dose in Japanese patients with a body surface area (BSA) < 1.5 m² and locally advanced or metastatic lung adenocarcinoma.

Methods

Eligible patients received docetaxel 75 mg/m² every 21 days and nintedanib administered at 200 mg twice daily (bid), starting on day 2 of each cycle. Treatment was continued until disease progression or undue toxicity. The primary endpoint was the number of patients experiencing dose-limiting toxicities (DLTs) in cycle 1 (days 1–21).

Results

Of 10 treated patients, 2 patients (20%) experienced DLTs during cycle 1. These DLTs were grade 3 liver enzyme elevations [alanine aminotransferase (2 patients) and aspartate aminotransferase (2 patients)], and grade 2 hyperbilirubinemia (1 patient). Nine patients met the predefined criteria for nintedanib 200 mg bid plus docetaxel 75 mg/m² to be considered a tolerable starting dose. All patients experienced ≥ 1 adverse event (AE) during the treatment period (all drug-related), but no patients experienced AEs that led to discontinuation of nintedanib. Of the five serious AEs reported during treatment, none were drug-related. There was no apparent effect of nintedanib on the pharmacokinetics of docetaxel. The objective response and disease control rates were 40 and 70%, respectively.

Conclusion

Nintedanib 200 mg bid plus docetaxel 75 mg/m² is a tolerable starting dose in Japanese patients with a BSA < 1.5 m² with locally advanced or metastatic lung adenocarcinoma.

ClinicalTrials.gov number

NCT02300298.

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Correction to: HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours

Following publication of the original article [1], the authors reported an error in one of the author names. In this Correction the incorrect and correct author names are listed.

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Deletion of Rap1b, but not Rap1a or Epac1, Reduces Protein Kinase A–Mediated Thyroid Cancer

Thyroid, Ahead of Print.

https://ift.tt/2AMzKoH

Current Thyrotropin Immunoassays Recognize Macro-Thyrotropin Leading to Hyperthyrotropinemia in Females of Reproductive Age

Thyroid, Ahead of Print.

https://ift.tt/2OztDqx

Using the American Thyroid Association Risk-Stratification System to Refine and Individualize the American Joint Committee on Cancer Eighth Edition Disease-Specific Survival Estimates in Differentiated Thyroid Cancer

Thyroid, Ahead of Print.

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Incidence and Survival of Thyroid Cancer in Children, Adolescents, and Young Adults in Denmark: A Nationwide Study from 1980 to 2014

Thyroid, Ahead of Print.

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A Novel Homozygous Selenocysteine Insertion Sequence Binding Protein 2 (SECISBP2, SBP2) Gene Mutation in a Turkish Boy

Thyroid, Ahead of Print.

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Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments

Abstract

Background

To date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program.

Case Presentations

Five out of six cases were female and median age of patients at assessment was 12.9 (SD = 1.13) years. On average, patients' percentage of treatment goal weight was 80.5% at initial assessment (SD = 8.56) and 81.9% (SD = 7.08) when family therapy began. Cases 1, 2 and 3 were admitted to a specialized inpatient unit at assessment due to medical instability (2) or failed outpatient treatment (1), and all six cases presented with severe co-morbid anxiety. All patients were treated using a combination of medical monitoring, family therapy, medication (including olanzapine, fluoxetine and in two cases cyproheptadine), and cognitive behavioural therapy. At treatment termination, all six patients had achieved their goal weight.

Conclusion

These cases illustrate the complex ways in which young patients with ARFID can present, the illness' effect on development and mental health, and the positive outcomes associated with weight gain and concurrent treatment for co-morbid anxiety disorders.

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Pilot trial of the hu14.18-IL2 immunocytokine in patients with completely resectable recurrent stage III or stage IV melanoma

Abstract

Phase I testing of the hu14.18-IL2 immunocytokine (IC) in melanoma patients showed immune activation, reversible toxicities, and a maximal tolerated dose of 7.5 mg/m²/day. Preclinical data in IC-treated tumor-bearing mice with low tumor burden documented striking antitumor effects. Patients with completely resectable recurrent stage III or stage IV melanoma were scheduled to receive 3 courses of IC at 6 mg/m²/day i.v. on days 1, 2 and 3 of each 28-day course. Patients were randomized to complete surgical resection either following neoadjuvant (Group A) or prior to adjuvant (Group B) IC course 1. Primary objectives were to: (1) evaluate histological evidence of anti-tumor activity and (2) evaluate recurrence-free survival (RFS) and OS. Twenty melanoma patients were randomized to Group A (11 patients) or B (9 patients). Two Group B patients did not receive IC due to persistent disease following surgery. Six of 18 IC-treated patients remained free of recurrence, with a median RFS of 5.7 months (95% confidence interval (CI) 1.8-not reached). The 24-month RFS rate was 38.9% (95% CI 17.5–60.0%). The median follow-up of surviving patients was 50.0 months (range: 31.8–70.4). The 24-month OS rate was 65.0% (95% CI 40.3–81.5%). Toxicities were similar to those previously reported. Exploratory tumor-infiltrating lymphocyte (TIL) analyses suggest prognostic value of TILs from Group A patients. Prolonged tumor-free survival was seen in some melanoma patients at high risk for recurrence who were treated with IC.

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Nasal Tuberculosis in a Teenage Female

Abstract

Although cutaneous tuberculosis (TB) is a rare form of extra-pulmonary TB, lupus vulgaris is the commonest variant of cutaneous TB. We present a 14 year female with non-healing ulcer over the upper lip extending and destroying the collumela and part of anterior nasal septum. Histopathological examination revealed TB as a possible cause of the lesion. Identification of acid-fast bacilli on direct stained smears confirms the diagnosis of TB. Complete healing of the ulcer was achieved with anti-tuberculous regime leaving a residual fibrosis over the site of the ulcer.

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Nasal Tuberculosis in a Teenage Female

Abstract

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Correction to: Indoor and outdoor concentrations of BTEX and formaldehyde in Tehran, Iran: effects of building characteristics and health risk assessment

The original publication of this paper contains a mistake. The correct name and affiliation of the 3rd Author is presented in this paper.

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Tumor Molecular Testing Guides Anti‐PD‐1 Therapy and Provides Evidence for Pathogenicity of Mismatch Repair Variants

AbstractLynch syndrome is characterized by germline abnormalities in mismatch repair (MMR) genes, leading to predisposition to multiple cancers [1]. A second hit to the unaffected allele is required for tumorigenesis. MMR proteins repair incorrectly paired nucleotides and prevent generation of insertions and deletions at microsatellites [2]. Aberrancies in these MMR proteins can be a result of germline mutations or somatic alterations. Defective MMR results in microsatellite instability (MSI) and a high mutational burden [3].The clinical implications of MSI are becoming readily apparent, as presence of MSI leads to the generation of neoantigens, stimulating tumor‐associated lymphocytes [4,5]. This has led to the use of programmed cell death protein 1 blockade for MMR‐deficient tumors [6]. The U.S. Food and Drug Administration recently approved pembrolizumab for any advanced solid tumor demonstrating MSI and nivolumab for metastatic MSI colorectal cancer. However, the clinical significance of numerous MMR gene variants remains uncertain. The International Society for Gastrointestinal Hereditary Tumors classification system categorizes 2,360 MMR variants, which can be used to gauge pathogenicity [7]. There are many variants of uncertain significance (VUS; or class 3) for which clinicians are unable to provide recommendations. In this study, we employed the combination of germline testing and tumor mutational assessment to help discern the clinical relevance of VUS and guide immunotherapeutic decisions.Key Points. A clinical dilemma arises when genomic testing yields variants of uncertain significance (VUS).Germline VUS were identified in two patients with gastrointestinal malignancies, but only one patient had a second‐hit mutation in a mismatch repair gene leading to mismatch repair deficiency that conferred response to immunotherapy.The combination of germline testing along with tumor mutational assessment can help discern the clinical relevance of VUS and can help guide therapeutic decision‐making toward individualized patient care.

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Intracranial Response to Anti‐Programmed Death 1 Therapy in a Patient with Metastatic Non‐Small Cell Lung Cancer with Leptomeningeal Carcinomatosis

AbstractCentral nervous system metastasis in non‐small cell lung cancer remains a therapeutic challenge and confers a poor prognosis. Here we describe a patient with lung adenocarcinoma, parenchymal brain metastases, and leptomeningeal carcinomatosis who demonstrated a sustained response to programmed death 1 inhibition combined with stereotactic radiosurgery.

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Role of Family Obligation Stress on Ugandan Women's Participation in Preventive Breast Health

AbstractBackground.The purpose of this study is to determine the role of family obligation stress on Ugandan women's participation in preventive breast health through the receipt of breast cancer education and health check‐ups.Materials and Methods.A validated survey was conducted on a community sample of Ugandan women, providing a multi‐item scale to assess preventive breast‐health‐seeking behaviors and measure family obligation stress (FO; range 6–18). Univariate and multivariate linear regression was used to assess associations between sociodemographic factors and FO. Univariate and multivariate linear regression (used in conjunction with the robust sandwich estimator for standard errors) and probability differences (PDs) were used to evaluate associations between preventive breast‐health‐seeking behaviors, sociodemographic factors, and FO.Results.A total of 401 Ugandan women ages 25–74 participated in the survey. Most had three or more children in the home (60%) and were employed full time (69%). Higher FO was associated with increasing number of children and/or adults in the household (p < .05), full‐time employment (p < .001), and being single (p = .003). Women with higher FO were less likely to participate in breast cancer education (PD = −0.02 per 1‐point increase, p = .008) and preventive health check‐ups (PD = −0.02, p = .018), associations that persisted on multivariate analysis controlling for sociodemographic factors.Conclusion.Ugandan women with high FO are less likely to participate in preventive breast cancer detection efforts including breast cancer education and preventive health check‐ups. Special efforts should be made to reach women with elevated FO, because it may be a risk factor for late‐stage presentation among women who develop breast cancer.Implications for Practice.High family obligation stress (FO) significantly reduces women's participation in preventive health check‐ups and breast cancer education. These findings support research in U.S. Latinas showing high FO negatively affects women's health, suggesting that FO is an important factor in women's health‐seeking behavior in other cultures. Addressing family obligation stress by including family members involved in decision‐making is essential for improving breast cancer outcomes in low‐ and middle‐income countries, such as Uganda.

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“Hey Mom, Now I'm Officially an Oncologist”

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Alternate Endpoints for Phase II Trials in Advanced Neuroendocrine Tumors

AbstractBackground.In phase II trials for neuroendocrine tumors (NETs), the objective response rate (ORR) is traditionally used as a primary endpoint. However, the validity of the ORR as a primary endpoint has never been systematically examined. Therefore, a literature‐based analysis of phase II trials for NETs was performed to identify valid alternative endpoints for predicting median progression‐free survival (PFS) in clinical trials for NETs.Materials and Methods.Phase II trials of medical treatment for advanced NETs were identified based on a systematic search using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.Results.A total of 22 trials were identified, and 1,310 patients and 27 treatment arms were included in the analysis. There was no significant relationship between the ORR and median PFS (r = .374; 95% confidence interval [CI], −0.051 to 0.800; p = .085). Conversely, 12‐month PFS rates showed very strong correlations with median PFS (r = .929; 95% CI, 0.831–1.027; p < .001).Conclusion.The results of the present analysis indicate that the ORR is not significantly correlated with median PFS and suggest that 12‐month PFS rates are good alternate endpoints for screening phase II trials for NETs.Implications for Practice.Phase II trials are screening trials that seek to identify agents with sufficient activity to continue development. Thus, earlier endpoints are preferable, and the objective response rate (ORR) has been traditionally used as a surrogate endpoint in phase II trials for neuroendocrine tumors (NETs). However, the present study showed that the ORR was not significantly correlated with median progression‐free survival (PFS). On the other hand, the 12‐month PFS rate showed very strong correlation with median PFS and is considered a good alternate endpoint for screening phase II trials for NETs.

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Hyponatraemia and seizures in Merrem’s hump-nosed pit viper (Hypnale hypnale) envenoming: a case report

Hump-nosed pit vipers (Genus: Hypnale) are medically important snakes in Sri Lanka and South India. Merrem's Hump-nosed pit viper (Hypnale hypnale) frequently leads to potentially fatal envenomings in Sri Lanka a...

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Effectiveness of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique for reducing motion artifacts caused by mandibular movements on fat-suppressed T2-weighted magnetic resonance (MR) images

Publication date: Available online 2 August 2018

Source: Magnetic Resonance Imaging

Author(s): Hiroaki Shimamoto, Tomomi Tsujimoto, Naoya Kakimoto, Minami Majima, Yuri Iwamoto, Yurie Senda, Shumei Murakami

Abstract

Purpose

To compare a fat-suppressed T2-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (T2W-PROPELLER) sequence with a fat-suppressed T2-weighted fast spin-echo (T2W-FSE) sequence in the oral and maxillofacial regions for the evaluation of the presence of motion artifacts caused by mandibular movements.

Methods

Fifty-six healthy adult volunteers were examined in a closed mouth position and then with three different rhythmical mandibular movements throughout MR scanning: open-close movement (movement 1), lateral movement (movement 2) and open-close and lateral movement (movement 3). All subjects were scanned first with fat-suppressed T2W-FSE and then with fat-suppressed T2W-PROPELLER while performing the same movements. Motion artifacts, including ghosting or pulsation artifacts, streak artifacts, susceptibility artifacts and the overall image quality were independently evaluated by two oral and maxillofacial radiologists using a five-point scale. The score graded by the two observers was averaged.

Results

The inter-observer agreement was almost perfect for all evaluated items (κ ≥ 0.81). The T2W-PROPELLER images showed significantly fewer ghosting artifacts than T2W-FSE images in subjects performing the mandibular movements throughout MR scanning (P < .001). T2W-PROPELLER images also showed significantly fewer pulsation artifacts than T2W-FSE images, regardless of the performance of a movement, throughout MR scanning (P < .001). Finally, the T2W-PROPELLER images showed a significantly better overall image quality than T2W-FSE images in subjects performing movements 2 or 3 throughout MR scanning (P < .001).

Conclusion

The PROPELLER technique was found to be effective in reducing the motion artifacts caused by mandibular movements on fat-suppressed T2W MR images in the oral and maxillofacial regions.

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Ten years of myocutaneous flaps for pressure ulcers in patients with spinal lesions: analysis of complications in the framework of a specialised medical-surgical pathway

Introduction: The objective of the study is to analyse complications associated with surgery for pelvic pressure ulcers: their frequency, nature and rate of surgical revisions. The secondary aims are to analyse the rate of recurrence, length of stay and time to healing, and to determine factors associated with complications and recurrence.Methods: It is a single-centre, retrospective cohort study with a 10 year follow-up, setting in Nantes University Hospital, France, a specialist centre for Spinal Cord Injury (SCI).

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“Silicone Breast Prostheses; a cohort study of complaints, complications and explantations between 2003 and 2015.”

Complications after silicone implantation, with silicone extravasation being the most severe, remain a safety issue in breast implantation surgery. The purpose of our study was to determine the incidence of medium and long-term postoperative complaints and complications, and indications for explantation in patients with a silicone breast implant.

https://ift.tt/2AByjZN

Custom CAD/CAM implants for complex craniofacial reconstruction in children: our experience based on 136 cases

CAD-CAM patient specific implants offer cerebral protection and improved facial balance without the disadvantages of autologous bone such as donor site morbidity and unpredictable resorption. Several alloplastic materials are available but titanium, polymethylmethacrylate (PMMA) and polyetheretherketone (PEEK) are the current popular choices. We reviewed our experience applying alloplastic CAD-CAM materials in the reconstruction of complex pediatric craniofacial deformities.

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Diagnostic value of fluorine-18 deoxyglucose positron emission tomography/computed tomography in deep sternal wound infection

Deep sternal wound infection (DSWI) is a refractory complication after heart surgery, and debridement is the first-line treatment. The accurate identification of the extent of the infection is the key to successful debridement. The present study assessed the diagnostic accuracy of fluorine-18 deoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) for identifying the infected area of DSWI.

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An analysis of the cosmetic surgery experience acquired through UK Plastic Surgery training

Aims: Cosmetic surgery is an essential component of Plastic Surgery training. Our study demonstrates the average cosmetic surgery experience of UK Plastic Surgery registrars over their 6-year training scheme. Comparison is made with the operative requirements for the Certificate of Completion of Training (CCT) and the Royal College of Surgeons Cosmetic Certification scheme.Methods: Using the web-based eLogbook, we analysed all of the cosmetic surgery operations recorded by Plastic Surgery Registrars during their specialist training.

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The Foot Fillet Flap for Ischial Pressure Sore Reconstruction: A New Indication

The main cause of ischial pressure sores in paraplegic patients is prolonged sitting without pressure relief. These wounds are subject to recurrence and may need repeated reconstruction with local flaps. When all options are exhausted, the total thigh flap is the last resort. Disarticulation of the hip joint impairs stability even when sitting and causes subsequently very high discomfort. In this manuscript, we describe an alternative to the total thigh flap to avoid hip disarticulation: the foot fillet flap.

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Saphenous nerve transfer: A new approach to restore sensation of sole

Loss of protective sensation in the sole may lead to repeated trauma, chronic non healing ulcers and even amputation. Saphenous Nerve (SN) to Posterior Tibial Nerve (PTN) transfer can provide restoration of sensation in sole.

https://ift.tt/2vbZ95S

Robotic Nipple Sparing Mastectomy and immediate Breast Reconstruction with Robotic Latissimus Dorsi Flap Harvest – Technique and preliminary results

Robotic nipple sparing mastectomy (R-NSM) was associated with promising cosmetic outcomes [1, 2]. Robotic surgical platforms were also successfully applied in the field of breast reconstruction, either in the harvest of autologous latissimus dorsi flap [3] or in the dissection of submuscular pocket for insertion of a prosthesis [1, 2, 4]. The da Vinci surgical platform can perform NSM with immediate breast reconstruction (IBR) via a small axillary wound. In this study of two cases, we report the preliminary experience and clinical outcome of R-NSM and IBR with robotic latissimus dorsi flap harvest (RLDFH).

https://ift.tt/2AxdVsZ

Best Practice Guidelines Breast Imaging for Aesthetic Surgery: British Society of Breast Radiology (BSBR), Association of Breast Surgery Great Britain & Ireland (ABS), British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to: implants, lipomodelling, and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists.Pre-aesthetic surgeryAll women should undergo a full breast history and clinical examination.Abnormal or uncertain clinical assessment (e.g. family history or other related risk, breast symptoms, uncertain examination findings) requires specialist breast assessment in a recognised breast facility.

https://ift.tt/2OBnfii

The clinical value of serum squamous cell carcinoma antigens 1 and 2 in head and neck squamous cell carcinoma

Nocturnal Hypoventilation May Have a Protective Effect on Ischemic Heart Disease in Patients with Obesity Hypoventilation Syndrome

Rejuvenation Research, Ahead of Print.

https://ift.tt/2LUBaBz

Quality analysis and policy recommendations on the utilization of community basic public health services in urban and suburban Shanghai from 2009 to 2014

Abstract

Disparities in quality of basic public health services exist between urban and rural populations, but there is no data about these disparities between urban and suburban populations in Shanghai. The study aims to analyze and compare the quality of basic public health service utilization of community health service centers in Shanghai urban and suburban areas between 2009 and 2014. This was a cross-sectional study. Using a two-stage random sampling method, 80 community health service centers were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistical analysis, principal component analysis, and forecast analysis were used to compare and analyze basic health services utilization quality between urban and suburban centers. During the 6 years, there has been an increasing trend of the basic public health service effectiveness of prevention services, health care services, rehabilitation services, health education services, and health indexes in Shanghai urban and suburban areas. Prevention services, health care services, health education services, and population health index indicators of urban areas were better than those of the suburbs, while effectiveness indicators of rehabilitation services were lower than that of the suburbs. The urban areas had four principal component scores lower than the suburbs (P < 0.001, P = 0.006, P < 0.001, and P = 0.015). During the 6 years, with the strengthening of national support, basic public health service utilization has increased rapidly, and effectiveness of services has improved obviously. Nevertheless, there is an imbalance of basic public health service utilization between urban and suburban areas.

https://ift.tt/2LYRfq3

Molecular Genetics of Premature Ovarian Insufficiency

Publication date: Available online 2 August 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Xue Jiao, Hanni Ke, Yingying Qin, Zi-Jiang Chen

Premature ovarian insufficiency (POI) is highly heterogeneous in genetic etiology. Yet identifying causative genes has been challenging with candidate gene approaches. Recent approaches using next generation sequencing (NGS), especially whole exome sequencing (WES), in large POI pedigrees have identified new causatives and proposed relevant candidates, mainly enriched in DNA damage repair, homologous recombination, and meiosis. In the near future, NGS or whole genome sequencing will help better define genes involved in intricate regulatory networks. The research into miRNA and age at menopause represents an emerging field that will help unveil the molecular mechanisms underlying pathogenesis of POI. Shedding light on the genetic architecture is important in interpreting pathogenesis of POI, and will facilitate risk prediction for POI.

https://ift.tt/2OFMnVs

Complementary medicine in radiation oncology

Abstract

Introduction

Recently, complementary and alternative medicine (CAM) has moved more into the focus, and cancer societies such as the German Cancer Society (Deutsche Krebsgesellschaft, DKG) have established working groups to develop a guideline for CAM. The present work aims to evaluate the acceptance of CAM in the whole radiation oncology community.

Methods

We conducted an online survey on CAM and sent the modified questionnaire that was successfully distributed to all members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynakologische Onkologie, AGO) of the DKG in 2014 to the members of the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie und Strahlentherapie, DEGRO). The survey consisted of 17 questions regarding personal information and current CAM guidelines within the workplace/clinic.

Results

A total of 143 members participated. Of these, 12% had some CAM qualification. For hematological cancer in 35% and in up to 76% for breast cancer, CAM treatment is offered in German radiation oncology facilities, mainly due to fatigue symptoms. CAM is part of routine treatment in 32.2%, 22.0% are planning to incorporate it. Most physicians advise patients to partake in sports activities and recommend dietary supplements and nutritional counseling. The cost of CAM treatment is fully covered in 9.8% of all participating facilities.

Conclusion

Today, CAM is integrated into cancer care; however, skepticism regarding its effect still exists. Evidence-based results must be generated to convince physicians of the effectiveness of CAM methods. CAM qualifications must be included in physicians' training to improve their understanding and counseling regarding CAM options in cancer care.

https://ift.tt/2Me5nZx

Correction to: HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours

Following publication of the original article [1], the authors reported an error in one of the author names. In this Correction the incorrect and correct author names are listed.

https://ift.tt/2OEhlx4

P2X7 receptor is involved in lung injuries induced by ischemia-reperfusion in pulmonary arterial hypertension rats

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Lian Duan, Guo-huang Hu, Yi-jin Li, Cheng-liang Zhang, Meng Jiang

Abstract

Pulmonary arterial hypertension (PAH) is a progressive disease that ultimately leads to right heart failure and death. Current strategies are ineffective to prevent and cure PAH, especially in those who undergo cardiopulmonary bypass. P2 × 7 receptors (P2 × 7Rs) have been implied to participate in the pathogenesis of PAH and injuries induced by ischemia-reperfusion (IR). In the present study, we aimed to assess the potential therapeutic effects of anti-P2 × 7Rs on PAH and IR-induced lung injuries in rats and explore their underlying cellular and molecular mechanisms. In the present study, we have successfully established rat models with PAH and/or lung IR injuries. Immunohistochemical staining, western blot, and polymerase chain reaction were performed to detect the P2 × 7R expression in these models; P2 × 7R-specific inhibitor, Brilliant Blue G (BBG), was used to antagonize P2 × 7R, and enzyme-linked immunosorbent assay was used to help evaluate the P2 × 7R-mediated function in PAH with or without IR. Moreover, BBG, SB203580 (p38/MAPK inhibitor), and CD39 (adenosine triphosphate hydrolase) were applied to explore the inner signal pathway in vitro and in vivo. Our findings showed that P2 × 7R was involved in the development of PAH. By applying BBG, we have shown that the severity of PAH and IR was ameliorated through reducing the release of proinflammatory cytokines. Moreover, our results in vitro and in vivo indicated that P2 × 7R regulated the release of inflammatory mediators by the p38/MAPK signal pathway. Most important, CD39 showed the most dominant potential in improving inflammation in lung injuries caused by PAH and IR. In conclusion, the inhibition of P2 × 7R could effectively attenuate inflammation in lung injuries caused by PAH and IR in rats by reducing proinflammatory cytokines through regulating the p38/MAPK pathway.

https://ift.tt/2vbDmLw

Marijuana Use and Psychosocial and QOL Outcomes Among Patients With Head and Neck Cancer

This case-matched cohort study investigates differences in psychosocial and quality of life outcomes between marijuana users and nonusers among patients with newly diagnosed head and neck cancer.

https://ift.tt/2vtR0J9

A Slow-Growing Fibrous Parapharyngeal Mass

A woman in her 60s had a large, nonmobile, firm tumor extending from the postauricular region to the parotid gland, scalp, and neck that had been growing slowly for more than 20 years; she was a former smoker, and there was no palpable lymphadenopathy. What is your diagnosis?

https://ift.tt/2LNyS8k

Cricopharyngeal Muscle Dysfunction Following Hypoglossal Nerve Stimulator Placement

This case report describes a patient with new-onset cricopharyngeus muscle dysfunction after activation of hypoglossal nerve stimulation therapy.

https://ift.tt/2O5zQsZ

Dornase Alfa Ototoxic Effects in Animals and Efficacy for Clogged Tympanostomy Tubes in Children

This pilot study investigates the ototoxic effects of dornase alfa in a chinchilla model and its efficacy vs ofloxacin in a randomized clinical trial of children with clogged tympanostomy tubes.

https://ift.tt/2LLE10w

Effect of Nitrous Oxide as a Treatment for Subjective, Idiopathic, Nonpulsatile Bothersome Tinnitus

This randomized clinical trial investigates whether inhaled nitrous oxide and oxygen vs inhaled nitrogen and oxygen can reduce bothersome tinnitus among adults with subjective, idiopathic, nonpulsatile tinnitus of 6 months' duration or longer.

https://ift.tt/2O3f1OY

Relation between serum CC16 levels and asthma predictive index in pre-schoolers with recurrent wheezing

Publication date: September–October 2018

Source: Allergologia et Immunopathologia, Volume 46, Issue 5

Author(s): J.A. Castro-Rodriguez, I. Atton, G. Villarroel, C.A. Serrano

Abstract

Background

Low levels of serum CC16 were reported in asthmatic adults, but the studies on children were scarce and conflicting. The aim of this study was to compare serum CC16 levels in pre-school children with recurrent wheezing assessed using an asthma predictive index (API).

Methods

We performed a case-control study based on API, with all enrolled pre-school children who had recurrent wheezing episodes (>3 episodes/last year confirmed by a physician) and had presented at one paediatric clinic in Santiago, Chile. The population was divided according to stringent API criteria into positive or negative.

Results

In a one-year period, 60 pre-schoolers were enrolled. After excluding 12, 48 pre-schoolers remained (27 males, age range from 24 to 71 months) and completed the study; 34 were API positive and 14 were API negative. There were no significant differences in demographics between groups. The level of serum CC16 levels for pre-schoolers with a positive API and negative API were (median 9.2 [7.1–11.5] and 9.4 [5.5–10], p = 0.26, respectively). The area under the curve for the serum CC16 levels to predict a positive API was 0.6, 95% CI [0.43–0.77], p = 0.3. A correlation between serum CC16 levels and age was found (r = 0.36 [0.07–0.59], p = 0.01], but not between serum CC16 levels and peripheral eosinophils blood.

Conclusion

There was no evidence that serum CC16 levels played a role in recurrent wheezing and a positive API in pre-school children. More studies are needed to confirm this finding.

https://ift.tt/2n4DN5J

Allergological characterization of children treated with oral immunotherapy to egg

Publication date: September–October 2018

Source: Allergologia et Immunopathologia, Volume 46, Issue 5

Author(s): M. Tortajada-Girbés, M. Hernández Pérez

https://ift.tt/2Kl9AbK

Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis

Abstract

Purpose

To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs).

Methods

The databases of MEDLINE, EMBASE and Cochrane library were searched up to 3 Jun, 2018. In this meta-analysis, data of volume reduction rates (VRRs) at the 3-, 6- and 12-month follow-up, and complications are obtained to evaluate the effectiveness and safety of cMWA and uMWA for the treatment of BTNs.

Results

Nine studies involving 1461 patients with 1845 BTNs were included. The pooled VRR at the 3-month follow-up after MWA therapy reached 54.3% (95% CI: 45.3–63.3%, I² = 97.6%), 73.5% (95% CI: 66.7–80.3%, I² = 94.9%) at the 6-month follow-up, and 88.6% (95% CI: 84.9–92.4%, I² = 92.7%) at the 12-month follow-up. The pooled proportions of overall, major and minor complications were 52.4% (95% CI: 29.8–74.9%; I² = 99.5%), 4.8% (95% CI: 2.7–7.0%; I² = 55.9%) and 48.3% (95% CI: 31.2–65.4%; I² = 99.7%). Both cMWA and uMWA achieved similar pooled VRR at the 3-month follow-up (58.4 vs 45.3%, P = 0.07) and pooled proportion of major complications (4.9 vs 5.0%, P = 0.49), while uMWA had higher pooled proportions of overall and minor complications than cMWA (97.8 vs 29.7%, P < 0.01; 97.8 vs 21.0%, P < 0.01), with more patients suffering pain and skin burn after uMWA (100 vs 5.5%, P < 0.01; 47.2 vs 0.2%, P < 0.01).

Conclusion

MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.

https://ift.tt/2Awde2U

Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives

Abstract

Adrenal incidentalomas constitute a common clinical problem with an overall prevalence of around 2–3%, but are more common with advancing age being present in 10% of those aged 70 years. The majority of these lesions are benign adrenocortical adenomas (80%), characterized in 10–40% of the cases by autonomous cortisol hypersecretion, and in 1–10% by aldosterone hypersecretion. Several observational studies have shown that autonomous cortisol and aldosterone hypersecretion are more prevalent than expected in patients with osteopenia and osteoporosis: these patients have accelerated bone loss and an increased incidence of vertebral fractures. In contrast to glucocorticoid action, the effects of aldosterone on bone are less well understood. Recent data, demonstrating a concomitant co-secretion of glucocorticoid metabolites in patients with primary aldosteronism, could explain some of the metabolic abnormalities seen in patients with aldosterone hypersecretion. In clinical practice, patients with unexplained osteoporosis, particularly when associated with other features such as impaired glucose tolerance or hypertension, should be investigated for the possible presence of autonomous cortisol or aldosterone secretion due to an adrenal adenoma. Randomized intervention studies are needed, however, to investigate the optimum interventions for osteoporosis and other co-morbidities in these patients.

https://ift.tt/2n7mpNW

Prognostic Subgroups for Survival Outcomes in BRAF V600–Mutated Metastatic Melanoma

This exploratory recursive partitioning analysis modeled associations between prespecified covariates and survival outcomes using pooled data from 4 randomized clinical trials of adult patients with BRAF V600–mutated metastatic melanoma treated with dacarbazine, vemurafenib, or cobimetinib plus vemurafenib.

https://ift.tt/2LKehl8

Underutilization of Combined-Modality Therapy in Limited-Stage Small Cell Lung Cancer

To the Editor In their analysis for limited-stage small cell lung cancer, Pezzi et al report that substantial numbers of patients are not receiving standard-of-care treatment. Notably, Medicare/Medicaid beneficiaries were less likely to receive radiotherapy vs the privately insured. The authors theorize that similar effects by insurance status were not observed for chemotherapy partially due to competitive chemotherapy reimbursement afforded by the 340b Drug Pricing Program.

https://ift.tt/2vwjhii

Neutropenia

This Patient Page provides information on neutropenia, a condition associated with having an abnormally low number of neutrophils in the blood resulting in increased risk of infection.

https://ift.tt/2LKcA7f

Underutilization of Combined-Modality Therapy in Limited-Stage Small Cell Lung Cancer—Reply

In Reply We are pleased by the interest of Alcorn and colleagues in our study looking at barriers to combined-modality therapy for the initial management of limited-stage small cell lung cancer (LS-SCLC) in the National Cancer Database (NCDB). With current efforts to retract the 340b and Medicaid Discount Program, we thank Alcorn et al for their call to action to address the large number of patients not receiving standard combined-modality therapy for LS-SCLC seen in the NCDB. As proposed in our article, we agree that additional analyses are urgently needed to further interrogate the causes of heterogeneous care delivery for LS-SCLC.

https://ift.tt/2vpWPr8

Resistance to Osimertinib in Patients With EGFR T790M–Positive Lung Cancer

This cohort study examines mechanisms of acquired resistance to osimertinib in patients with non–small cell lung cancer and the associated clinical implications.

https://ift.tt/2LOKMhY

Engaging Patients in Value-Based Cancer Care

This Viewpoint examines how a more patient-focused payment model could improve the success of payment reforms that encourage higher-value care.

https://ift.tt/2vCKvEf

Outcomes From a Minority-Based Lung Cancer Screening Program vs the National Lung Screening Trial

This population-based study assesses demographic characteristics, CT scan findings, and lung cancer detection in minority populations compared with outcomes from the National Lung Screening Trial.

https://ift.tt/2LOKveW

ACE gene dosage determines additional autonomic dysfunction and increases renal angiotensin II levels in diabetic mice

OBJECTIVES: The present study aimed to investigate cardiovascular autonomic modulation and angiotensin II (Ang II) activity in diabetic mice that were genetically engineered to harbor two or three copies of the angiotensin-converting enzyme gene. METHODS: Diabetic and non-diabetic mice harboring 2 or 3 copies of the angiotensin-converting enzyme gene were used in the present study. Animals were divided into 4 groups: diabetic groups with two and three copies of the angiotensin-converting enzyme gene (2CD and 3CD) and the respective age-matched non-diabetic groups (2C and 3C). Hemodynamic, cardiovascular, and autonomic parameters as well as renal Ang II expression were evaluated. RESULTS: Heart rate was lower in diabetic animals than in non-diabetic animals. Autonomic modulation analysis indicated that the 3CD group showed increased sympathetic modulation and decreased vagal modulation of heart rate variability, eliciting increased cardiac sympathovagal balance, compared with all the other groups. Concurrent diabetes and either angiotensin-converting enzyme polymorphism resulted in a significant increase in Ang II expression in the renal cortex. CONCLUSION: Data indicates that a small increase in angiotensin-converting enzyme activity in diabetic animals leads to greater impairment of autonomic function, as demonstrated by increased sympathetic modulation and reduced cardiac vagal modulation along with increased renal expression of Ang II.

https://ift.tt/2vvdQjM

Does resistance training improve body image satisfaction among the elderly? A cross-sectional study

OBJECTIVE: This study aims to evaluate whether body image satisfaction improves with practice in resistance training in elderly women. METHODS: Forty women were selected and randomly divided into an untrained group (UN) group and a group trained in resistance exercises (RT). To evaluate body image satisfaction, the silhouette matching task was used. RESULTS: No differences were found between current (5.45±0.24) and ideal (4.7±0.12) silhouettes in the RT group. However, the UN group showed a significant difference (p<0.01) between current (10.4±0.43) and ideal (5.6±0.26) silhouettes. The current silhouette was significantly different between the UN and RT groups (p<0.002). However, the ideal silhouette value did not differ between them. Body satisfaction was present in 90% of the participants in the RT group, and the difference was 15% less than that in the UN group (x2 test, p<0.001). CONCLUSION: Resistance training in elderly women can promote satisfaction with their body image.

https://ift.tt/2LOJGTo

Intraoperative imprint cytology versus histological diagnosis for the detection of sentinel lymph nodes in breast cancer treated with neoadjuvant chemotherapy

OBJECTIVES: To compare imprint cytology and paraffin section histology for sentinel lymph node detection in women with breast cancer treated with neoadjuvant chemotherapy. METHOD: A cross-sectional study and report of the sentinel lymph node statuses of 64 patients with breast cancer who underwent intraoperative imprint cytology and neoadjuvant chemotherapy in a referral cancer institute in Rio de Janeiro, Brazil, between 2014 and 2016. RESULTS: The mean age was 51 years. The most common histological type was invasive ductal carcinoma (93.75%), and the most common differentiation grade was 2 (62.5%). Overall, 153 lymph nodes were identified, with a mean of 2.39/case. Thirty-four lymph nodes tested positive for malignancy by imprint cytology, and 55 tested positive by histology. Of the 55 positive lymph nodes, 41 (74.5%) involved macrometastases, and 14 (25.5%) involved micrometastases. There were 21 false negatives with imprint cytology, namely, 7 for macrometastases and 14 for micrometastases, resulting in a rate of 17.6%. The sensitivity of imprint cytology was 61.8%, with a specificity and positive predictive value of 100%, a negative predictive value of 82.4% and an accuracy of 86.3%. The method presented null sensitivity for the identification of micrometastases. CONCLUSIONS: The false-negative rate with imprint cytology was associated with the number of sentinel lymph nodes obtained. The rate found for complete response to neoadjuvant chemotherapy was comparable to the rates reported in the literature. The accuracy of imprint cytology was good, and its specificity was excellent for sentinel lymph node detection; however, the method was unable to detect lymph node micrometastases.

https://ift.tt/2vwWTFo

Adrenocortical incidentalomas and bone: from molecular insights to clinical perspectives

Abstract

https://ift.tt/2n7mpNW

Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis

Abstract

Purpose

To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs).

Methods

Results

Conclusion

MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.

https://ift.tt/2Awde2U

Dosisdichte neodadjuvante Chemotherapie beim Harnblasenkarzinom

https://ift.tt/2LKJJzM

Sekundärmalignome nach Strahlen- und Chemotherapie

Zusammenfassung

Hintergrund

Folgeneoplasien stellen eine der schwerwiegendsten Spätfolgen nach einer Krebserkrankung dar.

Ziel der Arbeit

Die aktuelle Forschung zu Folgeneoplasien nach Krebs im Kindesalter und deren Ergebnisse werden zusammengefasst.

Material und Methoden

Als Datenbasis für die Spätfolgenforschung dienen sowohl die Daten der international aufgebauten Krebsregister als auch eine Reihe etablierter Studien wie die Childhood Cancer Survivor Studies (CCSS) oder PanCare.

Ergebnisse

Nahezu jeder 10. Überlebende einer Krebserkrankung im Kindealter erkrankt binnen 35 Jahren an einer Folgeneoplasie. Systemische Folgeneoplasien, darunter v. a. akute myeloische Leukämien, treten insbesondere in den ersten 10 Jahren nach einer Ersterkrankung auf, wobei insbesondere Chemotherapeutika als eine Ursache hierfür identifiziert wurden. Solide Folgeneoplasien können auch 35 und länger Jahre nach einer Ersterkrankung beobachtet werden. Bei einigen soliden Folgeneoplasien, z. B. des ZNS, der Schilddrüse oder Brust, wurde eine deutliche Assoziation zu einer vorangegangenen Strahlentherapie festgestellt.

Schlussfolgerung

Als weitere Risikofaktoren für eine Folgeneoplasie gelten neben der Tumortherapie an sich ein jüngeres Alter bei Behandlung, die Art der Erstneoplasie sowie genetische Vorbelastungen. Klassische Risikofaktoren für eine Krebserkrankung, z. B. Rauchen, können das Folgeneoplasierisiko zusätzlich erhöhen.

https://ift.tt/2vtwHeT

In vivo mechanical characterization of human facial skin combining curved surface imaging and indentation techniques

Skin Research and Technology, EarlyView.

https://ift.tt/2Kmt7IX

Refusal of Cancer‐Directed Surgery in Head and Neck Squamous Cell Carcinoma Patients

The Laryngoscope, EarlyView.

https://ift.tt/2vtS6ol

Interim Digital PET/CT in Predicting Outcomes for Participants With Locally Advanced Oropharyngeal Cancer Undergoing Chemoradiation Therapy

Conditions: Oropharyngeal Squamous Cell Carcinoma; HPV Positive Oropharyngeal Squamous Cell Carcinoma
Interventions: Procedure: Computed Tomography; Procedure: Positron Emission Tomography
Sponsors: Ohio State University Comprehensive Cancer Center; National Cancer Institute (NCI)
Not yet recruiting

https://ift.tt/2LYq9zc

Manual Therapy in Treating Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors

Conditions: Cancer Survivor; Dysphagia; Fibrosis; Head and Neck Carcinoma
Interventions: Procedure: Manual Therapy; Other: Quality-of-Life Assessment; Other: Questionnaire Administration
Sponsors: M.D. Anderson Cancer Center; National Cancer Institute (NCI)
Recruiting

https://ift.tt/2McIPs1

Body Scan Activity on Bone Marrow Transplant Patients and Their Caregivers

Condition: Hematological Malignancy
Interventions: Behavioral: Body Scan; Other: Rotterdam Symptom Checklist; Other: Practice Logs
Sponsors: Washington University School of Medicine; Barnes-Jewish Hospital
Recruiting

https://ift.tt/2vcg5ZY

Adjuvant Treatment of Apatinib in Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Interventions: Drug: Apatinib mesylate tablet; Radiation: Intensity-modulated radiation therapy (IMRT); Drug: Cisplatin
Sponsors: Wei Jiang; Wuzhou Red Cross Hospital; Guangxi Minzu Hospital; People's Hospital of Lingshan; Guangxi Naxishan Hospital; People's Hospital of Baise; People's Hospital of Laibin
Recruiting

https://ift.tt/2Ma7cq5

PG2 Concurrent With Chemoradiation for Locally Advanced Esophageal Cancer

Conditions: Cancer-related Fatigue; Survival; Tumor, Esophageal
Intervention: Drug: Astragalus Polysaccharides 500 mg
Sponsor: PhytoHealth Corporation
Not yet recruiting

https://ift.tt/2v8jdpO

Interim Digital PET/CT in Predicting Outcomes for Participants With Locally Advanced Oropharyngeal Cancer Undergoing Chemoradiation Therapy

Manual Therapy in Treating Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors

Body Scan Activity on Bone Marrow Transplant Patients and Their Caregivers

Adjuvant Treatment of Apatinib in Nasopharyngeal Carcinoma

PG2 Concurrent With Chemoradiation for Locally Advanced Esophageal Cancer

'Vaginal rejuvenation' devices 'have serious risks,' warn FDA

Some women may opt for a 'vaginal rejuvenation' procedure to improve vaginal tone or pelvic function. This can bring 'serious' health risks, say the FDA.

https://ift.tt/2vuLS7P

'Vaginal rejuvenation' devices 'have serious risks,' warn FDA

Some women may opt for a 'vaginal rejuvenation' procedure to improve vaginal tone or pelvic function. This can bring 'serious' health risks, say the FDA.

https://ift.tt/2vuLS7P

Treatment of hydroxyurea-induced ulcers with topical timolol

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2vcdyz0

Disclosure of relevant financial relationships

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2O3BqM0

Widespread elastosis perferans serpiginosa secondary to tiopronin

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2vcdj74

Who is most likely to get a tattoo? Epidemiologic study of a representative sample of 5,000 French subjects

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2O1ftNJ

White piedra

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2OCwDm0

White fibrous papulosus of the neck

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2MbOY7Q

What is the most satisfactory treatment for skin tightening according to age?

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2ODDsnq

What can hide a faun tail?

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2O1f263

Wells syndrome triggered by toxocariasis

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2OGFxPs

Voriconazole-induced phototoxicity, malignancy, and periostitis in a child with autosomal dominant hyper-IgE syndrome

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2MbedXK

Video-based education in pediatric atopic dermatitis

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2OCRANB

Video education to improve recognition of common benign and malignant cutaneous lesions and skin cancer prevention in the public

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2M9wJ2N

Verrucous psoriasis: Developing after discontinuation of ustekinumab and good response after readministration

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2v8lGQK

Venous treatment of lipodermatosclerosis to improve ambulatory function

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2AzAqNT

Validity of subclassifying warfarin-associated nonuremic calciphylaxis

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2ODRO7a

Validation of scratching severity as an objective assessment for itch

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2AzA7md

Use of cyclosporine, azathioprine, and mycophenolate mofetil in the treatment of skin disease in the United States, 2003-2014

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2n7XTMp

Utility of whole-exome sequencing in detecting novel compound heterozygous mutations in COL7A1 among families with severe recessive dystrophic epidermolysis bullosa in India—implications for diagnosis, prognosis, and prenatal testing

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2AzzNnv

Utility of TLE1 immunohistochemistry in melanoma

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2OBfOYw

Ustekinumab versus secukinumab in the treatment of severe psoriasis: Head-to-head comparison on its first year after market approval

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3, Supplement 1

Author(s):

https://ift.tt/2Azzp8x

Formononetin attenuated allergic diseases through inhibition of epithelial-derived cytokines by regulating E-cadherin

Publication date: Available online 2 August 2018

Source: Clinical Immunology

Author(s): Li Lianqu, Wang Yan, Wang Xiaoyu, Tao Yu, Bao Kaifa, Hua Yongqing, Jiang Guorong, Hong Min

Abstract

Radix Astragali, has long been used to alleviate allergic diseases (ADs). Formononetin is one of the major active components in Radix Astragali, but its mechanism on ADs is not definitively known. The fluorescein isothiocyanate isomer-induced atopic contact dermatitis mouse model and poly I:C or lipopolysaccharide-treated HaCaT cells were used to examine thymic stromal lymphopoietin (TSLP)/interleukin (IL)-33 production and expression of E-cadherin. After administration of formononetin, TSLP/IL-33 levels decreased both in vitro and in vivo, while E-cadherin was increased in vivo and restored in vitro. Furthermore, small interference RNA silencing of E-cadherin resulted in elevated levels of TSLP, whereas the inhibitory effect of formononetin on TSLP was no longer observed. In addition, TSLP resulted in no detectable changes in delocalization or protein expression of E-cadherin in HaCaT cells. These results indicated that formononetin showed a protective effect in ADs, which was correlated with decreasing TSLP/IL-33 production via regulation of E-cadherin.

https://ift.tt/2LMdDnk

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Head &Neck, EarlyView.

https://ift.tt/2McRRoP

Sublingual cysts of different entities in an infant – a case report and literature review

Publication date: Available online 2 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jan Oliver Voss, Salvatore Buehling, Nadine Thieme, Christian Doll, Kathrin Hauptmann, Max Heiland, Nicolai Adolphs, Jan-Dirk Raguse

Abstract

Background

Congenital cysts and fistulas of the neck are common in children, often located in the head and neck area. Belonging to the group of tumor-like conditions, dermoid and epidermoid cysts are dysontogenetic lesions with seldom multiple co-occurrences in infants.

Case report

We report on a nine-month-old female with a persisting congenital fistula of the tongue. The patient was admitted with acute poor feeding and hypersalivation, which started within the last 24 h. Magnetic resonance imaging detected a fistula of the tongue connected to sublingual cystic lesions. Intraoral surgical removal of three cystic lesions and the fistula was performed under general anesthesia. Histopathological analysis confirmed the coexistence of an epidermoid cyst and two dermoid cysts.

Conclusion

Sudden feeding difficulties in combination with dysphagia and tongue displacement in pediatric patients pose an emergency situation that requires prompt diagnostic clarification. A persisting congenital fistula of the tongue is a clear indication of dysontogenetic lesions, including malformations, tumors, and tumor-like lesions. Congenital sublingual cysts are rare in infants, but can be life threatening when present. Surgical excision with histopathological analysis is essential to exclude any form of malignancy and malignant transformation.

https://ift.tt/2O69eIt

Therapie bei Tumorschmerz: Vergleich der S3-Leitlinie der AWMF zur Palliativmedizin und der WHO-Leitlinie

Zusammenfassung

Hintergrund und Ziel

Die WHO-Empfehlungen zur Tumorschmerztherapie (WHO-LL) basieren auf einem Expertenkonsens von 1996. Das Kapitel „Tumorschmerz" der S3-Leitlinie „Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung" (P‑LL) orientiert sich an der EAPC-Leitlinie (European Association of Palliative Care) zu Opioiden in der Tumorschmerztherapie von 2012. Sie basiert, wann immer möglich, auf randomisierten kontrollierten Studien (RCT) hoher Qualität.

Methoden

Die WHO- und die P‑LL wurden vergleichend analysiert, zusätzlich erfolgte eine selektive Literaturrecherche zu nach der P‑LL erschienenen Publikationen.

Ergebnisse

Die Schmerzerfassung beruht v. a. auf der Schmerzanamnese, der körperlichen Untersuchung sowie der Intensitätsbeurteilung. Die Einteilung der WHO-LL in schwach wirksame Opioide (Stufe II) und stark wirksame Opioide (Stufe III) orientiert sich in der P‑LL nicht mehr nur an der Substanz, sondern an der Dosis. Als Mittel der ersten Wahl für mittlere bis starke Tumorschmerzen werden Morphin, Oxycodon und Hydromorphon genannt, L‑Methadon hat den Status einer „Kann-Empfehlung". Die Notwendigkeit einer Bedarfsmedikation wird in beiden LL erwähnt. Zu favorisieren sei immer die orale Gabe, laut P‑LL ist die transdermale Applikation „Kann-Empfehlung". Die Empfehlungen zur Nichtopioidanalgetika beschränken sich in der WHO-LL auf nichtsteroidale Antirheumatika (NSAR) bei ossären Metastasen mit Beachtung des Ceiling-Effekts. Die P‑LL erwähnt zusätzlich Metamizol bei leichten Schmerzen als Alternative zu NSAR und Paracetamol sowie die Kombination der 3 Nichtopioidanalgetika mit Stufe-III-Opioiden.

Schlussfolgerung

Die neue P‑LL beruht auf einem formalen Entwicklungsprozess, möglichst hochwertiger wissenschaftlicher Evidenz und einem Konsensusprozess. Da nur wenige RCT zur Tumorschmerztherapie bestehen, musste häufig auf Expertenmeinungen zurückgegriffen werden, und der Empfehlungsgrad ist oft niedrig oder offen. Die Unterschiede der LL sind relativ gering, nichtpharmakologische Therapieansätze fehlen in beiden LL.

https://ift.tt/2KjXWOk

Bath-Related Headache

Abstract

Purpose of Review

The purpose of this review is to summarize the most up-to-date literature on bath-related headache, a rare disorder.

Recent Findings

Initially described in middle-aged Asian women, it is now reported in a wider demographic. More information is available about the pathophysiology of bath-related headache, including its classification as a subtype of reversible cerebral vasoconstriction syndrome (RCVS). Nimodipine can be effective in patients both with and without vasospasm.

Summary

Bath-related headache is a rare form of thunderclap headache. Although its mechanism is still unclear, it is associated with vasospasm and RCVS. Controlled trials investigating the use of nimodipine and other agents may be useful in furthering our understanding of and treatment of this phenomenon.

https://ift.tt/2LJhG3E

Strides Toward Better Understanding of Post-Traumatic Headache Pathophysiology Using Animal Models

Abstract

Purpose of Review

In recent years, the awareness of the detrimental impact of concussion and mild traumatic brain injuries (mTBI) is becoming more apparent. Concussive head trauma results in a constellation of cognitive and somatic symptoms of which post-traumatic headache is the most common. Our understanding of post-traumatic headache is limited by the paucity of well validated, characterized, and clinically relevant animal models with strong predictive validity. In this review, we aim to summarize and discuss current animal models of concussion/mTBI and related data that start to shed light on the pathophysiology of post-traumatic headache.

Recent Findings

Each of the models will be discussed in terms of their face, construct, and predictive validity as well as overall translational relevance to concussion, mTBI, and post-traumatic headache. Significant contributions to the pathophysiology of PTH garnered from these models are discussed as well as potential contributors to the development of chronic post-traumatic headache.

Summary

Although post-traumatic headache is one of the most common symptoms following mild head trauma, there remains a disconnect between the study of mild traumatic brain injury and headache in the pre-clinical literature. A greater understanding of the relationship between these phenomena is currently needed to provide more insight into the increasing frequency of this debilitating condition in both military and civilian populations.

https://ift.tt/2vvIrNV

Technique for reconstruction of large clival defects through an endoscopic‐assisted tunneled retropharyngeal approach

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2LHWmLQ

Phytomanagement of trace metals in mangrove sediments of Hormozgan, Iran, using gray mangrove ( Avicennia marina )

Abstract

Trace elements (Zn, Cu, Pb, and Cd) in root and leaf tissues of the gray mangrove (Avicennia marina) and in corresponding sediment samples were studied. Samples were taken from the inflow/outflow points in two distinct habitats, i.e., the Hara Protected Area and the Azini Bay, of Hormozgan Province in south Iran. Heavy metal concentrations (μg g⁻¹ of dry weight) in the sediments of the Hara Protected Area ranged from 16.0 to 68.0 for Pb, 15.0 to 52.0 for Zn, 9.0 to 27.0 for Cu, and 1.0 to 3.3 for Cd. In the Azini Bay, these concentrations ranged from 7.1 to 27.5 for Pb, 17.1 to 55.9 for Zn, 12.1 to 37.9 for Cu, and 0.2 to 2.3 for Cd. The accumulation trend of heavy metal concentrations in the roots of A. marina was in the order Pb (16.1) > Zn (15.8) > Cu (9.3) > Cd (1.3) μg g⁻¹ of dry weight in the Hara Protected Area and in the order Zn (13.7) > Cu (9.4) > Pb (5.5) > Cd (0.6) μg g⁻¹ of dry weight in the Azini Bay. The value of translocation factor (TLF) was smaller than 1 in both regions. It was estimated from 0.44 to 0.62 in the Hara Protected Area and from 0.51 to 1.01 in the Azini Bay. The enrichment coefficient for root (ECR) varied from 0.32 to 0.93 in the Hara Protected Area and from 0.32 to 0.51 in the Azini Bay. The ratio of heavy metals in leaves/sediments (ECL) also varied from 0.01 to 0.67 in the Hara Protected Area and from 0.01 to 0.47 in the Azini Bay. The enrichment coefficient for leaf (ECL) was always lower than ECR in both regions. Based on the above findings, A. marina can be regarded as an excluder for the heavy metals examined in this study, given its low efficiency in translocating and accumulating the heavy metals in the shoots. Apart from serving as a baseline for the study area, findings could be useful for mitigating heavy metal contamination in these sensitive ecosystems through possible phytomanagement using gray mangrove.

https://ift.tt/2LJnTwp

Lesional and circulating levels of interleukin‐17 and 25‐hydroxycholecalciferol in active acne vulgaris: Correlation to disease severity

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2MaHRMM

Lesional and circulating levels of interleukin‐17 and 25‐hydroxycholecalciferol in active acne vulgaris: Correlation to disease severity

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2MaHRMM

Postoperative acute kidney injury: A never-ending challenge

No abstract available

https://ift.tt/2vs7KAx

Cardiac arrest during spinal anaesthesia in a patient with undiagnosed Brugada syndrome

No abstract available

https://ift.tt/2LMfo3N

Impact of intra-operative fluid and noradrenaline administration on early postoperative renal function after cystectomy and urinary diversion: A retrospective observational cohort study

BACKGROUND The use of noradrenaline to enable a restrictive approach to intra-operative fluid therapy to avoid salt and water overload has gained increasing acceptance. However, concerns have been raised about the impact of this approach on renal function. OBJECTIVES To identify risk factors for acute kidney injury (AKI) in patients undergoing cystectomy with urinary diversion and determine whether administration of noradrenaline and intra-operative hydration regimens affect early postoperative renal function. DESIGN Retrospective observational cohort study. SETTING University hospital, from 2007 to 2016. PATIENTS A total of 769 consecutive patients scheduled for cystectomy and urinary diversion. Those with incomplete data and having pre-operative haemodialysis were excluded. MAIN OUTCOME MEASURES AKI was defined as a serum creatinine increase of more than 50% over 72 postoperative hours. Multiple logistic regression analysis was performed to model the association between risk factors and AKI. RESULTS Postoperative AKI was diagnosed in 86/769 patients (11.1%). Independent predictors for AKI were the amount of crystalloid administered (odds ratio (OR) 0.79 [95% confidence interval (CI), 0.68 to 0.91], P = 0.002), antihypertensive medication (OR 2.07 [95% CI, 1.25 to 3.43], P = 0.005), pre-operative haemoglobin value (OR 1.02 [95% CI, 1.01 to 1.03], P = 0.010), duration of surgery (OR 1.01 [95% CI, 1.00 to 1.01], P = 0.002), age (OR 1.32 [95% CI, 1.44 to 1.79], P = 0.002) but not the administration of noradrenaline (OR 1.09 [95% CI, 0.94 to 1.21], P = 0.097). Postoperative AKI was associated with longer hospital stay (18 [15 to 22] vs. 16 [15 to 19] days; P = 0.035) and a higher 90-day major postoperative complication rate (41.9 vs. 27.5%; P = 0.002). CONCLUSION Noradrenaline administration did not increase the risk for AKI. A too restrictive approach to administration of crystalloids was associated with an increased risk for AKI, particularly in older patients, those receiving antihypertensive medication, and those whose surgery was prolonged. As AKI was associated with longer hospital stay and increased postoperative morbidity, these observations should be taken into account to improve outcome when addressing peri-operative fluid management. TRIAL REGISTRATION Not applicable.

https://ift.tt/2Mcrpf1

Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

BACKGROUND Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING Operating rooms of six hospitals in Europe and USA. DESIGN Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml−1; P

https://ift.tt/2LNhrEH

Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery: A case–control study with propensity matching

BACKGROUND Goal-directed fluid therapy (GDFT) has been associated with improved patient outcomes. However, implementation of GDFT protocols remains low despite growing published evidence and the recommendations of multiple regulatory bodies in Europe. We developed a closed-loop-assisted GDFT management system linked to a pulse contour monitor to assist anaesthesiologists in applying GDFT. OBJECTIVE To assess the impact of our closed-loop system in patients undergoing major abdominal surgery in an academic hospital without a GDFT programme. DESIGN A case–control study with propensity matching. SETTING Operating rooms, Erasme Hospital, Brussels. PATIENTS All patients who underwent elective open major abdominal surgery between January 2013 and December 2016. INTERVENTION Implementation of our closed-loop-assisted GDFT in April 2015. METHODS A total of 104 patients managed with closed-loop-assisted GDFT were paired with a historical cohort of 104 consecutive non-GDFT patients. The historical control group consisted of patients treated before the implementation of the closed-loop-system, and who did not receive GDFT. In the closed-loop group, the system delivered a baseline crystalloid infusion of 3 ml kg−1 h−1 and additional 100 ml fluid boluses of either a crystalloid or colloid for haemodynamic optimisation. MAIN OUTCOME MEASURES The primary outcome was intra-operative net fluid balance. Secondary outcomes were composite major postoperative complications, composite minor postoperative complications and hospital length of stay (LOS). RESULTS Baseline characteristics were similar in both groups. Patients in the closed-loop group had a lower net intra-operative fluid balance compared with the historical group (median interquartile range [IQR] 2.9 [1.6 to 4.4] vs. 6.2 [4.0 to 8.3] ml kg−1 h−1; P

https://ift.tt/2vuGwtf

Epidrum is an unreliable device for identifying the thoracic epidural space

No abstract available

https://ift.tt/2LLj461

Safety of moderate-to-deep sedation performed by sedation practitioners: A national prospective observational study

BACKGROUND In the Netherlands, a significant proportion of moderate-to-deep sedation is performed by sedation practitioners under the indirect supervision of an anaesthesiologist but there are limited safety data available. OBJECTIVE To estimate the rate of sedation-related adverse events and patient relevant outcomes (PRO). DESIGN This was a prospective national observational study. Data were collected with a modified adverse event reporting tool from the International Sedation Task Force of the World Society of Intravenous Anaesthesia. SETTING A total of 24 hospitals in the Netherlands where moderate-to-deep sedation was performed by sedation practitioners from the 1 February 2015 to 1 March 2016. PATIENTS Consecutive adults undergoing moderate-to-deep sedation for gastrointestinal, pulmonary and cardiac procedures. INTERVENTION Observation: Analysis included descriptive statistics and a multivariate logistic regression model for an association between adverse events and PRO. MAIN OUTCOME MEASURES The primary outcome was the rate of unfavourable PRO (admission to ICU, permanent neurological deficit, pulmonary aspiration or death). Secondary outcome was the rate of moderate-to-good PRO (unplanned hospital admission or escalation of care). Composite outcome was the sum of all primary and secondary outcomes. RESULTS A total of 11 869 patients with a median age of 64 years [interquartile range 51 to 72] were included. ASA physical score distribution was: first, 19.1%; second, 57.6%; third, 21.6%; fourth, 1.2%. Minimal adverse events occurred in 1517 (12.8%), minor adverse events in 113 (1.0%) and major adverse events in 80 instances (0.7%). Primary outcome: Five (0.04%) unfavourable PRO were observed; four patients needing admission to the intensive care unit; and one died. Secondary outcome: 12 (0.1%) moderate-to-good PRO were observed. Moderate and major adverse events were associated with the composite outcome [3.7 (95% confidence interval 1.1 to 11.9) and 40.6 (95% confidence interval 11.0 to 150.4)], but not minimal or minor adverse events. CONCLUSION Moderate-to-deep sedation performed by trained sedation practitioners has a very low rate of unfavourable outcome.

https://ift.tt/2Mcr4ZN

The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study

BACKGROUND Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs. OBJECTIVE We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data. DESIGN This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study. SETTINGS A total of 146 hospitals across 29 countries. PATIENTS Adult patients requiring intra-operative ventilation during general anaesthesia for surgery. INTERVENTIONS The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation. MAIN OUTCOME MEASURES Prediction performance of developed models for PPCs. RESULTS Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample. CONCLUSION The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov, number NCT01601223.

https://ift.tt/2LNt1zA

Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A 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/2MehUfg

Sudden-onset trismus after respiratory arrest in a patient with an acute exacerbation of hereditary angioedema

No abstract available

https://ift.tt/2LNsSw2

Does a hypnosis session reduce the required propofol dose during closed-loop anaesthesia induction?: A randomised controlled trial

BACKGROUND Hypnosis has a positive effect on peri-operative anxiety and pain. OBJECTIVE The objective of this study was to assess the impact of a formal deep hypnosis session on the consumption of propofol for anaesthetic induction using automated administration of propofol guided by the bispectral index (BIS) in a closed loop. DESIGN A 1 : 1 randomised, usual-care-controlled, single-centre trial. SETTING Tertiary care centre in France from April 2014 to December 2015. PATIENTS Female adult patients scheduled for outpatient gynaecological surgery under general anaesthesia. INTERVENTION Before surgery, patients were randomised to receive either a deep hypnosis session or routine care. Anaesthetic induction was performed automatically by propofol without opioids and was assisted by the BIS in a closed loop. MAIN OUTCOME MEASURES The primary endpoint was the propofol dose required for anaesthesia induction, defined as a BIS less than 60 for at least 30 s. RESULTS Data for 31 patients in the hypnosis group and 35 in the control group were analysed. There was no evidence of a difference in the mean required propofol dose for anaesthetic induction between the hypnosis and the control groups (2.06 mg kg−1 (95% confidence interval [1.68 to 2.43]) versus 1.79 mg kg−1 (95% CI [1.54 to 2.03]), P = 0.25, respectively). CONCLUSION The current study, which was designed to determine the effect of a deep hypnosis session on anaesthesia induction using an automated tool for propofol administration, failed to detect a difference in the required dose of propofol. TRIAL REGISTRATION ClinicalTrials.gov, NCT02249364.

https://ift.tt/2McqUBF

Comparative study of concordance between bispectral index recordings obtained from the standard frontal and infra-orbital sensor position

No abstract available

https://ift.tt/2LNsKwy

Peri-operative copeptin concentrations and their association with myocardial injury after vascular surgery: A prospective observational cohort study

BACKGROUND Copeptin levels in conjunction with cardiac troponin may be used to rule out early myocardial infarction in patients presenting with chest pain. Raised pre-operative copeptin has been shown to be associated with postoperative cardiac events. However, very little is known about the peri-operative time course of copeptin or the feasibility of very early postoperative copeptin measurement to diagnose or rule-out myocardial injury. OBJECTIVES In this preparatory analysis for a larger trial, we sought to examine the time course of peri-operative copeptin and identify the time at which concentrations returned to pre-operative levels. Second, in an explorative analysis, we sought to examine the association of copeptin in general and at various time points with myocardial injury occurring within the first 48 h. DESIGN Preparatory analysis of a prospective, observational cohort study. SETTING Single university centre from February to July 2016. PATIENTS A total of 30 consecutive adults undergoing vascular surgery. INTERVENTION Serial peri-operative copeptin measurements. MAIN OUTCOME MEASURE We measured copeptin concentrations before and immediately after surgery (0 h), then at 2, 4, 6 and 8 h after surgery and on the first and second postoperative day. Postoperative concentrations were compared with pre-operative levels with a Wilcoxon signed-rank test. Second, we explored an association between postoperative copeptin concentrations and myocardial injury by the second postoperative day. Myocardial injury was defined as a 5 ng l−1 increase between pre-operative and postoperative high-sensitivity cardiac troponin T with an absolute peak of at least 20 ng l−1. RESULTS Immediate postoperative copeptin concentrations (median [interquartile range]) increased nearly eight-fold from pre-operative values (8.5 [3.6 to 13.8] to 64.75 pmol l−1 [29.6 to 258.7]; P

https://ift.tt/2MfDsbH

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 2 Αυγούστου 2018

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