Head and Neck Diseases by Alexandros G.Sfakianakis: 12/06/18

Πέμπτη 6 Δεκεμβρίου 2018

Cheaper drugs and techniques to fulfill chief executive officer perspectives – any choices?

Purpose of review Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. Recent findings Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change – even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. Summary Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort. Correspondence to Professor Thomas Ledowski, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia. Tel: +61 8 92242244; e-mail: Thomas.ledowski@health.wa.gov.au Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QLERfD

Withholding or withdrawing life support versus physician-assisted death: a distinction with a difference?

Purpose of review Withholding or withdrawing life-sustaining therapy is generally differentiated from physician-assisted suicide or euthanasia based on the distinction between intention and foresight. We reviewed the literature surrounding the validity of this distinction. Recent findings Many physicians from different specialties express a perceived distinction between intention and foresight. The distinction between intention and foresight differs from the morally irrelevant distinction between doing and allowing. Intention and foresight may be distinguished by their opposing directions of fit between world and mind. Intention is held to be of greater moral significance than foresight because it guides and constrains our actions, determines the moral quality of our actions, and expresses the moral character of the agent. Opponents of the distinction argue that it undermines moral accountability for foreseen consequences of our actions and is overly concerned with the physician's state of mind rather than the patient's experience. They also argue that intentions may be vague and difficult to express or ascertain. Summary Several reasons may be given in favor of the distinction between intention and foresight. Given this distinction, the moral permissibility of withholding or withdrawing life-sustaining therapy does not necessarily entail the moral permissibility of physician-assisted suicide or euthanasia. Correspondence to Ewan C. Goligher, MD, PhD, Toronto General Hospital, 585 University Ave., Peter Munk Building, 11-192, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340 4800 ext. 6810; e-mail: ewan.goligher@utoronto.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2SxLM9f

Role of anesthesiologists in managing perioperative anemia

Purpose of review Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. Recent findings Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedure during surgery. Restrictive transfusion triggers in adult cardiac surgery have been shown to be beneficial in the majority of studies. Elderly patients and defined comorbidities might require higher transfusion triggers. Both, intravenous and oral iron increase hemoglobin values when given prior to surgery. Oral iron is effective when given several weeks prior to elective surgery. Erythropoietin is a treatment decision individualized to each patient. Summary Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide. Correspondence to Andrea U. Steinbicker, MD, MPH, Westfalische Wilhelms-Universitat Munster, Muenster; Muenster University Hospital, Albert-SChweitzer Campus 1, Building A1, 48149 Muenster, Germany. Tel: +0049 251 83 47898; e-mail: andrea.steinbicker@ukmuenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2SwyUAg

Preoperative rehabilitation for thoracic surgery

Purpose of review Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways. Recent findings Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved through interventions such as smoking cessation programmes, correction of anaemia, improvement of nutritional status and improved oral hygiene. These interventions may also have the additional benefit of enabling high-risk patients previously deemed unsuitable for surgery to be optimized to such a degree that they can undergo surgery. These interventions will achieve maximal benefit when delivered early in lung cancer pathways; this requires close collaboration amongst multidisciplinary teams. Summary Lung cancer surgery carries significant risk of postoperative pulmonary complications. Through integrating prehabilitation interventions into lung cancer pathways, there are opportunities to improve long-term outcomes for patients. Correspondence to Richard Templeton, MB.ChB, FRCA, Wythenshawe Hospital, Manchester Foundation Trust, Southmoor Road, Manchester M23 9LT, UK. Tel: +441612914514; e-mail: rtempleton7@doctors.org.uk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QJPBes

Sodium-glucose cotransporter-2 inhibitors: an overview and perioperative implications

Purpose of review Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors. Recent findings Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden. In addition, there is a reduction in HbA1c levels, blood pressure, weight and readmissions secondary to heart failure in this patient population. However, these drugs have been also associated with an increased incidence of adverse events, such as euglycemic ketoacidosis, urinary tract infections, acute kidney injury and limb amputations. Summary SGLT 2 inhibitors are being increasingly prescribed secondary to their significant salutatory effect in patients with type II diabetes mellitus. Although there are no perioperative consensus guidelines for management of patients on SGLT2 inhibitors, they should be discontinued at least 24–48 h prior to major surgeries. Their overall management in the perioperative period should be carried out on a case-to-case basis using a multidisciplinary approach. Correspondence to Amit Bardia, MBBS, Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06515, USA. E-mail: amit.bardia@yale.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Sw3D0c

Ethical lessons learned and to be learned from mass casualty events by terrorism

Purpose of review The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. Recent findings Several responses in the literature over the past few years have attempted to reflect where the battlefront of ethical dilemmas falls. These include issues of resource allocation, triage, bioterror, the therapeutic relationship with terrorists, dual loyalty, and challenges in the role in the promotion of virtuous behavior as a physician under difficult conditions. Summary Although many challenges exist, physicians need to be prepared for ethical response to terror. With their associated unique status, providing legitimacy and specialized ability in the management and approach to terror situations, physicians are held to a higher standard and need to rise to the occasion. This is required in order to promote ethical behavior under trying conditions and ethical sensitivity of the medical profession by means of being attuned to the reality around. Correspondence to Rael D. Strous, MD, MHA, Mayanei Hayeshua Medical Center, 17 HaRav Povarski Street, Bnei Brak, Israel. Tel: +972 73 3398015; fax: +972 73 3398003; e-mail: raels@post.tau.ac.il Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QCDXSj

The ethics of treating family members

Purpose of review Many medical professionals receive requests from family and friends asking for medical advice and treatment. But should medics treat their family? Ethically can we treat, or refuse to treat, family members? This is a common ethical challenge that most doctors face during their career and there is limited evidence available. By examining ethical principles, we aim to answer these questions and provide a framework that will guide decision making in this area. Recent findings There is a paucity of evidence available. Many ethical systems exist and have been discussed since ancient Greece but in recent years, bioethics has become more prominent in medical thinking and debate. Summary We examine ethical systems such as virtue ethics, utilitarianism, deontology and principlism and how they relate to treating family members. We then look at cases in different contexts and describe a system for approaching such cases, allowing doctors to conform to moral standards, and consider ethical arguments, prior to embarking upon any treatment course with a relative. Correspondence to Paul C. McConnell, MB, ChB (Hons), FRCA, EDIC, FFICM, Consultant Intensive Care Medicine, Royal Alexandra Hospital, Paisley PA2 9PJ, Scotland. Tel: +0141 314 6609; e-mail: paulmcconnell@nhs.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QDCb3j

Resource allocation in ICU: ethical considerations

Purpose of review Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. Recent findings The problem of fair and ethical resource allocation has perpetually plagued health care. Recent work has looked at value for money, benefits of therapies and how we define futility, but these still fall victim to the same problems that classical schools of ethical thought have tried to tackle. Summary Many ethical principles provide a framework on which to allocate resources to certain cohorts of patients, however, most appear too rigid to be fully and primarily utilized for intensive care admission. We suggest a collaboration of principles be applied to achieve a moral, ethical and common sense approach to this issue. Over resourcing and under resourcing is also suggested to be problematic for patients and healthcare workers alike. Correspondence to Paul C. McConnell, MB ChB (Hons) FRCA EDIC FFICM, Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9QF, UK. Tel: +0141 314 6609; e-mail: paulmcconnell@nhs.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2SwRZlJ

Nonstandard do-not-resuscitate orders

Purpose of review Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. Recent findings Studies show both providers and patients confuse the meaning and implication of DNR orders. In the United States, out-of-hospital DNR orders are legislated at the state level. Most states standardized out-of-hospital DNR orders so caregivers can immediately recognize and accept the order and act on its behalf. These out-of-hospital orders are complicated by the need to be printed on paper that does not always accompany the individual. Oregon created an online system whereby individuals recorded their end-of-life wishes that medical personnel can access with an Internet connection. This system improved communication of end-of-life wishes in patients who selected comfort care only. Summary To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification. Correspondence to Gregory E. Holt, MD, PhD, University of Miami School of Medicine, Miami, FL 33136, USA. E-mail: gholt@miami.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2SwRW9x

CD8‐positive lymphomatoid papulosis (type D): Some lesions may lack CD30 expression and overlap histologically with mycosis fungoides

Abstract

Background

CD8⁺ lymphomatoid papulosis is frequently indistinguishable histopathologically from primary cutaneous aggressive epidermotropic CD8⁺ T‐cell lymphoma except for the expression of CD30. However, absent or weak expression of CD30 has been rarely reported in cases of CD8⁺ LyP.

Objective

We aim to study the clinical and pathologic features of cases of CD8⁺ LyP with no or minimal expression of CD30.

Material and Methods

We identified all cases of CD8⁺ LyP diagnosed in our institution over a period of 10 years. Blinded comparison of clinical and histopathologic features of cases with and without CD30 expression was performed.

Results

Among seven cases (four patients) with definitive clinical and histopathologic diagnosis of CD8⁺ LyP, two cases (29%) had no expression of CD30. These two cases had more prominent epidermotropism, less epidermal ulceration, and less vascular damage relative to cases with CD30 expression and therefore resembled mycosis fungoides and type B LyP. CD5 and CD7 were frequently lost regardless of the CD30 status. Expression of cytotoxic markers was not different between the two groups. In the two cases with lack of CD30 expression, subsequent biopsies showed classic features of CD8⁺ LyP with strong expression of CD30.

Conclusion

CD8⁺ LyP with lack of expression of CD30 may have distinct histopathologic features that resemble mycosis fungoides and LyP type B. Clinically, they are indistinguishable from their CD30⁺ counterparts, signifying the importance of clinical correlation to avoid the erroneous diagnosis of lymphoma. Interval biopsies may be needed to establish a definitive diagnosis.

https://ift.tt/2SARYNV

Direct and Collateral Alterations of Functional Cortical Circuits in a Rat Model of Subcortical Band Heterotopia

Abstract

Subcortical band heterotopia (SBH), also known as double-cortex syndrome, is a neuronal migration disorder characterized by an accumulation of neurons in a heterotopic band below the normotopic cortex. The majority of patients with SBH have mild to moderate intellectual disability and intractable epilepsy. However, it is still not clear how cortical networks are organized in SBH patients and how this abnormal organization contributes to improper brain function. In this study, cortical networks were investigated in the barrel cortex in an animal model of SBH induced by in utero knockdown of Dcx, main causative gene of this condition in human patients. When the SBH was localized below the Barrel Field (BF), layer (L) four projection to correctly positioned L2/3 pyramidal cells was weakened due to lower connectivity. Conversely, when the SBH was below an adjacent cortical region, the excitatory L4 to L2/3 projection was stronger due to increased L4 neuron excitability, synaptic strength and excitation/inhibition ratio of L4 to L2/3 connection. We propose that these developmental alterations contribute to the spectrum of clinical dysfunctions reported in patients with SBH.

https://ift.tt/2G467Si

Effect of brightness and contrast variation for detectability of root resorption lesions in digital intraoral radiographs

Abstract

Objectives

To evaluate the performance of periapical radiography assessed under different radiographic brightness and contrast variations in the detection of simulated internal (IRR) and external (ERR) root resorption lesions. Additionally, observers' preferences related to image quality for these diagnostic tasks were evaluated.

Methods

Thirty single-root teeth were divided into two groups (n = 15): IRR, in which lesions were simulated using mechanical and biochemical processes; and ERR, in which cavities standardized with drills of different sizes were performed on the root surfaces. Digital radiographs were obtained and subsequently adjusted in 4 additional combinations, resulting in 5 brightness/contrast variations (V1–V5). Five radiologists evaluated the radiographs. The observers' preference on the image quality was also recorded.

Results

For both conditions, there were no differences in the accuracy and specificity between the five brightness/contrast variations (p > 0.05), but the sensitivity for ERR was significantly lower in V4 (+ 15% brightness/−15% contrast) in the large size (p < 0.05). The observers classified V2 (− 15% brightness/+15% contrast) as the "best" image quality for IRR and ERR evaluation.

Conclusions

For IRR and ERR lesions, brightness and contrast variation does not affect the diagnostic performance of digital intraoral radiography within the tested range. The observers prefer images with a reasonable decrease in brightness and increase in contrast.

Clinical relevance

Brightness and contrast enhancement tools are commonly applied in digital radiographic assessment. The use of these tools for detection of root resorptions can be applied according to the observer preference without influence on diagnostic accuracy.

https://ift.tt/2G46aNY

Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review

Abstract

Background

Biofilm management and infection control are essential after periodontal and implant surgery. In this context, chlorhexidine (CHX) mouth-rinses are frequently recommended post-surgically. Despite its common use and many studies in this field, a systematic evaluation of the benefits after periodontal or implant surgery is—surprisingly—still missing.

Objectives

To evaluate the benefits of chlorhexidine rinsing after periodontal or implant surgery in terms of plaque and inflammation reduction potential. Furthermore, to screen whether the concentration changes or additives in CHX solutions reduce side effects associated with its use.

Materials and methods

A systematic literature search was performed for clinical trials, which compared CHX rinsing after periodontal or implant surgery with rinsing using placebo, non-staining formulations, or solutions with reduced concentrations of the active compound. Four databases (Medline, PubMed, Embase, Cochrane) were searched up to June 2018. Two reviewers independently identified and screened the literature.

Results

From 691 titles identified, only eleven publications met the inclusion criteria and were finally included. Mainly early publications assessed the benefits of CHX over placebo rinsing, whereas more recent publications focused more on the evaluation of new formulations with regard to effectiveness and side effects. The use of CHX after surgery showed in general significant reduction in plaque (means of 29–86% after 1 week) and bleeding (up to 73%) as compared to placebo. No consensus, however, was found regarding the most beneficial CHX formulation avoiding side effects.

Conclusion

Chlorhexidine rinsing helps to reduce biofilm formation and gingival inflammation after surgery. However, no additional reduction of periodontal probing depth over any given placebo or control solution could be found irrespective of whether CHX was used or not. The use of additives such as antidiscoloration systems (ADS) or herbal extracts may reduce side effects while retaining efficacy.

Clinical relevance

Within the limitations of this review, it can be concluded that CHX may represent a valuable chemo-preventive tool immediately after surgery, during the time period in which oral hygiene capacity is compromised. To reduce the side effects of CHX and maintain comparable clinical effects, rinsing with less concentrated formulations (e.g., 0.12%) showed the most promising results so far.

https://ift.tt/2rlbwKy

Recycled gypsum board acted as a mineral swelling agent for improving thermal conductivity characteristics in manufacturing of green lightweight building brick

Abstract

Lightweight building bricks manufactured from non-hazardous residues incorporating mineral foaming agents have been successfully developed over past two decades. Very little information is available on recycling and reutilization of construction and demolition waste used as the pore foaming agent in manufacturing lightweight brick. In this research, the mineral swelling agent was gypsum board recycled from construction and demolition waste. The mineral swelling agent effect on the characteristics of green lightweight building materials sintered from drinking water purification (DWP) sludge was investigated. Green lightweight building materials were contained up to 50% (wt%) mineral swelling agent and fired at a temperature ranged between 950 °C and 1050 °C. The experimental results indicated that lightweight building materials have successfully sintered between 1000 °C and 1020 °C and added up to 40% (wt%) recycled gypsum board. The sintered building materials have the characteristics of relatively high compressive strength, low bulk density, and thermal conductivity that were in compliance with relevant Taiwan criteria for application in lightweight building materials. To further consider the eco-friendly and environmental safety of lightweight building materials, the recycled gypsum board can act as a good mineral swelling agent, but can also enhance the chemical stabilization and reduce the metals leachability of lightweight materials based on acidic neutralization capacity (ANC) analysis results. To estimate the carbon dioxide emission in manufacturing and transportation of lightweight materials that sintered this experimental conditions, the estimated carbon dioxide reduction rates were approximately 28.6% and 16.7%, respectively, as a result of the energy saving. Experimental results have confirmed that the feasibility of recycled gypsum board used as a swelling agent and good potential for construction works in green lightweight building materials.

https://ift.tt/2E6VAmw

Intracerebroventricular administration of sulfated CCK octapeptide induces anxiety‐like behavior in goldfish

Abstract

Sulfated cholecystokinin octapeptide (CCK‐8s) is involved in feeding regulation as an anorexigenic neuropeptide in vertebrates. In rodents, intracerebroventricular (ICV) administration of CCK‐8s has been shown to affect not only feeding behavior, but also psychomotor activity. However, there is still no information regarding the psychophysiological effects of CCK‐8s in goldfish. Therefore, we examined the effect of synthetic goldfish (gf) CCK‐8s on psychomotor activity in this species. ICV administration of gfCCK‐8s at 0.1, 0.5 and 2.5 pmol/g body weight (BW) did not affect swimming distance (locomotor activity). Since intact goldfish prefer the lower to the upper area of a tank, we used this as a preference test (upper/lower test) for assessing anxiety‐like behavior. ICV administration of gfCCK‐8s at 2.5 pmol/g BW shortened the time spent in the upper area. The action of gfCCK‐8s mimicked that of FG‐7142 (the central‐type benzodiazepine receptor inverse agonist, an anxiogenic agent) at 5 and 10 pmol/g BW. The anxiogenic‐like effect of gfCCK‐8s was abolished by treatment with the CCK receptor antagonist proglumide at 50 pmol/g BW. We also investigated the localization of CCK/gastrin‐like immunoreactivity in the goldfish brain. CCK/gastrin‐like immunoreactivity was observed in the anxiety‐related regions (the nucleus habenularis and the interpeduncular nucleus). These data indicate that gfCCK‐8s potently affects psychomotor activity in goldfish, and exerts an anxiogenic‐like effect via the CCK receptor‐signaling pathway.

https://ift.tt/2RMcevG

Electrophysiological Properties of Identified Oxytocin and Vasopressin Neurons

Abstract

To understand the contribution of intrinsic membrane properties to the different firing patterns of oxytocin (OT) and vasopressin (VP) neurons in vivo, in vitro studies are needed, where stable intracellular recordings can be made. Combining immunochemistry for OT and VP and intracellular dye injections allows characterization of identified OT and VP neurons, and several differences between the two cell types have emerged. These include a greater transient K⁺ current that delays spiking to stimulus onset, and a higher Na⁺ current density leading to greater spike amplitude and a more stable spike threshold, in VP neurons. VP neurons also show a greater incidence of both fast and slow Ca²⁺‐dependent depolarizing afterpotentials, the latter of which summate to plateau potentials and contribute to phasic bursting. In contrast, OT neurons exhibit a sustained outwardly rectifying potential (SOR), and a consequent depolarizing rebound potential, not found in VP neurons. The SOR makes OT neurons more susceptible to spontaneous inhibitory synaptic inputs and correlates with a longer period of spike frequency adaptation in these neurons. While both types exhibit prominent Ca²⁺‐dependent afterhyperpolarizing potentials (AHPs) that limit firing rate and contribute to bursting patterns, Ca²⁺‐dependent AHPs in OT neurons selectively show significant increases during pregnancy and lactation. In OT, but not VP neurons, AHPs are highly dependent on the constitutive presence of the second messenger, phosphatidylinositol 4,5‐bisphosphate, which permissively gates N‐type channels that contribute the Ca²⁺ during spike trains that activates the AHP. In contrast to the intrinsic properties supporting phasic bursting in VP neurons, the synchronous bursting of OT neurons has only been demonstrated in vitro in cultured hypothalamic explants and is completely dependent on synaptic transmission. Additional differences in Ca²⁺ channel expression between the two neurosecretory terminal types suggests these channels are also critical players in the differential release of OT and VP during repetitive spiking, in addition to their importance to the potentials controlling firing patterns.

https://ift.tt/2Qe8CpE

Both the Filler Amount and Columellar Elasticity Are Important in Injection Rhinoplasty in the Columella

No abstract available

https://ift.tt/2RFPbmi

Patient‐Centered Oncology or Population‐Centered Oncology—Which Do We Want, and Which Tradeoffs Are We Willing To Accept?

https://ift.tt/2PokAHS

Bisphenol S exposure affects gene expression related to intestinal glucose absorption and glucose metabolism in mice

Abstract

Bisphenol S, an industrial chemical, has raised concerns for both human and ecosystem health. Yet, health hazards posed by bisphenol S (BPS) exposure remain poorly studied. Compared to all tissues, the intestine and the liver are among the most affected by environmental endocrine disruptors. The aim of this study was to investigate the molecular effect of BPS on gene expression implicated in the control of glucose metabolism in the intestine (apelin and its receptor APJ, SGLT1, GLUT2) and in the liver (glycogenolysis and/or gluconeogenesis key enzymes (glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK)) and pro-inflammatory cytokine expression (TNF-α and IL-1β)). BPS at 25, 50, and 100 μg/kg was administered to mice in water drink for 10 weeks. In the duodenum, BPS exposure reduces significantly mRNA expression of sodium glucose transporter 1 (SGLT1), glucose transporter 2 (GLUT2), apelin, and APJ mRNA. In the liver, BPS exposure increases the expression of G6Pase and PEPCK, but does not affect pro-inflammatory markers. These data suggest that alteration of apelinergic system and glucose transporters expression could contribute to a disruption of intestinal glucose absorption, and that BPS stimulates glycogenolysis and/or gluconeogenesis in the liver. Collectively, we reveal that BPS heightens the risk of metabolic syndrome.

https://ift.tt/2rqUXg0

Retraction: Visual evaluation of train-of-four and double burst stimulation, fade at various currents, using a rubber band. Saitoh Y, Nakazawa K, Makita K, et al.

No abstract available

https://ift.tt/2G1qcJ2

Targeting the affective component of pain with ketamine: A tool to improve the postoperative experience?

No abstract available

https://ift.tt/2rnx7lB

Prediction of bilateral cerebral oxygen desaturation from a single sensor in adult cardiac surgery

No abstract available

https://ift.tt/2G1q6Ba

Uterine tilt for caesarean section

No abstract available

https://ift.tt/2roj8fb

Continuous haemodynamic effects of left tilting and supine positions during Caesarean section under spinal anaesthesia with a noninvasive cardiac output monitor system

No abstract available

https://ift.tt/2GgiI55

Low-dose ketamine infusion reduces postoperative hydromorphone requirements in opioid-tolerant patients following spinal fusion: A randomised controlled trial

BACKGROUND The current opioid epidemic highlights the urgent need for effective adjuvant therapies to complement postoperative opioid analgesia. Intra-operative ketamine infusion has been shown to reduce postoperative opioid consumption and improve pain control in opioid-tolerant patients after spinal fusion surgery. Its efficacy for opioid-naïve patients, however, remains controversial. OBJECTIVE We hypothesised that low-dose ketamine infusion after major spinal surgery reduces opioid requirements in opioid-tolerant patients, but not in opioid-naïve patients. DESIGN Randomised placebo-controlled study. SETTING Single-centre, tertiary care hospital, November 2012 until November 2014. PATIENTS A total of 129 patients were classified as either opioid-tolerant (daily use of opioid medications during 2 weeks preceding the surgery) or opioid-naïve group, then randomised to receive either ketamine or placebo; there were thus four groups of patients. All patients received intravenous hydromorphone patient-controlled analgesia postoperatively. INTERVENTION Patients in the ketamine groups received a ketamine infusion (bolus 0.2 mg kg−1 over 30 min followed by 0.12 mg kg−1 h−1 for 24 h). Patients in the placebo groups received 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was opioid consumption during the first 24 h postoperatively. The secondary outcome was numerical pain scores during the first 24 h and central nervous system side effects. RESULTS Postoperative hydromorphone consumption was significantly reduced in the opioid-tolerant ketamine group, compared with the opioid-tolerant placebo group [0.007 (95% CI 0.006 to 0.008) versus 0.011 (95% CI 0.010 to 0.011) mg kg−1 h−1, Bonferroni corrected P

https://ift.tt/2rqLjtU

Reply to: fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2G1pNq0

Ketamine stakes in 2018: Right doses, good choices

No abstract available

https://ift.tt/2G0oQ0P

Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery: A randomised double-blind placebo controlled study

BACKGROUND When administered as a continuous infusion, ketamine is known to be a potent analgesic and general anaesthetic. Recent studies suggest that a single low-dose administration of ketamine can provide a long-lasting effect on mood, but its effects when given in the postoperative period have not been studied. OBJECTIVE We hypothesised that a single low-dose administration of ketamine after bariatric surgery can improve pain and mood scores in the immediate postoperative period. DESIGN We performed a randomised, double-blind, placebo-controlled study to compare a single subanaesthetic dose of ketamine (0.4 mg kg−1) with a normal saline placebo in the postanaesthesia care unit after laparoscopic gastric bypass and gastrectomy. SETTING Single-centre, tertiary care hospital, October 2014 to January 2018. PATIENTS A total of 100 patients were randomised into the ketamine and saline groups. INTERVENTION Patients in the ketamine group received a single dose of ketamine infusion (0.4 mg kg−1) in the postanaesthesia care unit. Patients in the placebo groups received 0.9% saline. OUTCOME MEASURES The primary outcome was the visual analogue pain score. A secondary outcome was performance on the short-form McGill's Pain Questionnaire (SF-MPQ). RESULTS There were no significant differences in visual analogue pain scores between groups (group-by-time interaction P = 0.966; marginal group effect P = 0.137). However, scores on the affective scale of SF-MPQ (secondary outcome) significantly decreased in the ketamine group as early as postoperative day (POD) 2 [mean difference = −2.2 (95% bootstrap CI −2.9 to 1.6), Bonferroni adjusted P

https://ift.tt/2rqLdm2

Cerebral oximetry monitoring. To guide physiology, avert catastrophe or both?

No abstract available

https://ift.tt/2GcNqMq

Shared decision-making for postoperative analgesia: A semistructured qualitative study

BACKGROUND Shared decision-making (SDM) and decision-support tools have attracted broad support in healthcare as they improve medical decision-making. Experts disagree on how these can help patients evaluate their present situation and possible outcomes of therapy, and how they might reduce decisional conflict. Little is known about their implementation, especially in anaesthesiology. OBJECTIVE To obtain a more fundamental understanding of pre-operative SDM and evaluate the use of a decision-support tool for postoperative analgesia after major thoracic and abdominal surgery. DESIGN A qualitative study with semistructured, in-depth interviews of patients and professionals. SETTING Patient recruitment took place at the Radboud University Medical Centre in Nijmegen and the Canisius Wilhelmina Hospital in Nijmegen, a nonacademic teaching centre. Professionals of the Radboud University Medical Centre were invited to participate in the interviews. PARTICIPANTS Interviews were performed with 10 individual patients and two focus groups both consisting of eight different professionals. MAIN OUTCOME MEASURES To gain insight into the provision of pre-operative information, decision-making processes and the clarity and usability of a prototype decision-support tool. RESULTS Professionals seemed to provide their patients with information directed towards the application of epidural analgesia, providing little attention to its negative effects. For many patients, the information was not tailored to their needs. Patients' involvement in decision-making was minimal, but they did not feel a need for more involvement. They were positive about the decision-support tool, although they indicated that it would not have influenced their treatment decision. Professionals expressed their doubt about the capacity of their patients to fully understand the decisions involved and about the clinical usability of the decision-support tool, because patients might misinterpret the information provided. CONCLUSION The results of this study suggest that both patients and professionals did not adhere to some 'self-evident' principles of SDM when postoperative analgesia after major thoracic and abdominal surgery was discussed.

https://ift.tt/2rqL7uG

Short- and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial

BACKGROUND The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN A single-blind, randomised controlled trial. SETTING A tertiary care teaching hospital in The Netherlands, from 2014 to 2016. PATIENTS A total of 126 patients aged between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy (coronary artery bypass grafts and/or valve replacement) were included. Exclusion criteria were BMI above 35 kg m−2, history of cardiac surgery, chronic pain conditions, neurological conditions, allergy to opioids or paracetamol, language barrier and pregnancy. INTERVENTIONS Patients were allocated randomly to receive intra-operatively either a continuous remifentanil infusion or intermittent intra-operative fentanyl as needed in addition to standardised anaesthesia with propofol and intermittent intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES Warm and cold detection and pain thresholds 3 days and 12 months after surgery. In addition the use of remifentanil, presence of postoperative chronic pain, age, opioid consumption and pre-operative quality of life were tested as a predictor for altered pain sensitivity 12 months after surgery. RESULTS Both warm and cold detection, and pain thresholds, were not significantly different between the remifentanil and fentanyl groups 3 days and 12 months after surgery (P > 0.05). No significant predictors for altered pain sensitivity were identified. CONCLUSION Earlier reports of increased pain sensitivity 1 year after the use of remifentanil could not be confirmed in this randomised study using Quantitative Sensory Testing. This indicates that remifentanil plays a minor role in the development of chronic thoracic pain. Still, the relatively high incidence of chronic thoracic pain and its accompanying impact on quality of life remain challenging problems. TRIAL REGISTRATION The study was registered at EudraCT (ref: 2013-000201-23) and ClinicalTrials.gov (https://ift.tt/2Mq69Sn).

https://ift.tt/2rqL4Pw

Assessing the effect of dexmedetomidine in patients with pre-eclampsia

No abstract available

https://ift.tt/2rqL3eq

Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time (73.0 ± 14.8 and 86.6 ± 5.7 min; P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P

https://ift.tt/2G2I1XT

Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study

BACKGROUND Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications. OBJECTIVES To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery. DESIGN Randomised, controlled and double-blind study. SETTING The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014. PATIENTS A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain. INTERVENTIONS Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery). MAIN OUTCOME MEASURE The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h. RESULTS In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported. CONCLUSION Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population.

https://ift.tt/2G59594

Fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2rpSzGp

Reply to: fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2rxsllH

Incidence of peri-operative paediatric cardiac arrest and the influence of a specialised paediatric anaesthesia team: Retrospective cohort study

BACKGROUND Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN Retrospective cohort study with before-and-after analysis. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. PATIENTS A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016. INTERVENTION Implementation of a specialised paediatric anaesthesia team and training programme occurred in 2014 This included hands-on supervised training in all fields of paediatric anaesthesia, double staffing for critical paediatric cases and a 24/7 emergency team. A logistic regression analysis with risk factors (age, ASA physical status, emergency) was used to evaluate the impact of implementation of the specialised paediatric anaesthesia team. MAIN OUTCOME MEASURES Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention. RESULTS Twelve of 25 paediatric cardiac arrests were classified as anaesthesia-attributable. The incidence of overall peri-operative paediatric cardiac arrest was 8.1/10 000 (95% CI 5.2 to 12.7) in the period 2008 to 2013 and decreased to 4.6/10 000 (95% CI 2.1 to 10.2) in 2014 to 2016. Likewise, the incidence of anaesthesia-attributable cardiac arrest was lower after 2013 [1.6/10 000 (95% CI 0.3 to 5.7) vs. 4.3/10 000 (95% CI 2.3 to 7.9)]. Using logistic regression, children anaesthetised after 2013 had nearly a 70% lower probability of anaesthesia-attributable cardiac arrest (odds ratio 0.306, 95% CI 0.067 to 1.397; P = 0.1263). For anaesthesia-attributable cardiac arrest, young age was the most contributory risk factor, whereas in overall paediatric cardiac arrest, ASA physical statuses 3 to 5 played a more important role. CONCLUSION In this study on incidences of peri-operative paediatric cardiac arrest from a European tertiary care university hospital, implementation of a specialised paediatric anaesthesia team and training programme was associated with lower incidences of peri-operative paediatric cardiac arrest and a reduced probability of anaesthesia-attributable cardiac arrest.

https://ift.tt/2G0oNlF

Reply to: prediction of bilateral cerebral oxygen desaturation from a single sensor in adult cardiac surgery

No abstract available

https://ift.tt/2rqKNfs

Reply to: fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2G1pNq0

The effect of pectoral block type II on persistent pain: Follow up of a randomised trial and hypotheses for further analyses

No abstract available

https://ift.tt/2rqJ8Xw

Retraction: Visual evaluation of train-of-four and double burst stimulation, fade at various currents, using a rubber band. Saitoh Y, Nakazawa K, Makita K, et al.

No abstract available

https://ift.tt/2G1qcJ2

Targeting the affective component of pain with ketamine: A tool to improve the postoperative experience?

No abstract available

https://ift.tt/2rnx7lB

Prediction of bilateral cerebral oxygen desaturation from a single sensor in adult cardiac surgery

No abstract available

https://ift.tt/2G1q6Ba

Uterine tilt for caesarean section

No abstract available

https://ift.tt/2roj8fb

Continuous haemodynamic effects of left tilting and supine positions during Caesarean section under spinal anaesthesia with a noninvasive cardiac output monitor system

No abstract available

https://ift.tt/2GgiI55

Low-dose ketamine infusion reduces postoperative hydromorphone requirements in opioid-tolerant patients following spinal fusion: A randomised controlled trial

Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery: A randomised double-blind placebo controlled study

Cerebral oximetry monitoring. To guide physiology, avert catastrophe or both?

No abstract available

https://ift.tt/2GcNqMq

Shared decision-making for postoperative analgesia: A semistructured qualitative study

Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study

Ketamine stakes in 2018: Right doses, good choices

No abstract available

https://ift.tt/2G0oQ0P

Short- and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial

Assessing the effect of dexmedetomidine in patients with pre-eclampsia

No abstract available

https://ift.tt/2rqL3eq

Fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2rpSzGp

Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

Reply to: fluid therapy for critical haemorrhage during elective noncardiac surgery

No abstract available

https://ift.tt/2rxsllH

Incidence of peri-operative paediatric cardiac arrest and the influence of a specialised paediatric anaesthesia team: Retrospective cohort study

Reply to: prediction of bilateral cerebral oxygen desaturation from a single sensor in adult cardiac surgery

No abstract available

https://ift.tt/2rqKNfs

Dentin isotopic reconstruction of individual life histories reveals millet consumption during weaning and childhood at the Late Neolithic (4500 bp) Gaoshan site in southwestern China

Abstract

Here, we present results of a pilot project that measured δ¹³C and δ¹⁵N values in bone collagen (ribs and femora) as well as dentin serial sections to examine individual dietary life histories at a Late Neolithic (4500 bp) site known as Gaoshan Ancient City (高山古城) located on the Chengdu Plain in Sichuan Province, China. The isotopic data of the bones indicate that humans consumed C₃‐based foods, which corresponds to the dominance of rice agriculture in this region. However, the isotopic data of the dentin serial sections of five individuals display much more positive δ¹³C values than those of the bones, strongly suggesting that millets (a C₄ crop) contributed substantially to human diets during the weaning process and early childhood. Furthermore, the isotopic profiles of dentin sections of the first molars and canines demonstrate that the cession of weaning was individually variable and completed between ~2.5 and 4 years of age. Although limited in scope, this pilot study offers new evidence of millet consumption during human growth and development even though individuals relied on rice exclusively as adults. Moreover, our study provides another perspective with which to rethink the role that millets played during the development and spread of millet agriculture to the south of China in terms of cultural exchange and migration.

https://ift.tt/2roeFcp

Issue Information ‐ TOC

No abstract is available for this article.

https://ift.tt/2GgeV7R

Auditory exostosis: Exploring the daily life at an early sedentary population (Körtik Tepe, Turkey)

Abstract

Auditory exostosis (AE) is a bony anomaly located on the tympanic portion of the temporal bone. Cold water, wind chill, and the effects of temperature are considered to be contributors to the development of AE. It is frequently encountered among surfers, lifeguards, whitewater kayakers, swimmers, and divers. Accordingly, there is a strong relationship between prolonged exposure to cold water and the frequency and grade of AE. For this reason, AE can be accepted as an occupational anomaly.

In this study, AE from Körtik Tepe, Turkey, were analysed to understand the lifestyle of early hunter gatherer populations from Anatolia. One hundred twenty‐eight individuals and 174 temporal bones from Körtik Tepe were examined for the frequency and severity (graded) of AE. Forty‐five individuals (35.2%) have exostosis of various sizes. Half of 40 male individuals and 42.5% of females (n: 40) have AE with no statistically significant difference between the sexes. First observed in individuals 7 years of age, severity and frequency of AE increase with age. Besides increasing in frequency, the increase in size of AE suggest a continuous and prolonged exposure to cold water.

The people of Körtik Tepe, which is surrounded by numerous freshwater sources, must have been subjected to cold water through activities such as bathing, cleaning, swimming, and playing in the water, as well as fishing. Our results suggest that the lifestyle of early sedentary people in Körtik Tepe was rather egalitarian with little or no gender differences and was closely connected to aquatic sources. Bioarchaeological data suggest that Körtik Tepe can be accepted as a community of hunter‐gatherer‐fishermen.

https://ift.tt/2rqsfvY

Over 4,500 years of trepanation in Poland: From the unknown to therapeutic advisability

Abstract

This paper discusses 6 trepanned skulls from central Poland, dating from the late Neolithic (3,000–2,800 BC) to early modern times (18th century AD). Four of them come from a small area in and around the town of Brześć Kujawski in Kujawy, a region of long‐lasting and intense human settlement in Poland. The analysed skulls provide striking evidence for the long history of trepanation in this part of Europe. Three surgical techniques were used: sawing, scraping, and drilling, either on their own or in combination with one another. Regardless of the method, all the trepanations were fully healed, which proves long‐term survival of the patients. All skulls belonged to adult males, who were generally at a higher risk of trauma in the populations from which 4 of the specimens derive. The studied skulls demonstrate a marked evolution in trepanation practices over time. Trepanations from the late medieval and early modern times tend to be smaller, less life threatening, and clearly made for therapeutic purposes to remedy cranial injuries. The remarkable skills of the surgeons who performed them could be linked to the influence of the renowned Danzig Anatomical School in Gdańsk, which was one of the leading centres of medical and anatomical research in northern and central Europe in the 17th and 18th centuries.

https://ift.tt/2G4GqRp

Genetic profiling of basal cell carcinomas detects postzygotic mosaicism in basal cell naevus syndrome

Summary

Basal cell naevus syndrome (BCNS) is associated with germline mutations in the PTCH1 gene. Postzygotic mosaicism can also cause BCNS. Here we describe two patients, one with multiple basal cell carcinomas (BCCs) and one with clinical BCNS, who had no PTCH1 mutation in DNA extracted from blood. In both patients, we performed genetic analysis on different BCCs, revealing the presence of a shared PTCH1 mutation in all tumours. Our findings show that in patients with symptoms of BCNS and initial absence of a PTCH1 mutation in blood, genetic profiling of BCCs can detect postzygotic mosaicism.

https://ift.tt/2QinG5N

Genetic profiling of basal cell carcinomas detects postzygotic mosaicism in basal cell naevus syndrome

Summary

https://ift.tt/2QinG5N

Issue Information

https://ift.tt/2E9v0tl

Looking back to move forward

https://ift.tt/2QHw3ag

Issue Information

https://ift.tt/2E9v0tl

Looking back to move forward

https://ift.tt/2QHw3ag

Quantitative analysis of carotid arterial calcification using airway CT in obstructive sleep apnea

To evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT).

https://ift.tt/2SwJneO

Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study

In the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.

https://ift.tt/2EiYaGW

Randomized phase II trial of the prophylactic use of celecoxib for the prevention of oxaliplatin-related peripheral vascular pain in Capeox (YCOG1205)

Abstract

Purpose

Capeox is widely used as an adjuvant chemotherapy regimen of colorectal cancer that does not require central vein catheter insertion. However, oxaliplatin-related vascular pain with peripheral administration is a major adverse event. We assessed the preventive effect of Celecoxib on oxaliplatin-related vascular pain.

Methods

A multicenter study of the Yokohama Clinical Oncology Group (YCOG) in Japan. This study was an open label, randomized non-comparative phase II study between Capeox without Celecoxib (C+ Group) and with it (C− group). The primary endpoint was the appearance frequency of grade ≥ 2 vascular pain according to the Verbal Rating Scale (VRS).

Results

Between October 2012 and February 2014, 81 patients were recruited to this study and randomly divided into 2 groups: 38 patients in the C− group and 39 patients in the C+ group. Four cases were excluded at the analysis stage because they had not received the allocated intervention. The rate of grade ≥ 2 vascular pain was 55.3% in the C− group and 53.8% in the C+ group (p = 1.000).

Conclusions

Celecoxib was unable to prevent oxaliplatin-related vascular pain in this study. However, it may be able to decrease the vascular pain that patients already have.

https://ift.tt/2AY8Gzp

Concentrations and chemical fractions of Cu, Zn, Cd, and Pb at ten metallurgical sites in China

Abstract

Metal pollution in urban soils due to smelting and electroplating has become a severe problem in China. In this study, the concentration, chemical fraction, and leaching behavior of typical metals (Cu, Zn, Cd, and Pb) in soil samples from ten metallurgical sites were studied. The results show that some of the soils were polluted with Cu and most were heavily polluted with multiple metals, especially Zn, Cd, and Pb. The average concentration of Cu, Zn, Cd, and Pb was 498, 4145, 89, and 5091 mg/kg, respectively. Chemical fractionation revealed that Cu, Zn, Cd, and Pb were mainly present in the acid-soluble fraction in polluted soils, but predominated in the residual fraction in unpolluted soils, demonstrating that allogenic metals in the soils were mostly present in the more labile fractions. Toxicity characteristic leaching procedure results were in agreement with the chemical fractionation study, indicating that the higher the total metal content, the higher the leachability, mobility, bioavailability, and potential toxicity to the environment, especially groundwater. Use of chemical fractionation results instead of total metal concentrations would provide better insight into the distribution and binding forms of metals for better assessment of their mobility and bioavailability. The study would provide much more important information for developing better remediation strategies for contaminated sites.

https://ift.tt/2SzwctS

CT-based dose recalculations in head and neck cancer radiotherapy: comparison of daily dose recalculations to less time-consuming approaches

Abstract

Background

The goal of this study was to investigate if daily dose recalculations are necessary or if less time-consuming approaches can be used to identify dose differences to the planned dose in patients with head and neck cancers (H&N).

Methods

For 12 H&N patients treated with helical tomotherapy, daily dose calculations were performed retrospectively. Four different summation doses (SuDo) were calculated: DayDo (daily dose calculation), MVCTx2, MVCTx5, and MVCTx10 (dose calculations every second, fifth, and tenth fraction). Dose recalculations were depicted on the last contoured mega voltage CT (MVCT). The DayDo was compared to the planned dose and to the less time-consuming SuDo scenarios. The doses were assessed for the planning target volume (PTV) and the organs at risk (OARs): mandible (mand), spinal cord (SC), spinal cord +5 mm (SC+5 mm), parotid glands (PG).

Results

The ipsilateral PG, contralateral PG, and PTV volume decreased by −22.5% (range: −34.8 to 5.2%), −19.5% (−31.5 to 15.8%), and −2.6% (−16.7 to 0.2%), respectively. There was a significant median mean dose (Dmean) dose difference for DayDo compared to the planned dose for PG total of 1.9 Gy (−3.3 to 7.3 Gy). But less time-consuming SuDo compared to DayDo showed statistically significant but not clinically relevant (<2%) dose differences for several organs. Hence the small dose difference to the gold standard (DayDo), we recommend dose recalculations every fifth MVCT in order to identify the occurrence of dose differences compared to the planned dose.

Conclusion

Daily dose calculations are the most precise to assess dose differences between actual and planned dose. Dose recalculations on every fifth MVCT (i. e., weekly control CTs) are an applicable and time-saving way of identifying patients with significant dose differences compared to the planned dose.

https://ift.tt/2E4yiOj

Expression of Insulinoma-Associated Protein 1 (INSM1) and Orthopedia Homeobox (OTP) in Tumors with Neuroendocrine Differentiation at Rare Sites

Abstract

Insulinoma-associated protein 1 (INSM1) and orthopedia homeobox (OTP) are transcription factors that play a critical role in neuroendocrine (NE) and neuroepithelial cell development. INSM1 has been identified in multiple tumors of NE or neuroepithelial origin, whereas OTP expression has been mainly studied in NE tumors of pulmonary origin. Expression of OTP appears to correlate with poorer prognosis in pulmonary carcinoids; however, its expression patterns in other NE/neuroepithelial tumors need further investigation. Here, we assessed the diagnostic utility of INSM1 and OTP in tumors with NE differentiation at relatively uncommon sites including prostate, breast, and tumors of gynecologic origin. Thirty-two formalin-fixed, paraffin-embedded cases were used to construct a tissue microarray. Immunohistochemistry for INSM1 and OTP was performed and scored semi-quantitatively. INSM1 was diffusely expressed in 60% of gynecologic tumors, 71.4% of mammary carcinoma, and 25% of prostate adenocarcinoma with NE differentiation. Diffuse expression of OTP was detected in 50% of prostate adenocarcinoma with NE differentiation and 100% neuroendocrine carcinoma of the ovary. Immunostain for achaete-scute homolog 1, chromogranin, synaptophysin, and CD56 supported the NE and/or neuroepithelial differentiation of the tumors. In summary, INSM1 is expressed in most of the tumors with NE and neuroepithelial differentiation in this study, confirming the diagnostic utility of INSM1 as a novel and sensitive marker of NE/neuroepithelial differentiation. The expression of OTP in some NE tumors outside of lung expands the spectrum of tumors that may express this biomarker and should be considered when working up a NE tumor of unknown primary site.

https://ift.tt/2E21vt4

Environmental temperature and air humidity and prevalence of maxillary sinus retention cysts: possible relationships (preliminary study)

Abstract

Objectives

The aims of this study were to determine the prevalence of maxillary sinus retention cysts (MSRCs) and to evaluate the effects of mean temperature and mean air humidity on the prevalence of MSRCs in two cities in Turkey.

Methods

This retrospective study was conducted in Antalya and Erzurum, two cities with different air humidities and temperatures in Turkey. Panoramic images of patients who visited the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University and Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University for diagnostic purposes were evaluated. A total of 4800 panoramic images were included in the study. The mean age of the patients was 27.03 ± 6.48 years. The prevalence of MSRCs was analyzed according to sex, mean temperature, and mean air humidity. Values of p < 0.05 were considered statistically significant.

Results

Among the 4800 panoramic images evaluated, 228 indicated the presence of MSRCs. MSRCs were found significantly more frequently in males than in females. The prevalence was 3% in Antalya and 6.5% in Erzurum, with a total prevalence of 4.8%. While there was a significant correlation between the total amount of cysts and monthly mean air humidity in Erzurum, the correlation effect size was very low.

Conclusions

The total prevalence of MSRCs was 4.8%. There were no correlations between the frequency of MSRCs and the mean air humidity or mean temperature.

https://ift.tt/2QFUG7g

Application of carotenoid to alleviate the oxidative stress caused by phenanthrene in wheat

Abstract

It is reported that the accumulated polycyclic aromatic hydrocarbons (PAHs) can cause wheat leaf chlorosis, and we identified that carotenoid (Car) and superoxide dismutase (SOD) are the two most active factors in antioxidant system in the previous study. Herein, we applied Car as an exogenous chemical added to alleviate the toxicity triggered by phenanthrene (a model PAH) in wheat seedlings. In the exogenous Car addition groups, we found that the leaf number would grow three, and the relative biomass and the relative root length of 20 mg L⁻¹ Car added would take positive changes that increased by 171.35% and 108.08% of the phenanthrene-treated group at day 9, respectively. Under the subcellular structure, vacuole would be clear and clean, chloroplast and mitochondria shapes turned normal in the exogenous Car addition groups, and their osmophilic particle densities were much lower than the phenanthrene-treated group. Chlorophyll a, chlorophyll b, and total chlorophyll concentrations also recovered after Car was added in the phenanthrene treatments for 9 days. The activity of SOD, another active factor, also decreased when Car was added, and the values dropped to 16.54 and 24.61 U g⁻¹ for the 10 and 20 mg L⁻¹ Car addition groups, respectively. Like the SOD activity, malondialdehyde (MDA) concentrations of the two Car addition groups decreased to 26.50% and 26.87% of the phenanthrene treatment. The relative concentrations of 5 kinds of amino acids (valine, alanine, proline, aspartic acid, and lysine) recovered significantly, and the principal component analysis suggested that amino acid concentrations were in recovery progress when Car was added in phenanthrene treatments. Therefore, it is concluded that Car is an effective PAH toxicity relief. Our result offers a new way to improve the plant resistance to PAH pollution in the environment.

Graphical abstract

https://ift.tt/2EhA1kj

Pretreatment Hearing Level—Another Prognostic Factor in Sudden Sensorineural Hearing Loss

To the Editor We read with great interest the article titled "Association of Vertigo With Hearing Outcomes in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis" by Yu et al. The authors concluded that vertigo may be negatively associated with hearing recovery in patients with sudden sensorineural hearing loss (SSHL).

https://ift.tt/2PoLJdO

Association of Audiometric Age-Related Hearing Loss With Depressive Symptoms in Hispanic Individuals

This multicenter, cross-sectional study uses Community Health Study/Study of Latinos data collected from 4 US communities to assess whether an association exists between age-related, audiometrically measured hearing loss and clinically relevant depressive symptoms in Hispanic adults 50 years or older.

https://ift.tt/2zOweqJ

Publication Bias and Systematic Reviews in Top-Ranked Otolaryngology Journals

This study analyzes whether 324 systematic reviews that contain at least 1 meta-analysis with 10 or more primary studies published in top otolaryngology journals that do not evaluate for publication bias show evidence of such bias.

https://ift.tt/2PmNh8o

Pretreatment Hearing Level—Another Prognostic Factor in Sudden Sensorineural Hearing Loss—Reply

In Reply We thank Dr Wu and colleagues for their interest and comments on our research. Various factors may affect hearing recovery after SSHL, such as age, degree of hearing loss, type of hearing loss, interval from onset of symptoms to treatment, tinnitus, type 2 diabetes, cardiovascular disease, and the presence of vertigo. We were unable to include the hearing level at onset into our analyses owing to the lack of corresponding data in the included studies. Moreover, only 1 of the included studies assessed the possible association between the presence of vertigo and hearing recovery in patients with severe sudden sensorineural hearing loss (≥60 dB). We also think that the opinion by Dr Wu et al that the presence of vertigo is significantly correlated only with hearing recovery in the group with profound SSHL may have implications for the understanding of the mechanisms of SSHL with vertigo, but we were unable to retrieve the raw data. At present, the pathogenesis, clinical manifestations, optimal treatments, and prognostic factors of SSHL are not clear. We are in the process of validating the occurrence of vertigo and its possible role in SSHL. A complete analysis of this role will require more unbiased studies with prospectively gathered data in a large sample size to estimate the precise association of vertigo with the clinical manifestation and prognosis of SSHL.

https://ift.tt/2zNmYTN

Whatever Happened to Local Otolaryngology Societies?

This essay describes the importance of, and decline of membership in, specialty medical societies.

https://ift.tt/2PoHvmH

Anterior Nasal Cavity Mass in a Neonate

A newborn twin girl was evaluated for a left-sided nasal mass causing nasal obstruction and difficulty breathing; physical examination showed a firm, pedunculated polypoid mass in the anterior nasal cavity at the vestibule with no fluid in the mass. What is your diagnosis?

https://ift.tt/2zJiyNS

Benefit of cetuximab addition to a platinum–fluorouracil-based chemotherapy according to KRAS-LCS6 variant in an unselected population of recurrent and/or metastatic head and neck cancers

Abstract

Objectives

To evaluate the benefit of cetuximab (Cx) addition to platinum-based and 5-fluorouracil chemotherapy (PFU) in unselected recurrent and/or metastatic head and neck cancer patients (R/MHNC) according to KRAS-LCS6 variant status.

Methods

All patients who received at least two PFU ± Cx cycles from 2004 to 2014 were retrospectively included into to two distinct study periods according to Cx implementation: patients treated by PFU alone before 2009 and those treated by PFU + Cx from 2009. Primary objective was to evaluate the progression-free survival (PFS) between the two groups. Secondary objectives were to analyze the overall survival (OS) between the two groups and the prognostic impact of KRAS-LCS6 variant. Factors associated with survival were determined by a Cox multivariate analysis including age, WHO performance status (PS), type of treatment, KRAS-LCS6 variant, Charlson's score and p16 status.

Results

Overall, 134 patients were included: 59 (44%) in PFU group and 75 (56%) in PFU + Cx group. Baseline characteristics were well balanced including 30% of patients with 2–3 PS. Median PFS was significantly improved in PFU + Cx group compared to PFU group (6.1 vs 4.4 months, respectively, HR 0.68, p = 0.02) and with a trend for better OS. A KRAS-LCS6 variant was found in 27 (25%) of samples without prognostic impact neither in whole population nor according to treatment. In multivariate analysis, addition of Cx to PFU was the only factor significantly associated with a better PFS (p = 0.01, HR 0.6).

Conclusion

Our results suggest that PFU + Cx combination may be effective in unselected population of R/MHNC regardless the KRAS-LCS6 variant status.

https://ift.tt/2L3wPte

Efficacy of abdominal peripheral nerve block and caudal block during robot-assisted laparoscopic surgery: a retrospective clinical study

Abstract

Purpose

We retrospectively analyzed the efficacy of abdominal peripheral nerve block (PNB) and caudal block (CB) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP).

Methods

Patients who underwent elective RARP at our hospital (Jan. 2015–Sept. 2016) were enrolled. We reviewed the 188 patients' anesthesia charts and medical records and divided the patients into three groups based on the anesthesia used in their cases: 76 patients in the total intravenous anesthesia (TIVA) group, 51 patients in the TIVA + abdominal PNB group (TI-PB group), and 61 patients in the TIVA + abdominal PNB + CB (TI-PB-CB group). We compared the groups' amounts of anesthetic drug usage, anesthesia times, and the presence/absence of additional opioid administration in the recovery room.

Results

The perioperative opioid use during anesthesia was significantly greater in the TIVA group than in the TI-PB-CB group. The total amount of muscle relaxant was significantly higher (p < 0.001) in the TIVA group than the TI-PB-CB group: 60.0 (50.0–70.0) mg vs. 50.0 (40.0–60.0) mg. Although there were no significant differences in the operation time, the frequency of the use of additional opioid administration was significantly higher (p < 0.01) in the TIVA group than the TI-PB group: 23.7% vs. 2.0%, respectively.

Conclusions

Although there was no influence on the anesthesia time, the muscle relaxant dose and the perioperative amount of opioid use were significantly less in the combined PNB + CB group. Our analyses suggest that not only PNB but also CB was useful for perioperative management in RARP.

Clinical trial registration

2016-1059.

https://ift.tt/2zOpUzo

Utility of first positron emission tomography‐computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies

Abstract

Background

The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined.

Methods

We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved.

Results

Thirty‐eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5‐year survival was significantly lower in the first posttreatment PET/CT‐positive group (35%) compared to the PET/CT‐negative group (93%) (P = .0008).

Conclusion

Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.

https://ift.tt/2UiYpXD

Crystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial

Abstract

Background

Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading.

Objective

We hypothesize that the mean blood pressure drop is greater when coloading with crystalloids.

Design

Prospective, observational clinical trial.

Setting

Two-centre study conducted in Berlin, Germany.

Patients

Parturients scheduled for a Caesarean section were screened for eligibility.

Intervention

The study protocol and patient monitoring were based on the standard operating procedure for Caesarean section in both centres. The data from the crystalloid group were prospectively collected between November 2014 and July 2015.

Main outcome measures

The primary endpoint was the median drop in mean blood pressure after induction of spinal anaesthesia. Secondary endpoints were incidence of hypotension (drop > 20% of baseline systolic pressure /drop < 100 mmHg), vasopressor and additional fluid requirements (mL), incidence of bradycardia (heart rate < 60 beats per minute), blood loss, Apgar score, and umbilical artery pH. In case of hypotension, patients received phenylephrine or cafedrine/theodrenaline according to their heart rate. A p < 0.05 was considered significant.

Results

345 prospectively enrolled patients (n = 193 crystalloid group vs. n = 152 colloid group) were analysed. The median drop in mean blood pressure was greater in the crystalloid group [34 mmHg (25; 42 mmHg) vs. 21 mmHg (13; 29 mmHg), p < 0.001]. Incidences of hypotension [93.3% vs. 83.6%, p: 0.004] and bradycardia [19.7% vs. 9.9%, p: 0.012] were also significantly greater in the crystalloid group. Vasopressor requirements, blood loss and neonatal outcome were not different between the groups.

Conclusions

Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid.

Trial registration

DRKS00006783 (http://www.drks.de).

https://ift.tt/2PmSkWc

Study of Anti-PD-1 Antibody SHR-1210 Plus Nimotuzumab in the Treatment of Advanced Esophageal Squamous Cell Carcinoma

Condition: Esophageal Squamous Cell Carcinoma
Intervention: Drug: Nimotuzumab + SHR-1210
Sponsor: The First Affiliated Hospital of Zhengzhou University
Not yet recruiting

https://ift.tt/2EiiWGG

Study of Anti-PD-1 Antibody SHR-1210 Plus Nimotuzumab in the Treatment of Advanced Esophageal Squamous Cell Carcinoma

Urbanization impact on residential energy consumption in China: the roles of income, urbanization level, and urban density

Abstract

This paper investigated the impact of urbanization on residential energy consumption (REC) in China by taking cognizance of the levels of income, urbanization and urban density. Threshold analyses were employed to investigate the nonlinear relationships based on the STIRPAT (Stochastic Impacts by Regression on Population, Affluence, and Technology) framework using a balanced panel dataset of 29 provinces of China over the period of 1998–2014. The common correlated effects mean group estimator (CCEMG) was used to address time-series cross-section (TSCS) issues. The results confirmed the existence of the nonlinear relationship between urbanization and REC in China. The impact of urbanization on REC varied at different economic development levels and urbanization levels. Specifically, urbanization decreased REC at the stage that per capita disposable income of urban residents (PDI) less than 2615 USD, while it increased REC at the stage that PDI higher than 2615 USD. Similarly, urbanization decreased REC at the stage that urbanization rate lower than 55.31% and increased REC after urbanization rate exceeded 55.31%. This study did not find evidence to support the urban environmental transition theory, indicating there was still no region in China had stepped into the win-win stage of urbanization and energy consumption. Furthermore, the nonlinear impact of urban density on REC was estimated and the results indicated that urban density exerted a positive effect on REC when urban density was lower than 808 inhabitants per square kilometer, while it was no longer relevant to REC after that threshold point. Based on these results, the corresponding countermeasures and suggestions to achieve low-carbon urbanization were put forward.

https://ift.tt/2UljNLF

Isolation and identification of endogenous RFRP1 and RFRP3 in the mouse hypothalamus

Abstract

Although RFamide‐related peptide (RFRP) preproprotein sequence is known in mice, until now the molecular structure of the mature, functional peptides processed from the target precursor molecule has not been determined. In the present study we purified endogenous RFRP1 and RFRP3 peptides from mouse hypothalamic tissue extracts using immunoaffinity column conjugated with specific antibodies against the mouse C‐terminus of RFRP‐1 and RFRP‐3. Employing liquid chromatography coupled with mass spectrometry (LC‐MS) we demonstrated, that RFRP1 consists of 15 and RFRP3 of 10 amino acid residues (ANKVPHSAANLPLRF‐NH₂ and SHFPSLPQRF‐NH₂, respectively). To investigate the distribution of RFRPs in the mouse central nervous system (CNS), we performed immunohistochemical (IHC) staining of the brain sections collected from wild‐type (WT) and Rfrp knock‐out (Rfrp KO) animals. This data together with gene expression in multiple tissues provides strong confidence that RFRP‐immunoreactive (RFRP‐ir) neuronal cells are localized in the dorsomedial (DMH) and between DMH and the ventromedial (VMH) hypothalamic nuclei. The identification of RFRP1 and RFRP3 peptides and the IHC visualization of targeting RFRPs neurons in the mice brain provide the basis for the investigations into a functional biology of RFRPs.

https://ift.tt/2AVkiTZ

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 6 Δεκεμβρίου 2018

Abstract

Background

Objective

Material and Methods

Results

Conclusion

Abstract

Objectives

Methods

Results

Conclusions

Clinical relevance

Abstract

Background

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Summary

Summary

Abstract

Purpose

Methods

Results

Conclusions

Abstract

Abstract

Background

Methods

Results

Conclusion

Abstract

Abstract

Objectives

Methods

Results

Conclusions

Abstract

Abstract

Objectives

Methods

Results

Conclusion

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

Abstract

Background

Methods