Head and Neck Diseases by Alexandros G.Sfakianakis: 01/15/19

Τρίτη 15 Ιανουαρίου 2019

Medications for Chronic Conditions and Periodontal Disease

Abstract

Purpose of the Review

This study aims to review the current literature and consider the use of medication in the medical literature and medication in the treatment of periodontal inflammation. Review articles and non-human studies were avoided. Pain-killers and antibiotics were not covered. Modified tetracycline was, however, included. Non-surgical periodontal therapy remains standard of care procedure in the management of periodontal inflammation.

Recent Findings

There is a large volume of publications with findings from adjunct treatment of periodontitis using non-steroidal anti-inflammatory drugs, also including aspirin. In recent years (2015–2018), there are with the exception of in vitro and animal studies. There are currently few human studies assessing the safety and efficacy of such medication to treat periodontal inflammation alone. In contrast, the medical literature has a large volume of such studies to control inflammatory processes. Foremost, studies primarily on cardiovascular diseases, rheumatoid arthritis, and osteoporosis have contributed information on the use of statins, bisphosphonates, cytokine inhibitors, and prednisone in the management of inflammation. Several of these studies have also identified that patients on such medication may benefit from reduced clinical evidence of periodontal inflammation. Due to side effects from many anti-inflammatory medications sole treatment of periodontal inflammation has yet to be considered. Diet rich in flavonoids may also provide potential benefits in the control of periodontal inflammation.

Summary

There is currently no scientific evidence to suggest anti-inflammatory treatment of periodontal inflammation. There are in vitro and non-human studies suggesting that some anti-inflammatory drugs may be effective in reducing the extent of periodontal inflammation. It should be recognized that patients under medical care may receive added dental benefits as the result of anti-inflammatory treatment of another systemic disease.

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Decreased recognition of paraneoplastic pemphigus in patients previously treated with anti‐CD 20 monoclonal antibodies

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Decreased recognition of paraneoplastic pemphigus in patients previously treated with anti‐CD 20 monoclonal antibodies

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Response to letter to the editor

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Levels, distributions, and ecological risk assessments of polybrominated diphenyl ethers and alternative flame retardants in river sediments from Vaal River, South Africa

Abstract

Sediments are known to be the ultimate sink for most pollutants in the aquatic environment. In this study, the concentrations of both legacy polybrominated diphenyl ethers (PBDEs) and alternative halogenated flame retardants (AHFRs) were measured in sediments samples from the Vaal River catchment. The concentrations of Σ₇BDE-congeners ranged from 20 to 78 ng g⁻¹ dry weight (dw) with BDE-209, -99, and -153 as the dominant congeners. The concentrations observed ranged from 9.4–56, 4–32, and 1–10.6 ng g⁻¹ for BDE-209, -99, and -153, respectively. The concentrations of AHFRs, mainly contributed by decabromodiphenyl ethane (DBDPE) at approximately 95% of total AHFRs, ranged from 64 to 359 ng g⁻¹ dw while the concentration of polybrominated biphenyls (PBBs), mainly PBB-209, ranged from 3.3–7.1 ng g⁻¹ dw. The ratios of AHFRs to PBDEs observed in this study were 0.76, 1.17, and 7.3 for 2-ethyl-1-hexyl-2,3,4,5-tetrabromobenzoate and bis-(2-ethylhexyl)-tetrabromophthalate (EH-TBB & BEH-TEBP)/penta-BDE; 1,2-bis-(2,4,6-tribromophenoxy) ethane (BTBPE)/octa-BDE; and DBDPE/BDE209, respectively. These results indicate dominance of some AHFRs compared to PBDEs. Our results indicates that BDE-99 poses high risk (RQ > 1) while BDE-209 posed medium risk (0.1 < RQ < 1). Though the concentration of DBDPE was several orders of magnitude higher than BDE209, its ecological risk was found to be negligible (RQ < 0.01). Thus, more attention is required to regulate the input (especially the e-waste recycling sites) of brominated flame retardants into the environment.

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The dilemma of the “ischemic-looking” electrocardiogram: Pulmonary embolism or acute coronary syndrome?

Paurush Ambesh, Aditya Kapoor, Sudeep Kumar, Sunil K Jain

Annals of Cardiac Anaesthesia 2019 22(1):89-91

Pulmonary embolism (PE) may be potentially fatal if not diagnosed and treated in time. Although specific electrocardiogram (ECG) findings often suggest the diagnosis of PE, occasionally, the ECG may mimic that of an acute coronary syndrome (ACS). We report an interesting case of a 45-year-old female presenting with sudden onset chest pain and shortness of breath with widespread ST depression in anterior precordial leads. Although initially treated and referred as a case of ACS, careful analysis of the ECG and subsequent echocardiography and computed tomography imaging confirmed the diagnosis of PE. Intensivists and cardiologists need to be aware that diagnostic dilemma between PE and ACS is not uncommon due to such "ischemic-looking" ECG as well as elevated troponin levels in both conditions. The use of multimodality imaging techniques is helpful in arriving at the correct diagnosis.

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Cardiac output monitoring: Technology and choice

Jeff Kobe, Nitasha Mishra, Virendra K Arya, Waiel Al-Moustadi, Wayne Nates, Bhupesh Kumar

Annals of Cardiac Anaesthesia 2019 22(1):6-17

The accurate quantification of cardiac output (CO) is given vital importance in modern medical practice, especially in high-risk surgical and critically ill patients. CO monitoring together with perioperative protocols to guide intravenous fluid therapy and inotropic support with the aim of improving CO and oxygen delivery has shown to improve perioperative outcomes in high-risk surgical patients. Understanding of the underlying principles of CO measuring devices helps in knowing the limitations of their use and allows more effective and safer utilization. At present, no single CO monitoring device can meet all the clinical requirements considering the limitations of diverse CO monitoring techniques. The evidence for the minimally invasive CO monitoring is conflicting; however, different CO monitoring devices may be used during the clinical course of patients as an integrated approach based on their invasiveness and the need for additional hemodynamic data. These devices add numerical trend information for anesthesiologists and intensivists to use in determining the most appropriate management of their patients and at present, do not completely prohibit but do increasingly limit the use of the pulmonary artery catheter.

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Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management

Neeti Makhija, Rohan Magoon, Ira Balakrishnan, Sambhunath Das, Vishwas Malik, Parag Gharde

Annals of Cardiac Anaesthesia 2019 22(1):1-5

The presence of dynamic left ventricular outflow tract obstruction (LVOTO) can complicate the postoperative course of patients undergoing surgical aortic valve replacement (AVR). The phenomenon of LVOTO is a consequence of an interplay of various pathoanatomic mechanisms. The prevailing cardiovascular milieu dictates the hemodynamic significance of the resultant LVOTO in addition to the anatomical risk factors. A thorough understanding of the predisposing factors, mechanism, and hemodynamic sequel of the obstruction is pivotal in managing these cases. A comprehensive echocardiographic examination aids in risk prediction, diagnosis, severity characterization, and follow-up of management efficacy in the setting of postoperative LVOTO. The armamentarium of management modalities includes conservative (medical) and surgical options. A stepwise approach should be formulated based on the physiological and anatomical substrates predisposing to LVOTO. The index phenomenon occurs more frequently than appreciated and should be considered when the post-AVR patients exhibit hemodynamic instability unresponsive to conventional supportive measures. The present article provides an overview of various peculiarities of this under-recognized phenomenon in the context of the perioperative management of patients undergoing AVR.

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Conversion during off-pump coronary artery bypass graft surgery: A case–control study

Murali Chakravarthy, Dattatreya Prabhakumar, TA Patil, Antony George, Vivek Jawali

Annals of Cardiac Anaesthesia 2019 22(1):18-23

Objectives: Off pump coronary artery bypass (OPCAB) surgery is carried out as an alternative to conventional coronary artery bypass grafting using cardiopulmonary bypass (CPB). At times 'conversion' to CPB may be required to bail out a situation resulting from acute decompensation of the heart. It is reported that such conversion carries significant mortality risk. Since we conduct coronary revascularization by OPCAB technique as the preferred technique, we conducted this study with an aim to identify the markers of adverse outcome during conversion in Indian patients. Design: Case control retrospective study. Setting: Tertiary referral center. Participants: We conducted three thousand two hundred OPAB surgeries in the period between 2013 to16. Ninety patients (3.1%) required conversion to complete the revascularization (Con version group). Twice the number of patients who underwent OPCAB surgery without conver sion were chosen as controls (Control group). Intervention: OPCAB surgery Results: Mortality in the conversion group was 5.56% in contrast to 0.06% in the controls (P = 0.01). The conversion group had higher left ventricular end diastolic pressure, incidence of endarterectomy, and intra-aortic balloon counter pulsation requirement. Female gender was also predictive of conversion. The total chest drain, duration of ventilation, ICU stay and hospital stay were also higher in the conversion group. Conversion was associated with 9.47 times the odds for mortality. Conclusion: Conversion during OPCAB is associated with significantly increased mortality. Female gender, increased left ventricular end diastolic pressure and preoperative requirement of Intra-aortic balloon are markers of increased risk of mortality when converted.

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Quadricuspid aortic valve associated with aortic insufficiency contributors

Nicholas Paul Suraci, Bryan Kerner, Salomon Poliwoda, Orlando Santana, Gerald Rosen

Annals of Cardiac Anaesthesia 2019 22(1):99-100

A 51-year-old male presented with a wound in his right hand that was suspicious for possible septic emboli of cardiac origin. With transesophageal echocardiography, the patient was found to have a rare quadricuspid aortic valve. This quadricuspid valve can present with variable symptoms and physical exam findings. Due to embryological defects, this pathology is associated with several other anatomical defects that are important to recognize prior to surgical intervention. Transesophaegeal echocardiography remains the gold standard in detection of quadricuspid aortic valve and identification of other possible cardiac lesions.

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Rupture of sinus of valsalva – A 15 years single institutional retrospective review: Preoperative heart failure has an impact on post operative outcome?

Anitha Diwakar, Sathya Swaroop Patnaik, Channabasavaraj S Hiremath, Kolli S Chalam, Parvatkumar Dash

Annals of Cardiac Anaesthesia 2019 22(1):24-29

Background: We reviewed our experience with ruptured sinus of Valsalva aneurysms (RSOV) to determine a correlation with preexisting heart failure (HF) and coexisting cardiac lesions (aortic regurgitation [AR] and ventricular septal defect [VSD]) to postoperative left ventricular (LV) dysfunction and postoperative outcomes. Materials and Methods: Retrospective review of RSOV cases over 15 years showed that RSOV repair was done in 87 patients. We looked for patients who presented with HF and patients having AR and/or VSDs. Statistical analysis was done to see if the coexisting lesions and preoperative HF were associated with postoperative LV dysfunction. Chi-square test was used on contingency table for statistical analysis. Complications in the postoperative period and prolonged Intensive Care Unit stay were noted. Results: 17% (15/87) presented with HF. Fifty-two patients had moderate to severe AR and 50 patients had VSD. Seventeen patients had postoperative LV dysfunction. The correlation of preoperative HF and coexisting lesions with postoperative LV dysfunction was not statistically significant. Two patients underwent redo surgery for residual RSOV and AR. Two patients had arrhythmias. One patient had cerebrovascular accident. No mortality was seen in the study. Conclusion: Preoperative HF and the presence of VSD and/or AR have no statistical significant correlation with postoperative LV dysfunction. As the outcome of RSOV repair is good, all patients need to undergo early repair to avoid complications.

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Unrecognized double aortic arch in a preterm infant: Diagnostic challenges and perioperative management

Balaji Srimurugan, Jessin Jayashankar, Rakhi Balachandran, Sunil S Gopalraj

Annals of Cardiac Anaesthesia 2019 22(1):83-85

Vascular rings are relatively rare, and are frequently overlooked as a potential cause of neonatal respiratory distress in non specialized centres. This might lead to delay in diagnosis during which the child is subjected to repeated respiratory insults. Procrastination in prompt diagnosis and management can lead to significant comorbidities or even death. We highlight the case report of a preterm infant with an unrecognized double aortic arch who presented with severe respiratory morbidity and the subsequent management.

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Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series

Fayaz Mohammed Khazi, Faozi Al-Safadi, Yehia Karaly, Nayyer R Siddiqui, Bassil Al-Zamkan, Obaid Aljassim

Annals of Cardiac Anaesthesia 2019 22(1):30-34

The development of a myocardial infarction ventricular septal rupture is a rare fatal complication, and the surgical repair is the treatment of choice. In most of the scenarios, the operation will be done as an emergency procedure that carries high mortality. Prognosis of these patients depends on prompt echocardiographic diagnosis and the proactive medical and surgical therapy. More recently, various options have been put forward including the timing for surgery, percutaneous closure devices, and the improved outcome with initial stabilization with medical treatment including mechanical support. In this retrospective case series, we are presenting the management of these patients who presented us in different clinical scenarios and trying to identify the risks for the poor outcome and to formulate a strategy to improve the outcome.

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Endovascular approach in chronic aortoiliac disease in patient undergoing coronary artery bypass surgery

Fotini Ampatzidou, Charilaos-Panagiotis Koutsogiannidis, Aggelos Megalopoulos, George Trelopoulos, George Drossos

Annals of Cardiac Anaesthesia 2019 22(1):96-97

Internal thoracic artery (ITA) is an excellent conduit for coronary artery bypass surgery (CABG). We present a patient with known preoperative aortoiliac disease with anterior collateral pathway who had an indication for elective coronary bypass. The use of ITA in these patients may cause lower limb ischemia. Detecting Winslow's anastomotic pathway before CABG is of utmost importance.

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Comparison of hemodynamic response and postoperative pain score between general anaesthesia with intravenous analgesia versus general anesthesia with caudal analgesia in pediatric patients undergoing open-heart surgery

Dharma Jivan Samantaray, Meena Trehan, Vivek Chowdhry, Satish Reedy

Annals of Cardiac Anaesthesia 2019 22(1):35-40

Context: Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery. Aims: This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures. Settings and Design: We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique. Subjects and Methods: After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's test. Results: The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004). Conclusions: Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.

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Clinical usage of high-flow oxygenation in postcardiac surgery patients

Ali Jabbari, Ebrahim Alijanpour, Shabnam Tabasi

Annals of Cardiac Anaesthesia 2019 22(1):107-108

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Assessment of ventricular function in patients of atrial septal defect by strain imaging before and after correction

Prashant Kumar, Achyut Sarkar, Sandeep Kumar Kar

Annals of Cardiac Anaesthesia 2019 22(1):41-46

Background: Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction. Patients and Methods: 2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured. Result: Improvement in LV ejection fraction (P = 0.0001) and myocardial performance index (MPI) (P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI (P < 0.0001) and tricuspid annular plane systolic excursion (P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction. Conclusion: There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.

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Bioprosthetic valve thrombosis in carcinoid heart disease

Kimberly Naden Hollander, Brijen L Joshi

Annals of Cardiac Anaesthesia 2019 22(1):79-82

Tricuspid regurgitation in carcinoid syndrome leads to significant morbidity and mortality that may warrant a tricuspid valve replacement. However, for patients with high serotonin levels and known hypercoagulable risks, the optimum timing for surgery and postoperative anticoagulation approaches remain unclear. High serotonin-triggered hypercoagulability makes prosthetic valves susceptible to thrombosis. Despite appropriate management with a somatostatin analog, some patients continue to have high markers of serotonin that causes platelet aggregation and rapid clot formation. In severely symptomatic patients who require valve surgery, it may not be feasible to postpone surgery until these metabolites are normalized, which may add a substantial risk for postoperative valve thrombosis to an otherwise uneventful procedure. In some, there is a significant need to predict and prevent bioprosthetic valve thrombosis in carcinoid heart disease and to identify best anticoagulation practices across a spectrum of its complex coagulation dynamics and clinical presentation.

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“Vitamin D” as a profile marker for cardiovascular diseases

Deepak Oberoi, Vinit Mehrotra, Anurag Rawat

Annals of Cardiac Anaesthesia 2019 22(1):47-50

Objective: A growing body of research indicates that there exists a correlation between Vit D deficiency and cardiovascular diseases (CVD). In addition to being genetically determined, it is strongly influenced by lifestyle factors. In this study, Vit D and its interrelated factors have been studied as profile marker for identifying the risk of CVD in patients. Methods: The present study includes comparison of a total 200 adults CVD patients with the healthy patients as control, by measuring their serum lipid levels and Vit D concentrations with other CVD risk factors. Results: The average serum Vit D in CVD patients and controls are found to be 22.55±6.2 ng/ml and 37.62±3.2 ng/ml respectively, showing that 63% of CVD patients and 35% of controls are Vit D deficient. Serum lipids levels were considered as marker for patients having CVD which include high levels of total cholesterol, triglycerides, and low-density lipoprotein-cholesterol while low levels of high-density lipoproteins-cholesterol levels. Other risk factors like hypertension, lifestyle, smoking, dietary factors and nutritional status shows significantly correlation for CVD patients compared to controls. Conclusion: Literature supports the relationship between lipid profile and Vit D level by using this as a profile marker for CVD patients. Our study also suggests the same that vitamin D can be used as profile marker for cardiovascular diseases.

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Off-pump coronary bypass grafting in a post-pneumonectomy patient: Challenges and management

Anand Kumar, Udgeath Dhir, Vishal Jain, Surendra Yadav, Ankit Purohit

Annals of Cardiac Anaesthesia 2019 22(1):86-88

Pulmonary complications are common in cardiac surgical patients. Limited respiratory reserves along with the pain associated with sternotomy add to the morbidity. Patients undergoing cardiac surgery who have had a pneumonectomy done before can be even more challenging to manage perioperatively due to a single-functioning lung. We present a case of a postpneumonectomy patient who underwent off-pump coronary artery bypass grafting. Perioperative optimization of lung function tests was stressed upon including the chest physiotherapy and early mobilization. Preoperative thoracic epidural catheter was inserted for postoperative pain and other proven benefits of thoracic epidural in coronary artery disease patients. We could conclude from our experience that proper optimization of lung function tests and meticulous pain management along with fast-tracking are keys to the management of such patients.

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Practice patterns of left-sided double-lumen tube: Does it match recommendation from literature – A single-centre observational pilot study

Prachi Kar, Archana Pathy, Ayya Syama Sundar, Ramachandran Gopinath, Srilata Moningi

Annals of Cardiac Anaesthesia 2019 22(1):51-55

Context: Choosing appropriate-size double-lumen tube (DLT) has always been a challenge as it depends on existing guidelines based on gender, height, tracheal diameter (TD), or personal experience. However, there are no Indian data to match these recommendations. Aim: To find out whether the size of DLT used correlates with height, weight, TD, or left main stem bronchus diameter (LMBD). We also documented clinical consequences of any of our current practice. Setting and Design: Single-center observational pilot study. Subjects and Methods: Prospective, observational study of 41 patients requiring one-lung ventilation with left-side DLT. The choice of DLT was entirely on the discretion of anesthesiologist in charge of the case. Data were collected for TD, LMBD, height, weight, age, sex, and amount of air used in the tracheal and bronchial cuff. Any intraoperative complications and difficulty in isolation were also noted. Statistical Analysis: The statistical analysis was done with the National Council of Statistical Software version 11. Results: Average TD and LMBD were 16.5 ± 0.9 and 10.7 ± 0.8 mm for males and 14.2 ± 1.1 and 9.4 ± 1.1 mm for females, respectively. There was a weak correlation between DLT size and height (R2 = 0.0694), TD (R2 = 0.3396), and LMBD (R2 = 0.2382) in the case of males. For females, the correlation between DLT size and height (R2 = 0.2656), TD (R2 = 0.5302), and LMBD (R2 = 0.5003) was slightly better. Conclusion: Although there was a weak correlation between DLT size and height, TD, and LMBD, the overall intraoperative outcome and lung isolation were good.

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Perioperative management of intramyocardial hydatid cyst with off-pump technique

Yamini Gupta, Madhuri Priyadarshi

Annals of Cardiac Anaesthesia 2019 22(1):92-95

Cardiac echinococcosis is a rare disease. Depending on the location of hydatid cyst in the heart, clinical presentation can be an asymptomatic case or lethal stroke, arrhythmias, valvular dysfunction, cardiac tamponade, cardiac failure, shock, and even death. Treatment of choice for cardiac hydatid cysts is surgical excision, even in an asymptomatic patient. We present a case report of an asymptomatic case of off-pump removal of intramyocardial hydatid cyst. A 21-year-old male presented asymptomatically and was diagnosed with a hydatid cyst incidentally during a regular checkup. Echocardiography and cardiac computed tomography angiography images demonstrated an intramyocardial hydatid cyst on the lateral aspect of the left ventricle with slight extension over the anterior and posterior regions. Important aspects of diagnosis and management specific to cardiac hydatid cyst along with the review of literature have been discussed.

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A survey of practices during cardiopulmonary bypass in India: An Indian association of cardiovascular and thoracic anesthesiologist endeavor

Deepak Prakash Borde, Shreedhar S Joshi, Murali Chakravarthy, Vishwas Malik, Ranjith B Karthekeyan, Antony George, Thomas Koshy, Uday Gandhe, Suresh G Nair

Annals of Cardiac Anaesthesia 2019 22(1):56-66

Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. Results: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. Conclusions: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.

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Massive subcutaneous emphysema after off-pump coronary bypass surgery

Monish S Raut, Sumir Dubey, Ganesh Shivnani, Arun Maheshwari, Sibashankar Kar

Annals of Cardiac Anaesthesia 2019 22(1):97-98

Subcutaneous emphysema is a condition when air gets accumulated into the tissues under the skin and in the soft tissues of the chest wall or neck but can also spread to other parts of the body. It generally causes minimal symptoms and nonlethal; sometimes, it may be severe and life-threatening if deeper tissues of the thoracic outlet and chest are involved. It is essential to know the mechanisms of subcutaneous emphysema after cardiac surgery.

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Descriptive statistics and normality tests for statistical data

Prabhaker Mishra, Chandra M Pandey, Uttam Singh, Anshul Gupta, Chinmoy Sahu, Amit Keshri

Annals of Cardiac Anaesthesia 2019 22(1):67-72

Descriptive statistics are an important part of biomedical research which is used to describe the basic features of the data in the study. They provide simple summaries about the sample and the measures. Measures of the central tendency and dispersion are used to describe the quantitative data. For the continuous data, test of the normality is an important step for deciding the measures of central tendency and statistical methods for data analysis. When our data follow normal distribution, parametric tests otherwise nonparametric methods are used to compare the groups. There are different methods used to test the normality of data, including numerical and visual methods, and each method has its own advantages and disadvantages. In the present study, we have discussed the summary measures and methods used to test the normality of the data.

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Research on the electrostatic characteristic of coal-fired fly ash

Abstract

China is the biggest consumer of coal. Every year, half or more of China's coal is used in the power industry. Most thermal power plants in China use electrostatic precipitators to treat solid particulate matter in flue gas. The efficiency of the electrostatic precipitator in removing dust has a considerable influence on atmospheric pollutants. However, the most important factor affecting the efficiency of the electrostatic precipitator in removing dust is the dielectric properties of the fly ash. Through the study of volt-ampere characteristics, electrical and capacitive properties, and electrical breakdown characteristics of coal-fired fly ash, it is found that the V–I characteristics of ash samples in thermal power plant do not strictly follow the formula ( \( R=\frac{U}{I} \) ), the type of coal, and the chemistry of coal. Ingredients are related; disparate types of ash samples have disparate capacitances, and the measurement of capacitive contrast resistance has a certain influence.

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Impact of substrate material on algal biofilm biomass growth

Abstract

Algae are being grown for wastewater purification and biofuels production. Their growth on a substrate facilitates these uses by allowing facile separation of algae from the water. Here, we compare different materials to determine which would best serve this purpose. A mixed culture of Anabaena and Chlorella was grown on various synthetic and natural fiber fabric substrates in a trough system with recirculating simulated wastewater. Filter materials studied as substrates for algal growth were muslin, olefin, pellon (acrylic), two types of polyester, and two types of nylon. Biomass accumulation on the various filter substrates was recorded at 7, 14, and 28 days. Filters were weighed before and after the growth periods and changes in dry biomass were recorded. Biomass accumulation was significantly affected by the fabric type. Olefin fostered the greatest increase in biomass while nylon and polyester also supported competitive increases in biomass. Pellon showed the smallest biomass increase and muslin decreased in mass due to material disintegration. Other concerns such as abrasion resistance and UV susceptibility are discussed.

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Isolation, characterization, and therapeutic activity of bergenin from marlberry ( Ardisia colorata Roxb.) leaf on diabetic testicular complications in Wistar albino rats

Abstract

Bergenin is one of the phytochemical constituents in marlberry (Ardisia colorata Roxb.) having antioxidant, anti-diabetic, and anti-inflammatory properties. A. colorata has been used as an herbal medicine in Southeast Asia particularly in Northeast India to treat diabetes. Bergenin was isolated from methanol extract of A. colorata leaf (MEACL) by column chromatography and TLC profiling. Characterization and structural validation of bergenin were performed by spectroscopic analyses. A LC-ESI-MS/MS method was developed for the quantitation of bergenin and validated as per the guidelines of FDA and EMA. The validated method was successfully utilized to quantify bergenin concentration in MEACL samples. Therapeutic efficacy of bergenin was investigated on streptozotocin-induced diabetic rats by following standard protocols. Bergenin supplementation significantly improved the physiological and metabolic processes and in turn reverses diabetic testicular dysfunction via increasing serum testosterone concentrations and expression pattern of PCNA, improving histopathological and histomorphometric manifestations, modulating spermatogenic events and germ cell proliferation, restoring sperm quality, reducing sperm DNA damage, and balancing the antioxidant enzymes levels. Hence, A. colorata leaf is one of the alternate rich resources of bergenin and could be used as a therapeutic agent for diabetic testicular complications.

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The coracoid process is supplied by a direct branch of the 2nd part of the axillary artery permitting use of the coracoid as a vascularised bone flap, and improving it's viability in Latarjet or Bristow procedures

A comprehensive understanding of the anatomy of the vascular supply of the coracoid is needed to en- sure that the coracoid remains vascularised in order to optimize bone union during any coracoid transfer procedures. It is the purpose of this study to present an anatomical overview of the blood supply of the coracoid process, describing a previously unidentified vessel that arises directly from the axillary artery and nourishes the coracoid process, permitting the coracoid to be used as a free bone flap.

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An evaluation of the levels of organochlorine compounds (OCPs and PCBs) in cultured freshwater and wild sea fish eggs as an exposure biomarker for environmental contamination

Abstract

In this study, the eggs of 30 wild Black Sea whiting (Merlangius merlangus euxinus, Nordmann, 1840) and 30 farmed freshwater rainbow trout (Oncorhynchus mykiss, Walbaum, 1792) collected from Samsun Province in Turkey were analyzed to determine the level of contamination by nine organochlorine pesticides (OCPs), namely α-hexachlorocyclohexane (α-HCH), β-HCH, γ-HCH (lindane), hexachlorobenzene (HCB), aldrin, 2,4′-dichlorodiphenyltrichloroethane (DDT), 4,4′-DDT, 2,4′-dichlorodiphenyldichloroethylene (DDE), 4,4′-DDE, and 15 polychlorinated biphenyls (PCBs) (PCB-28, -70, -74, -81, -99, -101, -118, -138, -153, -156, -170, -180, -183, -187, and -208), and their potential use as biomarkers to monitor levels of environmental contamination. OCPs and PCBs in the fat of fish eggs were extracted cryogenically and their concentrations were determined with a gas chromatography-electron capture detector (GC-ECD). The whiting eggs showed high OCP and PCB levels compared to the rainbow trout eggs. The median ∑ DDT values for whiting and rainbow trout eggs were 1601.62 ng g⁻¹ fat (range 824.87–5049.81) and 406.49 ng g⁻¹ fat (range 199.88–588.82); median ∑Indicator PCBs were 1264.24 ng g⁻¹ fat (range 520.05–6140.32) and 82.11 ng g⁻¹ fat (range 2.85–215.97); and median ∑ HCHs were 155.66 ng g⁻¹ fat (range 35.45–330.40) and 13.48 ng g⁻¹ fat (range 4.44–66.44), respectively. In the whiting eggs, the ∑Indicator PCB level was above the maximum residue limit (MRL) of 200 ng g⁻¹ fat stated in the European Commission Regulation (EC) and Turkish Food Codex (TFC). In addition, there was a significant difference between the contamination levels of the eggs of the two species. In conclusion, it appears that fish eggs can serve as a valuable biomarker for the level of contamination of persistent organochlorine contaminants in different aquatic environments.

http://bit.ly/2RxEZAk

Essential oil of Chrysanthemum indicum L.: potential biocontrol agent against plant pathogen Phytophthora nicotianae

Abstract

Phytophthora nicotianae is currently considered one of the most devastating oomycete plant pathogens, and its control frequently relies solely on the use of systemic fungicides. There is an urgent need to find environment-friendly control techniques. This study examined the chemical composition, inhibitory activity, and possible modes of action of the essential oil of Chrysanthemum indicum L. (EOC) flower heads against P. nicotianae. The EOC was obtained using hydrodistillation at a 0.15% yielded. It inhibited mycelial growth and spore germination of P. nicotianae at a minimum inhibitory concentration (MIC) of 200 μL/L, and exhibited fumigation effects (92.68% inhibition at 157.48 μL/L). Marked deformation of P. nicotianae mycelia included deformed tip enlargement, shrinkage, and rupture. Further, 55 and 47 compounds were identified using gas chromatography-mass spectrometry (GC-MS) and headspace solid-phase microextraction (HS-SPME) GC-MS analyses, representing 88.2% and 98.91% of the total EOC, respectively. Monoterpenes (25.77%) and sesquiterpenes (54.14%) were the major components identified using GC-MS, whereas monoterpenes were the main constituents in the HS-SPME GC-MS analysis. The higher proportions of sesquiterpenes and monoterpenes could be responsible for the inhibitory activity of EOC, which increased mycelia membrane permeability and the content of mycelial malondialdehyde (MDA) in a dose-dependent manner. Cell death also occurred. Thus, destruction of the cell wall and membrane might be two modes of action of EOC. Our results would be useful for the development of a new plant source of fungicide for P. nicotianae-induced disease.

http://bit.ly/2RrERSQ

Diagnostik der Sepsis – Teil 2: Erregeridentifikation

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 38-48
DOI: 10.1055/a-0756-4651

Im Rahmen der Sepsis und des septischen Schocks spielen, trotz der zunehmenden Verbreitung von neuen molekularbiologischen Verfahren, der kulturelle Erregernachweis und die Resistenztestung weiterhin die entscheidende Rolle in der antimikrobiellen Therapie auf der Intensivstation. Hierbei kann der Erregernachweis für die antimikrobielle Therapie einerseits direkt aus dem Patientenblut, andererseits aber auch aus diversen anderen Probenmaterialien (respiratorische Sekrete, Punktat, intraoperative Abstriche etc.) geführt werden. Ein Nachteil konventioneller kultureller Verfahren im Kontext kritisch kranker Patienten ist die zeitliche Latenz bis zum Erregernachweis bzw. zum Ergebnis der Resistenztestung. Molekularbiologische Verfahren wie Techniken der Erregerdiagnostik und Resistenztestung, die auf Polymerase Chain Reaction (PCR) oder vor allem Next-Generation Sequencing (NGS) basieren, versprechen hier zwar kürzere Umlaufzeiten, sind aber aktuell noch kein klinischer Standard. Trotzdem besitzen diese Verfahren das Potenzial, einen Paradigmenwechsel in der Erregerdiagnostik herbeizuführen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FhlR2i

Sechs-Monats-Outcome nach restriktivem oder liberalem Transfusionsregime in der Herzchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-4
DOI: 10.1055/a-0817-3208

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FiwT7n

Sepsis-Update: Definition und Epidemiologie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 10-20
DOI: 10.1055/a-0625-5492

Sepsis ist eine häufige Erkrankung auf den Intensivstationen weltweit, die mit einer relevanten Morbidität und Mortalität einhergeht. Bis heute gibt es keine spezifische Therapie der Sepsis – allein die frühe Diagnosestellung und schnellstmögliche therapeutische Intervention können das Outcome der Patienten verbessern. Daher ist eine Definition des Krankheitsbildes der Sepsis mit hoher diagnostischer Sensitivität und Spezifität unabdingbar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FhnsVU

Ketamin: weniger Nebenwirkungen bei langsamer Infusion?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 5-6
DOI: 10.1055/a-0817-2141

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FgZVVA

DGEM-Leitlinie: Klinische Ernährung in der Intensivmedizin – Kurzversion

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 63-73
DOI: 10.1055/a-0805-4118

Fragestellung Variationen in der klinischen Ernährungstherapie können die Prognose kritisch kranker Patienten beeinflussen. Hier präsentieren wir die Kurzversion der aktualisierten, konsensbasierten S2k-Leitlinie „Klinische Ernährung in der Intensivmedizin" der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Kooperation mit 7 anderen nationalen Fachgesellschaften. Als Zielpopulation der Leitlinie wurden kritisch kranke, erwachsene Patienten, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden, definiert. Methodik Die früheren Leitlinien der DGEM wurden in Einklang mit den aktuellen Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) als S2k-Leitlinie aktualisiert. Als Grundlage für die Empfehlungen wurde die Evidenz von randomisiert-kontrollierten Studien, Metaanalysen und Beobachtungsstudien mit angemessener Fallzahl und hoher methodologischer Qualität (bis Mai 2018) sowie aktuell gültige Leitlinien internationaler Fachgesellschaften herangezogen und kommentiert. Die Empfehlungsstärke ist rein sprachlich beschrieben. Jede Empfehlung wurde mittels Delphi-Verfahren abschließend bewertet und konsentiert. Ergebnisse In der vorliegenden Kurzversion werden alle 69 Empfehlungen für essenzielle, praxisrelevante Bestandteile der klinischen Ernährung der Zielpopulation zusammenfassend dargestellt. Ein spezifischer Fokus ist die Adjustierung der Ernährung gemäß den Phasen der kritischen Erkrankung sowie gemäß der individuellen Toleranz gegenüber exogener Substratzufuhr. Unter anderem werden Empfehlungen zur Beurteilung des Ernährungszustandes, zur Indikation für eine klinische Ernährungstherapie, zum Zeitpunkt des Beginns, zum Applikationsweg, zur Menge und Zusammensetzung der Ernährungssubstrate (Makro- und Mikronährstoffe) sowie zu speziellen Aspekten der Ernährung bei adipösen kritisch kranken Patienten und Patienten mit extrakorporalen Unterstützungsverfahren gegeben. Schlussfolgerung Die Kurzversion der Leitlinie gibt eine prägnante Übersicht über alle 69 aktualisierten Handlungsempfehlungen zur enteralen und parenteralen Ernährung erwachsener kritisch kranker Patienten, die an mind. einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden. Die Gültigkeit der Leitlinie beträgt voraussichtlich 5 Jahre (2018 – 2023).
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FiwPo9

ICU: Lactoferrin gegen nosokomiale Infektionen?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 6-7
DOI: 10.1055/a-0817-2154

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Fi2ar6

Diagnostik der Sepsis – Teil 1: allgemeine Diagnostik und Fokussuche-/sanierung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 22-36
DOI: 10.1055/a-0625-5507

Die Sepsis ist ein medizinischer Notfall mit weiterhin hoher Sterblichkeit. Die Surviving Sepsis Campaign (SSC) gibt für die Diagnostik und die Gabe eines adäquaten Breitspektrumantibiotikums ein Zeitfenster von max. 1 h nach Stellen der Verdachtsdiagnose „Sepsis" vor. Aktuell wird dieses sog. 1 h-Maßnahmenbündel kritisch diskutiert. Als Kernaspekt der Fokussuche orientiert sich die Art der Bildgebung am vermuteten Fokus und dem Patientenkollektiv. Bei kritisch kranken Patienten ist die kontrastmittelverstärkte Computertomografie häufig Mittel der Wahl. Die Erregerdetektion erfolgt meist kulturbasiert. Daher sind mikrobiologische Proben aus einfach zugänglichen Kompartimenten, mindestens aber die Entnahme von 2 Blutkultursets, obligat und sollten vor der Gabe eines Antibiotikums erfolgen. Von herausragender Bedeutung sind vor allem intraoperative Abstriche aus sonst sterilen Kompartimenten. Suspekte Katheter (z. B. zentralvenöse Katheter, Dialysekatheter) oder potenziell infizierte implantierte Medizinprodukte (z. B. Schrittmacher, Defibrillatoren) sollten – wenn vertretbar – zügig entfernt und einer mikrobiologischen Aufarbeitung zugeführt werden. Generell sollten alle notwendigen Maßnahmen zur Fokussanierung/-kontrolle so schnell wie medizinisch/logistisch möglich, mindestens aber innerhalb von 6(– 12)h nach Beginn der Sepsis, erfolgt sein. Es existiert bislang kein spezifischer Biomarker für das Krankheitsbild der Sepsis. Biomarker wie das Procalcitonin (PCT) und das C-reaktive Protein (CRP) spielen im Kontext der Sepsis beim infektiologischen Management und Therapiemonitoring auf der Intensivstation eine wichtige Rolle. Vielversprechende Biomarker wie das midregionale Pro-Adrenomedullin (MR-proADM) oder das Presepsin werden außerhalb von Studien noch nicht in der klinischen Routine eingesetzt. Als Marker von Mikrozirkulationsstörungen und eines gestörten Metabolismus spielt das Laktat (bzw. die Laktat-Clearance) als prognostischer Parameter der Sepsis eine große Rolle.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FfPlya

Sepsis – weiter eine große Herausforderung!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 8-9
DOI: 10.1055/a-0808-1194

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Fgkpy0

Sepsis-Update: evidenzbasierte Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 50-62
DOI: 10.1055/a-0625-5521

Sepsis und septischer Schock stellen medizinische Notfälle dar, die einer kompetenten Früherkennung und eines entsprechenden sofortigen, zielgerichteten Managements bedürfen. Die Therapie der Sepsis und des septischen Schocks hat sich während der letzten Jahre kontinuierlich weiterentwickelt. Dieser Beitrag gibt einen Überblick über die aktuelle Evidenz der Therapie der Sepsis und des septischen Schocks und deren Umsetzung in die klinische Praxis.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FfPkdx

Heute aus der Gynäkologie: Neugeborenenreanimation und Notsectio

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 74-78
DOI: 10.1055/s-0042-101628

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Ff93Kx

ICU: welches Antibiotikum bei vancomycinresistenten Enterokokken (VRE)?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-5
DOI: 10.1055/a-0817-2987

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FgkqC4

18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: reports of 182 nodules

Abstract

Purpose

In oncological patients, ¹⁸F-FDG PET/CT performance for pulmonary nodules' characterization is not well-established. Thus, the purpose of this study was to evaluate the ¹⁸F-FDG PET/CT diagnostic performance in pulmonary nodules detected during follow-up in oncological patients and the relationship between malignancy and nodules' characteristics.

Methods

We retrospectively evaluated 182 pulmonary nodules (121 solitary, 61 multiple; mean size = 16.5 ± 8.1 mm, mean SUVmax = 5.2 ± 5.1) in 148 oncological patients (89 males; mean age = 69.5 ± 8.4 years). Final diagnosis was established by histology or radiological follow-up. Diagnostic performance of ¹⁸F-FDG visual analysis (malignancy-criterion: uptake ≥ mediastinal activity), ROC curve analysis for SUVmax and nodules' characteristics were assessed.

Results

In 182 nodules, the prevalence of malignancy was 75.8%; PET/CT provided sensitivity = 79%, specificity = 81.8%, accuracy = 79.7%, PPV = 93.1%, NPV = 55.4%; ROC analysis (SUVmax cut-off = 1.7) provided sensitivity = 85.5%, specificity = 72.7%. In 121 solitary nodules, the prevalence of malignancy was 87.6%; PET/CT provided sensitivity = 82.1%, specificity = 73.3%, accuracy = 81%, PPV = 95.6%, NPV = 36.7%; ROC analysis (SUVmax cut-off = 2) provided sensitivity = 84%, specificity = 80%. In 61 multiple nodules, the prevalence of malignancy was 52.5%; PET/CT (nodule and patient-based analysis, respectively) provided sensitivity = 68.7% and 88.9%, specificity = 86.2% and 55.6%, accuracy = 77% and 77.8%, PPV = 84.4% and 80%, NPV = 71.8% and 71.5%; ROC analysis (nodule-based, SUVmax cut-off = 1.8) provided sensitivity = 71.9%, specificity = 82.8%. Malignant nodules were prevalent in males, in solitary pattern and in upper lobes, and had significantly greater size and metabolic activity (SUVmax and TLG) than benign ones, with no differences in interval-time between previous cancer diagnosis and nodule detection, patients' age or other nodules' features (lung side, central/peripheral). When comparing solitary and multiple patterns, malignant nodules had significantly greater size and metabolic activity than benign ones in both groups.

Conclusions

In oncological patients, ¹⁸F-FDG PET/CT provides good diagnostic performance for ruling in the malignancy in pulmonary nodules detected during follow-up, even at small size and especially when solitary. In multiple patterns, PET seems useful in the perspective of a personalized management, for identifying the "reference" nodule deserving histological assessment.

http://bit.ly/2QLZYKB

A new frontier for amyloid PET imaging: multiple sclerosis

http://bit.ly/2VSo3mG

Bertoldo, F., Boccardo, F., Bombardieri, E., Evangelista, L., Valdagni, R. (Eds.) Bone Metastases from Prostate Cancer: Biology, Diagnosis and Management

http://bit.ly/2QSzp6m

Longitudinal association between astrocyte function and glucose metabolism in autosomal dominant Alzheimer’s disease

Abstract

Purpose

The spatial resolution of ¹⁸F-fluorodeoxyglucose PET does not allow the specific cellular origin of its signal to be determined, but it is commonly accepted that transport and trapping of ¹⁸F-fluorodeoxyglucose reflects neuronal glucose metabolism. The main frameworks for the diagnosis of Alzheimer's disease suggest that hypometabolism measured with ¹⁸F-fluorodeoxyglucose PET is a biomarker of neuronal injury and neurodegeneration. There is preclinical evidence to suggest that astrocytes contribute, at least partially, to the in vivo ¹⁸F-fluorodeoxyglucose PET signal. However, due to a paucity of PET tracers for imaging astrocytic processes, the relationship between astrocyte function and glucose metabolism in human brain is not fully understood. The aim of this study was to investigate the longitudinal association between astrocyte function and glucose metabolism in Alzheimer's disease.

Methods

The current investigation combined longitudinal PET data from patients with autosomal dominant Alzheimer's disease, including data on astrocyte function (¹¹C-deuterium-l-deprenyl binding) and glucose metabolism (¹⁸F-fluorodeoxyglucose uptake). Research participants included 7 presymptomatic and 4 symptomatic mutation carriers (age 44.9 ± 9.8 years and 58.0 ± 3.7 years, respectively) and 16 noncarriers (age 51.1 ± 14.2 years). Eight carriers and eight noncarriers underwent longitudinal follow-up PET imaging at an average of 2.8 ± 0.2 and 3.0 ± 0.5 years from baseline, respectively.

Results

Longitudinal decline in astrocyte function as measured using ¹¹C-deuterium-l-deprenyl PET was significantly associated with progressive hypometabolism (¹⁸F-fluorodeoxyglucose uptake) in mutation carriers; no significant association was observed in noncarriers.

Conclusion

The emerging data shift the accepted wisdom that decreases in cerebral metabolism measured with ¹⁸F-fluorodeoxyglucose solely reflect neuronal injury, and places astrocytes more centrally in the development of Alzheimer's disease.

http://bit.ly/2VXL9Z1

Correction to: Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer

An error occurred in the labelling of Fig. 3, where math symbols for SUV thresholds were inverted in panel b when the EARL threshold was applied to the PSF dataset and vice versa. This figure should read as follows: Fig. 3: Prognostic value of tumour SUVmax

http://bit.ly/2QQRy4r

Performance of 18 F-FDG PET/MRI and 18 F-FDG PET/CT for T and N staging in patients with non-small-cell lung cancer

http://bit.ly/2VXLzyz

Severe posterior hypometabolism but normal perfusion in a patient with chronic fatigue syndrome/myalgic encephalomyelitis revealed by PET/MRI

http://bit.ly/2QRo8DA

Amyloid burden identifies neuropsychological phenotypes at increased risk of progression to Alzheimer’s disease in mild cognitive impairment patients

Abstract

Purpose

The extent of amyloid burden associated with cognitive impairment in amnestic mild cognitive impairment is unknown. The primary aim of the study was to determine the extent to which amyloid burden is associated to the cognitive impairment. The secondary objective was to test the relationship between amyloid accumulation and memory or cognitive impairment.

Materials and methods

In this prospective study 66 participants with amnestic mild cognitive impairment underwent clinical, neuropsychological and PET amyloid imaging tests. Composite scores assessing memory and non-memory domains were used to identify two clinical classes of neuropsychological phenotypes expressing different degree of cognitive impairment. Detection of amyloid status and definition of optimal amyloid ± cutoff for discrimination relied on unsupervised k-means clustering method.

Results

Threshold for identifying low and high amyloid retention groups was of SUVr = 1.3. Aß + participants showed poorer global cognitive and episodic memory performance than subjects with low amyloid deposition. Aß positivity significantly identified individuals with episodic memory impairment with a sensitivity and specificity of 80 and 79%, (χ2 = 21.48; P < 0.00001). Positive and negative predictive values were 82 and 76%, respectively. Amyloid deposition increased linearly as function of memory impairment with a rate of 0.13/ point of composite memory score (R = −44, P = 0.0003).

Conclusion

The amyloid burden of SUVr = 1.3 allows early identification of subjects with episodic memory impairment which might predict progression from MCI to Alzheimer's disease.

Trial registration

EudraCT 2015-001184-39.

http://bit.ly/2VXIEpU

Improved beta-amyloid PET reproducibility using two-phase acquisition and grey matter delineation

Abstract

Purpose

We investigated whether the reproducibility of standard visual reporting (STD method) in flutemetamol (FMM) PET can be improved using a newly introduced method that uses grey matter edges derived from the perfusion phase (GM-EDGE method).

Methods

Two-phase FMM PET was performed in 121 patients with mild cognitive impairment. Five nuclear medicine physicians blindly and independently evaluated all late-phase scans, initially employing the STD method and later the GM-EDGE method. A five-point scale was used to express the degree of amyloid positivity, and a binary classification (positive/negative) was used in combination with subjective confidence (five-point scale). Multirater Fleiss' kappa, intraclass correlation coefficient (ICC) and inter-rater reliability (Cohen's kappa) were determined for the STD and GM-EDGE methods.

Results

The weighted Cohen's kappa values for the five-point measure of amyloid positivity ranged from 0.63 to 0.73 (median 0.70) for the STD method and from 0.76 to 0.89 (median 0.80) for the GM-EDGE method (ICC 0.84, 95% CI 0.79–0.88, for the STD method; 0.91, 95% CI 0.89–0.94, for the GM-EDGE method). The nonweighted Cohen's kappa value for the binary classification ranged from 0.73 to 0.93 (median 0.82) for the STD method and 0.90 to 0.97 (median 0.93) for the GM-EDGE method (Fleiss' kappa 0.82, 95% CI 0.77–0.88, for the STD method; 0.93, 95% CI 0.87–0.99, for the GM-EDGE method). The GM-EDGE method resulted in significantly greater subjective confidence in the readings of four physicians (p < 0.010). The binary classification was concordant among all five physicians in 80.8% of the scans using the STD method and in 91.6% of the scans using the GM-EDGE method (p = 0.016).

Conclusion

The newly introduced GM-EDGE method was associated with significantly higher inter-rater agreement among physicians and higher subjective confidence in the reading. The method is easy to implement in clinical practice, especially when the perfusion phase is utilized clinically.

http://bit.ly/2QOhEoQ

Diagnostik der Sepsis – Teil 2: Erregeridentifikation

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 38-48
DOI: 10.1055/a-0756-4651

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FhlR2i

Sechs-Monats-Outcome nach restriktivem oder liberalem Transfusionsregime in der Herzchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-4
DOI: 10.1055/a-0817-3208

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FiwT7n

Sepsis-Update: Definition und Epidemiologie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 10-20
DOI: 10.1055/a-0625-5492

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FhnsVU

Ketamin: weniger Nebenwirkungen bei langsamer Infusion?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 5-6
DOI: 10.1055/a-0817-2141

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FgZVVA

DGEM-Leitlinie: Klinische Ernährung in der Intensivmedizin – Kurzversion

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 63-73
DOI: 10.1055/a-0805-4118

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FiwPo9

ICU: Lactoferrin gegen nosokomiale Infektionen?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 6-7
DOI: 10.1055/a-0817-2154

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Fi2ar6

Diagnostik der Sepsis – Teil 1: allgemeine Diagnostik und Fokussuche-/sanierung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 22-36
DOI: 10.1055/a-0625-5507

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FfPlya

Sepsis – weiter eine große Herausforderung!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 8-9
DOI: 10.1055/a-0808-1194

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Fgkpy0

Sepsis-Update: evidenzbasierte Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 50-62
DOI: 10.1055/a-0625-5521

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://bit.ly/2FfPkdx

Heute aus der Gynäkologie: Neugeborenenreanimation und Notsectio

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 74-78
DOI: 10.1055/s-0042-101628

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2Ff93Kx

ICU: welches Antibiotikum bei vancomycinresistenten Enterokokken (VRE)?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-5
DOI: 10.1055/a-0817-2987

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://bit.ly/2FgkqC4

EAACI position paper: Comparing insect hypersensitivity induced by bite, sting, inhalation or ingestion in human beings and animals

Abstract

Adverse reactions to insects occur in both human and veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in all species. In this position paper, we summarize the current knowledge on insect allergy induced via stings, bites, inhalation or ingestion, and compare reactions in companion animals to those in people. With few exceptions, the situation in human insect allergy is better documented than in animals. We focus on a review of recent literature, and give overviews of the epidemiology and clinical signs. We discuss allergen sources and allergenic molecules to the extent described, and aspects of diagnosis, prophylaxis, management and therapy.

http://bit.ly/2M9yUEc

Mobile health tools for the management of chronic respiratory diseases

Abstract

Background

The market of mobile health (mHealth) technology is rapidly evolving, making new mobile technologies potentially available for health care systems. Patient empowerment through self‐monitoring of symptoms, shared decision making with the physician and easily accessible education are important features extending the reach of mHealth technology beyond traditional care.

Methods

Two digital distribution platforms (Apple App Store and Google Play Store) were searched for currently available mobile applications (apps) for patients with chronic respiratory diseases (CRDs). A new index (score ranging from 0‐10) was developed to assess the potential of apps as a tool to empower patients through mobile technology (based on self‐monitoring, personalized feedback and patient education app features).

Results

One hundred and twelve apps were retained for analysis and could be classified in 5 categories: Asthma (n=71), COPD (n=15), Asthma and COPD (n=15), Rhinitis and Asthma (n=5) and Rhinosinusitis (n=6). Eighty percent were developed by medical technology companies compared to 18% by medical doctors and 2% by pharmaceutical companies. Two‐thirds of apps allow disease self‐monitoring whereas over half of apps provide patient feedback through graphs. Sixty percent of apps contain easily accessible patient education material. Only sixteen percent of apps reach a score of ≥7 on the newly designed patient empowerment index.

Conclusions

A variety of apps are available for patients with CRDs of which only few were developed by or jointly with medical doctors. The majority of these apps include self‐monitoring tools but only few also provide personalized feedback, which is needed to adopt these apps into daily care.

http://bit.ly/2sv7L5S

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Papillary thyroid microcarcinoma (PTMC) has excellent outcomes, but extensive lymph node (LN) metastasis can be associated with fatal outcomes. We evaluated the mutational profiles of primary tumors and their metastatic LNs of PTMCs with extensive lateral cervical LN metastases.

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

A total of seven somatic variants were confirmed in the PTMCs compared to the normal tissue. The BRAF^V600E mutation was the most common and seen in 12 primary tumors (75%) and 11 metastatic LNs (69%). A nonsense mutation in AR and an in-frame deletion in ACVR2A were detected in one primary tumor and its metastatic LN (6%). Missense mutations in KMT2A, RAF1, and ROS1 were detected in one primary tumor (3%). A frameshift deletion mutation in JAK2 was detected in a metastatic LN (3%). In PTMCs without the BRAF mutation, an ALK and RET rearrangement (one PTMC and its metastatic LN, 6%) was detected. In one patient, the BRAF mutation was detected in the primary tumor, but only a RET rearrangement was detected in its metastatic LN. No mutations were detected in two patients.

Conclusion

The mutational frequency of PTMCs was really low, even in those with extensive LN metastasis. The mutational status of the primary tumor and its metastatic LNs were not significantly different, and this suggests a minor role for genetic alterations in the process of LN metastasis in PTMC.

http://bit.ly/2MbitY6

Effect of spiral undersampling patterns on FISP MRF parameter maps

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Gregor Körzdörfer, Josef Pfeuffer, Thomas Kluge, Matthias Gebhardt, Bernhard Hensel, Craig H. Meyer, Mathias Nittka

Abstract

Purpose

Artifacts arising from undersampling are not always treatable as incoherent noise for the pattern matching process in Magnetic Resonance Fingerprinting (MRF). To estimate the effect of undersampling artifacts on MRF quantitative results, spiral sampling trajectories and their temporal variation is examined.

Methods

The effect of sampling trajectories and their variation during the MRF experiment was assessed by characterizing aliasing artifacts. Temporal rearrangements of sampling trajectories were tested and evaluated in simulations and scans of phantoms and in a volunteer brain.

Results

Results show that some temporal variations of sampling patterns can lead to spatial biases in MRF parameter maps. Observed effects are consistent with derived performance indicators for different interleaving schemes, leading to substantially improved MRF sampling patterns.

Conclusion

With the help of the presented simulation framework, MRF implementations can be investigated and improved. This was demonstrated for a spiral FISP (Fast imaging with steady-state free precession) MRF implementation, where a significantly improved interleaving scheme was identified, and confirmed by experiment.

http://bit.ly/2Hmt1oK

Susceptibility weighted MRI after uterine artery embolization for leiomyoma

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Yasuyuki Yamahana, Tetsuya Katsumori, Hiroshi Miura, Shunsuke Asai, Sachimi Yamada, Akiko Takahata, Kei Yamada

Abstract

Purpose

To evaluate whether susceptibility-weighted MR imaging (SWI) findings are associated with tumor infarction on contrast-enhanced MRI (CE-MRI) after uterine artery embolization (UAE) for leiomyoma.

Methods

This was a single institution, retrospective study. Between February 2016 and April 2017, 27 consecutive patients underwent UAE and completed SWI and CE-MRI before and 1 week after UAE. Two blinded readers independently reviewed the MRI of 261 tumors ≥1 cm in all patients. We evaluated the relationship between the hypointense peripheral rim observed on the tumor surface on post-procedural SWI and the infarction rates (≥90%, <90%) of each tumor based on post-procedural CE-MRI. Inter-reader correlation coefficients (ICC) and the sensitivity and specificity of the rim were measured.

Results

Substantial inter-reader agreement was noted in post-procedural SWI interpretations (ICC = 0.681, 95% CI; 0.547, 0.771). The rim was observed in 66.7% (174/261) of tumors by reader 1 and 55.9% (146/261) of tumors by reader 2 on post-procedural SWI. Correlations were observed between the rim and ≥90% tumor infarction by readers 1 and 2 (Spearman's coefficient = 0.474 and 0.438, p < 0.001 and p < 0.001, respectively). The sensitivity and specificity of the rim to tumor infarction were 77.2 and 82.6% (reader 1), and 65.8 and 100% (reader 2), respectively.

Conclusions

The present study demonstrated that the hypointense peripheral rim was observed on some leiomyomas on SWI immediately after UAE. The rim correlated with tumor infarction on post-procedural CE-MRI. This SWI finding was helpful for evaluating embolic effects on leiomyomas in the acute phase after UAE.

http://bit.ly/2RN3Ak1

Space-time variant weighted regularization in compressed sensing cardiac cine MRI

Publication date: Available online 14 January 2019

Source: Magnetic Resonance Imaging

Author(s): Alejandro Godino-Moya, Javier Royuela-del-Val, Muhammad Usman, Rosa-María Menchón-Lara, Marcos Martín-Fernández, Claudia Prieto, Carlos Alberola-López

Abstract

Purpose

To analyze the impact on image quality and motion fidelity of a motion-weighted space-time variant regularization term in compressed sensing cardiac cine MRI.

Methods

k-t SPARSE-SENSE with temporal total variation (tTV) is used as the base reconstruction algorithm. Motion in the dynamic image is estimated by means of a robust registration technique for non-rigid motion. The resulting deformation fields are used to leverage the regularization term. The results are compared with standard k-t SPARSE-SENSE with tTV regularization as well as with an improved version of this algorithm that makes use of tTV and temporal Fast Fourier Transform regularization in x-f domain.

Results

The proposed method with space-time variant regularization provides higher motion fidelity and image quality than the two previously reported methods. Difference images between undersampled reconstruction and fully sampled reference images show less systematic errors with the proposed approach.

Conclusions

Usage of a space-time variant regularization offers reconstructions with better image quality than the state of the art approaches used for comparison.

http://bit.ly/2HqC6gj

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

Conclusion

http://bit.ly/2MbitY6

Revisiting age‐related admission following tonsillectomy in the pediatric population

Objectives/Hypothesis

The objectives of this study were to examine patient outcomes using a 36‐month age cutoff as a strict admission criterion following tonsillectomy, and review the safety and determine the plausibility of same‐day discharge of children under 3 years old following tonsillectomy.

Study Design

Retrospective chart review.

Methods

A chart review of patients aged 24 to 42 months undergoing tonsillectomy over a 3‐year period was conducted. Patients were stratified into <36 months and ≥ 36 months cohorts. Data collected included demographics, medical/sleep history, inpatient records, 30‐day emergency department visits, and readmission data. Bivariate comparisons were made using χ² and Wilcoxon tests for categorical and continuous variables.

Results

Between July 2014 and July 2017, 427 patients aged 24 to 42 months underwent tonsillectomy at our institution. Thirty‐day emergency department visit, readmission, and greater‐than‐expected length of stay rates were 3.0% versus 3.7% (P = .75), 1.0 versus 1.8% (P = .61), and 4.7% versus 4.5% (P = 1.00) between the younger and older cohorts, respectively, with no difference in complication rates identified based on age.

Conclusions

No significant difference in adverse outcomes was appreciated based on a cutoff of 36 months of age at a tertiary center over 3 years. There should continue to be ongoing studies addressing strict age‐related admission criteria.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2RuZ0rl

Water-soluble ion components of PM 10 during the winter-spring season in a typical polluted city in Northeast China

Abstract

From January 1 to April 22, 2014, an online analyzer for monitoring aerosols and gases (MARGA) was used to measure and analyze water-soluble ions in inhalable particulate matter with a diameter less than 10 μm (PM₁₀) during winter-spring in Shenyang city, China. The results yielded three main findings. (1) During the entire observation period and in seven pollution episodes, SO₄²⁻, NO₃⁻, and NH₄⁺ (SNA) accounted for 84.4–93.1% of the total water-soluble ions (TWSIs). TWSIs accounted for 32% of PM₁₀ mass during the entire observation period, and the contribution of TWSIs in PM₁₀ ranged from 33.4–43.1% in the seven pollution episodes. The contribution of TWSIs components increased during the pollution episodes, but certain differences were observed in different pollution episodes. In terms of ionic equilibrium, the total concentration of negative ions was slightly greater than that of positive ions and the difference was 3.1% of the total ion load on average, indicating that local aerosols are mainly neutral. The water-soluble ions show clear diurnal variation with the high concentration around 09:00 for SO₄²⁻, NH₄⁺, and Cl⁻ which is consistent with the high heating grade index. (2) Pollution episodes often occur in Northeast China, especially during the winter period. Due to the low temperature in the winter, the local coal burning for heating is one of the main sources of pollution besides vehicle exhaust and industrial pollution, which is supported by the higher NO₃⁻/SO₄²⁻ ratio in April than that in January to March. Sometimes, under the prevailing wind directions of W and SSW, the long-distance transport of pollutants from the Beijing-Tianjin-Hebei region and Shandong province superimposed on local pollution leads to the most severe pollution, such as Ep3 and Ep5. (3) SO₄²⁻ concentration is closely related to ambient water vapor pressure (e*), with increase as e* increased depending on the temperature. NO₃⁻ concentration showed a linear relationship of excess NH₄⁺, which suggests homogeneous gas-phase reaction of ammonia and nitric acid is possibly an important pathways of nitrate formation in the haze pollution process in Shenyang City. In addition, our results also suggest the nighttime liquid-phase reaction may cause large increases of nitrate in the haze pollution process.

http://bit.ly/2FwimWC

Experimental assessment and multi-response optimization of diesel engine performance and emission characteristics fuelled with Aegle marmelos seed cake pyrolysis oil-diesel blends using Grey relational analysis coupled principal component analysis

Abstract

This research focuses on the detailed experimental assessment of compression ignition (CI) engine behavior fuelled with Aegle marmelos (AM) seed cake pyrolysis oil blends. The study on effects of engine performance and emission a characteristic was designed using L₂₅ orthogonal array (OA). These multi-objectives were normalized through gray relational analysis (GRA). Likewise, the principal component analysis (PCA) was performed to assess the weighting values respective to every performance and emission characteristics. The variability induced by using the input process parameters was allocated using analysis of variance (ANOVA). Hence, GRA-coupled PCA were employed to determine the optimal combination of CI engine control factors. The greater combination of engine characteristics levels were selected with F₅ and W₅. The higher brake thermal efficiency (BTE) have been obtained for F20 fuel as 22.01% at peak engine load, which is 11.43% for diesel. At peak load condition, F20 fuel emits 14.99% lower HC and 18.52% lower CO as compared to diesel fuel. The improved engine performance and emission characters can be attained by setting the optimal engine parameter combination as F20 blend at full engine load condition. The validation experiments show an improved average engine performance of 67.36% and average lower emission of 64.99% with the composite desirability of 0.8458.

http://bit.ly/2FAr9pO

Analysis of the spatial variation of indoor radon concentrations (national survey in Bulgaria)

Abstract

This paper presents the methodology and results of the national radon survey in Bulgaria and its spatial variability. The measurements were carried out in 2778 dwellings using CR-39 track detectors over two successive 9 and 3-month periods from April 2015 to March 2016. The arithmetic (AM) and geometric (GM) means of annual indoor radon concentration were 111 ± 105 Bq/m³ and 81 Bq/m³ (GSD = 2.15), respectively. The distribution of data has been accepted to be log-normal. Two hypotheses have been investigated in the paper. The first one was a spatial variation of indoor radon concentration and the second was spatiality of the factor that influences radon variation. The indoor radon concentrations in the 28 districts have been significantly different, which prove the first hypothesis. The influence of the factors, geology (geotectonic unit, type of rock, and faults distance of the measuring site), type of the region, and the presence of the basement in the building on radon spatial variation, was examined. The analyses have been shown that they significantly affect radon variations but with a relatively small contribution in comparison to the radon variation between district. Furthermore, the significance and contribution of the investigated factors were different in each district, which confirmed the second hypothesis for their spatiality.

http://bit.ly/2FrXa4b

Retrograde parotidectomy under local anesthesia for benign, malignant, and inflammatory lesions

Publication date: Available online 14 January 2019

Source: American Journal of Otolaryngology

Author(s): Michael Chang, Alanna Coughran, Yu-Jin Lee, Jeremy Collins, Davud Sirjani

Abstract

Objective

To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).

Methods

A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center.

Results

Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1–2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free.

Conclusion

In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.

http://bit.ly/2ClLegi

Zielgerichtete und Immuntherapien verändern die Therapielandschaft bei hämatologischen Neoplasien immer mehr

http://bit.ly/2TS1RqP

Audiological outcomes in Pediatric patients with congenital aural atresia implanted with transcutaneous active bone conduction hearing implant

Publication date: Available online 14 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Zernotti ME, Chiaraviglio MM, Mauricio SB, P.A. Tabernero, Zernotti M, M.F. Di Gregorio

Abstract

Objectives

The objective of this study is to evaluate the safety and efficacy of the transcutaneous Bone Conduction Implant, the Bonebridge, in patients with congenital aural atresia.

Methods

Audiometry, speech recognition test and free field audiometry were performed. Word recognition scores and speech perception was evaluated using Spanish phonetically-balanced disyllables word list.

Results

Fourteen subjects were implanted with the Bonebridge (seven bilateral placements). The study cohort comprised seven males and seven females aged from 3 to 17 years (mean age 9.76yrs). All patients accepted and benefited from the implanted Bonebridge system. The pre-operative PTA₄ was 66.4 dB (64.2-68.6, 95-%CI) and improved after activation to 19.2 dB (16.9-21.5, 95%-CI), resulting in a mean functional gain of 48 dB. Regarding speech discrimination, the pre-operative outcomes of the disyllabic measurements were 34.3% and for monosyllables 27.4%. Following activation the speech discrimination improved to 98.6% and 97.9%, respectively. No infections or adverse device related effects occurred in patient group.

Conclusion

We have concluded that the Bonebridge implant is an innovative solution for patients with conductive or mixed hearing loss and unilateral loss suffering from congenital atresia. Different surgical techniques may be used for implant placement, based on the patient's anatomy. Studies show improved functional gain, better speech perception, and lower rates of percutaneous complications associated with this implant.

http://bit.ly/2SQXGvv

Auditory brainstem implantation in children with hearing loss: effect on speech production

Publication date: Available online 14 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jolien Faes, Steven Gillis

Abstract

Auditory brainstem implantation (ABI) is a recent technique in children's hearing restoration. Up till now the focus in the literature has mainly been the perceptual outcomes after implantation, whereas the effect of ABI on spoken language is still an almost unexplored area of research. This study presents a one-year follow-up of the volubility of two children with ABI. The volubility of signed and oral productions is investigated and oral productions are examined in more detail. Results show clear developmental trends in both children, indicating a beneficial effect of ABI on spoken language development.

http://bit.ly/2AN0937

Early life undernutrition reprograms CD4+ T-cell glycolysis and epigenetics to facilitate asthma

Publication date: Available online 15 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Xi Chen, Hui Lin, Daping Yang, Wei Xu, Guangwei Liu, Xinmei Liu, Jianzhong Sheng, Hefeng Huang

Abstract

Background

Exposure to early life undernutrition is closely related to higher risks of adverse immunologic outcomes in adulthood. Although it has been suggested that asthma has its origins in early life, its underlying mechanisms remain largely unknown.

Objective

We characterized the impacts of early life undernutrition on T lymphocytes, which play a pivotal role in immune diseases, and we investigated whether this contributes to susceptibility to asthma in adulthood.

Methods

Pregnant mice were fed a protein restriction diet (PRD) to establish an early life undernutrition model. Naïve CD4⁺ T cells (CD4⁺CD62L^hiCD44^-) from offspring were used throughout the study. Type 2 T helper (Th2) differentiation was examined by FACS and ELISA under Th2-polarized conditions in vitro and by ovalbumin (OVA)-induced experimental asthma in vivo. T-cell metabolism was measured with a Seahorse XF96 Analyzer. DNA methylation levels were measured by bisulfite sequencing.

Results

PRD CD4⁺ T cells displayed increased activation and proliferation and were prone to differentiate into Th2 cells both in vitro and in vivo, leading to susceptibility to experimental asthma. Mechanistically, early life undernutrition upregulated mTORC1- dependent glycolysis and induced conserved noncoding DNA sequence 1 (CNS1) DNA hypomethylation in Th2 cytokine locus of CD4⁺ T cells. Glycolysis blockades undermined increased Th2 skewing and alleviated experimental asthma in PRD mice.

Conclusion

Early life undernutrition induced mTORC1-dependent glycolysis upregulation and Th2 cytokine locus hypomethylation in CD4⁺ T cells, resulting in increased T-cell activation, proliferation and Th2 skewing and further susceptibility to experimental asthma.

Graphical abstract

Graphical abstract for this article

http://bit.ly/2CixoLq

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 15 Ιανουαρίου 2019

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