This PSA from Queensland Ambulance Service reminds people to check on their friends and neighbors during the holidays and not to be afraid to call for an ambulance if they need help.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 27 Δεκεμβρίου 2015
When to call an ambulance: A Christmas PSA
When to call an ambulance: A Christmas PSA
This PSA from Queensland Ambulance Service reminds people to check on their friends and neighbors during the holidays and not to be afraid to call for an ambulance if they need help.
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When to call an ambulance: A Christmas PSA
This PSA from Queensland Ambulance Service reminds people to check on their friends and neighbors during the holidays and not to be afraid to call for an ambulance if they need help.
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Evaluation of mean platelet volume as a predictor of gastric disorders
2015-12-27T15-01-44Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Ozgur Turk, Ziya Taner Ozkececi, Bartu Badak, Ahmet Bal.
Aim: Gastric disorders present in a wide range, including malignant and benign diseases of the upper gastrointestinal system. Increased MPV levels are associated with inflammation. The goal of this study was to determine the diagnostic importance of MPV in gastric disorders and evaluate level of MPV in patients that underwent upper gastrointestinal endoscopy. Materials and Methods: Patients who had undergone endoscopy and shown to have a gastric disorder with blood count performed were included in the study. Only one surgeon performed all of the endoscopies. MPV value, platelet count, hemoglobin and white blood cell count levels were analyzed. Results: 116 patients were included in the study. Mean age of all patients was 47,8±16,4. Mean value of MPV was determined to be 7,79±1,21, within the range of 5,85 to 12,5 fL. There was no significant correlation between diagnoses and MPV levels (P>0,05). Additionally, there was no significant difference in MPV levels in histopathological diagnoses groups (p>0,05). There was a highly negative correlation between platelet count and MPV levels in a Scatter Plot correlation graph (r=0,083). Conclusions: MPV is a frequently used hematological parameter that indicates platelet function and activity affected by inflammation. It was hypothesized that changes in MPV levels could be associated with gastric disorders. Statistical analysis of the data revealed there was no association between MPV and gastric disorders. It is suggested that MPV is not a suitable marker to determine gastric disorders, however further larger studies can be useful to determine the importance of MPV such a context.
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Let It (Microbially) Snow...
I made this video in October of 2015, with my Biology 350 Microbiology students at the University of Puget Sound. A drop of Pseudomonas syringae expressing ice nucleation protein hits supercooled pure water, and fun results. This is the way that Snomax works to commercially generate snow, inci...
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Fungus in my brothers sports drink
Unopened sports drink containing a fungal contaminant
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Small vertical changes in jaw relation affect motor unit recruitment in the masseter
Summary
Strategies for recruitment of masseter muscle motor units (MUs), provoked by constant bite force, for different vertical jaw relations have not previously been investigated. The objective of this study was to analyse the effect of small changes in vertical jaw relation on MU recruitment behaviour in different regions of the masseter during feedback-controlled submaximum biting tasks. Twenty healthy subjects (mean age: 24·6 ± 2·4 years) were involved in the investigation. Intra-muscular electromyographic (EMG) activity of the right masseter was recorded in different regions of the muscle. MUs were identified by the use of decomposition software, and root-mean-square (RMS) values were calculated for each experimental condition. Six hundred and eleven decomposed MUs with significantly (P < 0·001) different jaw relation-specific recruitment behaviour were organised into localised MU task groups. MUs with different task specificity in seven examined tasks were observed. The RMS EMG values obtained from the different recording sites were also significantly (P < 0·01) different between tasks. Overall MU recruitment was significantly (P < 0·05) greater in the deep masseter than in the superficial muscle. The number of recruited MUs and the RMS EMG values decreased significantly (P < 0·01) with increasing jaw separation. This investigation revealed differential MU recruitment behaviour in discrete subvolumes of the masseter in response to small changes in vertical jaw relations. These fine-motor skills might be responsible for its excellent functional adaptability and might also explain the successful management of temporomandibular disorder patients by somatic intervention, in particular by the use of oral splints.
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Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to CPAP
Summary
The aim of this retrospective study was to evaluate the effect of individually adjusted custom-made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non-adherent to continuous positive airway pressure (CPAP) therapy. During 2007-2013, 116 patients with moderate (n = 82) and severe (n = 34) OSA non-adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Ten of the participants (8·6%) were lost to follow-up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28-90). Nocturnal respiratory polygraphic recordings were performed at baseline and follow-up. Average time between baseline polygraphy and follow-up was 12 months. A successful OA treatment outcome was based on polygraphy at the follow-up and divided into three groups: 1 = AHI <5; 2 = 5 ≤ AHI <10 and >50% reduction in baseline AHI; and 3. >50% reduction in baseline AHI. If there was a ≤ 50% reduction in baseline AHI at the follow-up, the treatment was considered as a failure. The overall treatment success rate was 75%. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). Low oxygen saturation (SpO2 nadir) had a high predictive value for OA treatment failure. OA treatment of patients non-adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated.
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Intramuscular innervations of lower leg skeletal muscles: applications in their clinical use in functional muscular transfer
Abstract
Purpose
This study aims to investigate nerve distribution patterns of human lower leg skeletal muscles using a modified Sihler's staining method.
Methods
Sixteen lower leg from eight fresh adult cadavers were used in this study and all the skeletal muscles were dissected. The muscle specimens were classified according to Lim's classification. The specimens were then stained by further modified Sihler's staining technique. Data were analyzed according to research results.
Results
After the staining, we found four patterns of nerve distribution in human lower leg muscles: (1) Type 1: single nerve pattern in which the nerve branches into two either running parallel to each other or radiating in a spray pattern (such as the extensor digitorum longus, extensor hallucis longus, fibularis brevis and flexor hallucis longus). (2) Type 2: double nerve pattern, one being proximal and the other being distal (such as the extensor digitorum longus, flexor digitorum longus, flexor hallucis longus). (3) Type 3: multiple branch pattern (such as the tibialis anterior, fibularis longus, gastrocnemius, soleus, tibialis anterior and popliteus).
Conclusion
Our modified Sihler's staining method is useful for research of large muscles and intramuscular nerves in human. These findings might provide guidance for clinicians for muscle reconstruction surgery.
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A Mouse Model for Laser-induced Choroidal Neovascularization
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The top ten AFP Community Blog posts of 2015
- Kenny Lin, MD, MPH and Jennifer Middleton, MD, MPH
Some themes that emerged from this year's list of most-read posts included avoiding overtreatment, challenging medical dogma in management of low back pain and myocardial infarction, and estimating efficacy and adverse effects of depression therapies in primary care settings. Happy holidays and best wishes for the New Year!
1. Advise patients to steer clear of these six orthopedic procedures (March 16) - 1804 views
What accounts for the continued popularity of ineffective orthopedic procedures? Excessive magnetic resonance imaging (MRI) plays a role. Patients who perceive surgery to be a "quick fix" may not have the patience to stick with physical therapy and rehabilitation. And there is the inescapable reality that, necessary or not, these procedures pay well.
2. Can treating mild hypertension be too much medicine? (January 2) - 935 views
Key take-home points are that the absolute benefits of treating otherwise healthy persons with mild hypertension are relatively small; lifestyle modification should generally precede medication; and blood pressure measurement should be performed and repeated carefully to ensure accurate identification of hypertensive patients.
3. ACC/AHA and Framingham calculators overestimate cardiovascular risk (March 3) - 841 views
Men in the Multi-Ethnic Study of Atherosclerosis cohort with a calculated ACC/AHA risk score of 7.5 to 10 percent had an actual event rate of only 3 percent; and just over 5 percent of women with a similar risk score experienced cardiovascular events.
4. Acetaminophen ineffective for chronic low back pain - now what? (April 6) - 826 views
Intuitively, acetaminophen seems like a reasonable choice for treating chronic LBP. It's inexpensive and relatively safe when used at recommended doses. This 2015 meta-analysis overturns that recommendation and should prompt a change in the clinical guidelines.
5. Stop beta-blockers 30 days after acute MI? (March 23) - 794 views
The greatest challenge for family physicians managing patients following up after an AMI admission may be the decision to stop a beta-blocker. Discontinuing therapies may be difficult for physicians.
6. Guest post: quality medical care makes patients feel at home (Sept. 7) - 766 views
In my view, the definition of good care includes communication, patience, concern, and perseverance. A high quality, "patient-centered" medical home is based on these human characteristics and not on outcome criteria, EHR meaningful use, or other measures.
7. Announcing the #AFPTop20 Tweet Chat on August 26th (August 17) - 760 views
On Wednesday, August 26th at 4 PM Eastern, @AFPJournal held its first #AFPTop20 Tweet Chat to take a deeper dive into the findings of some of the top POEMs of the year and their ramifications for family physicians.
8. Which antidepressants have the highest suicide risk? (July 6) - 748 views
In a United Kingdom cohort of 240,000 adult patients with depression, the adjusted hazard ratios for venlafaxine and mirtazapine for suicidal behavior were 1.70 (1.44 to 2.02) and 1.85 (1.61 to 2.13), respectively, compared with citalopram.
9. How to make sure your patients understand health information (July 15) - 713 views
A large body of evidence demonstrates strong associations between low health literacy and poorer health outcomes; compared to patients with high health literacy, patients with low literacy have more hospitalizations, more emergency department visits, and are less likely to receive appropriate preventive and chronic care services.
10. Depression treatment: the evidence base from a primary care perspective (Feb. 23) - 695 views
This systematic review provides guidance for family physicians treating patients with mild to moderate depression as well as severe depression; it provides reassurance to patients unable to attend multiple psychotherapy sessions that even a few sessions can provide benefit.
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TWiEVO 2: Faster than a speeding virus
On episode #2 of the new science show This Week in Evolution, Nels and Vincent talk about how a cellular enzyme contributes to the very high mutation rate of human immunodeficiency virus type 1. You can find TWiEVO #2 at microbe.tv/twievo.
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TWiV 369: Camel runny noses and other JNK
Hosts: Vincent Racaniello, Alan Dove, and Kathy Spindler
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A Luxmas Tree!
This is included in my recent blog post (http://ift.tt/1PnoRc5), but here it is by itself. Photobacterium leignothi "stars" on Petri plates hung on my tree, and a 5 second exposure makes for a nondenominational "Luxmas Tree." Happy Microbial Holidays!
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Cyclic GMP-AMP Synthase Is Required for Cell Proliferation and Inflammatory Responses in Rheumatoid Arthritis Synoviocytes
Rheumatoid arthritis (RA) is characterized by inflammatory cell infiltration, fibroblast-like synoviocytes (FLS) invasive proliferation, and joint destruction. Cyclic GMP-AMP synthase (cGAS) is a cytosolic DNA sensor that induces immune activation. In this study, we examined whether cGAS plays a role in RA FLS. In this study, cGAS was overexpressed in RA-FLS compared with OA FLS. TNFα stimulation induced cGAS expression in RA FLS. Overexpression of cGAS promoted the proliferation and knockdown of cGAS inhibited the proliferation of RA FLS. cGAS overexpression enhanced the production of proinflammatory cytokines and matrix metalloproteinases (MMPs) as well as AKT and ERK phosphorylation in TNFα-stimulated FLS. In contrast, cGAS silencing inhibited production of proinflammatory cytokines and matrix metalloproteinases (MMPs) as well as AKT and ERK phosphorylation in TNFα-stimulated FLS. These results suggest that cGAS activates the AKT and ERK pathways to promote the inflammatory response of RA FLS, and the development of strategies targeting cGAS may have therapeutic potential for human RA.
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Levo-Tetrahydropalmatine Attenuates Bone Cancer Pain by Inhibiting Microglial Cells Activation
Objective. The present study is to investigate the analgesic roles of L-THP in rats with bone cancer pain caused by tumor cell implantation (TCI). Methods. Thermal hyperalgesia and mechanical allodynia were measured at different time points before and after operation. L-THP (20, 40, and 60 mg/kg) were administrated intragastrically at early phase of postoperation (before pain appearance) and later phase of postoperation (after pain appearance), respectively. The concentrations of TNF-α, IL-1β, and IL-18 in spinal cord were measured by enzyme-linked immunosorbent assay. Western blot was used to test the activation of astrocytes and microglial cells in spinal cord after TCI treatment. Results. TCI treatment induced significant thermal hyperalgesia and mechanical allodynia. Administration of L-THP at high doses significantly prevented and/or reversed bone cancer-related pain behaviors. Besides, TCI-induced activation of microglial cells and the increased levels of TNF-α and IL-18 were inhibited by L-THP administration. However, L-THP failed to affect TCI-induced astrocytes activation and IL-1β increase. Conclusion. This study suggests the possible clinical utility of L-THP in the treatment of bone cancer pain. The analgesic effects of L-THP on bone cancer pain maybe underlying the inhibition of microglial cells activation and proinflammatory cytokines increase.
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The Younger the Mother, the Worse Her Health at Midlife: Study
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Reliability of cervical lordosis measurement techniques on long-cassette radiographs
Abstract
Purpose
Lateral radiographs are commonly used to assess cervical sagittal alignment. Three assessment methods have been described and are commonly utilized in clinical practice. These methods are described for perfect lateral cervical radiographs, however in everyday practice radiograph quality varies. The aim of this study was to compare the reliability and reproducibility of 3 cervical lordosis (CL) measurement methods.
Methods
Forty-four standing lateral radiographs were randomly chosen from a lateral long-cassette radiograph database. Measurements of CL were performed with: Cobb method C2–C7 (CM), C2–C7 posterior tangent method (PTM), sum of posterior tangent method for each segment (SPTM). Three independent orthopaedic surgeons measured CL using the three methods on 44 lateral radiographs. One researcher used the three methods to measured CL three times at 4-week time intervals. Agreement between the methods as well as their intra- and interobserver reliability were tested and quantified by intraclass correlation coefficient (ICC) and median error for a single measurement (SEM). ICC of 0.75 or more reflected an excellent agreement/reliability. The results were compared with repeated ANOVA test, with p < 0.05 considered as significant.
Results
All methods revealed excellent intra- and interobserver reliability. Agreement (ICC, SEM) between three methods was (0.89°, 3.44°), between CM and SPTM was (0.82°, 4.42°), between CM and PTM was (0.80°, 4.80°) and between PTM and SPTM was (0.99°, 1.10°). Mean values CL for a CM, PTM, SPTM were 10.5° ± 13.9°, 17.5° ± 15.6° and 17.7° ± 15.9° (p < 0.0001), respectively. The significant difference was between CM vs PTM (p < 0.0001) and CM vs SPTM (p < 0.0001), but not between PTM vs SPTM (p > 0.05).
Conclusions
All three methods appeared to be highly reliable. Although, high agreement between all measurement methods was shown, we do not recommend using Cobb measurement method interchangeably with PTM or SPTM within a single study as this could lead to error, whereas, such a comparison between tangent methods can be considered.
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A probe into the Short wave diathermy (SWD) practice in an urban private physiotherapy clinics: ethical practice and safety survey
2015-12-27T06-46-51Z
Source: International Journal of Therapies and Rehabilitation Research
swati meshram, DR. MEDHA Deo, DR. DHWANI RAJ Raj.
Background: to ensure safety & effectiveness various national & international bodies like FDA, CSP have laid down guidelines for the use of SWD (short wave diathermy). Physiotherapists working in private clinical set up however seem to have ignorance about this guidelines or its basic implementation is lacking. Method: 49 physiotherapy practitioners were interviewed for their knowledge base, mode of application (6 items) & the awareness about recommended guidelines (5 items) etc. was investigated Results: 47 out of 49 (85%) of physiotherapy practitioner mentioned SWD as an EMF generating modality. Only 33 practitioners (67.3%) attempted specific items related to SWD application. All of them used SWD in continues mode. 7(14%) of the therapist discerned SWD as the medium frequency current. 9 (18%) therapist were not aware of the type of frequency used in operation of this EPA. 45% therapist used SWD during acute condition. 22 (49%) of sample population confirmed that they were aware of recommended guidelines. 9 (41%) of them said to follow WHO guidelines while 13 (59%) stated FDA. 21 out of 33 (63%) felt that SWD cannot be replaced by any other modality. Conclusion: Sampled population was unaware of the recommended guidelines for the safe practice of SWD. Key words: SWD, electromagnetic field application, recommended guidelines. Mode of practice.
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Status of Human Papillomavirus Infection in the Ethnic Population in Yunnan Province, China
HPV genotypes have distinct distributions among various ethnic populations worldwide. In December 2013, 237 and 159 cervical samples were collected from Hani and Han ethnic women, respectively, in Mojiang, a rural county in southern Yunnan. The overall HPV infection rate (21.1%) among the Hani women was significantly higher than that among the Han women (12.6%). The high-risk (HR) and low-risk (LR) HPV and single- and multiple-genotype infection rates among the Hani women were 11.0%, 4.6%, 15.6%, and 5.5%, respectively. HPV-16 (3.8%) was the most prevalent genotype among the Hani women, followed by HPV-52 (1.7%), HPV-31 (0.8%), and HPV-33 (0.8%). Comparatively, the Han women had lower infection rates of high-risk (8.2%), low-risk (1.2%), single-genotype (9.4%), and multiple-genotype HPV infections (3.1%). HPV-16 (3.1%) was also the predominant genotype among the Han women, followed by HPV-52 (1.3%), HPV-33 (0.6%), HPV-44 (0.6%), and HPV-54 (0.6%). The area background, number of children, and past history of STIs were recognized as potential risk factors for HPV infection. Rural background, age, education level, number of children, and illness history were significantly associated with HPV infection among the Hani women. These findings highlight the urgent need for HPV prevention and control strategies in Yunnan, particularly for the Hani ethnic women.
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Impact of pH Management Interval on Biohydrogen Production from Organic Fraction of Municipal Solid Wastes by Mesophilic Thermophilic Anaerobic Codigestion
The biohydrogen productions from the organic fraction of municipal solid wastes (OFMSW) were studied under pH management intervals of 12 h (PM12) and 24 h (PM24) for temperature of °C and °C. The OFMSW or food waste (FW) along with its two components, noodle waste (NW) and rice waste (RW), was codigested with sludge to estimate the potential of biohydrogen production. The biohydrogen production was higher in all reactors under PM12 as compared to PM24. The drop in pH from 7 to 5.3 was observed to be appropriate for biohydrogen production via mesophilic codigestion of noodle waste with the highest biohydrogen yield of 145.93 mL/g under PM12. When the temperature was increased from 37°C to 55°C and pH management interval was reduced from 24 h to 12 h, the biohydrogen yields were also changed from 39.21 mL/g to 89.67 mL/g , 91.77 mL/g to 145.93 mL/g , and 15.36 mL/g to 117.62 mL/g for FW, NW, and RW, respectively. The drop in pH and VFA production was better controlled under PM12 as compared to PM24. Overall, PM12 was found to be an effective mean for biohydrogen production through anaerobic digestion of food waste.
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Hypoxia-Induced Epithelial-Mesenchymal Transition Is Involved in Bleomycin-Induced Lung Fibrosis
Pulmonary fibrosis is a severe disease that contributes to the morbidity and mortality of a number of lung diseases. However, the molecular and cellular mechanisms leading to lung fibrosis are poorly understood. This study investigated the roles of epithelial-mesenchymal transition (EMT) and the associated molecular mechanisms in bleomycin-induced lung fibrosis. The bleomycin-induced fibrosis animal model was established by intratracheal injection of a single dose of bleomycin. Protein expression was measured by Western blot, immunohistochemistry, and immunofluorescence. Typical lesions of lung fibrosis were observed 1 week after bleomycin injection. A progressive increase in MMP-2, S100A4, α-SMA, HIF-1α, ZEB1, CD44, phospho-p44/42 (p-p44/42), and phospho-p38 MAPK (p-p38) protein levels as well as activation of EMT was observed in the lung tissues of bleomycin mice. Hypoxia increased HIF-1α and ZEB1 expression and activated EMT in H358 cells. Also, continuous incubation of cells under mild hypoxic conditions increased CD44, p-p44/42, and p-p38 protein levels in H358 cells, which correlated with the increase in S100A4 expression. In conclusion, bleomycin induces progressive lung fibrosis, which may be associated with activation of EMT. The fibrosis-induced hypoxia may further activate EMT in distal alveoli through a hypoxia-HIF-1α-ZEB1 pathway and promote the differentiation of lung epithelial cells into fibroblasts through phosphorylation of p38 MAPK and Erk1/2 proteins.
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Intramuscular innervations of lower leg skeletal muscles: applications in their clinical use in functional muscular transfer
Abstract
Purpose
This study aims to investigate nerve distribution patterns of human lower leg skeletal muscles using a modified Sihler's staining method.
Methods
Sixteen lower leg from eight fresh adult cadavers were used in this study and all the skeletal muscles were dissected. The muscle specimens were classified according to Lim's classification. The specimens were then stained by further modified Sihler's staining technique. Data were analyzed according to research results.
Results
After the staining, we found four patterns of nerve distribution in human lower leg muscles: (1) Type 1: single nerve pattern in which the nerve branches into two either running parallel to each other or radiating in a spray pattern (such as the extensor digitorum longus, extensor hallucis longus, fibularis brevis and flexor hallucis longus). (2) Type 2: double nerve pattern, one being proximal and the other being distal (such as the extensor digitorum longus, flexor digitorum longus, flexor hallucis longus). (3) Type 3: multiple branch pattern (such as the tibialis anterior, fibularis longus, gastrocnemius, soleus, tibialis anterior and popliteus).
Conclusion
Our modified Sihler's staining method is useful for research of large muscles and intramuscular nerves in human. These findings might provide guidance for clinicians for muscle reconstruction surgery.
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Peroral endoscopic myotomy in the endoscopy unit: location, location, location.
Peroral endoscopic myotomy in the endoscopy unit: location, location, location.
Gastrointest Endosc. 2016 Jan;83(1):126-8
Authors: Pannu D, White JD, Draganov PV
PMID: 26706301 [PubMed - in process]
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Anti-Inflammatory Activity of Triterpenes Isolated from Protium paniculatum Oil-Resins
Protium is the main genus of the Burseraceae family and one of the most common genera in South America, with an important species called "breu." Gum and oil-resins of this species are used as tonic and stimulant and for the treatment of ulcers and inflammation. The present study aims to isolate and investigate the anti-inflammatory activity of triterpene compounds isolated from oil-resin of Protium paniculatum. The pentacyclic triterpenes α,β-amyrin, acetylated α,β-amyrin, α,β-amyrone, and brein/maniladiol did not alter the viability of murine J774 macrophages (IC50 > 20 µg/mL), with the exception of mixture of brein/maniladiol which showed moderate cytotoxic activity. Also it was observed that compounds at 10 µg/mL inhibited more than 80% of production of NO•, although only α,β-amyrin was able to inhibit the production of TNF-α (). The compounds inhibited the production of IL-6 and induced the production of IL-10 in murine J774 macrophages stimulated by LPS. α,β-Amyrone inhibited the expression of COX-2 and also inhibited the formation of paw or ear edema in rats and mice, having a quick and immediate effect. This study may provide the basis for future investigations on the therapeutic role of α,β-amyrone in treating inflammation.
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Huangqi Jianzhong Tang for Treatment of Chronic Gastritis: A Systematic Review of Randomized Clinical Trials
To assess the clinical effects and safety of Huangqi Jianzhong Tang (HQJZ) for the treatment of chronic gastritis (CG), three English databases and four Chinese databases were searched through the inception to January 2015. In randomized controlled trials (RCTs) comparing HQJZ with placebo, no intervention and western medicine were included. A total of 9 RCTs involving 979 participants were identified. The methodological quality of the included trials was generally poor. Meta-analyses demonstrated that HQJZ plus conventional medicine was more effective in improving overall gastroscopy outcome than western medicine alone for treatment of chronic superficial gastritis with the pooling result of overall improvement [OR 3.78 (), ]. In addition, the combination of HQJZ with antibiotics has higher overall effect rate than antibiotics alone for the treatment of CG [OR 2.60 (), ]. There were no serious adverse events reported in both the intervention and controlled groups. HQJZ has the potential of improvement of the patients' gastroscopy outcomes, Helicobacter pylori clearance rate, traditional Chinese Medicine syndromes, and overall effect rate alone or in combination use with conventional western medicine for chronic atrophic gastritis. However, due to poor methodological quality, the beneficial effect and safeties of HQJZ for CG could not be confirmed.
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Neutrophilic Bronchial Inflammation Correlates with Clinical and Functional Findings in Patients with Noncystic Fibrosis Bronchiectasis
Background. Neutrophilic bronchial inflammation is a main feature of bronchiectasis, but not much is known about its relationship with other disease features. Aim. To compare airway inflammatory markers with clinical and functional findings in subjects with stable noncystic fibrosis bronchiectasis (NCFB). Methods. 152 NFCB patients (62.6 years; females: 57.2%) underwent clinical and functional cross-sectional evaluation, including microbiologic and inflammatory cell profile in sputum, and exhaled breath condensate malondialdehyde (EBC-MDA). NFCB severity was assessed using BSI and FACED criteria. Results. Sputum neutrophil percentages inversely correlated with FEV1 (; rho = −0.428), weakly with Leicester Cough Questionnaire score (; rho = −0.58), and directly with duration of the disease (; rho = 0.3) and BSI severity score (; rho = 0.37), but not with FACED. Sputum neutrophilia was higher in colonized subjects, P. aeruginosa colonized subjects showing greater sputum neutrophilia and lower FEV1. Patients with ≥3 exacerbations in the last year showed a significantly greater EBC-MDA than the remaining patients. Conclusions. Sputum neutrophilic inflammation and biomarkers of oxidative stress in EBC can be considered good biomarkers of disease severity in NCFB patients, as confirmed by pulmonary function, disease duration, bacterial colonization, BSI score, and exacerbation rate.
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Smell Tests Could One Day Reveal Head Trauma and Neurodegenerative Disease
Memory for odors is particularly complex, making scratch-n-sniff tests an early indicator of damage to the brain
-- Read more on ScientificAmerican.com
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Holiday season's videos
We have seen many creative season's greetings videos with robots this year, some even featuring a da Vinci. Check these out below!
2015 - ALTAIR Robotics LAB Christmas Clip - YouTube
Check out more on IEEE Spectrum Automaton Blog and on RoboHub
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Multiple analyses of factors related to complications in endoscopic sinus surgery.
Multiple analyses of factors related to complications in endoscopic sinus surgery.
J Chin Med Assoc. 2015 Dec 16;
Authors: Chou TW, Chen PS, Lin HC, Lee KS, Tsai HT, Lee JC, Leu YS, Wang YP
Abstract
BACKGROUND: This study was undertaken to evaluate whether endoscopic sinus surgery (ESS) with a microdebrider had an impact on complication rates, and to facilitate the determination of factors associated with complications in patients who underwent ESS at a tertiary referral center in Taiwan.
METHODS: This investigation was a retrospective study and literature review. We analyzed 997 consecutive patients who underwent ESS at Mackay Memorial Hospital in Taipei, Taiwan from January 2006 through February 2010. All data including those of patient medical information, and peri- and postoperative complications were provided by the surgeons involved in patient medical care. We analyzed the complication rates using the following 10 variables by univariate analysis and multivariate logistic regression: gender, age, Lund-Mackay score, polyp grading, previous sinonasal surgery, surgeon skill, adjunctive sinonasal surgery, mesenteric type of anterior ethmoid artery, Keros skull base type, and the use of a microdebrider.
RESULTS: Of the 997 patients in our study, 78 (7.8%) had complications. Major complications occurred in five patients (0.5%): two with cerebrospinal fluid rhinorrhea, one with medial rectus muscle damage, and two with retrobulbar hematoma. Minor complications were found in 73 patients (7.3%), which included 32 patients with perioperative estimated blood loss > 15% of the total estimated blood volume, 26 with lamina papyracea damage, two with orbital cellulitis, and 13 with postoperative bleeding. Univariate analysis showed that risk factors related to complication rate were advanced Lund-Mackay scores (scores 19-24), advanced polyp grading (Grades 2 and 3), inexperienced surgeon (resident), and microdebrider usage. However, multivariate analysis revealed that complication rate was linked to advanced Lund-Mackay scores (Scores 19-24), mesenteric type of anterior ethmoid artery, and inexperienced surgeon.
CONCLUSION: Overall, the results of our study showed that the ESS complication rate was 7.8%, with risk factors including advanced Lund-Mackay scores (19-24, odds ratio 10.4) and inexperienced surgeon. It was also noted that ESS with a microdebrider had no impact on complication rates, although the presence of a mesenteric type of anterior ethmoid artery proved to be a protective factor.
PMID: 26706826 [PubMed - as supplied by publisher]
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Speech processing asymmetry Revealed BY dichotic listening and functional brain imaging.
Speech processing asymmetry Revealed BY dichotic listening and functional brain imaging.
Neuropsychologia. 2015 Dec 16;
Authors: Hugdahl K, Westerhausen R
Abstract
In this article, we review research in our laboratory from the last 25-30 years on the neuronal basis for laterality of speech perception focusing on the upper, posterior parts of the temporal lobes, and its functional and structural connections to other brain regions. We review both behavioral and brain imaging data, with a focus on dichotic listening experiments, and using a variety of imaging modalities. The data have come in most parts from healthy individuals and from studies on normally functioning brain, although we also review a few selected clinical examples. We first review and discuss the structural model for the explanation of the right-ear advantage (REA) and left hemisphere asymmetry for auditory language processing. A common theme across many studies have been our interest in the interaction between bottom-up, stimulus-driven, and top-down, instruction-driven, aspects of hemispheric asymmetry, and how perceptual factors interact with cognitive factors to shape asymmetry of auditory language information processing. In summary, our research have shown laterality for the initial processing of consonant-vowel syllables, first observed as a behavioral REA when subjects are required to report which syllable of a dichotic syllable-pair they perceive. In subsequent work we have corroborated the REA with brain imaging, and have shown that the REA is modulated through both bottom-up manipulations of stimulus properties, like sound intensity, and top-down manipulations of cognitive properties, like attention focus.
PMID: 26706774 [PubMed - as supplied by publisher]
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Moral considerations in non-EXIT airway management.
Moral considerations in non-EXIT airway management.
Int J Pediatr Otorhinolaryngol. 2015 Dec 10;
Authors: Walker P
Abstract
The case report "Management of the critical airway when an EXIT procedure is not an option" has important moral decision-making implications. If intubation was not quickly successful, then significant hypoxic brain injury may have resulted. A full discussion of the moral implications in cases such as this, prior to delivery, is important - both to the family and to the clinicians involved. Our contemporary era is characterised by a pronounced disparity of values and belief systems. An active process for moral decision-making based upon dialogic consensus, is seen as more appropriate than contemplation of ethical frameworks alone. This is increasingly important as the armamentarium of life-sustaining technology available to clinicians steadily increases.
PMID: 26706315 [PubMed - as supplied by publisher]
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Letter to the Editor regarding "Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile?"
Letter to the Editor regarding "Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile?"
Int J Pediatr Otorhinolaryngol. 2015 Dec 8;
Authors: Bakshi SS
PMID: 26706314 [PubMed - as supplied by publisher]
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Norrin Mediates Angiogenic Properties via the Induction of Insulin-like Growth Factor-1.
Norrin Mediates Angiogenic Properties via the Induction of Insulin-like Growth Factor-1.
Exp Eye Res. 2015 Dec 16;
Authors: Zeilbeck LF, Müller BB, Leopold SA, Senturk B, Langmann T, Tamm ER, Ohlmann A
Abstract
Norrin is an angiogenic signaling molecule that activates canonical Wnt/β-catenin signaling, and is involved in capillary formation in retina and brain. Moreover, Norrin induces vascular repair following an oxygen-induced retinopathy (OIR), the model of retinopathy of prematurity in mice. Since insulin-like growth factor (IGF)-1 is a very potent angiogenic molecule, we investigated if IGF-1 is a downstream mediator of Norrin's angiogenic properties. In retinae of transgenic mice with an ocular overexpression of Norrin (βB1-Norrin), we found at postnatal day (P)11 a significant increase of IGF-1 mRNA compared to wild-type littermates. In addition, after treatment of cultured Müller cells or dermal microvascular endothelial cells with Norrin we observed an increase of IGF-1 and its mRNA, an effect that could be blocked with DKK-1, an inhibitor of Wnt/β-catenin signaling. When OIR was induced, the expression of IGF-1 was significantly suppressed in both transgenic βB1-Norrin mice and wild-type littermates when compared to wild-type animals that were housed in room air. Furthermore, at P13, one day after the mice had returned to normoxic conditions, IGF-1 levels were significantly higher in transgenic mice compared to wild-type littermates. Finally, after intravitreal injections of inhibitory α-IGF-1 antibodies at P12 or at P12 and P14, the Norrin-mediated vascular repair was significantly attenuated. We conclude that Norrin induces the expression of IGF-1 via an activation of the Wnt/β-catenin signaling pathway, an effect that significantly contributes to the protective effects of Norrin against an OIR.
PMID: 26706283 [PubMed - as supplied by publisher]
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Understanding Lymphangiogenesis in Knockout Models, the Cornea, and Ocular Diseases for the Development of Therapeutic Interventions.
Understanding Lymphangiogenesis in Knockout Models, the Cornea, and Ocular Diseases for the Development of Therapeutic Interventions.
Surv Ophthalmol. 2015 Dec 16;
Authors: Yang JF, Walia A, Huang YH, Han KY, Rosenblatt MI, Azar DT, Chang JH
Abstract
A major focus of cancer research for several decades has been understanding the ability of tumors to induce new blood vessel formation, a process known as angiogenesis. Unfortunately, only limited success has been achieved in the clinical application of angiogenesis inhibitors. We now know that lymphangiogenesis, the growth of lymphatic vessels, likely also plays a major role in tumor progression. Thus, therapeutic strategies targeting lymphangiogenesis or both lymphangiogenesis and angiogenesis may represent promising approaches for treating cancer and other diseases. Importantly, research progress toward understanding lymphangiogenesis is significantly behind that related to angiogenesis. A PubMed search of 'angiogenesis' returns nearly 80,000 articles, whereas a search of 'lymphangiogenesis' returns approximately 2,635 articles. This stark contrast can be explained by the lack of molecular markers for identifying the invisible lymphatic vasculature that persisted until less than two decades ago combined with the intensity of research interest in angiogenesis during the past half-century. Still, significant strides have been made in developing strategies to modulate lymphangiogenesis, largely using ocular disease models. Here, we review the current knowledge of lymphangiogenesis in the context of knockout models, ocular diseases, the biology of activators and inhibitors, and the potential for therapeutic interventions targeting this process.
PMID: 26706194 [PubMed - as supplied by publisher]
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Phytochemical Screening and Acute Oral Toxicity Study of Java Tea Leaf Extracts
The term Java tea refers to the decoction of Orthosiphon stamineus (OS) Benth (Lamiaceae) leaves, which are widely consumed by the people in Europe and South East Asian countries. The OS leaves are known for their use in traditional medicinal systems as a prophylactic and curative agent for urinary stone, diabetes, and hypertension and also as a diuretic agent. The present study was aimed at evaluating its possible toxicity. Herein, the major phytochemical constituents of microwave dried OS leaf, which is the common drying process for tea sachets in the market, were also identified. The acute oral toxicity test of aqueous, 50% aqueous ethanolic, and ethanolic extracts of OS was performed at a dose of 5000 mg/Kg body weight of Sprague-Dawley rats. During the 14-day study, the animals were observed for any mortality, behavioral, motor-neuronal abnormalities, body weight, and feed-water consumption pattern. The hematological and serum biochemical parameters to assess the kidney and liver functions were carried out, along with the histological analysis of these organs. It was found that all microwave dried OS leaf extracts did not cause any toxic effects or mortality at the administered dose. No abnormality was noticed in all selected parameters in rats of both sexes as compared with their respective control groups. Thus, the possible oral lethal dose for microwave dried Java tea leaves is more than 5000 mg/Kg body weight.
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Small Cell Neuroendocrine Carcinomas Arising in the Head and Neck Region.
Small Cell Neuroendocrine Carcinomas Arising in the Head and Neck Region.
J Oral Maxillofac Surg. 2015 Nov 22;
Authors: Hosokawa S, Takahashi G, Baba S, Mineta H
Abstract
PURPOSE: This study evaluated the clinical factors associated with outcomes of head and neck small cell neuroendocrine carcinoma (SCNEC-HN).
MATERIALS AND METHODS: A retrospective review of clinical data was performed for 11 patients with SCNEC-HN treated at the Hamamatsu University Hospital (Hamamatsu, Japan). Clinical features, treatment methods, and outcomes were evaluated. The main outcome measurements were disease stage, patient age, primary tumor site, treatment procedures, and estimated survival rates. Survival rates were calculated using the Kaplan-Meier method.
RESULTS: Patients were followed for a mean of 40.0 months (range, 8 to 191 months). The 1-, 2-, and 5-year overall survival rates were 52.0, 20.8, and 10.4%, respectively. Rates did not differ significantly between the N2 and N0/1 groups, although the latter had a slightly better prognosis (P = .08).
CONCLUSION: Chemoradiotherapy was a reasonable treatment for patients with SCNEC-HN. Those with N0/1 or maxillary sinus SCNEC-HN had a better prognosis than those with N2 disease or cancers at other sites, respectively. However, more aggressive treatment might not be warranted even for patients with limited disease. The outcomes continue to be suboptimal, and more effective therapies are needed because most patients had local or distant failure.
PMID: 26706487 [PubMed - as supplied by publisher]
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Pre-Treatment of Depression Prior to Cervical Spine Surgery Improves Patients' Perception of Post-operative Health Status: A retrospective Single Institutional Experience.
Pre-Treatment of Depression Prior to Cervical Spine Surgery Improves Patients' Perception of Post-operative Health Status: A retrospective Single Institutional Experience.
World Neurosurg. 2015 Dec 16;
Authors: Elsamadicy AA, Adogwa O, Cheng J, Bagley C
Abstract
BACKGROUND: Previous research has indicated that postoperative pain and functional outcomes are influenced by affective disorders, especially depression. The aim of this retrospective analysis is to assess whether pre-treatment of depression prior to surgery improved patient reported outcomes measures and overall satisfaction with care.
METHODS: 140 adult patients (Pre-Treated patients: 25, Control patients: 115) underwent Anterior Cervical Discectomy and Fusion at Duke University Medical Center were included in this study. Of the 140 patients, 25 patients had a known history of depression diagnosed and treated by a board certified psychiatrist with an antidepressant at least 6 months prior to surgery. Enrollment criteria included available demographic, surgical, medication and clinical outcome data. Patients completed the Neck Disability Index (NDI), Short-Form 12 (SF-12) and Visual Analog Pain Scale (VAS) before surgery, then at 3, 6, 12, and 24- months after surgery. Clinical outcomes were compared between both patient cohorts.
RESULTS: Baseline characteristics were similar between both cohorts, Table 1. At baseline there were no significant differences in NDI (p=0.11), SF-12 PCS (p=0.63), and VAS-neck pain (p=0.80), Table 2. There were no significant differences in the incidence of nerve root injury (p=0.00) or durotomy (p=0.31) between the treatment and control cohorts, Table 3. At 1-year post-operatively, both cohorts demonstrated similar improvement in VAS-neck pain (p=0.92), NDI (p=0.32), SF-12 PCS (p=0.15) and SF-12 MCS (p=0.38), Table 4. These results were durable through 2-years. At 2-year, both the demonstrated similar improvement from baseline in VAS-neck pain (p=0.88), NDI (p=0.43), SF-12 PCS (p=0.28) and SF-12 MCS (p=0.40), Figure 1.results CONCLUSION: Our study suggests that in patients with depression, pre-treatment with antidepressants prior to surgery significantly improves their perception and pain and functional disability.
PMID: 26706296 [PubMed - as supplied by publisher]
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Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer.
Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer.
J Electromyogr Kinesiol. 2015 Nov 30;
Authors: Kim SJ, Cheon HJ, Lee HN, Hwang JH
Abstract
The aim of this study is to reveal the mechanism of esophagectomy-mediated swallowing motion disorders. Forty-seven patients who underwent 3-stage esophagectomy with cervical anastomosis and VFSS for esophageal cancer were selected. Twenty-three patients displayed subglottic aspiration (aspiration group) and the other 24 patients did not show any aspiration or penetration in the videofluoroscopic swallowing study after esophagectomy (no aspiration group). For comparison, 27 healthy volunteers (normal group) were included. Maximal anterior displacement of the hyoid (MADH), maximal superior displacement of the hyoid (MSDH), maximal rotation of the epiglottis (MRE) and pharyngeal delay time (PDT) were measured by image J software. MADH, MRE, and PDT in normal group were significantly different from those in aspiration and no aspiration groups (P<0.001). The normal group displayed a significantly different PDT compared to the no aspiration and aspiration groups, and the no aspiration group had a significantly different PDT compared to the aspiration group (P<0.001). The mechanism of swallowing motion disorders caused by the esophagectomy in esophageal cancer includes the decreased anterior movement of the hyoid and rotation of the epiglottis caused by the prolonged operation time and delayed pharyngeal reflex caused by the laryngeal sensory disturbance. Among them, the main mechanism of subglottic aspiration after esophagectomy is the delayed pharyngeal reflex.
PMID: 26705964 [PubMed - as supplied by publisher]
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A case of tubular adenoma developing after bladder augmentation: Case report and literature review.
A case of tubular adenoma developing after bladder augmentation: Case report and literature review.
Int J Surg Case Rep. 2015 Dec 11;19:17-20
Authors: Hayashi Y, Shiyanagi S, Nagae I, Ishizaki T, Kasuya K, Katsumata K, Yamataka A, Tsuchida A
Abstract
INTRODUCTION: We encountered a rare case of tubular adenoma developing after bladder augmentation. We here report our case as well as summarize reports in the literature on adenomas developing after bladder augmentation.
PRESENTATION OF CASE: A 23-year-old man came to our hospital for routine surveillance cystoscopy. He was born with a lipomyelomeningocele and neurogenic bladder with low bladder compliance, and hence his bladder was routinely emptied by clean intermittent catheterization. He was also treated with anticholinergic agents. However, because the patient's neurogenic bladder was unstable, he underwent sigmoidocolocystoplasty when he was 8-years old. After the bladder augmentation, he was examined annually by surveillance cystoscopy. On cystoscopy, a 5-mm pedunculated polyp was found on the front side of the sigmoid colon cap. Therefore, we performed snare polypectomy together with electrocoagulation under cystoscopy. The patient's final diagnosis was tubular adenoma (mild atypia) with no malignancy, as assessed by histopathology. There has been no evidence of recurrence after the polypectomy on routine surveillance cystoscopy.
DISCUSSION: To the best of our knowledge, there have been 11 cases of adenoma occurring after bladder augmentation reported in the literature, including our present case. There are several carcinogenic pathways associated with colorectal oncogenesis. Adenomas that are larger than 1.0cm in diameter with a marked villous component have a high risk of oncogenesis.
CONCLUSION: We believe that the early detection of carcinoma or adenoma and their treatment at an early stage is crucial. Therefore, we recommend routine surveillance cystoscopy for patients after bladder augmentation.
PMID: 26706596 [PubMed - as supplied by publisher]
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Endovascular repair for an extracranial internal carotid aneurysm with cervical access: A case report.
Endovascular repair for an extracranial internal carotid aneurysm with cervical access: A case report.
Int J Surg Case Rep. 2015 Dec 3;19:14-16
Authors: Rivera-Chavarría IJ, Alvarado-Marín JC
Abstract
BACKGROUND: Carotid aneurysms are a rare pathology. This vascular disorder can be asymptomatic or it can cause local compression. The disorder poses a high risk of embolization and rupture.
PRESENTATION OF CASE: A 79 years old female, presents with a right internal carotid fusiform aneurysm, approximately 3.8cm in diameter, localized 3.30cm from the common carotid artery bifurcation with an extremely tortuous common carotid artery.
DISCUSSION: Surgical management of the extracranial internal carotid artery remains varying and challenging, particularly with a distal internal carotid aneurysm and with anatomical difficulties.
CONCLUSION: Endovascular management of an internal carotid aneurysm with cervical access using an expanded polytetrafluoroethylene covered stent with Heparin Bioactive Surface in the carotid area, is safe and effective.
PMID: 26706595 [PubMed - as supplied by publisher]
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Clinical Outcomes of Reoperation for Failed Antireflux Operations.
Clinical Outcomes of Reoperation for Failed Antireflux Operations.
Ann Thorac Surg. 2015 Dec 16;
Authors: Wilshire CL, Louie BE, Shultz D, Jutric Z, Farivar AS, Aye RW
Abstract
BACKGROUND: Up to 18% of patients undergoing antireflux operations will require reoperation. Authors caution that with each additional reoperation, fewer patients achieve satisfaction. The quality of life in patients who underwent revision operations was compared with patients who underwent primary antireflux operations to determine the effectiveness of revision operations.
METHODS: We retrospectively reviewed patients who underwent revision after failed antireflux operations from 2004 to 2014. Patients were divided into two groups: first reoperation (Reop[1]) and more than one reoperation (Reop[>1]). For comparison, a control group of patients who underwent primary antireflux operations was included. Patients underwent quality of life assessment preoperatively and postoperatively.
RESULTS: We identified 105 reoperative patients: 94 Reop(1), 11 Reop(>1), and 112 controls. The primary reason for failure was combined fundoplication herniation and slippage. Morbidity, mortality, and readmission rates were similar in all groups. Postoperative outcomes were improved in all groups but to a lesser degree in subsequent reoperations. Gastroesophageal Reflux Disease Health-Related Quality of Life: controls, 20.0 to 2.0; Reop(1), 26.5 to 4.0; and Reop(>1), 13.0 to 2.0. Quality of Life in Reflux and Dyspepsia: controls, 4.5 to 7.0; Reop(1), 3.7 to 6.7; and Reop(>1), 3.5 to 5.8. Dysphagia Severity Score: controls, 44.0 to 45.0; Reop(1), 36.0 to 45.0; and Reop(>1), 30.8 to 45.0.
CONCLUSIONS: Patients undergoing revision antireflux operations have improved quality of life, relatively normal swallowing, and primary symptom resolution at a median of 20 months postoperatively. However, patients who undergo more than one reoperation have lower quality of life scores and less improvement in dysphagia, suggesting that other procedures such as Roux-en-Y or short colon interposition, should be considered after a failed initial reoperation.
PMID: 26706754 [PubMed - as supplied by publisher]
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Is Dysphagia After Cardiac Operations a "Preexisting Condition"?
Is Dysphagia After Cardiac Operations a "Preexisting Condition"?
Ann Thorac Surg. 2015 Dec 16;
Authors: Bowles BJ, Puntil-Sheltman J
Abstract
BACKGROUND: Controversy exists about the incidence of dysphagia after cardiac operations, and very little is known about the baseline risk in this patient population. This study evaluated the incidence of dysphagia both preoperatively and postoperatively in patients undergoing cardiac operations.
METHODS: Patients undergoing cardiac operations were screened for dysphagia preoperatively using a 90-mL water swallow challenge protocol, a mini cognitive/speech screen, and a modified oral mechanism screen. The tests were repeated after extubation once the patient was alert and oriented. Patient characteristics were analyzed in conjunction with the results of the swallow screens to identify risk factors for dysphagia.
RESULTS: Of 176 patients tested, 15 (8.5%) failed the swallow screen preoperatively. Age, gender, and comorbidities were compared. Patients who failed the swallow study preoperatively were slightly older (76.1 vs 73.3 years, p = 0.047) and had a higher incidence of chronic renal failure (13.3% v. 0.6%, p = 0.017), but gender and other comorbidities were not significantly different. Postoperatively, 38 patients failed the swallow screen (21.6%). Those who failed the postoperative screen were also older (75.6 vs 72.9 years, p = 0.012), but other factors (including chronic renal failure) were not significantly different. All of the patients who failed the swallow screen preoperatively also failed postoperatively.
CONCLUSIONS: Unrecognized dysphagia in patients who need cardiac operations is a common problem and accounts for a substantial portion of that seen postoperatively. Older patients are at increased risk of dysphagia, but gender and medical comorbidities are not useful predictors of this risk.
PMID: 26706753 [PubMed - as supplied by publisher]
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Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer.
Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer.
J Electromyogr Kinesiol. 2015 Nov 30;
Authors: Kim SJ, Cheon HJ, Lee HN, Hwang JH
Abstract
The aim of this study is to reveal the mechanism of esophagectomy-mediated swallowing motion disorders. Forty-seven patients who underwent 3-stage esophagectomy with cervical anastomosis and VFSS for esophageal cancer were selected. Twenty-three patients displayed subglottic aspiration (aspiration group) and the other 24 patients did not show any aspiration or penetration in the videofluoroscopic swallowing study after esophagectomy (no aspiration group). For comparison, 27 healthy volunteers (normal group) were included. Maximal anterior displacement of the hyoid (MADH), maximal superior displacement of the hyoid (MSDH), maximal rotation of the epiglottis (MRE) and pharyngeal delay time (PDT) were measured by image J software. MADH, MRE, and PDT in normal group were significantly different from those in aspiration and no aspiration groups (P<0.001). The normal group displayed a significantly different PDT compared to the no aspiration and aspiration groups, and the no aspiration group had a significantly different PDT compared to the aspiration group (P<0.001). The mechanism of swallowing motion disorders caused by the esophagectomy in esophageal cancer includes the decreased anterior movement of the hyoid and rotation of the epiglottis caused by the prolonged operation time and delayed pharyngeal reflex caused by the laryngeal sensory disturbance. Among them, the main mechanism of subglottic aspiration after esophagectomy is the delayed pharyngeal reflex.
PMID: 26705964 [PubMed - as supplied by publisher]
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Irradiation of localized squamous cell carcinoma of the nasal vestibule.
Irradiation of localized squamous cell carcinoma of the nasal vestibule.
Head Neck. 2015 Dec 26;
Authors: Vanneste BG, Lopez-Yurda M, Tan IB, Balm AJ, Borst GR, Rasch CR
Abstract
BACKGROUND: The purpose of this study was to evaluate the long-term results of primary radiotherapy treatment for squamous cell carcinoma (SCC) of the nasal vestibule.
METHODS: Eighty-one patients were treated with external beam radiotherapy (EBRT) and/or interstitial radiotherapy (IRT) for a primary, localized, Wang classified SCC of the nasal vestibule.
RESULTS: Median follow-up was 38 months. T1 tumors were treated with IRT: we observed 1 local failure (at 13 months) among 48 patients (5-year local control rate of 97%). Most T2 tumors (20 of 26) were treated with EBRT. There were 8 local recurrences among 26 patients (5-year local control rate of 68%). For the T3 tumors (n = 7; all treated with EBRT), we observed local recurrence in 2 patients (5-year local control rate of 53%). The late-term side effects were relatively mild.
CONCLUSION: Local primary radiotherapy (either IRT for T1 or EBRT for T2/3) is an adequate treatment for SCC of the nasal vestibule with little late sequelae. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
PMID: 26706779 [PubMed - as supplied by publisher]
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Prognostic value of the neutrophil-to-lymphocyte ratio in patients with laryngeal squamous cell carcinoma.
Prognostic value of the neutrophil-to-lymphocyte ratio in patients with laryngeal squamous cell carcinoma.
Head Neck. 2015 Dec 26;
Authors: Wong BY, Stafford ND, Green VL, Greenman J
Abstract
BACKGROUND: The neutrophil/lymphocyte ratio (NLR) has been found to be predictive of survival outcome in a range of tumors. The purpose of this study was to investigate the prognostic value of pretreatment (NLR) in patients with laryngeal squamous cell carcinoma (SCC).
METHODS: A retrospective analysis of 140 patients with laryngeal SCC treated between 2005 and 2010 in the Hull and East Yorkshire Hospitals NHS Trust was carried out. Patient records were evaluated and both pretreatment neutrophil and lymphocyte counts were documented together with survival data, sex, smoking status, nodal classification, and disease staging.
RESULTS: An elevated NLR was significantly associated with advanced disease stage (eg, node-positive and tumors stage III and IV). In addition, a high NLR was significantly associated with poor overall survival (OS) but not disease-free survival (DFS) on multivariate analysis, with the greatest significance seen in patients with the highest NLR.
CONCLUSION: Pretreatment NLR may serve as a useful prognostic marker in laryngeal SCC; however, a large prospective study is required to determine an optimal NLR cutoff value. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
PMID: 26706179 [PubMed - as supplied by publisher]
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Intensity-modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes.
Intensity-modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes.
Head Neck. 2015 Dec 26;
Authors: Lewis GD, Holliday EB, Kocak-Uzel E, Hernandez M, Garden AS, Rosenthal DI, Frank SJ
Abstract
BACKGROUND: Intensity-modulated proton therapy (IMPT) has the potential to spare dose to organs at risk (OAR) when compared to intensity-modulated radiotherapy (IMRT) while maintaining excellent clinical outcomes.
METHODS: Ten patients with nasopharyngeal carcinoma (NPC) were identified for whom IMPT was planned; 9 patients also had a comparison photon-based IMRT plan generated. Dosimetric comparison of mean radiation dose to 29 adjacent OAR was performed. Disease control, survival, and toxicity outcomes were collected from the medical records.
RESULTS: There were significant differences in mean doses in 15 of the 29 OAR; 13 OAR received lower mean dose with proton-based plans. Median follow-up was 24.5 months (range, 19-32 months). Two-year locoregional control was 100% and the 2-year overall survival was 88.9%.
CONCLUSION: We observed dosimetric advantages conferred by IMPT compared to IMRT. Further study is needed to determine if these translate into reduced toxicity and/or improved disease control. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
PMID: 26705956 [PubMed - as supplied by publisher]
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Intensity-modulated radiotherapy for head and neck surgeons.
Intensity-modulated radiotherapy for head and neck surgeons.
Head Neck. 2015 Dec 26;
Authors: Gutiontov SI, Shin EJ, Lok B, Lee NY, Cabanillas R
Abstract
The development of intensity-modulated radiotherapy (IMRT) has played a major role in improving outcomes and decreasing morbidity in patients with head and neck cancer. This review addresses this vital modality with a focus on the important role of the head and neck surgeon. The technique as well as its benefits and points of caution are outlined, the definitions of tumor and treatment volumes are discussed, and the dose and fractionation are detailed. Following this are several sections dedicated to the role of the head and neck surgeon in the planning of both definitive and postoperative radiotherapy to the primary site and neck. There is a focus throughout on anatomic and surgical considerations; commonly encountered situations are illustrated. With a deeper understanding of this technique and their own pivotal contribution to target delineation, head and neck surgeons will be poised to expand their role and improve cancer care for their patients. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.
PMID: 26705685 [PubMed - as supplied by publisher]
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Multiple analyses of factors related to complications in endoscopic sinus surgery.
Multiple analyses of factors related to complications in endoscopic sinus surgery.
J Chin Med Assoc. 2015 Dec 16;
Authors: Chou TW, Chen PS, Lin HC, Lee KS, Tsai HT, Lee JC, Leu YS, Wang YP
Abstract
BACKGROUND: This study was undertaken to evaluate whether endoscopic sinus surgery (ESS) with a microdebrider had an impact on complication rates, and to facilitate the determination of factors associated with complications in patients who underwent ESS at a tertiary referral center in Taiwan.
METHODS: This investigation was a retrospective study and literature review. We analyzed 997 consecutive patients who underwent ESS at Mackay Memorial Hospital in Taipei, Taiwan from January 2006 through February 2010. All data including those of patient medical information, and peri- and postoperative complications were provided by the surgeons involved in patient medical care. We analyzed the complication rates using the following 10 variables by univariate analysis and multivariate logistic regression: gender, age, Lund-Mackay score, polyp grading, previous sinonasal surgery, surgeon skill, adjunctive sinonasal surgery, mesenteric type of anterior ethmoid artery, Keros skull base type, and the use of a microdebrider.
RESULTS: Of the 997 patients in our study, 78 (7.8%) had complications. Major complications occurred in five patients (0.5%): two with cerebrospinal fluid rhinorrhea, one with medial rectus muscle damage, and two with retrobulbar hematoma. Minor complications were found in 73 patients (7.3%), which included 32 patients with perioperative estimated blood loss > 15% of the total estimated blood volume, 26 with lamina papyracea damage, two with orbital cellulitis, and 13 with postoperative bleeding. Univariate analysis showed that risk factors related to complication rate were advanced Lund-Mackay scores (scores 19-24), advanced polyp grading (Grades 2 and 3), inexperienced surgeon (resident), and microdebrider usage. However, multivariate analysis revealed that complication rate was linked to advanced Lund-Mackay scores (Scores 19-24), mesenteric type of anterior ethmoid artery, and inexperienced surgeon.
CONCLUSION: Overall, the results of our study showed that the ESS complication rate was 7.8%, with risk factors including advanced Lund-Mackay scores (19-24, odds ratio 10.4) and inexperienced surgeon. It was also noted that ESS with a microdebrider had no impact on complication rates, although the presence of a mesenteric type of anterior ethmoid artery proved to be a protective factor.
PMID: 26706826 [PubMed - as supplied by publisher]
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