Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Δευτέρα 19 Σεπτεμβρίου 2016
Electrochemical stability of ionic liquids: general influences and degradation mechanisms
The stability of ionic liquids is of paramount importance in selecting the appropriate ionic liquid for a well-defined application. This Review provides an overview of stability issues, both chemical and electrochemical, and the underlying degradation mechanisms that are known. The influence of various functionalities on the stability of the ionic liquid, influencing both the cationic as the anionic parts of the ionic liquid, still requires several careful studies.
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The Impact of Emergency Department Census on the Decision to Admit
Abstract
Objective
We evaluated the effect of Emergency Department (ED) census on disposition decisions made by ED physicians.
Methods
We performed a retrospective analysis using 18 months of all adult patient encounters seen in the main ED at an academic tertiary care center. Patient census information was calculated at the time of physician assignment for each individual patient, and included the number of patients in the waiting room (waiting room census) and number of patients being managed by the patient's attending (physician load census). A multiple logistic regression model was created to assess the association between these census variables and the disposition decision, controlling for potential confounders including ESI acuity, patient demographics, arrival hour, arrival mode, and chief complaint.
Results
49,487 patient visits were included in this analysis, of which 37% were admitted to the hospital. Both census measures were significantly associated with increased chance of admission; the OR (odds ratio) per patient increase for waiting room census was 1.011, (95% CI: 1.001-1.020), and the OR for physician load census was 1.010, (95% CI: 1.002-1.019). To put this in practical terms, this translated to a modeled rise from 35.3% to 40.1% when shifting from an empty waiting room and zero patient load to a 12-patient wait and 16-patient load for a given physician.
Conclusion
Waiting room census and physician load census at time of physician assignment were positively associated with the likelihood that a patient would be admitted, controlling for potential confounders. Our data suggests that disposition decisions in the ED are influenced not only by objective measures of a patient's disease state, but also by workflow related concerns.
This article is protected by copyright. All rights reserved.
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Shared Decision Making in the Emergency Department among patients with Limited Health Literacy: Beyond Slower and Louder
Abstract
Health literacy is "the degree to which individuals can obtain, process and understand the basic health information needed to make appropriate health decisions and access health services needed to prevent or treat illness." The prevalence of limited health literacy (LHL) among adult ED patients is as high as 88%. Numeracy, or the "ability to understand and use numbers in daily life," is a continuum of skills that ranges from basic recognition and computation of numbers to understanding and use of high level skills such as probability, risk, and randomization.
This article is protected by copyright. All rights reserved.
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Associations of Emergency Department Length-of-Stay with Publicly Reported Quality-of-Care Measures
Abstract
Objective
The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length-of-stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals.
Methods
Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures.
Results
The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would "definitely recommend" the hospital, and a 6 minute increase in time to pain management for long bone fracture (p<0.01 for all). A one hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (LWBS) (95% CI 25-68%). ED LOS was not associated with hospital readmissions (p=0.14) or time to percutaneous coronary intervention (p=0.14).
Conclusion
In this longitudinal study of hospitals across the US, improvements in ED timeliness measures are associated with improvements in the patient experience.
This article is protected by copyright. All rights reserved.
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The Predictive Value of Pre-Endoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients with Upper Gastrointestinal Bleeding – A Systematic Review
Abstract
Objectives
Risk-stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using pre-endoscopic risk scores can aid ED physicians in disposition decision-making. We conducted a systematic review to assess the predictive value of pre-endoscopic risk scores for 30-day serious adverse events.
Methods
We searched MEDLINE, PubMed, Embase and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating pre-endoscopic risk scores and excluded reviews, case reports and animal studies. The composite outcome included 30-day mortality, recurrent bleeding and need for intervention. In 2 phases (screening and full review), 2 reviewers independently screened articles for inclusion and extracted patient level data and the consensus data was used for analysis. We reported sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios with 95% confidence intervals.
Results
We identified 3,173 articles, of which 16 were included: 3 studied Glasgow Blatchford Score (GBS), 1 clinical Rockall score (cRockall) and 2 AIMS65; 6 compared GBS and cRockall, 3 compared GBS, a modification of the GBS and cRockall and 1 compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS was 0.98 and 0.16 respectively; for the cRockall it was 0.93 and 0.24 respectively; and for the AIMS65 it was 0.79 and 0.61 respectively. The GBS with a cut-off point of 0 had a sensitivity of 0.99 and a specificity of 0.08.
Conclusion
The GBS with a cut-off point of 0 was superior over other cut-off points and risk scores for identifying low-risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.
This article is protected by copyright. All rights reserved.
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Is blue dye still required during sentinel lymph node biopsy for breast cancer?
Mirjam CL Peek, Tibor Kovacs, Rose Baker, Hisham Hamed, Ash Kothari and Michael Douek
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KLRC3, a Natural Killer receptor gene, is a key factor involved in glioblastoma tumourigenesis and aggressiveness
Abstract
Glioblastoma is the most lethal brain tumour with a poor prognosis. Cancer stem cells (CSC) were proposed to be the most aggressive cells allowing brain tumour recurrence and aggressiveness. Current challenge is to determine CSC signature to characterize these cells and to develop new therapeutics. In a previous work, we achieved a screening of glycosylation-related genes to characterize specific genes involved in CSC maintenance. Three genes named CHI3L1, KLRC3 and PRUNE2 were found overexpressed in glioblastoma undifferentiated cells (related to CSC) compared to the differentiated ones. The comparison of their roles suggest that KLRC3 gene coding for NKG2E, a protein initially identified in NK cells, is more important than both two other genes in glioblastomas aggressiveness. Indeed, KLRC3 silencing decreased self-renewal capacity, invasion, proliferation, radioresistance and tumourigenicity of U87-MG glioblastoma cell line. For the first time we report that KLRC3 gene expression is linked to glioblastoma aggressiveness and could be a new potential therapeutic target to attenuate glioblastoma.
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PPAR Agonists Promote the Differentiation of Porcine Bone Marrow Mesenchymal Stem Cells into the Adipogenic and Myogenic Lineages
Purpose: The aim of this work was to evaluate the effect of PPAR agonists on the differentiation and metabolic features of porcine mesenchymal stem cells induced to the adipogenic or myogenic lineages. Methods: Bone marrow MSCs from neonate pigs were isolated and identified by cell proliferation, cell surface markers or the gene expression of stem cells (CD44, CD90, CD105 or Oct4 and Nanog, respectively). Cells were differentiated into adipose or muscle cells and treated with the PPAR agonists; adipogenic and myogenic differentiation was promoted by adding these compounds. The expression of PPAR#x03B3; (an adipose marker) and MyoD1 and MyHC (muscle markers), metabolic changes and expression levels of metabolic enzymes involved in glycolysis, lipogenesis, lipolysis and the pentose phosphate pathway were tested by qPCR. Results: MSCs from neonate pigs exhibited high proliferation and were positive for CD44, CD90 and CD105 markers and Oct4 and Nanog expression. The treatment that promoted the highest expression of PPAR#x03B3; was 50 µM of conjugated linoleic acid (CLA) c9 t11 (6.44 ± 0.69-fold, p ≤ 0.0001) in the adipose differentiation, and upregulation of HX2, ACCAα, ATGL, LPL and G6DP (p ≤ 0.0001) and downregulation of PFK and ACCAβ (p ≤ 0.0001) were found. For muscle differentiation, the best treatment was 50 µM of CLA c10 t12 (59.72 ± 4.72-fold, p ≤ 0.0001), and metabolic changes were upregulation of PFK, ACCAβ, G6DP, CPT1 and PPARβ/δ (p ≤ 0.0001), but no effect was observed with HX2 and ACCAα (p ≥ 0.05). Conclusions: Our results suggest that differentiated cells exhibit a typical cell lineage metabolism and higher efficiencies both in anabolism and catabolism.
Cells Tissues Organs
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Cells Tissues Organs
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Tunning optical properties of perovskite nanocrystals by supermolecular mercapto-[small beta]-cyclodextrin
Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC04908G, Communication
DOI: 10.1039/C6CC04908G, Communication
Qi-Le Li, Wen-Xiu Lu, Neng Wan, Shou-Nian Ding
This work reports a host-guest interaction strategy for systematically manipulating the optical properties of cesium lead halide perovskites nanocrystals (CsPbBr3 NCs) by protectant-mediated mercapto-[small beta]-cyclodextrin (SH-[small beta]-CD). The fluorescence of CsPbBr3 NCs...
The content of this RSS Feed (c) The Royal Society of Chemistry
This work reports a host-guest interaction strategy for systematically manipulating the optical properties of cesium lead halide perovskites nanocrystals (CsPbBr3 NCs) by protectant-mediated mercapto-[small beta]-cyclodextrin (SH-[small beta]-CD). The fluorescence of CsPbBr3 NCs...
The content of this RSS Feed (c) The Royal Society of Chemistry
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Optimal timing for hepatitis C therapy in US patients eligible for liver transplantation: a cost-effectiveness analysis
Summary
Background
Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal for those with ongoing viraemia and is associated with higher rates of allograft failure and death. However, the optimal timing of HCV treatment for patients awaiting transplant remains unclear.
Aim
To evaluate the comparative cost-effectiveness of treating HCV pre-LT vs. post-LT (pre-emptive or after HCV recurrence).
Methods
A Markov state-transition model was created to simulate the progression of a cohort of HCV-genotype 1 or 4 cirrhotic patients from the time of transplant listing until death. We then used this model to study the cost-effectiveness of ledipasvir–sofosbuvir (LDV/SOF) with ribavirin for 12 weeks, administered for three separate treatment strategies: (i) pre-LT; (ii) post-LT preemptively prior to HCV recurrence; or (iii) post-LT after HCV recurrence.
Results
In the base-case analysis using a median model for end-stage liver disease (MELD) score <25 at the time of transplant, we found that pre-LT treatment of HCV led to more QALYs for fewer dollars compared to other strategies. Analysis limited to living donor LT recipients revealed that pre-LT treatment was also the most cost-effective strategy. When the analysis was repeated for MELD ≥25, decompensated disease (Child–Pugh class B or C), and hepatocellular carcinoma cases, preemptive post-LT strategy was more cost-effective.
Conclusions
Treatment of HCV prior to liver transplantation appears to be the most cost-effective strategy for patients with a MELD score <25. For patients with a MELD ≥25 or decompensated cirrhosis, preemptive post-liver transplantation treatment before HCV recurrence is the most cost-effective strategy.
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The inter-relationship of symptom severity and quality of life in 2055 patients with primary biliary cholangitis
Summary
Background
Age at presentation with primary biliary cholangitis (PBC) is associated with differential response to ursodeoxycholic acid (UDCA) therapy. Younger-presenting patients are less likely to respond to treatment and more likely to need transplant or die from the disease. PBC has a complex impact on quality of life (QoL), with systemic symptoms often having significant impact.
Aim
To explain the impact of age at presentation on perceived QoL and the inter-related symptoms which impact upon it.
Methods
Using the UK-PBC cohort, symptoms were assessed using the PBC-40 and other validated tools. Data were available on 2055 patients.
Results
Of the 1990 patients reporting a global PBC-QoL score, 66% reported good/neutral scores and 34% reported poor scores. Each 10-year increase in age at presentation was associated with a 14% decrease in risk of poor perceived QoL (OR = 0.86, 95% CI: 0.75–0.98, P < 0.05). All symptom domains were similarly age-associated (P < 0.01). Social dysfunction was the symptom factor with the greatest impact on QoL. Median (interquartile range) PBC-40 social scores for patients with good perceived QoL were 18 (14–23) compared with 34 (29–39) for those with poor QoL.
Conclusion
The majority of patients with primary biliary cholangitis do not feel their QoL is impaired, although impairment is reported by a sizeable minority. Age at presentation is associated with impact on perceived QoL and the symptoms impairing it, with younger patients being more affected. Social dysfunction makes the greatest contribution to QoL impairment, and it should be targeted in trials aimed at improving life quality.
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High-resolution DOA extraction (for wireless communication systems): theoretical analysis and experimental verification
Dit onderzoek concentreert zich op één specifiek hoge resolutie parameter extractie algoritme, met name het SAGE algoritme. Met dat algoritme kunnen we de verschillende aankomstrichtingen van elk belangrijk pad extraheren. Op die manier wordt niet alleen de azimuthhoek en de elevatiehoek, maar ook de tijdsvertraging (of de afstand), de Doppler frequentieverschuiving en de complexe amplitude (of het vermogen) zeer precies geschat. De nauwkeurigheid van de schattingen en de invloed van positiefouten en koppeling worden onderzocht. Het algoritme wordt uitgetest met simulaties en geverifieerd met meetdata, die bekomen werden in een binnenhuisconfiguratie op de universiteit van Kassel. In het geval van grote antenneroosters en voor breedbandige metingen worden er aanpassingen aan dit algoritme voorgesteld. Ook het stralingspatroon wordt toegevoegd in dit algoritme. Daarnaast komen de berekening en realisatie van twee van de vijf ideale uniform verdeelde bolvormige antenneroosters aan bod. Zij lossen hiermee de dubbelzinnigheid van de fase op, die ontstaat als de aankomstrichtingen geschat moeten worden in de drie dimensies.
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Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases
British Journal of Surgery
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Safety and efficacy of daclatasvir-sofosbuvir in HCV genotype 1-mono-infected patients
Journal of Hepatology
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Delivering beneficial bacteria to the GI tract
Massachusetts Institute of Technology Research News
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Perioperative chemotherapy with FOLFOX in resectable gastroesophageal adenocarcinoma in real life practice: An AGEO multicenter retrospective study
Digestive and Liver Diseases
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Hepatic resection for hepatocellular carcinoma in cirrhotic patients with portal hypertension
Surgical Practice
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Effectiveness of pelvic physiotherapy in children with functional constipation, compared with standard medical care
Gastroenterology
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Clinical influence of anastomotic stricture caused by pancreatogastrointestinalstomy following pancreatoduodenectomy
Surgery Today
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Efficacy and safety of target combined chemotherapy in advanced gastric cancer: A meta-analysis and system review
BMC Cancer
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Simultaneous multi-slice echo planar diffusion weighted imaging of the liver and the pancreas: Optimization of signal-to-noise ratio and acquisition time and application to intravoxel incoherent motion analysis
European Journal of Radiology
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Childhood irritable bowel syndrome characteristics are related to both sex and pubertal development
The Journal of Pediatrics
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Single incision laparoscopic 90 % pancreatectomy for the treatment of persistent hyperinsulinemic hypoglycemia of infancy
Pediatric Surgery International
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Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study
Liver International
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Are anti-tumor necrosis factor trough levels predictive of mucosal healing in patients with inflammatory bowel disease?: A systematic review and meta-analysis
Journal of Clinical Gastroenterology
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The human gut microbiome of Latin America populations: A landscape to be discovered
Current Opinion in Infectious Diseases
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Plasma miR-122 and miR-200 family are prognostic markers in colorectal cancer
International Journal of Cancer
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A Popular myth - low-histamine diet improves chronic spontaneous urticaria - fact or fiction?
Journal of the European Academy of Dermatology and Venereology
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Can percutaneous cholecystostomy be a definitive treatment in the elderly?
Surgical Practice
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Effect of continuous positive airway pressure on liver enzymes in obstructive sleep apnea: A meta-analysis
The Clinical Respiratory Journal
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Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers
European Journal of Radiology
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Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy
British Journal of Surgery
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Value of routine staging imaging studies for patients with stage III breast cancer
Background and Objectives
Routine staging imaging studies (RSIS) are optional in stage III breast cancer (BC). The impact of RSIS on treatment decisions and patient outcomes has not been extensively studied. The goal of this study was to determine whether RSIS in stage III BC affected treatment or patient outcomes.
Methods
Stage III BC patients from 2000 to 2010 were retrospectively identified. RSIS results and treatment plan in response to RSIS results were recorded. Univariate and multivariate Cox proportional hazards regression models with time-dependent covariates were used to assess associations between RSIS use and recurrence-free survival (RFS).
Results
Of 420 patients, 362 (86.2%) received RSIS. RSIS were negative in 264 (72.9%), indeterminate in 77 (18.3%), and positive in 21 patients (5.0%) for metastatic disease. Treatment was altered in 21 (5.8%) patients based on RSIS results (20 with metastatic disease, 1 with indeterminate disease). There was no difference in RFS with RSIS use on multivariate analysis (hazard ratio 1.3; 95% confidence interval 0.73–2.5, P = 0.32).
Conclusions
Most stage III BC patients underwent RSIS, but RSIS results infrequently affected treatment decisions. There was no significant difference in RFS with RSIS use. RSIS to identify metastatic disease for stage III BC has limited value. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Surgical excision margin for primary acral melanoma
Background and Objectives
This study aimed to evaluate treatment outcomes of acral melanoma (AM) based on the excision margin.
Methods
A retrospective cohort study was conducted for patients with primary AM, analyzing recurrence rates, local and in-transit recurrence-free survival (LITRFS), disease-free survival (DFS), and melanoma-specific survival (MSS).
Results
Data from 129 patients of AM were analyzed. In 53 patients with thin AM (thickness ≤1 mm), neither recurrence nor mortality occurred regardless of whether the excision margin was >1 cm or not. Seventy-six patients had thick AM (thickness >1 mm), including 36 treated with a <2 cm excision margin and 40 with a 2 cm margin. Multivariate analyses revealed that a 2 cm margin was associated with a reduced rate of local recurrence (HR, 0.120; P-value = 0.023) and LITR (HR, 0.187; P-value = 0.013) compared with a <2 cm margin. DFS and MSS did not differ between the two groups.
Conclusions
Thin AM were successfully treated with a 1 cm excision margin. For thick AM, a 2 cm excision margin provided improved local control, compared with a <2 cm margin; however, this benefit did not translate into a survival gain. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Distance to the anal verge is associated with pathologic complete response to neoadjuvant therapy in locally advanced rectal cancer
Background and Objectives
Achieving a pathologic complete response (pCR) after neoadjuvant therapy has been associated with better prognosis in rectal cancer patients. The objective of this study was to investigate the relationship between distance to the anal verge (DTAV) and pCR.
Methods
Review of a prospectively maintained database of patients with locally advanced rectal cancer who received neoadjuvant treatment was completed. Uni- and multivariate analysis assessed the association between DTAV and pCR after neoadjuvant therapy.
Results
Of 827 included patients, 20% had a pCR. We found that pCR rates were 11% for tumors <4 cm, 24% for tumors 4–6 cm, 30% for tumors at 6–8 cm, 17% for tumors 8–10 cm, and 14% for tumors >10 cm from the anal verge (P = 0.002). Multivariate analysis also showed a strong association between DTAV and pCR (P = 0.008). The bimodal distribution of pCR resulted in a lower odds ratio of pCR for tumors <4 and >8 cm from the anal verge.
Conclusions
Patients with low tumors (<4 cm) and higher tumors (>8 cm), were less likely to have a pCR. Further investigation is warranted to determine if these observations are related to tumor biology or possibly differences in radiation technique. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Prognostic value of occult tumor cells obtained by peritoneal lavage in patients with resectable pancreatic cancer and no ascites: A systematic review
The poor survival of patients with resectable pancreatic cancer might be related to the presence of occult peritoneal tumor cells (OPTC). This systematic review studies the prognostic value of cytology and carcinoembryonic antigen (CEA) by real-time polymerase chain reaction in peritoneal fluid. The results suggest that presence of OPTC is related to a worse survival in patients with resectable pancreatic cancer. Future studies should investigate its possible role in selecting patients for specific treatment strategies. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Enantioselective construction of branched 1,3-dienyl substituted quaternary carbon stereocenters by asymmetric allenyl Claisen rearrangement
Chem. Commun., 2016, Advance Article
DOI: 10.1039/C6CC06481G, Communication
DOI: 10.1039/C6CC06481G, Communication
Yangbin Liu, Haipeng Hu, Lili Lin, Xiaoyu Hao, Xiaohua Liu, Xiaoming Feng
The enantioselective Claisen rearrangement of allenyl vinyl ethers was realized to access branched 1,3-dienyl-substituted all-carbon quaternary stereocenters using a NiII-N,N[prime or minute]-dioxide complex.
To cite this article before page numbers are assigned, use the DOI form of citation above.
The content of this RSS Feed (c) The Royal Society of Chemistry
The enantioselective Claisen rearrangement of allenyl vinyl ethers was realized to access branched 1,3-dienyl-substituted all-carbon quaternary stereocenters using a NiII-N,N[prime or minute]-dioxide complex.
To cite this article before page numbers are assigned, use the DOI form of citation above.
The content of this RSS Feed (c) The Royal Society of Chemistry
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Increasing use of nonsurgical therapy in advanced-stage oral cavity cancer: A population-based study
Abstract
Background
National guidelines support surgical-based treatment and offer nonsurgical therapy as an alternative for advanced-stage oral cavity squamous cell carcinoma (SCC). There are limited data evaluating current utilization of these therapies and their survival outcomes.
Methods
A total of 5856 patients were found in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2008 with resectable advanced-stage oral cavity SCC tumors. Outcomes were disease-specific survival (DSS) and overall survival (OS).
Results
Surgical therapy had significantly improved mean DSS and OS (115 and 71 months, respectively) compared to nonsurgical therapy (63 and 35 months, respectively; p < .001). The use of nonsurgical therapy was significantly associated with the hard palate, and patients who were single, divorced, and black, with T3, T4, and N3 tumors, and the percent utilization has significantly increased from 12% to 20% (p < .05).
Conclusion
Utilization of nonsurgical therapy for advanced-stage oral cavity SCC is increasing and is independently associated with a reduction in survival, as well as patient factors traditionally associated with reduced access to medical care and advanced T and N classifications. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
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Hyperbaric oxygen therapy for maxillary bone radiation-induced injury: A 15-year single-center experience
ABSTRACT
Background
Although hyperbaric oxygen therapy (HBOT) is used to treat chronic radiation tissue injury, clinical evidence supporting its use in maxillary bone osteoradionecrosis (ORN) is lacking. Therefore, the purpose of this study was to report our results of collected patient outcomes from a single center's large experience using HBOT to treat maxillary bone ORN.
Methods
From 1999 to 2015, 21 patients received treatment for maxillary bone ORN at our center. The medical records were retrospectively reviewed for the following variables: age, sex, comorbidities, tumor stage and site, previous surgery, previous radiotherapy or chemoradiation therapy, HBOT data, response to treatment and further management.
Results
A positive clinical outcome from HBOT occurred in 85.7% of patients with ORN and was proven radiologically in 14 of 15 patients (93.3%). In 5 patients, reconstructive surgery was required thereafter.
Conclusion
Controversy exists regarding the management of ORN of the maxillofacial skeleton. Our large, single-center experience probably supports the efficacy of HBOT for maxillary bone ORN. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
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Κυριακή 18 Σεπτεμβρίου 2016
Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.
Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.
Crit Rev Oncol Hematol. 2016 Oct;106:64-90
Authors: Mannelli G, Cecconi L, Gallo O
Abstract
BACKGROUND: Multi-step cancerogenesis guides laryngeal cancer onset and it includes a wide variety of pre-cancerous lesions macroscopically challenging to identify and distinguish from initial cancerous foci.
OBJECT: Different modalities of diagnostic techniques of laryngeal epithelial lesions exist and they do not offer a single system to make a differential diagnosis. Hence, this meta-analysis aimed to synthesize the validity of each single diagnostic tool to improve laryngeal patient management.
METHODS: A systematic review of literature was led searching for articles mentioning the following terms: larynx, laryngeal precancerous lesions, laryngeal cancer, white light (WL) endoscopy, stroboscopy, contact endoscopy (CE), autofluorescence (AF), ultrasound (US), narrow band imaging (NBI), computed axial tomography (CAT), magnetic resonance imaging (MRI), positron emission tomography (PET), CAT/PET. Then, a quantitative analysis was carried on for paper published after 2005 onward.
RESULTS: The search identified 7215 publications, of which 3616 published after 2005, with a final results of a total of 214 articles stratified and included by our selection criteria. 42 out of 214 articles were selected for quantitative synthesis. 25 out of 41 studies had a good quality score, 16 were fair.
CONCLUSIONS: A comprehensive overview of the most recent advances in laryngeal imaging technology combined with all of the information needed to interpret findings and manage patients with voice disorders can be found herein. Our flow-chart allows clinicians in risk-stratify patients and select proper examination modalities to provide appropriate care. Study limitations, together with possible clinical and research implications have been counted.
PMID: 27637353 [PubMed - in process]
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Fungal disease detection in plants: Traditional assays, novel diagnostic techniques and biosensors
Source:Biosensors and Bioelectronics, Volume 87
Author(s): Monalisa Ray, Asit Ray, Swagatika Dash, Abtar Mishra, K. Gopinath Achary, Sanghamitra Nayak, Shikha Singh
Fungal diseases in commercially important plants results in a significant reduction in both quality and yield, often leading to the loss of an entire plant. In order to minimize the losses, it is essential to detect and identify the pathogens at an early stage. Early detection and accurate identification of pathogens can control the spread of infection. The present article provides a comprehensive overview of conventional methods, current trends and advances in fungal pathogen detection with an emphasis on biosensors. Traditional techniques are the "gold standard" in fungal detection which relies on symptoms, culture-based, morphological observation and biochemical identifications. In recent times, with the advancement of biotechnology, molecular and immunological approaches have revolutionized fungal disease detection. But the drawback lies in the fact that these methods require specific and expensive equipments. Thus, there is an urgent need for rapid, reliable, sensitive, cost effective and easy to use diagnostic methods for fungal pathogen detection. Biosensors would become a promising and attractive alternative, but they still have to be subjected to some modifications, improvements and proper validation for on-field use.
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Dual-Directional Immunomodulatory Effects of Corbrin Capsule on Autoimmune Thyroid Diseases
Purpose. To investigate the effects of Corbrin Capsule (CS-C-Q80), a drug derived from Cordyceps sinensis (Berk.) Sacc., on autoimmune thyroid diseases (AITD). Methods. 44 Patients with Graves's disease (GD) and 56 patients with Hashimoto's thyroiditis (HT) were randomly assigned to treatment group (GD-Tx and HT-Tx) or control group (GD-Ct and HT-Ct). The control groups were given methimazole or levothyroxine only while the treatment groups were given Corbrin Capsule (2.0 g tid) besides the same conventional prescriptions as control groups. Thyroid hormones, thyroid antibodies, and T lymphocyte subsets were quantified at baseline and 24 weeks posttreatment. Results. Significant drop of serum anti-TPO-Ab levels was observed in both GD-Tx and HT-Tx groups. Before treatment, GD patients had higher helper T cells compared to cytotoxic T cells, while HT patients suffered from a nearly inverted proportion of helper T/cytotoxic T cells. There was a significant drop of the helper T/cytotoxic T cells ratio in GD-Tx to the median of the normal ranges after Corbrin treatment for 24 weeks, while that in HT-Tx was elevated. Conclusion. Corbrin Capsule could restore the balance between helper T and cytotoxic T cells in both GD and HT patients with dual-directional immunomodulatory effects. And it could significantly reduce the autoantibody levels in both GD and HT.
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Copyrolysis of Biomass and Coal: A Review of Effects of Copyrolysis Parameters, Product Properties, and Synergistic Mechanisms
Concerns in the last few decades regarding the environmental and socioeconomic impacts of the dependence on fossil fuels have resulted in calls for more renewable and alternative energy sources. This has led to recent interest in copyrolysis of biomass and coal. Numerous reviews have been found related to individual pyrolysis of coal and biomass. This review deals mainly with the copyrolysis of coal and biomass and then compares their results with those obtained using coal and biomass pyrolysis in detail. It is controversial whether there are synergistic or additive behaviours when coal and biomass are blended during copyrolysis. In this review, the effects of reaction parameters such as feedstock types, blending ratio, heating rate, temperature, and reactor types on the occurrence of synergy are discussed. Also, the main properties of the copyrolytic products are pointed out. Some possible synergistic mechanisms are also suggested. Additionally, several outlooks based on studies in the literature are also presented in this paper.
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Pancreatic mucinous cystadenocarcinoma: epidemiology and outcomes.
Pancreatic mucinous cystadenocarcinoma: epidemiology and outcomes.
Int J Surg. 2016 Sep 13;
Authors: Doulamis IP, Mylonas KS, Kalfountzos CE, Mou D, Haj-Ibrahim H, Nasioudis D
Abstract
BACKGROUND: Pancreatic mucinous cystadenocarcinoma is a rare malignancy. Our aim was to investigate the demographic, pathological characteristics, treatment modalities and survival of patients with mucinous cystadenocarcinoma via the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database analysis.
MATERIALS AND METHODS: This was a retrospective population-based study of SEER database's records on patients with mucinous cystadenocarcinoma diagnosed from 1988 to 2012. Primary outcome measures were clinico-pathological characteristics, observed survival and disease-specific survival of patients.
RESULTS: A total of 507 patients were identified. Median age at diagnosis was 67 years and most patients were female (68.4%). The tumors were mainly low grade (82.9%, grade I-II) and frequently localized (42.8%) in the body/tail of the pancreas (45.6%). According to Kaplan-Meier curves observed survival was 111 months (95%CI: 82.5, 139.5) vs 14 months (95% CI: 10.9, 17.1) vs 4 months (95%CI: 2.9, 5.1) for patients with localized, regional and distant disease, respectively. One-year disease-specific survival for patients with localized disease was 90.1%, vs. 56.7% for those with regional and 18.7% with distant tumor spread.
CONCLUSIONS: Mucinous cystadenocarcinomas tend to be low grade tumors, localized to the pancreatic body/tail. Surgery as the primary therapeutic intervention and tumor stage are independent predictors of disease-specific survival.
PMID: 27638187 [PubMed - as supplied by publisher]
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FIRST, "KNOW" HARM: Response to Letter to the Editor.
FIRST, "KNOW" HARM: Response to Letter to the Editor.
Dysphagia. 2016 Sep 8;
Authors: Bizzarro MJ, Lefton-Greif MA, McGinley BM, Siner JM
PMID: 27638423 [PubMed - as supplied by publisher]
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Large retropharyngeal abscess: a case of mistaken identity.
Large retropharyngeal abscess: a case of mistaken identity.
BMJ Case Rep. 2016;2016
Authors: Makaram N, Gohil R, Gardiner Q, Manickavasagam J
Abstract
We report an unusual case of nasopharyngeal carcinoma (NPC), presenting initially as a retropharyngeal collection. We discuss the investigation, diagnosis and management of NPC and furthermore review the literature of NPC, emphasising the varied presentation. A 44-year-old Caucasian male ex-smoker presented with a 10-day history of a painless left-sided neck lump; progressive dysphagia and unintentional weight loss. Examination demonstrated a large left posterior pharyngeal swelling with soft palatal effacement, confirmed on nasoendoscopy. A CT scan revealed a fluid collection in the retropharyngeal space, which partially occluded the nasopharynx, and numerous satellite lesions were identified along with cervical lymphadenopathy. The suspected abscess was drained in theatre and nasopharyngeal biopsies were taken. These revealed Epstein-Barr virus-positive NPC. Staging investigations revealed a T4N2M0l carcinoma. Treatment consisted of radical chemoradiation therapy with curative intent. NPC is known for its varied and late presentation, and is an important condition to be aware of when considering a differential diagnosis of pharyngeal masses.
PMID: 27637277 [PubMed - as supplied by publisher]
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A case of dysphagia following botulinum toxin injection for neck rejuvenation.
A case of dysphagia following botulinum toxin injection for neck rejuvenation.
J Cosmet Dermatol. 2016 Sep 16;
Authors: Phothong W, Wanitphakdeedecha R, Keskool P, Manuskiatti W
Abstract
Botulinum toxin type A (BTX-A) is now extensively employed for cosmetic concerns. Upper face rejuvenation, including glabella frown lines and crow's feet lines, received FDA approval for cosmetic uses. However, other off-label uses for lower face conditions have been employed for texture and contouring purposes, including masseter hypertrophy and vertical banding of the neck. BTX-A for rejuvenation of the aging neck is an effective and popular treatment with high patient satisfaction rates. Alleviating the aging appearance of the neck by BTX-A is the result of denervation of hyperkinetic platysma. Concerning an extensive area of treatment and the relationship of treated muscles with other nearby muscles, dermatologists should be aware of potential adverse effects of the BTX-A injection. We herein present a case of dysphagia following botulinum toxin injection for the treatment of platysma bands.
PMID: 27637174 [PubMed - as supplied by publisher]
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Vertigo and dizziness in children.
Vertigo and dizziness in children.
Handb Clin Neurol. 2016;137:353-63
Authors: Jahn K
Abstract
Vertigo and dizziness of at least moderate severity occur in >5% of school-aged children and cause considerable restrictions in participation in school and leisure activity. More than 50% of dizzy children also have headache. Vestibular migraine and benign paroxysmal vertigo as a migraine precursor are the most common diagnoses in dizziness clinics for children and adolescents. They account for 30-60% of diagnoses. Other common causes are somatoform, orthostatic, or posttraumatic dizziness. All other disorders that are known to cause vertigo and dizziness in adults also occur in children, but incidence rates are usually lower. The vestibular and balance systems are largely developed after 1 year of age. Therefore, clinical and laboratory testing is reliable. Brain magnetic resonance imaging to exclude severe conditions, such as a brainstem tumor, is necessary only if clinical - in particular, ocular motor - testing is abnormal. Most conditions causing vertigo and dizziness in childhood and adolescence are treatable. Nonpharmacologic prophylaxis should always be recommended in vestibular migraine. Behavioral support is useful in somatization. Evidence for the effectiveness of drug therapy is largely based on experience in adult populations. High-quality controlled studies in childhood cohorts are sparse. It is important to make a correct diagnosis early on, as counseling and appropriate treatment may avoid chronic illness.
PMID: 27638083 [PubMed - in process]
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Vestibular migraine.
Vestibular migraine.
Handb Clin Neurol. 2016;137:301-16
Authors: von Brevern M, Lempert T
Abstract
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders. Recently, diagnostic criteria for VM have been elaborated jointly by the International Headache Society and the Bárány Society. Clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction. Findings in the interval may yield mild signs of damage to both the central vestibular and ocular motor system and to the inner ear. These interictal clinical signs are not specific to VM but can be also observed in migraineurs without a history of vestibular symptoms. How migraine affects the vestibular system is still a matter of speculation. In the absence of high-quality therapeutic trials, treatment is targeted at the underlying migraine.
PMID: 27638080 [PubMed - in process]
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Posttraumatic dizziness and vertigo.
Posttraumatic dizziness and vertigo.
Handb Clin Neurol. 2016;137:295-300
Authors: Szczupak M, Hoffer ME, Murphy S, Balaban CD
Abstract
Traumatic brain injury is an increasingly common public health issue, with the mild variant most clinically relevant for this chapter. Common causes of mild traumatic brain injury (mTBI) include motor vehicle accidents, athletics, and military training/deployment. Despite a range of clinically available testing platforms, diagnosis of mTBI remains challenging. Symptoms are primarily neurosensory, and include dizziness, hearing problems, headaches, cognitive, and sleep disturbances. Dizziness is nearly universally present in all mTBI patients, and is the easiest symptom to objectify for diagnosis. Aside from a thorough history and physical exam, in the near future specialized vestibular function tests will be key to mTBI diagnosis. A battery of oculomotor (antisaccade, predictive saccade) and vestibular tasks (head impulse test) has been demonstrated to sensitively and specifically identify individuals with acute mTBI. Vestibular therapy and rehabilitation have shown improvements for mTBI patients in cognitive function, ability to return to activities of daily living, and ability to return to work. Dizziness, as a contributor to short- and long-term disability following mTBI, is ultimately crucial not only for diagnosis but also for treatment.
PMID: 27638079 [PubMed - in process]
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Otologic disorders causing dizziness, including surgery for vestibular disorders.
Otologic disorders causing dizziness, including surgery for vestibular disorders.
Handb Clin Neurol. 2016;137:279-93
Authors: Bertholon P, Karkas A
Abstract
This chapter will focus on vertigo/dizziness due to inner-ear malformations, labyrinthine fistula, otosclerosis, infectious processes, and autoimmune inner-ear disorders. Inner-ear malformation due to dehiscence of the superior semicircular canal is the most recently described inner-ear malformation. Vertigo/dizziness is typically induced by sound and pressure stimuli and can be associated with auditory symptoms (conductive or mixed hearing loss). Labyrinthine fistula, except after surgery for otosclerosis, in the context of trauma or chronic otitis media with cholesteatoma, still remains a challenging disorder due to multiple uncertainties regarding diagnostic and management strategies. Otosclerosis typically manifests with auditory symptoms and conductive or mixed hearing loss on audiometry. Vertigo/dizziness is rare in nonoperated otosclerosis and should draw clinical attention to an inner-ear malformation. Computed tomography scan confirms otosclerosis in most cases and should rule out an inner-ear malformation, avoiding needless middle-ear surgical exploration. Labyrinth involvement after an infectious process is unilateral when it complicates a middle-ear infection but can be bilateral after meningitis. Labyrinth involvement due to an inflammatory disease is a challenging issue, particularly when restricted to the inner ear. The diagnosis relies on the bilateral and rapid aggravation of audiovestibular symptoms that will not respond to conventional therapy but to immunosuppressive drugs.
PMID: 27638078 [PubMed - in process]
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Menière's disease.
Menière's disease.
Handb Clin Neurol. 2016;137:257-77
Authors: Espinosa-Sanchez JM, Lopez-Escamez JA
Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
PMID: 27638077 [PubMed - in process]
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Benign paroxysmal positional vertigo and its variants.
Benign paroxysmal positional vertigo and its variants.
Handb Clin Neurol. 2016;137:241-56
Authors: Nuti D, Masini M, Mandalà M
Abstract
Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
PMID: 27638076 [PubMed - in process]
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Bilateral vestibulopathy.
Bilateral vestibulopathy.
Handb Clin Neurol. 2016;137:235-40
Authors: Strupp M, Feil K, Dieterich M, Brandt T
Abstract
The leading symptoms of bilateral vestibulopathy (BVP) are postural imbalance and unsteadiness of gait that worsens in darkness and on uneven ground. There are typically no symptoms while sitting or lying under static conditions. A minority of patients also have movement-induced oscillopsia, in particular while walking. The diagnosis of BVP is based on a bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR). This deficit is diagnosed for the high-frequency range of the angular VOR by a bilaterally pathologic bedside head impulse test (HIT) and for the low-frequency range by a bilaterally reduced or absent caloric response. If the results of the bedside HIT are unclear, angular VOR function should be quantified by a video-oculography system (vHIT). An additional test supporting the diagnosis is dynamic visual acuity. Cervical and ocular vestibular-evoked myogenic potentials (c/oVEMP) may also be reduced or absent, indicating impaired otolith function. There are different subtypes of BVP depending on the affected anatomic structure and frequency range of the VOR deficit: impaired canal function in the low- and/or high-frequency VOR range only and/or otolith function only; the latter is very rare. The etiology of BVP remains unclear in more than 50% of patients: in these cases neurodegeneration is assumed. Frequent known causes are ototoxicity mainly due to gentamicin, bilateral Menière's disease, autoimmune diseases, meningitis and bilateral vestibular schwannoma, as well as an association with cerebellar degeneration (cerebellar ataxia, neuropathy, vestibular areflexia syndrome=CANVAS). In general, in the long term there is no improvement of vestibular function. There are four treatment options: first, detailed patient counseling to explain the cause, etiology, and consequences, as well as the course of the disease; second, daily vestibular exercises and balance training; third, if possible, treatment of the underlying cause, as in bilateral Menière's disease, meningitis, or autoimmune diseases; fourth, if possible, prevention, i.e., being very restrictive with the use of ototoxic substances, such as aminoglycosides. In the future vestibular implants may also be an option.
PMID: 27638075 [PubMed - in process]
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An overview of vestibular rehabilitation.
An overview of vestibular rehabilitation.
Handb Clin Neurol. 2016;137:187-205
Authors: Whitney SL, Alghwiri AA, Alghadir A
Abstract
Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.
PMID: 27638071 [PubMed - in process]
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Bedside examination.
Bedside examination.
Handb Clin Neurol. 2016;137:91-101
Authors: Straumann D
Abstract
In most dizzy patients a limited selection of bedside tests, together with the history, is adequate to establish a differential diagnosis and select the next diagnostic and therapeutic procedures. A set of basic bedside tests that should be applied in every patient with vertigo or imbalance allows identifying: (1) patients who need immediate referral for further assessment and treatment; (2) patients with nonthreatening disorders for which treatment can be started without more detailed testing; (3) patients with benign paroxysmal vertigo, in whom a detailed work-up is not required and who can immediately be treated with an appropriate particle-repositioning maneuver; and (4) patients who need a comprehensive neuro-otologic and neurologic work-up. Additional neuro-otologic bedside tests help to further refine the differential diagnosis.
PMID: 27638065 [PubMed - in process]
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Multisensory integration in balance control.
Multisensory integration in balance control.
Handb Clin Neurol. 2016;137:57-66
Authors: Bronstein AM
Abstract
This chapter provides an introduction to the topic of multisensory integration in balance control in, both, health and disease. One of the best-studied examples is that of visuo-vestibular interaction, which is the ability of the visual system to enhance or suppress the vestibulo-ocular reflex (VOR suppression). Of clinical relevance, examination of VOR suppression is clinically useful because only central, not peripheral, lesions impair VOR suppression. Visual, somatosensory (proprioceptive), and vestibular inputs interact strongly and continuously in the control of upright balance. Experiments with visual motion stimuli show that the visual system generates visually-evoked postural responses that, at least initially, can override vestibular and proprioceptive signals. This paradigm has been useful for the study of the syndrome of visual vertigo or vision-induced dizziness, which can appear after vestibular disease. These patients typically report dizziness when exposed to optokinetic stimuli or visually charged environments, such as supermarkets. The principles of the rehabilitation treatment of these patients, which use repeated exposure to visual motion, are presented. Finally, we offer a diagnostic algorithm in approaching the patient reporting oscillopsia - the illusion of oscillation of the visual environment, which should not be confused with the syndrome mentioned earlier of visual vertigo.
PMID: 27638062 [PubMed - in process]
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Alkylating agent induced NRF2 blocks endoplasmic reticulum stress-mediated apoptosis via control of glutathione pools and protein thiol homeostasis.
Alkylating agent induced NRF2 blocks endoplasmic reticulum stress-mediated apoptosis via control of glutathione pools and protein thiol homeostasis.
Mol Cancer Ther. 2016 Sep 16;
Authors: Zanotto-Filho A, Masamsetti VP, Loranc E, Tonapi SS, Gorthi A, Bernard X, Gonçalves RM, Moreira JC, Chen Y, Bishop AJ
Abstract
Alkylating agents are a commonly used cytotoxic class of anticancer drugs. Understanding the mechanisms whereby cells respond to these drugs is key to identify means to improve therapy while reducing toxicity. By integrating genome-wide gene expression profiling, protein analysis and functional cell validation, we herein demonstrated a direct relationship between NRF2 and Endoplasmic Reticulum (ER) stress pathways in response to alkylating agents, which is coordinated by the availability of glutathione (GSH) pools. GSH is essential for both drug detoxification and protein thiol homeostasis within the ER, thus inhibiting ER stress induction and promoting survival; an effect independent of its antioxidant role. NRF2 accumulation induced by alkylating agents resulted in increased GSH synthesis via GCLC/GCLM enzyme, and interfering with this NRF2 response by either NRF2 knockdown or GCLC/GCLM inhibition with buthionine sulfoximine (BSO) caused accumulation of damaged proteins within the ER, leading to PERK-dependent apoptosis. Conversely, upregulation of NRF2, through KEAP1 depletion or NRF2-myc overexpression, or increasing GSH levels with N-acetylcysteine (NAC) or glutathione-ethyl-ester (GSH-E), decreased ER stress and abrogated alkylating agents-induced cell death. Based on these results, we identified a subset of lung and head-and-neck carcinomas with mutations in either KEAP1 or NRF2/NFE2L2 genes that correlate with NRF2 targets overexpression and poor survival. In KEAP1 mutant cancer cells, NRF2 knockdown and GSH depletion increased cell sensitivity via ER stress induction in a mechanism specific to alkylating drugs. Overall, we show that the NRF2-GSH influence on ER homeostasis implicates defects in NRF2-GSH or ER stress machineries as affecting alkylating therapy toxicity.
PMID: 27638861 [PubMed - as supplied by publisher]
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[Working Group for Head and Neck Pathology of the German Society of Pathology : Chair's report 2016].
[Working Group for Head and Neck Pathology of the German Society of Pathology : Chair's report 2016].
Pathologe. 2016 Sep 14;
Authors: Weichert W
PMID: 27638532 [PubMed - as supplied by publisher]
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FIRST, "KNOW" HARM: Response to Letter to the Editor.
FIRST, "KNOW" HARM: Response to Letter to the Editor.
Dysphagia. 2016 Sep 8;
Authors: Bizzarro MJ, Lefton-Greif MA, McGinley BM, Siner JM
PMID: 27638423 [PubMed - as supplied by publisher]
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Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis.
Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis.
Allergy. 2016 Sep 17;
Authors: Schlosser RJ, Smith TL, Mace J, Soler ZM
Abstract
BACKGROUND: Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality-of-life (QOL) and asthma control using validated outcome metrics.
METHODS: Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini-Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study.
RESULTS: Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ (0.5 [SD±1.1], 95%CI: 0.2-0.7; p=0.002) and ACT scores (1.3 [±4.1], 95%CI: 0.2-2.4; p=0.025). Uncontrolled baseline asthma (ACT<20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (>0.5 points) and 50% of the time for ACT scores (>3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (p=0.045) and chronic obstructive pulmonary disease (COPD; p=0.015). Adjusted baseline ACT scores were worse in patients with COPD (p=0.004). Covariates associated with changes in miniAQLQ scores after ESS were preoperative corticosteroid dependency (p=0.011) and change in total SNOT-22 score (p=0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (p=0.016).
CONCLUSIONS: Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes. This article is protected by copyright. All rights reserved.
PMID: 27638398 [PubMed - as supplied by publisher]
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Zinc and zinc-containing biomolecules in childhood brain tumors.
Zinc and zinc-containing biomolecules in childhood brain tumors.
J Mol Med (Berl). 2016 Sep 16;
Authors: Hrabeta J, Eckschlager T, Stiborova M, Heger Z, Krizkova S, Adam V
Abstract
Zinc ions are essential cofactors of a wide range of enzymes, transcription factors, and other regulatory proteins. Moreover, zinc is also involved in cellular signaling and enzymes inhibition. Zinc dysregulation, deficiency, over-supply, and imbalance in zinc ion transporters regulation are connected with various diseases including cancer. A zinc ion pool is maintained by two types of proteins: (i) zinc-binding proteins, which act as a buffer and intracellular donors of zinc and (ii) zinc transporters responsible for zinc fluxes into/from cells and organelles. The decreased serum zinc ion levels have been identified in patients suffering from various cancer diseases, including head and neck tumors and breast, prostate, liver, and lung cancer. On the contrary, increased zinc ion levels have been found in breast cancer and other malignant tissues. Zinc metalloproteomes of a majority of tumors including brain ones are still not yet fully understood. Current knowledge show that zinc ion levels and detection of certain zinc-containing proteins may be utilized for diagnostic and prognostic purposes. In addition, these proteins can also be promising therapeutic targets. The aim of the present work is an overview of the importance of zinc ions, zinc transporters, and zinc-containing proteins in brain tumors, which are, after leukemia, the second most common type of childhood cancer and the second leading cause of death in children after accidents.
PMID: 27638340 [PubMed - as supplied by publisher]
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An enhanced random walk algorithm for delineation of head and neck cancers in PET studies.
An enhanced random walk algorithm for delineation of head and neck cancers in PET studies.
Med Biol Eng Comput. 2016 Sep 16;
Authors: Stefano A, Vitabile S, Russo G, Ippolito M, Sabini MG, Sardina D, Gambino O, Pirrone R, Ardizzone E, Gilardi MC
Abstract
An algorithm for delineating complex head and neck cancers in positron emission tomography (PET) images is presented in this article. An enhanced random walk (RW) algorithm with automatic seed detection is proposed and used to make the segmentation process feasible in the event of inhomogeneous lesions with bifurcations. In addition, an adaptive probability threshold and a k-means based clustering technique have been integrated in the proposed enhanced RW algorithm. The new threshold is capable of following the intensity changes between adjacent slices along the whole cancer volume, leading to an operator-independent algorithm. Validation experiments were first conducted on phantom studies: High Dice similarity coefficients, high true positive volume fractions, and low Hausdorff distance confirm the accuracy of the proposed method. Subsequently, forty head and neck lesions were segmented in order to evaluate the clinical feasibility of the proposed approach against the most common segmentation algorithms. Experimental results show that the proposed algorithm is more accurate and robust than the most common algorithms in the literature. Finally, the proposed method also shows real-time performance, addressing the physician's requirements in a radiotherapy environment.
PMID: 27638108 [PubMed - as supplied by publisher]
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Functional and psychiatric vestibular disorders.
Functional and psychiatric vestibular disorders.
Handb Clin Neurol. 2016;137:341-51
Authors: Staab JP
Abstract
Behavioral factors have long been recognized as affecting spatial orientation and balance function. Neuroanatomic and neurophysiologic studies conducted worldwide over the last 30 years have substantially advanced our knowledge about the inherently strong connectivity among threat/anxiety, vestibular, visual, and somatosensory systems in the brain. Clinical investigations have shed greater light on the nature of functional and psychiatric disorders that manifest or magnify vestibular morbidity. Concepts of these syndromes have changed over 150 years. Even their nomenclature has had different meanings in different eras. This chapter will review functional and psychiatric vestibular disorders. Terminology will follow the International Classification of Diseases, 11th edition, beta draft and the International Classification of Vestibular Disorders. Anxiety plays a central role in behavioral vestibular morbidity. Anxiety, traumatic stress, obsessive, and depressive disorders may be primary causes of episodic and chronic vestibular symptoms or secondary complications of other vestibular disorders. These psychiatric illnesses affect 30-50% of patients who consult neurologists or otologists for vestibular symptoms. Coexisting psychiatric disorders adversely affect treatment for patients with structural vestibular diseases, especially when unrecognized. Persistent postural-perceptual dizziness is the leading cause of long-term vestibular disability. Fortunately, pharmacologic, psychotherapeutic, and rehabilitative treatments of these illnesses have improved in recent years.
PMID: 27638082 [PubMed - in process]
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Eye movements in vestibular disorders.
Eye movements in vestibular disorders.
Handb Clin Neurol. 2016;137:103-17
Authors: Kheradmand A, Colpak AI, Zee DS
Abstract
The differential diagnosis of patients with vestibular symptoms usually begins with the question: is the lesion central or is it peripheral? The answer commonly emerges from a careful examination of eye movements, especially when the lesion is located in otherwise clinically silent areas of the brain such as the vestibular portions of the cerebellum (flocculus, paraflocculus which is called the tonsils in humans, nodulus, and uvula) and the vestibular nuclei as well as immediately adjacent areas (the perihypoglossal nuclei and the paramedian nuclei and tracts). The neural circuitry that controls vestibular eye movements is intertwined with a larger network within the brainstem and cerebellum that also controls other types of conjugate eye movements. These include saccades and pursuit as well as the mechanisms that enable steady fixation, both straight ahead and in eccentric gaze positions. Navigating through this complex network requires a thorough knowledge about all classes of eye movements to help localize lesions causing a vestibular disorder. Here we review the different classes of eye movements and how to examine them, and then describe common ocular motor findings associated with central vestibular lesions from both a topographic and functional perspective.
PMID: 27638066 [PubMed - in process]
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Anatomy, physiology, and physics of the peripheral vestibular system.
Anatomy, physiology, and physics of the peripheral vestibular system.
Handb Clin Neurol. 2016;137:1-16
Authors: Kingma H, van de Berg R
Abstract
Many medical doctors consider vertigo and dizziness as the major, almost obligatory complaints in patients with vestibular disorders. In this chapter, we will explain that vestibular disorders result in much more diverse and complex complaints. Many of these other complaints are unfortunately often misinterpreted and incorrectly classified as psychogenic. When we really understand the function of the vestibular system, it becomes quite obvious why patients with vestibular disorders complain about a loss of visual acuity, imbalance, fear of falling, cognitive and attentional problems, fatigue that persists even when the vertigo attacks and dizziness decreases or even disappears. Another interesting new aspect in this chapter is that we explain why the function of the otolith system is so important, and that it is a mistake to focus on the function of the semicircular canals only, especially when we want to understand why some patients seem to suffer more than others from the loss of canal function as objectified by reduced caloric responses.
PMID: 27638059 [PubMed - in process]
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Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment.
Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment.
Cytotherapy. 2016 Oct;18(10):1284-96
Authors: Bartlett RS, Guille JT, Chen X, Christensen MB, Wang SF, Thibeault SL
Abstract
BACKGROUND: Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison.
METHODS: Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (RT-PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist.
RESULTS AND DISCUSSION: Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]β1, alpha smooth muscle actin, interleukin-1β, interleukin-17β and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC-treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair.
PMID: 27637759 [PubMed - in process]
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Reply to letter "Therapeutic ductal injection in chronic sialadenitis is established".
Reply to letter "Therapeutic ductal injection in chronic sialadenitis is established".
Eur Arch Otorhinolaryngol. 2016 Sep 16;
Authors: Su CH, Lee KS, Tseng TM, Tseng H, Ding YF, Koch M, Hung SH
PMID: 27637754 [PubMed - as supplied by publisher]
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A prospective multicenter clinical feasibility study of a new automatic speaking valve for postlaryngectomy voice rehabilitation.
A prospective multicenter clinical feasibility study of a new automatic speaking valve for postlaryngectomy voice rehabilitation.
Eur Arch Otorhinolaryngol. 2016 Sep 14;
Authors: Lansaat L, de Kleijn BJ, Hilgers FJ, van der Laan BF, van den Brekel MW
Abstract
Evaluation of short- and long-term clinical feasibility and exploration of limitations and advantages of a new automatic speaking valve (ASV) for laryngectomized patients with integrated HME, the Provox FreeHands FlexiVoice (FlexiVoice). This ASV not only enables automatic, but also manual closure of the valve. A multicenter, prospective clinical study in 40 laryngectomized patients was conducted. Participants were asked to use the FlexiVoice for 26 weeks. The primary outcome measure was long-term compliance. Secondary outcome measures were: patient preference, hours of FlexiVoice use, device life of adhesive, voice and speech quality, and quality of life. After 26 weeks, 15 patients (37.5 %) were using the FlexiVoice on a daily basis, for a mean of 12.64 h/day (SD ± 5.03). Ten patients (25 %) were using the device on a non-daily basis, for a mean of 3.76 h/day (SD ± 2.07). The remaining 15 patients (37.5 %) discontinued using the FlexiVoice. Sixty percent of the 25 long-term users applied both automatic and manual closure of the valve. Unpredictable fixation of the adhesive was the main reason for discontinuing or not using the FlexiVoice on a daily basis. Overall, 18 patients (45 %) preferred the FlexiVoice, 16 patients (40 %) their usual HME, 3 patients (7.5 %) their usual ASV, 1 patient (2.5 %) preferred no device at all, and in 2 patients preference was not recorded. The minor technical issues identified could be corrected. The Provox FreeHands FlexiVoice appears to be a useful ASV, which allows for hands-free speech in a larger proportion of laryngectomized patients in the present cohort. The additional manual closure option of the device is beneficial for maintaining the adhesive seal longer.
PMID: 27637753 [PubMed - as supplied by publisher]
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Clinical features and surgical treatment for Chinese juvenile onset current respiratory papillomatosis (JORRP).
Clinical features and surgical treatment for Chinese juvenile onset current respiratory papillomatosis (JORRP).
Eur Arch Otorhinolaryngol. 2016 Sep 14;
Authors: Cui W, Xu W, Yang Q, Hu R
Abstract
Juvenile onset current respiratory papillomatosis (JORRP), which is the commonest benign laryngeal disease in children, has not been well investigated. This study aimed at further evaluating the clinical features and surgery for such children with JORRP. Patients diagnosed as JORRP in our department from January 2011 to June 2014 were enrolled, and the demographic and clinical data were collected. All the patients were followed up after surgery, and the recurrences were recorded. A total of 124 patients were included and categorized into low recurrence (<4/year, n = 97) and high recurrence (≥4/year, n = 27) groups based on the recurrence at diagnosis, respectively. The demographic characteristics were comparable in two groups. There were more patients in high recurrence group who had dyspnea II-III, abnormal chest X-ray findings and severe illness, and needed electrocardiscope monitoring (P < 0.05). Patients who had dyspnea II (P = 0.008) and severe illness (P = 0.002) needed electrocardiscope monitoring (P = 0.014) in high recurrence group were more prone to have recurrence after surgery. Multivariate logistic regression analysis proved that high recurrence at diagnosis was an independent risk factor for recurrence after surgery in JORRP [95 %CI OR 17.342 (1.266, 237.608), P = 0.033]. The recurrence at diagnosis could be used as a prognostic factor for JORRP after surgery, which could help to improve the therapeutic efficacy in such children.
PMID: 27637752 [PubMed - as supplied by publisher]
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Northern European manpower in Otorhinolaryngology-Head and Neck Surgery.
Northern European manpower in Otorhinolaryngology-Head and Neck Surgery.
Eur Arch Otorhinolaryngol. 2016 Sep 14;
Authors: Mäkitie AA, Irjala H, Steinsvåg S, Gudjonsson A, Lüscher M, Luxenberger W, Sahlstrand-Johnson P
PMID: 27637750 [PubMed - as supplied by publisher]
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Meeting the Unmet Need: Training General Surgeons to Perform Life-Saving Neurosurgical Procedures in Low-Resource Settings.
Meeting the Unmet Need: Training General Surgeons to Perform Life-Saving Neurosurgical Procedures in Low-Resource Settings.
World Neurosurg. 2016 Sep;93:474
Authors: Griswold D, Benet A, Berger MS, Lawton MT
PMID: 27637695 [PubMed - in process]
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Transcutaneous immunization in auricle skin induces antigen-specific mucosal and systemic immune responses in BALB/c mice.
Transcutaneous immunization in auricle skin induces antigen-specific mucosal and systemic immune responses in BALB/c mice.
Auris Nasus Larynx. 2016 Sep 13;
Authors: Nagano H, Jimura T, Nagano M, Makise T, Miyashita K, Kurono Y
Abstract
OBJECTIVE: Transcutaneous immunization (TCI) is a novel route of vaccination through application of a topical vaccine antigen on skin. Phosphorylcholine (PC) is a structural component of a variety of pathogens, and anti-PC immune responses protect mice against invasive bacterial diseases. The purpose of the study was to examine the effect of TCI using PC in back skin or auricle skin in BALB/c mice.
METHODS: TCI was performed in BALB/c mice in back skin or auricle skin using PC-keyhole limpet hemocyanin (KLH) plus cholera toxin (CT). Inoculations were given once each week for six consecutive weeks. Immunogenicity was evaluated by measuring PC-specific IgG and specific IgG1, IgG2a, IgM, IgA, and secretory IgA antibodies by ELISA. IL-4, IL-5, IL-10, IL-12, IL-13 and IFN-γ levels were also measured by ELISA.
RESULTS: Serum IgG after TCI in auricle skin was significantly higher than after TCI in back skin and in controls. Secretory IgA antibodies after TCI in auricle skin were also significantly higher than after TCI in back skin and in controls in nasal, BALF, vaginal and fecal samples. PC-specific IgG1 and IgG2a were significantly higher after TCI in auricle skin compared to controls and compared to TCI in back skin. IgG1 was significantly higher than IgG2a after TCI in auricle skin. Production of IFN-γ, IL-4 and IL-10 from CD4(+) cells was significantly higher after TCI in auricle skin than after TCI in back skin and in controls, whereas IL-5, IL-12 and IL-13 were not detected in any mice.
CONCLUSION: These results suggest that TCI in auricle skin using PC plus CT in BALB/c mice is a simple approach for induction of systemic and mucosal immune responses that are shifted in the Th2 direction.
PMID: 27637556 [PubMed - as supplied by publisher]
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The European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a paediatric assessment.
The European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a paediatric assessment.
Pediatr Allergy Immunol. 2016 Sep 17;
Authors: Rodríguez Del Río P, Vidal C, Just J, Tabar AI, Sanchez-Machin I, Eberle P, Borja J, Bubel P, Pfaar O, Demoly P, Calderón MA
Abstract
BACKGROUND: Safety data on "real-life" allergen immunotherapy (AIT) in children and adolescents is usually extrapolated from studies in adults.
METHODS: Patients aged 18 or under initiating aeroallergen AIT were evaluated in a prospective European survey. Patient profiles and systemic reactions (SRs) were recorded. Descriptive, univariate and multivariate analyses were used to identify risk factors for SRs.
RESULTS: A total of 1,563 patients (mean±SD age: 11.7±3.9 years; rhinitis: 93.7%; asthma: 61.5%; polysensitization: 62.5%) and 1,578 courses of AIT were assessed. Single-allergen AIT was administered in 89.5% of cases (n=1,412; mites: 49%; grass pollen: 25.8%; tree pollen: 8.7%; Alternaria: 4.6%; dander: 0.8%; weed pollen: 0.6%). Subcutaneous AIT (SCIT) was used in 71.4% (n=1,127) of the treatments, including 574 (50.9%) with natural extracts. Sublingual AIT (SLIT) was used for the remaining 451 treatments (drops: 73.8%; tablets: 26.2%). The mean±SD follow-up period was 12.9±3.3 months. The estimated total number of doses was 19,669 for SCIT and 131,550 for SLIT. Twenty-four patients (1.53%) experienced 29 SRs. Respiratory (55.7%) and skin symptoms (37.9%) were most frequent. Anaphylaxis was diagnosed in 3 SRs (10.3%), and adrenaline was administered in 2 of these cases. In a univariate analysis, the risk of SRs was lower in mite-sensitized patients and higher in cases of pollen polysensitization (>3), grass pollen extracts and the use of natural extracts (vs. allergoids).
CONCLUSIONS: In a real-life paediatric setting, AIT is safe. SRs are infrequent and generally not severe. Pollen polysensitization, grass pollen extracts and natural extracts (vs. allergoids) were risk factors for AIT-associated SRs. This article is protected by copyright. All rights reserved.
PMID: 27637414 [PubMed - as supplied by publisher]
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Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.
Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.
Crit Rev Oncol Hematol. 2016 Oct;106:64-90
Authors: Mannelli G, Cecconi L, Gallo O
Abstract
BACKGROUND: Multi-step cancerogenesis guides laryngeal cancer onset and it includes a wide variety of pre-cancerous lesions macroscopically challenging to identify and distinguish from initial cancerous foci.
OBJECT: Different modalities of diagnostic techniques of laryngeal epithelial lesions exist and they do not offer a single system to make a differential diagnosis. Hence, this meta-analysis aimed to synthesize the validity of each single diagnostic tool to improve laryngeal patient management.
METHODS: A systematic review of literature was led searching for articles mentioning the following terms: larynx, laryngeal precancerous lesions, laryngeal cancer, white light (WL) endoscopy, stroboscopy, contact endoscopy (CE), autofluorescence (AF), ultrasound (US), narrow band imaging (NBI), computed axial tomography (CAT), magnetic resonance imaging (MRI), positron emission tomography (PET), CAT/PET. Then, a quantitative analysis was carried on for paper published after 2005 onward.
RESULTS: The search identified 7215 publications, of which 3616 published after 2005, with a final results of a total of 214 articles stratified and included by our selection criteria. 42 out of 214 articles were selected for quantitative synthesis. 25 out of 41 studies had a good quality score, 16 were fair.
CONCLUSIONS: A comprehensive overview of the most recent advances in laryngeal imaging technology combined with all of the information needed to interpret findings and manage patients with voice disorders can be found herein. Our flow-chart allows clinicians in risk-stratify patients and select proper examination modalities to provide appropriate care. Study limitations, together with possible clinical and research implications have been counted.
PMID: 27637353 [PubMed - in process]
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Benign paroxysmal positional vertigo and its variants.
Benign paroxysmal positional vertigo and its variants.
Handb Clin Neurol. 2016;137:241-56
Authors: Nuti D, Masini M, Mandalà M
Abstract
Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
PMID: 27638076 [PubMed - in process]
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Meeting the Unmet Need: Training General Surgeons to Perform Life-Saving Neurosurgical Procedures in Low-Resource Settings.
Meeting the Unmet Need: Training General Surgeons to Perform Life-Saving Neurosurgical Procedures in Low-Resource Settings.
World Neurosurg. 2016 Sep;93:474
Authors: Griswold D, Benet A, Berger MS, Lawton MT
PMID: 27637695 [PubMed - in process]
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Pancreatic mucinous cystadenocarcinoma: epidemiology and outcomes.
Pancreatic mucinous cystadenocarcinoma: epidemiology and outcomes.
Int J Surg. 2016 Sep 13;
Authors: Doulamis IP, Mylonas KS, Kalfountzos CE, Mou D, Haj-Ibrahim H, Nasioudis D
Abstract
BACKGROUND: Pancreatic mucinous cystadenocarcinoma is a rare malignancy. Our aim was to investigate the demographic, pathological characteristics, treatment modalities and survival of patients with mucinous cystadenocarcinoma via the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database analysis.
MATERIALS AND METHODS: This was a retrospective population-based study of SEER database's records on patients with mucinous cystadenocarcinoma diagnosed from 1988 to 2012. Primary outcome measures were clinico-pathological characteristics, observed survival and disease-specific survival of patients.
RESULTS: A total of 507 patients were identified. Median age at diagnosis was 67 years and most patients were female (68.4%). The tumors were mainly low grade (82.9%, grade I-II) and frequently localized (42.8%) in the body/tail of the pancreas (45.6%). According to Kaplan-Meier curves observed survival was 111 months (95%CI: 82.5, 139.5) vs 14 months (95% CI: 10.9, 17.1) vs 4 months (95%CI: 2.9, 5.1) for patients with localized, regional and distant disease, respectively. One-year disease-specific survival for patients with localized disease was 90.1%, vs. 56.7% for those with regional and 18.7% with distant tumor spread.
CONCLUSIONS: Mucinous cystadenocarcinomas tend to be low grade tumors, localized to the pancreatic body/tail. Surgery as the primary therapeutic intervention and tumor stage are independent predictors of disease-specific survival.
PMID: 27638187 [PubMed - as supplied by publisher]
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Lower limb muscular activity during walking at different speeds: over-ground versus treadmill walking; a Voluntary Response evaluation
Publication date: Available online 17 September 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Khosro Khademi-Kalantari, Fatemeh Rahimi, Seyed Majid Hosseini, Alireza Akbarzade Baghban, Shapour Jaberzadeh
Objectiveto evaluate the overall lower limb muscular activity pattern during treadmill walking compared to over-ground walking.MethodologyThe study was conducted on 25 healthy young females. Surface electromyography was recorded from gastrocnemius, hamstrings, vasti and gluteus medius muscles during walking over-ground and treadmill at 3 different speeds (comfortable, slow and fast). The pattern of muscle activity was compared between two walking conditions at different speeds by the voluntary response index method. Voluntary response index is composed of two numeric values: magnitude which represents the strength of overall muscular activity, and similarity index which represents the resemblance of overall muscle activity.ResultsThe main effect of walking conditions and speed as well as their interaction effect (P<0.001) on magnitude of muscle activity were significant but not for similarity index.ConclusionsThe pattern of muscular activity during walking on treadmill and over-ground was similar but walking on treadmill induced higher muscular activity in the lower limb musculature.
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Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa
Publication date: Available online 16 September 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Liv-Jorunn Kolnes
Exercise in the context of anorexia nervosa is a multifaceted endeavour surrounded by controversy and uncertainty. A broader comprehension of this poorly understood phenomenon is required. Informed by the findings of a body examination of six individuals with anorexia nervosa, as well as exercise science, phenomenology and neurocognition, the purpose of this article is to elaborate on the potential role of exercise and physical therapy in the treatment of anorexia nervosa. The findings of the body assessment include constriction of posture, muscles and pattern of breathing. These bodily restraints are not necessarily merely associated with high levels of exercise, they may also reflect psychological strain accompanying the illness. The restricted breathing in particular is assumed to be associated with difficult thoughts and suppressed feelings. Based on the results of the body examination, as well as medical and psychological considerations accompanying the illness, it is suggested that interventions should focus on improving postural stability and restoring related muscular function. Integral to engaging in these activities, the potential to integrate proprioceptive information in this process may generate a more coherent experience of the body, as well as of the self, in these clients. Accordingly, constrictions of the body may have a vital role in constraining the experience of the self. As such, addressing bodily restraints in these clients may facilitate the experience of being the subject causing and controlling the movements. This is in marked contrast to clients' previous exercise experiences, which were associated with compulsion, rigidity and the absence of coherence and control.
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