Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Δευτέρα 11 Ιανουαρίου 2016
The role of ANGPTL3 in controlling lipoprotein metabolism
Abstract
Angiopoietin-like protein 3 (ANGPTL3) is a secretory protein regulating plasma lipid levels via affecting lipoprotein lipase- and endothelial lipase-mediated hydrolysis of triglycerides and phospholipids. ANGPTL3-deficiency due to loss-of-function mutations in the ANGPTL3 gene causes familial combined hypobetalipoproteinemia (FHBL2, OMIM # 605019), a phenotype characterized by low concentration of all major lipoprotein classes in circulation. ANGPTL3 is therefore a potential therapeutic target to treat combined hyperlipidemia, a major risk factor for atherosclerotic coronary heart disease. This review focuses on the mechanisms behind ANGPTL3-deficiency induced FHBL2.
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Association of cord blood des-acyl ghrelin with birth weight, and placental GHS-R1 receptor expression in SGA, AGA, and LGA newborns
Abstract
Although ghrelin in cord blood has been associated to birth weight, its role in fetal and postnatal growth has not been elucidated. The aim of this study was to analyze total ghrelin, acyl ghrelin (AG), and des-acyl ghrelin (DAG) in cord blood of newborns with idiopathic birth weight alterations, and to evaluate protein expression of placental GHS-R1, in order to investigate their correlation with birth weight and placental weight. We performed a cross-sectional comparative study in umbilical cord blood and placentas from healthy mothers of SGA, AGA, and LGA (small, adequate and large for gestational age) term newborns (n = 20 per group). Cord blood total ghrelin, AG, and DAG were measured by ELISA, and placental GHS-R1 expression was evaluated by Western blot. Cord blood DAG was higher in SGA compared to AGA newborns (902.1 ± 109.1 and 597.4 ± 58.2 pg/ml, respectively, p = 0.01) while LGA and AGA showed similar values (627.2 ± 76.4 pg/ml for LGA, p = 0.80). DAG negatively correlated with birthweight (r = −0.31, p = 0.02) and placental weight (r = −0.33, p = 0.02). No differences in AG or total ghrelin were found. GHS-R1 protein in placenta was not differentially expressed among SGA, AGA, and LGA. Our results suggest a role of DAG in intrauterine growth. Further studies are needed in order to elucidate the mechanisms by which DAG participates in fetal growth.
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Comparison of Q-switched Nd: YAG laser and fractional carbon dioxide laser for the treatment of solar lentigines in Asians
Background/Objective
Solar lentigines are benign pigmented lesions that occur mostly on sun-exposed areas. Q-switched and ablative lasers are effective for removing these lesions but the high incidence of postinflammatory hyperpigmentation raises concern in darker skin types. The objective of this study is to compare the efficacy and degree of postinflammatory hyperpigmentation with the Q-switched Nd:YAG and fractional carbon dioxide (CO2) laser for treatment of solar lentigines in Asians.
Study design
Twenty-five Thai patients (skin phototype III–IV) with at least two lesions of solar lentigines on upper extremities were enrolled in this study. Two lesions were randomly selected for the treatment with a single session of Q-switched Nd:YAG or fractional CO2 laser. Outcomes were evaluated using physician grading scale, colorimeter, and patient self-assessment at 6 and 12 weeks after treatment. Side effects were recorded.
Results
A total of 532 nm Q-switched Nd:YAG laser showed significant improvement of pigmentation over fractional CO2 laser at 6th and 12th week by both colorimeter assessment and physician grading scale (P < 0.05). No significant difference in postinflammatory hyperpigmentation from both lasers was observed. In terms of patient self-assessment, 80% of the patients treated with 532 nm Q-switched Nd:YAG laser had excellent results compared to 8% in fractional CO2 laser group. However, fractional CO2 laser treatment had faster healing time and less pain score compared to Q-switched Nd:YAG laser.
Conclusions
Q-switched Nd:YAG is superior to fractional CO2 laser for treatment of solar lentigines but requires longer healing time and produces more pain. The incidence of postinflammatory hyperpigmentation was not significantly different with both lasers. Further studies are needed to obtain the proper parameter and the treatment frequency of fractional CO2 laser in solar lentigines. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
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Fractionated bipolar radiofrequency and bipolar radiofrequency potentiated by infrared light for treating striae: A prospective randomized, comparative trial with objective evaluation
Background and Objective
Very few treatments for striae are based on prospective randomized trials. The objective of this study was to assess the efficacy of bipolar fractional radiofrequency and bipolar radiofrequency potentiated with infrared light, alone or combined, for treating abdominal stretch marks.
Study Design/Materials and Methods
Bicentric prospective interventional randomized controlled trial in the department of Dermatology of University Hospital of Nice and Aesthetics Laser Center of Bordeaux, France. Men and women of age 18 years or above, who presented for the treatment of mature or immature abdominal striae were included. The patients' abdomens were divided into four equal quadrants. Bipolar radiofrequency potentiated with infrared light and fractional bipolar radiofrequency were applied, alone or combined, and compared to the remaining untreated quadrant. The main criterion of evaluation was the measurement of depth of striae, using 3D photography at 6 months follow-up. A global assessment was also rated by the physician performing the treatment and by the patients. Histological analysis and confocal laser microscopy were additionally performed.
Results
A total of 22 patients were enrolled, and 384 striae were measured. In per protocol analysis mean striae depth was decreased by 21.64%, observed at 6 months follow-up with the combined approach, compared to an increase of 1.73% in the control group (P < 0.0001). No significant difference in striae width was observed between the treated or control quadrants. Global assessment by the physician who performed the treatment and by the patient both showed greater improved with the combination treatment compared to control areas (P = 0.004 and P = 0.01, respectively). A more homogeneous interlacing pattern and thicker collagen fibers with a decreased proportion of elastic fibers was observed after treatment.
Conclusion
Fractional bipolar radiofrequency, combined with bipolar radiofrequency potentiated by infrared light, is an effective treatment of both immature and mature striae of the abdomen. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
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Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study
Background and Objective
Varied physical and chemical characteristic of root canal sealers and different irrigant agitation systems can influence the depth of penetration. The aim of this in vitro study was to use a laser scanning confocal microscope in order to assess the dentinal tubules penetration of various sealers after the application of different final irrigation techniques.
Study Design/Materials and Methods
A total of 156 single-rooted extracted mandibular premolars were prepared up to size 40 and randomly distributed into four groups according to the sealer type (n = 39): AH Plus, iRoot SP, MTA Fillapex, and GF Bioseal. Each group was randomly subdivided into three groups according to the final irrigation protocol (n = 13): conventional needle irrigation (CI), photon-induced-photoacoustic streaming activation (PIPS), and passive ultrasonic irrigation (PUI). After the final irrigation procedures, the root canals were obturated with single gutta-percha and labeled sealer mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using three-way analysis of variance and Tukey's post hoc tests (P = 0.05).
Results
iRoot SP exhibited a significantly higher penetration area than the other groups (P < 0.001), although there were no statistically significant differences between AH Plus, MTA Fillapex, and GF Bioseal (P > 0.05). Er:YAG laser activation with PIPS and PUI had significantly higher penetration than CI (P < 0.001). Statistically significant differences were also determined at each root canal third (coronal > middle > apical; P < 0.001).
Conclusions
The dentinal tubule penetration area was significantly affected by the selection of root canal sealer, final irrigation procedure, and root canal third. Use of iRoot with PIPS tip or PUI seems advantageous in dentinal tubule penetration. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
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Transcranial laser stimulation improves human cerebral oxygenation
Background and Objective
Transcranial laser stimulation of the brain with near-infrared light is a novel form of non-invasive photobiomodulation or low-level laser therapy (LLLT) that has shown therapeutic potential in a variety of neurological and psychological conditions. Understanding of its neurophysiological effects is essential for mechanistic study and treatment evaluation. This study investigated how transcranial laser stimulation influences cerebral hemodynamics and oxygenation in the human brain in vivo using functional near-infrared spectroscopy (fNIRS).
Materials and Methods
Two separate experiments were conducted in which 1,064-nm laser stimulation was administered at (1) the center and (2) the right side of the forehead, respectively. The laser emitted at a power of 3.4 W and in an area of 13.6 cm2, corresponding to 0.25 W/cm2 irradiance. Stimulation duration was 10 minutes. Nine healthy male and female human participants of any ethnic background, in an age range of 18–40 years old were included in each experiment.
Results
In both experiments, transcranial laser stimulation induced an increase of oxygenated hemoglobin concentration (Δ[HbO2]) and a decrease of deoxygenated hemoglobin concentration (Δ[Hb]) in both cerebral hemispheres. Improvements in cerebral oxygenation were indicated by a significant increase of differential hemoglobin concentration (Δ[HbD] = Δ[HbO2] − Δ[Hb]). These effects increased in a dose-dependent manner over time during laser stimulation (10 minutes) and persisted after laser stimulation (6 minutes). The total hemoglobin concentration (Δ[HbT] = Δ[HbO2] + Δ[Hb]) remained nearly unchanged in most cases.
Conclusion
Near-infrared laser stimulation applied to the forehead can transcranially improve cerebral oxygenation in healthy humans. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.
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Cytoreductive surgery and HIPEC offers similar outcomes in patients with rectal peritoneal metastases compared to colon cancer patients: a matched case control study
Background & Objectives
The effect of cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with rectal peritoneal metastases (PM) is unclear. This case-control study aims to assess the results of cytoreduction and HIPEC in patients with rectal PM compared to colon PM patients.
Methods
Colorectal PM patients treated with complete macroscopic cytoreduction and HIPEC were included. Two colon cancer patients were case-matched for each rectal cancer patient, based on prognostic factors (T stage, N stage, histology type, and extent of PM). Short- and long-term outcomes were compared between both groups.
Results
From 317 patients treated with complete macroscopic cytoreduction and HIPEC, 29 patients (9.1%) had rectal PM. Fifty-eight colon cases were selected as control patients. Baseline characteristics were similar between groups. Major morbidity was 27.6% and 34.5% in the rectal and colon group, respectively (P = 0.516). Median disease-free survival was 13.5 months in the rectal group and 13.6 months in the colon group (P = 0.621). Two- and five-year overall survival rates were 54%/32% in rectal cancer patients, and 61%/24% in colon cancer patients (P = 0.987).
Conclusions
Cytoreduction and HIPEC in selected patients with rectal PM is feasible and provides similar outcomes as in colon cancer patients. Rectal PM should not be regarded a contra-indication for cytoreduction and HIPEC in selected patients. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Molecular targeting of papillary thyroid carcinoma with fluorescently labeled ratiometric activatable cell penetrating peptides in a transgenic murine model
Background and Objectives
Molecularly targeted fluorescent molecules may help detect tumors that are unseen by traditional white-light surgical techniques. We sought to evaluate a fluorescent ratiometric activatable cell penetrating peptide (RACPP) for tumor detection in a transgenic model of PTC.
Methods
Thirteen BRAFV600E mice with PTC were studied—seven injected intravenously with RACPP, four controls with saline. Total thyroidectomy was performed with microscopic white-light visualization. Fluorescent imaging of post-thyroidectomy fields was performed, and tissue with increased signal was removed and evaluated for PTC. Final samples were analyzed by a pathologist blinded to conditions. Vocal cord function was evaluated postoperatively with video laryngoscopy.
Results
The average in situ ratiometric (Cy5/Cy7) thyroid tumor-to-background contrast ratio was 2.27 +/− 0.91. Fluorescence-guided clean-up following thyroidectomy identified additional tumor in 2 of 7 RACPP animals (smallest dimension 1.2 mm), and decreased the number of animals with residual tumor from 4 to 3. All retained tumor foci on final pathology were smaller than 0.76 mm. Intact vocal abduction was present in all of the RACPP animals.
Conclusions
RACPPs successfully targeted PTC in a transgenic thyroidectomy model, and allowed for residual tumor detection that reduced positive margins beyond what was possible with white-light surgery alone. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Expression of the potential cancer stem cell markers CD133 and CD44 in medullary thyroid carcinoma: A ten-year follow-up and prognostic analysis
Background and Objectives
To investigate the expression profiles of cancer stem cells (CSCs) markers CD133 and CD44 in a cohort of medullary thyroid carcinoma (MTC) patients, and their prognostic values during 10-year follow-up.
Methods
MTC samples were obtained for H&E and immunohistochemical analysis. Survival analysis was performed using Kaplan–Meier method and log-rank test.
Results
Both the CD133 and CD44 positives were higher in MTC than control. High expression of CD133 and CD44 was positively correlated with capsule invasion and each other, and their co-expression was significantly correlated with capsule invasion, tissue invasion, and metastases at surgery. Tumor size, capsular invasion, tissue invasion, metastases at surgery, surgical plan, lymph node metastases, TNM stage, CD133, and CD44 were prognostic factors for overall survival (OS) and/or disease free survival (DFS). Both the CD133 and CD44 were unfavorable prognostic predictors for OS (P = 0.046, P = 0.03), while only CD44 was a significant predictor for DFS (P = 0.017). OS rate in CD133/CD44 co-expression group was significantly lower than that in non-co-expression group (χ2 = 8.44, P = 0.004).
Conclusion
Our study suggested the high expression of CD133 and CD44 in the MTC, and CD133 and CD44 expressions were correlated with capsule invasion and with OS. CD133 and/or CD44 may be prognostic factors for OS and/or DFS in our MTC patients. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc
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Predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer
Background and Objectives
Lateral and superior oropharyngeal reconstruction is technically challenging and can be complicated by postoperative dysphagia. The aim of this retrospective study was to identify the predictive factors of dysphagia after lateral and superior oropharyngeal reconstruction with free flap transfer and to establish better management for cases with these predictive factors.
Methods
We performed a retrospective chart review of 109 patients who had undergone lateral and superior oropharyngeal reconstruction with free flap transfer for oropharyngeal cancer. Preoperative, operative, and postoperative variables were examined, and possible predicative factors for dysphagia were subjected to univariate analysis and multivariate logistic regression analysis.
Results
Dysphagia occurred in 16 patients (14.7%). Multivariate logistic regression analysis identified extensive tongue base resection, postoperative radiotherapy, and history of radiotherapy to the head and neck region as independent factors contributing to dysphagia after lateral and superior oropharyngeal reconstruction. Of these factors, extensive tongue base resection was the most important.
Conclusions
Early intervention to minimize the risk of dysphagia should be performed for patients identified with these predictive factors. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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IL-32α has differential effects on proliferation and apoptosis of human melanoma cell lines
Background
Interleukin-32 (IL-32) is a recently recognized intracellular, proinflammatory cytokine which may play a role in cancer metastasis and patient survival. The role of IL-32 in cancer, especially its direct effect on cancer cells, is not well understood.
Material and Methods
Clonogenic assay, PCNA staining, Quick Cell Proliferation assay, TUNEL staining, and caspase-3 activity assay were used to investigate the in vitro role for IL-32α in human melanoma growth. We further investigated the possible molecular mechanisms using RT-PCR and immunohistochemical staining.
Results
Exogenous administration of IL-32α inhibited proliferation of the HTB-72 human melanoma cell line, but had little effect on other melanoma cell lines. Inhibition of proliferation in HTB-72 correlated with increased expression of p21 and p53. IL-32α administration also increased apoptosis in HTB-72. This finding correlated with increased expression of TRAILR1.
Conclusions
The data presented suggest a direct effect of IL-32α on the growth of human melanoma and give some insight into the mechanisms which may in part govern this effect. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Tumor histopathology predicts outcomes after resection of colorectal cancer liver metastases treated with and without pre-operative chemotherapy
Background and Objectives
Study objectives, included determination of: (i) associations between radiologic and pathologic responses of colorectal cancer liver metastases (CRCLM) to chemotherapy; and (ii) whether CRCLM histopathology is associated with recurrence free survival (RFS) after resection among patients not treated with pre-operative chemotherapy (untreated).
Methods
Demographics, clinicopathologic characteristics, and outcomes among patients who underwent CRCLM resection from 2007 to 2014 were reviewed. Tumor regression grade (TRG) of 1–2 and 4–5 depict low and high proportions of viable tumor relative to fibrosis, respectively.
Results
Of 138 patients, 84 (60.9%) were treated with pre-operative chemotherapy. In these patients, there was no difference in proportions with TRG 1–2 among those with verses without radiologic response (26.9% vs. 18.8%, P = 0.393). TRG 1–2 was associated with superior RFS on univariable (median 15 vs. 6 months, P < 0.001) and multivariable (P = 0.005) analyses. Radiologic response was not associated with RFS. Among untreated patients (n = 54), TRG 4–5 was associated with poor RFS on univariable (median 44 vs. 15 months, P = 0.011) and multivariable (P = 0.012) analyses.
Conclusions
High proportions of CRCLM fibrosis occur in 20% of patients without radiologic response to chemotherapy. Among untreated patients, high proportion of viable tumor relative to fibrosis is associated with poor RFS after resection. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Assessing the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer: A randomized clinical trial
Background
Robotic gastrectomy is increasingly used in gastric cancer patients. This study assessed the safety and efficacy of full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer.
Methods
Three hundred and eleven patients were randomized into an open gastrectomy group or a robotic gastrectomy group, and digestive restorations were performed under direct vision and with intracorporeal robot-sewn anastomosis, respectively. Length of postoperative hospital stay, number of lymph node dissections, surgical duration, blood loss, and complication rate after surgery were recorded.
Results
There were no significant differences in the number of lymph node dissections (30.9 ± 10.4 vs. 29.3 ± 9.7 days, P = 0.281) or complication rates (10.3 vs. 9.3%, P = 0.756) between the two groups. Surgical duration was significantly longer in the robotic gastrectomy group than in the open gastrectomy group (242.7 ± 43.8 vs. 192.4 ± 31.5 min, P = 0.002), whereas blood loss was less (94.2 ± 51.5 vs. 152.8 ± 76.9 ml, P < 0.001), length of postoperative hospital stay was shorter (5.6 ± 1.9 vs. 6.7 ± 1.9 days, P = 0.021), and postoperative restoration of bowel function was earlier (2.6 ± 1.1 vs. 3.1 ± 1.2 days, P = 0.028).
Conclusion
Full robotic gastrectomy with intracorporeal robot-sewn anastomosis for gastric cancer is safe and does not increase the complication risk during or after surgery. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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S-1 plus nab-paclitaxel is a promising regimen for pancreatic cancer in a preclinical model
Objectives
The aim of this study was to investigate the efficacy and mechanism of action of combined S-1 and nab-paclitaxel in pancreatic cancer.
Methods
Three human pancreatic cancer cell lines were treated with S-1, nab-paclitaxel, alone or in combination. Mice bearing subcutaneous xenograft of the cell line, PANC-1, were treated with the same drugs.
Results
The growth-inhibitory effect of combined S-1 and nab-paclitaxel was greater than that of the individual drugs, and the combination index value indicated that S-1 and nab-paclitaxel had a synergistic effect in vitro. The combination of S-1 and nab-paclitaxel showed greater efficacy in vivo than monotherapy, and the growth-inhibitory effect was significantly greater when compared with the controls (P = 0.009), although no significant reduction in body weight was observed. Fractional tumor volume analysis indicated that the combination had a synergistic effect. Tumor stroma staining with α-smooth muscle actin was significantly decreased by nab-paclitaxel (P < 0.001) while the number of CD31-stained microvessel lumina was significantly increased by the combination therapy when compared with the control (P = 0.046).
Conclusions
S-1 and nab-paclitaxel had a synergetic effect in preclinical studies with good tolerability, and may play a role in stromal depletion and tumor angiogenesis. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma
Background
Little is known regarding postoperative outcomes of elderly patients undergoing liver surgery for intrahepatic cholangiocarcinoma (ICC).
Methods
Five hundred and eighty-four patients undergoing liver resection for ICC between 1990 and 2015 were identified. Perioperative morbidity, mortality, overall survival (OS), and disease-free survival (DFS) were compared between elderly (>70 year, n = 129) and non-elderly (≤70 years, n = 455) patients.
Results
Older patients had a higher incidence of complications (elderly vs. non-elderly; 52.7% vs. 42.6%; P = 0.03), as well as major complications (elderly vs. non-elderly; 24.0% vs. 14.9%; P = 0.01); 30-day (0.1% vs. 3.3%; P > 0.05), and 90-day mortality (2.3% vs. 5.5%; P > 0.05) were comparable. Five-year OS and DFS were comparable between the elderly and non-elderly patients (OS, 13.3% vs. 24.4%; and DFS; 7.3% vs. 12.0%; P > 0.05). On propensity score matching, DFS and OS were also comparable among non-elderly versus elderly patients. Poor tumor grade was associated with worse DFS among elderly patients (HR = 1.6, 95%CI 1.0–2.6; P = 0.04), whereas periductal invasion (HR = 1.9, 95% CI 1.1–3.5; P = 0.03) and nodal disease (HR = 2.3, 95% CI 1.3–3.9; P = 0.003) were predictive of shorter DFS among non-elderly patients.
Conclusion
Elderly patients undergoing liver surgery for ICC demonstrated an increased risk of perioperative complications, but comparable long-term DFS and OS compared with younger patients. Rather, tumor characteristics were more predictive of worse long-term outcomes. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Prognostic significance of tumor regression grade for patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy followed by surgery
Background and objectives
To clarify prognostic factors for the patients with esophageal squamous cell carcinoma (ESCC) through an assessment of surgically resected specimens modified by neoadjuvant chemotherapy (nCT).
Methods
We retrospectively reviewed the clinicopathological data of 143 consecutive patients with ESCC who underwent nCT followed by surgery between 2008 and 2012 at our institution and conducted survival analysis. The tumor regression grade (TRG) was classified based on the proportion of residual tumor cells in the area where the tumor was thought to have existed before nCT as follows: Grade 0 (no therapeutic effect), Grade 1a (residual tumor cells ≥2/3), Grade 1b (1/3≤ residual tumor cells <2/3), Grade 2 (residual tumor cells <1/3), and Grade 3 (no residual tumor).
Results
The 3-year OS and RFS of patients with tumor regression grade 0/1a/1b-3 were 53.6%/73.3%/88.6% and 37.7%/60.5%/83.8%, respectively. A multivariate analysis demonstrated that TRG was an independent predictor of OS (TRG 1a-3: HR, 0.46; 95%CI, 0.23–0.89), in addition to venous invasion, and of RFS (TRG 1a-3: HR, 0.49; 95%CI, 0.28–0.84), in addition to ypT factor, and venous invasion.
Conclusions
TRG is a critical prognostic factor in patients with ESCC who had undergone nCT followed by surgery. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Dynamic assessment of carcinoembryonic antigen in the first month after liver resection for colorectal liver metastases as a rapid-recurrence predictor
Background
Carcinoembryonic antigen (CEA) is a tumor marker used widely for detecting the recurrence and predicting the prognosis of colorectal cancer. This study investigates the possibility of serial measurement of serum CEA in several weeks after liver resection for colorectal liver metastases (CRLM) in detecting earlier detection of recurrence.
Methods
From 2007 to 2014, CEA levels were assessed at 1 week and at 2–3 weeks after curative-intent liver resection among a total of 240 patients with CRLM. The CEA half-life was calculated and patients were divided into two groups: those with a CEA half-life ≤10 days or normalized (Group S), and those with a CEA half-life >10 days or rising (Group L).
Results
The 1-, 3-, and 5-year overall survival rates in Group S versus Group L were 91.3% versus 83.3%, 64.0% versus 41.3%, and 44.2% versus 29.3%, respectively (P = 0.0079). Multivariate analysis revealed that resection of extrahepatic lesions, four or more lesions of liver metastases, and categorization in Group L were independent factors of rapid recurrence within 100 days.
Conclusion
A CEA half-life >10 days or rising 1 month after curative-intent liver resection was associated with rapid recurrence of CRLM within 100 days. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Sentinel lymph node identification using superparamagnetic iron oxide particles versus radioisotope: The French Sentimag feasibility trial
Background and Objectives
The French Sentimag feasibility trial evaluated a new method for the localization of breast cancer sentinel lymph node (SLN) using Sienna+®, superparamagnetic iron oxide particles, and Sentimag® detection in comparison to the standard technique (isotopes ± blue dye).
Methods
We conducted a prospective multicentric paired comparison trial on 115 patients. SLN localization was performed using both the magnetic technique and the standard method. Detection rate and concordance between magnetic and standard tracers were calculated. Post-operative complications were assessed after 30 days.
Results
Results are based on 108 patients. SLN identification rate was 98.1% [93.5–99.8] for both methods, 97.2% [92.1–99.4] for Sienna+® and 95.4% [89.5–98.5] for standard technique. A mean of 2.1 SLNs per patient was removed. The concordance rate was 99.0% [94.7–100.0%] per patient and 97.4% [94.1–99.2] per node. Forty-six patients (43.4%) had nodal involvement. Among involved SLNs, concordance rate was 97.7% [88.0–99.9] per patient and 98.1% [90.1–100.0] per node.
Conclusions
This new magnetic tracer is a feasible method and a promising alternative to the isotope. It could offer benefits for ambulatory surgery or sites without nuclear medicine departments. J. Surg. Oncol. 2016;9999:XX–XX. © 2016 Wiley Periodicals, Inc.
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In vitro and clinical evaluation of SIG1273: a cosmetic functional ingredient with a broad spectrum of anti-aging and antioxidant activities
Summary
Background
Isoprenylcysteine (IPC) small molecules were identified as a new class of anti-inflammatory compounds over 20 years ago. Since then, they have been developed as novel cosmetic functional ingredients (CFI) and topical drug candidates. SIG1273 is a second generation CFI that has previously been shown to provide a broad spectrum of benefits for the skin through its anti-inflammatory and antimicrobial properties.
Objective
To determine whether SIG1273 possesses anti-aging properties in vitro and evaluate the tolerability and activity of SIG1273 when applied topically to human subjects.
Methods
To model photoaging in vitro, human dermal fibroblasts (HDFs) were exposed in culture to UVA to induce collagenase (MMP-1) production. An in vitro wound-healing model was based on the activation of HDF migration into cell-free tissue culture surface. Hydrogen peroxide-induced oxidative stress was performed using HDFs to measure intracellular ROS activity. Radical scavenging capacity was determined using a colorimetric antioxidant assay kit (ABTS method). Lastly, a 4-week, 29-subject study was performed in which SIG1273 was applied topically as a cream to assess its tolerance and activity in reducing the appearance of aging.
Results
In vitro studies demonstrate SIG1273 inhibits UVA-induced MMP-1 production, hydrogen peroxide-induced oxidative stress and promotes wound healing. Moreover, SIG1273 was shown to be a radical scavenging antioxidant. Clinical assessment of SIG1273 cream (0.25%) showed it was well tolerated with significant improvement in the appearance of fine lines, coarse wrinkles, radiance/luminosity, pore size, texture/smoothness, hydration and increased firmness.
Conclusions
SIG1273 represents a novel CFI with antioxidant, anti-aging, and anti-inflammatory properties that when applied topically is well tolerated and provides benefits to individuals with aging skin.
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Association of Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphism With Lung Cancer Susceptibility
Background and Objective:
The association between angiotensin-converting enzyme insertion/deletion gene polymorphism and lung cancer susceptibility is still being debated. This meta-analysis was performed to evaluate the relationship between angiotensin-converting enzyme insertion/deletion gene polymorphism and lung cancer risk.
Method:Association studies were identified from the databases of PubMed and China Biological Medicine Database disc as of June 1, 2015, and eligible investigations were synthesized using meta-analysis method.
Results:Ten investigations were identified for the analysis of association between angiotensin-converting enzyme insertion/deletion gene polymorphism and lung cancer risk. There was no a marked association between D allele/DD genotype and lung cancer susceptibility, and II genotype did not play a protective role against lung cancer risk in the overall population (D: odds ratio = 1.05, 95% confidence interval: 0.88-1.26, P = .58; DD: odds ratio = 1.18, 95% confidence interval: 0.82-1.69, P = .38; II: odds ratio = 0.99, 95% confidence interval: 0.77-1.27, P = .93). Furthermore, angiotensin-converting enzyme insertion/deletion gene polymorphism was not associated with lung cancer susceptibility in Asian population and in Caucasians.
Conclusion:Angiotensin-converting enzyme insertion/deletion gene polymorphism was not associated with lung cancer susceptibility. However, more investigations are required to further clarify the association.
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Norcantharidin Inhibits SK-N-SH Neuroblastoma Cell Growth by Induction of Autophagy and Apoptosis
Norcantharidin, a low-toxic analog of the active anticancer compound cantharidin in Mylabris, can inhibit proliferation and induce apoptosis of multiple types of cancer cells. However, the anticancer activities of norcantharidin with respect to neuroblastoma, and its underlying mechanisms, have not been investigated. Therefore, our study was designed to determine the efficacy of norcantharidin on SK-N-SH neuroblastoma cell death and to elucidate detailed mechanisms of activity. In the present study, norcantharidin suppressed the proliferation and cloning ability of SK-N-SH cells in a dose-dependent manner, apparently by reducing the mitochondrial membrane potential and arresting SK-N-SH cells at the G2/M stage, accompanied by elevated expressions of p21 and decreased expressions of cyclin B1 and cell division control 2. Treatment by norcantharidin induced significant mitophagy and autophagy, as demonstrated by a decrease in Translocase Of Outer Mitochondrial Membrane 20 (TOM20), increased beclin1 and LC3-II protein expression, reduced protein SQSTM1/p62 expression, and accumulation of punctate LC3 in the cytoplasm of SK-N-SH cells. In addition, norcantharidin induced apoptosis through regulating the expression of B-cell lymphoma 2–associated X protein/B-cell lymphoma 2 and B-cell lymphoma 2–associated X protein/myeloid cell leukemia 1 and activating caspase-3 and caspase-9–dependent endogenous mitochondrial pathways. We also observed an increase in phosphor–AMP-activated protein kinase accompanied with a decrease in phosphor-protein kinase B and mammalian target of rapamycin expression after treatment with norcantharidin. Subsequent studies indicated that norcantharidin participates in cellular autophagy and apoptosis via activation of the c-Jun NH2-terminal kinases/c-Jun pathway. In conclusion, our results demonstrate that norcantharidin can reduce the mitochondrial membrane potential, induce mitophagy, and subsequently arouse cellular autophagy and apoptosis; the AMP-activated protein kinase, protein kinase B/mammalian target of rapamycin, and c-Jun NH2-terminal kinases/c-Jun signaling pathways are widely involved in these processes. Thus, the traditional Chinese medicine norcantharidin could be a novel therapeutic strategy for treating neuroblastoma.
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Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation
Purpose:
To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol.
Material and Methods:Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breath-hold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans.
Results:Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose.
Conclusion:Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.
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A rare presentation of bilateral spontaneous superficial femoral arteriovenous fistulas
Spontaneous arteriovenous fistulas are a rare clinical entity with very few cases reported in the literature. Prompt diagnosis and treatment is crucial and can prevent further complications in such patients. We report a case of a patient who presented with progressive bilateral claudication, discolouration of feet, hypaesthesia and non-healing ulcers. The patient had no history of trauma, aneurysm or surgery. After abnormal non-invasive studies, a peripheral angiogram revealed significant disease and obstruction of bilateral superficial femoral arteries. Spontaneous bilateral femoral arteriovenous fistulas were also found incidentally. After discussing the risks and benefits of multiple treatment options with the patient, percutaneous intervention with orbital atherectomy, balloon angioplasty and covered stent placements were performed. This treatment improved the patient's symptoms significantly.
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Unusual case of HIV with Kaposi sarcoma and neuroendocrine tumour
Description
A 50-year-old Black man with a 3-year history of HIV/AIDS on antiretroviral therapy (efavirenz/emtricitabine/tenofovir) presented with cough and dyspnoea. He had no significant medical history aside from HIV and had no history of opportunistic infections. He denied any history of smoking, alcohol or illicit drug abuse, and denied receiving blood transfusions. He had had unprotected sex with male partners in the past. His family history was positive for his mother having had a stroke. He had a history of non-compliance with antiretroviral therapy. Examination showed numerous brownish skin macules and purple coloured exophytic palatal lesions (figures 1 and 2). His CD4 count was 222 and viral load 1130 K copies/mL. Chest X-ray showed perihilar infiltrates (figure 3). CT of the chest revealed upper lobes and right middle lobe infiltrates mainly along the bronchovascular bundles (figure 4). Bronchoscopy showed a polypoidal...
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Etanercept-induced myositis: do we have to stop it? A surprising outcome
We discuss a case of a 47-year-old man who presented with progressive proximal muscle weakness of the upper and lower extremities and unstable gait. He had been on etanercept for 6 months for severe psoriasis and psoriatic arthritis with good control of his disease. Serum creatine kinase (CK) level was found to be 5666 U/L and muscle biopsy showed a marked inflammatory myopathic process likely secondary to etanercept. He was started on high-dose steroids and advised to discontinue etanercept. Despite our recommendation, he never stopped using etanercept due to fear of a psoriasis flare. Three months later, he had significant improvement of clinical symptoms, normalised serum CK levels and discontinued prednisone.
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An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the 'Achilles heel of optimal recovery
A 72-year-old woman was diagnosed with an avulsion fracture of the tuberosity of the calcaneus. The fracture was planned for elective fixation 12 days after the accident. The planned open reduction and internal fixation was not possible due to a decubital wound on the Achilles heel as a result of pressure on the skin of the fractured tuberosity. Closed reduction and internal fixation was performed, leading to an acceptable outcome. Avulsion fractures of the tuberosity of the calcaneus are rare injuries, and delay in treatment should be avoided as it may lead to preventable complications.
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Acute necrotising encephalopathy in a child with H1N1 influenza infection: a clinicoradiological diagnosis and follow-up
Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbreak, and more research to establish standard treatment protocols for this under-recognised entity.
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Benign cylindroma: a rare differential diagnosis of external ear canal tumour
Cylindromas are rare adnexal skin tumours that usually occur in the head and neck area. This article reports a case of benign cylindroma arising in the external auditory canal. A 75-year-old man presented with a 3-month history of right aural fullness; no other symptoms were reported. Ear microscopy examination revealed a skin mass on the floor of the external ear canal. A CT scan of the skull showed a well-circumscribed soft tissue mass, with no signs of underlying cortical bone erosion. Tumour resection through an endaural approach was performed. Histological examination revealed a benign cylindroma with margins free of tumour, so that no further treatment was necessary. 8 months after surgery the patient is asymptomatic with normal findings in the ear microscopy examination. Benign cylindroma has a high recurrence rate and can undergo malignant transformation. Therefore, complete surgical removal and close follow-up are of great importance.
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Macular infarction in a patient with Toxoplasma retinochoroditis
Toxoplasma retinochoroditis is one of the commonest causes of infectious posterior uveitis and may lead to occlusive retinitis. We present a case of a patient with Toxoplasma retinochoroditis who developed macular infarction after initial improvement on pharmacotherapy. The potential aetiology and outcome are described.
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Rare case of Mirizzi syndrome associated with cholecystogastric fistula
A woman in her mid-30s presented with upper right quadrant abdominal pain. On examination, there was mild upper right quadrant tenderness and negative Murphy's sign. Basic laboratory investigations revealed normal results except for elevated alkaline phosphatase. Subsequent imaging revealed chronic calculous cholecystitis and the dilated common bile duct harbouring stones, with pneumobilia. The patient underwent open cholecystectomy with common bile duct exploration. Intraoperatively, the gallbladder was found contracted, and densely adherent to and fistulising with the common bile duct and stomach.
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Myxoedema coma in the setting of hyperglycaemic hyperosmolar state
Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. We wanted to highlight this case of myxoedema coma occurring in the context of a hyperglycaemic hyperosmolar state (HHS), as the former condition is normally associated with hypoglycaemia, hyponatraemia and hypo-osmolality. Decompensated hypothyroidism should be considered in presentations of HHS as well as with other metabolic derangements, as delays in thyroid hormone replacement are associated with poorer outcomes. It has multisystem effects challenging its recognition and we discuss potential complications and their management.
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Scaphoid non-union in osteogenesis imperfecta
We report a case of scaphoid non-union in a child with osteogenesis imperfecta (OI) presenting 7 months after a fall. Following diagnosis, conservative treatment was initiated, but despite 4 months in a plaster cast, the fracture had failed to unite. Open reduction and internal fixation was performed (Acutrak screw) with bone graft harvested from the distal radius. Postoperative immobilisation continued for 10 weeks, and at 4 months the child was pain free and had resumed normal activities. The fracture had fully united radiologically at 9 months. Non-union is reported to occur in 23% of paediatric scaphoid fractures when treatment is delayed, and conservative and surgical treatment have both been described. Since OI increases the risk of non-union in long bone fractures, the scaphoid may also be at risk. We recommend a high level of suspicion for non-union in this patient group and a low threshold for consideration of surgical treatment.
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To stop or not? Tamoxifen therapy for secondary prevention of breast cancer in a patient with ocular toxicity
We report a case of a patient with treated breast cancer whose dilated fundus examination showed crystalline deposits in the central region of the macula. She was taking tamoxifen for secondary prevention. Optical coherence tomography revealed individual refractile deposits associated with intraretinal cysts in both eyes. Tamoxifen-related retinopathy was suspected. A decision to discontinue treatment with tamoxifen was considered but had to be taken in conjunction with the oncologist.
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Lymphoedema-distichiasis syndrome
Description
A 29-year-old woman with a history of renal cysts, hypertension and lymphoedema-distichiasis syndrome, was referred to ophthalmology, with bilateral blurred vision, hyperaemia and ocular pain, developed over months.
The patient had no positive family history for lymphoedema-distichiasis or other diseases.
Clinical examination revealed stunted height (144 cm), neck webbing (figure 1), bilateral and asymmetric lymphoedema (figure 2), bilateral distichiasis (figure 3) and keratitis (figure 4). Other ocular manifestations of lymphoedema-distichiasis, such as ptosis and strabismus, were excluded through ophthalmological examination.
Figure 1
Patient's neck webbing.
Figure 2
Bilateral and asymmetrical lymphoedema, which the patient presented since puberty, with progressive worsening and episodes of cellulitis.
Figure 3
Inferior distichiasis.
Figure 4
Discrete inferior keratitis.
Spinal MRI revealed multiple arachnoidal extradural cysts...
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Kaposi's sarcoma presenting as violaceous macules on the chest of a kidney transplanted patient
Organ transplant recipients have a high incidence of cancer associated with persistent viral infections, such as human herpes virus 8. This virus is associated with Kaposi's sarcoma, and a change in the dose or type of immunosuppression regimen should be the first step in its treatment. A multidisciplinary approach with nephrologists, dermatologists and oncologists is necessary for the management of this disease. We report a clinical case with atypical presentation and discuss the treatment options.
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Dermoscopic signs of lichen planus
Description
A 55-year-old woman presented with a 3-month history of violaceous, itchy, flat-topped papules located on her forearms (figure 1), trunk and legs. There was no history of drug intake.
Figure 1
Clinical presentation of active lichen planus. Purplish-violaceous, polygonal-shaped, flat-topped small papules located on the forearms. The surface is slightly shiny showing a network of fine white lines ('Wickham's striae'). Coalescence into linear plaques is related to Koebner phenomenon. Excoriations are also present.
The forearm lesions were studied with a hand-held dermoscope ( 10; Heine Optotechnik, Germany) revealing yellow dots and Wickham striae (WS), surrounded by radial linear and dotted capillaries (figure 2). Mature lesions also revealed peripheral pigmented dots and diffuse scale distribution (figure 3). The diagnosis of lichen planus (LP) was considered after clinical and dermoscopic correlation, and confirmed histologically. Screening for hepatitis B...
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Bronchial anthracofibrosis with interstitial lung disease: an association yet to be highlighted
Bronchial anthracofibrosis (BAF), an emerging pulmonary disease due to long-standing exposure to biomass fuel smoke, is predominantly seen in females from developing nations. BAF is known to be associated with tuberculosis, pneumonia, chronic obstructive pulmonary disease and lung cancer, but the association of BAF with interstitial lung disease (ILD) is rare and yet to be highlighted. A 72-year-old woman with a 30-year history of exposure to biomass fuel smoke presented with dry cough and exertional dyspnoea. Imaging demonstrated interlobular, intralobular and peribronchovascular interstitial thickening and honeycombing adjoining the subpleural regions, suggestive of the usual interstitial pneumonia pattern. A restrictive pattern with diffusion defect was noted. Fibrebronchoscopy revealed a bluish-black anthracotic pigmentation with a narrowed and distorted left upper lobe, and apical segment of left lower lobe bronchus, confirming BAF. A diagnosis of BAF with ILD was made. To the best of our knowledge, this is the first detailed description of this association.
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EurJOC Coming of Age
Abstract
Editor-in-chief Haymo Ross presents the most important changes for EurJOC in 2016, highlighting the new layout and the online-only format.
Editor-in-chief Haymo Ross presents the most important changes for EurJOC in 2016, highlighting the new layout and the online-only format.
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Non-Classically Controlled Signs in a Circularly Polarised Luminescent Molecular Puppet: The Importance of the Wire Structure Connecting Binaphthyl and Two Pyrenes (Eur. J. Org. Chem. 1/2016)
The cover picture shows two achiral pyrene puppets with one chiral binaphthyl puppeteer, in which the handedness of the pyrene puppets in the ground and photo-excited chiral states of the puppets is controlled by the wire's chemical structure, as proven by circular dichroism and circularly polarized luminescence spectra. Puppetry is one of the most common cultures in the world, that is well known as Ningyo-joruri (Japan), Kathputli (Rajasthani puppetry, India), and Marionette (Europe). In their article on 64 ff, M. Fujiki, Y. Imai et al. demonstrate the importance of well-designed structures of the chemical wires between the molecular puppet and molecular puppeteer in order to overcome thermal fluctuation that is determined solely by the Boltzmann distribution.
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Solution-based routes to ammine metal borohydrides: formation of ammonia-borane
Chem. Commun., 2016, Advance Article
DOI: 10.1039/C5CC10027E, Communication
DOI: 10.1039/C5CC10027E, Communication
Mehdi Mostajeran, David J. Wolstenholme, Chris Frazee, G. Sean McGrady, R. Tom Baker
Ammine metal borohydrides (AMBs) have recently commanded attention as low-temperature hydrogen sources.
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
Ammine metal borohydrides (AMBs) have recently commanded attention as low-temperature hydrogen sources.
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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Comparison of Serum MicroRNA21 and Tumor Markers in Diagnosis of Early Non-Small Cell Lung Cancer
Objective. To compare the clinical value of serum microRNA21 (miR21) and other tumor markers in early diagnosis of non-small cell lung cancer (NSCLC). Methods. Serums carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), and miR21 were detected in 50 NSCLC cases and 60 healthy control individuals. Results. Average serums miR21, CEA, NSE, and CYFRA21-1 levels were significantly higher in the case group than in control group (). Analysis of areas under the receiver operating characteristic (ROC) curve (AUC) revealed that CEA had the highest diagnostic efficiency for NSCLC. Serums miR21 and CYFRA21-1 levels were significantly lower at TNM stages I-II than stages III-IV (). Further, logistic multivariate regression analysis showed that the incidence of early NSCLC (TNM stages I-II) was correlated with serums CYFRA21-1 (OR = 1.076) and miR21 (OR = 2.473) levels (). By AUC analysis, miR21 had the highest diagnostic efficiency for early NSCLC, and single or combined detection of serums CYFRA21-1 and miR21 levels showed improved diagnostic efficiency for joint detection of both markers. Conclusions. Serum miR21 could serve as an important marker for auxiliary diagnosis of early NSCLC, while joint detection of serums miR21 and CYFRA21-1 levels could improve diagnostic efficiency.
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Getting Bang for Your Buck: The Specificity of Compensation and Benefits Information in Job Advertisements
Even though some organizations are trying to attract high-level applicants through offering superior compensation and benefits, reward statements in job advertisements are sometimes rather general and vague. On the basis of person-environment fit theories, we examine whether providing more specific information on attractive reward packages in job advertisements leads to higher perceived person-reward fit and subsequent job pursuit intentions. Furthermore, based on signaling theory, we propose that person-reward fit allows job seekers to make inferences about broader person-organization fit. Applying an online experimental design among 283 experienced potential applicants, we find that more specific compensation and benefits information results in higher job pursuit intentions and that this relationship is fully mediated by person-reward fit perceptions. In turn, the effect of person-reward fit is partially mediated by perceptions of person-organization fit, indicating that people might use reward information as signals for other organizational attributes in early stages of recruitment.
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Reading history maps: the siege of Ypres in 1383 mapped by Guillaume du Tielt
Old maps convey messages about early spatial arrangements. In some cases, they also tell a story, and hence can be qualified as 'history maps'. The interpretation of such maps is not easy, because they are witnesses to a strong dichotomy between the static representation of the landscape and the dynamic sequence of historical events. Digital Thematic Deconstruction allows to break through the iconographic composition and to extract the visual discourse from such an image stuffed with information. In this article, the method is applied to the bird's-eye view of the siege of Ypres in 1383, engraved by Guillaume du Tielt at the beginning of the seventeenth century, in order to assess the accuracy of the mapped topography and to get at the visual narrative. The results not only help interpret the meaning of such a history map, but also offer perspectives for comparing and juxtaposing history maps and textual records.
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Computer-aided exploration of architectural design spaces: a digital sketchbook
Het ontwerpproces van architecten vormt vaak geen lineair pad van ontwerpopgave tot eindresultaat, maar wordt veeleer gekenmerkt door exploratie of het doorzoeken van meerdere alternatieven in een (conceptuele) ontwerpruimte. Dit proces wordt in de praktijk vaak ondersteund door manueel schetsen, waarbij de ontwerpers schetsboek kan gelezen worden als een reeks exploraties. Dit soort interactie met de ontwerpruimte wordt in veel mindere mate ondersteund door hedendaagse computerondersteunde ontwerpsystemen. De metafoor van een digitaal schetsboek, waarbij menselijke exploratie wordt versterkt door de (reken)kracht van een computer, is het centrale onderzoeksthema van dit proefschrift. Hoewel het opzet van een ontwerpruimte op het eerste gezicht schatplichtig lijkt aan het onderzoeksveld van de artificiële intelligentie (AI), wordt het ontwerpen hier ruimer geïnterpreteerd dan het oplossen van problemen. Als onderzoeksmethodologie worden vormengrammatica's ingezet, die enerzijds nauw aanleunen bij de AI en een formeel raamwerk bieden voor de exploratie van ontwerpruimtes, maar tegelijkertijd ook weerstand bieden tegen de AI en een vorm van visueel denken en ambiguïteit toelaten. De twee bijhorende onderzoeksvragen zijn hoe deze vormengrammatica's digitaal kunnen worden gerepresenteerd, en op welke manier de ontwerper-computer interactie kan gebeuren. De resultaten van deze twee onderzoeksvragen vormen de basis van een nieuw hulpmiddel voor architecten: het digitaal schetsboek.
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Sliding mode control for a class of sub-systems with fractional order varying trajectory dynamics
In this paper, a sliding mode control strategy is discussed for a class of nonlinear mechanical sub-systems with varying trajectory dynamics. The proposed class of sub-systems are represented in this simulation example by a two link robot actuator/manipulator. The fractional order is introduced in the setpoint definition as to represent changes in the desired trajectory of this sub-system. Furthermore, the same order is used to adapt the control law to the new dynamics. Uncertainties are introduced in the model used for the control law, hence robustness is intrinsic.
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Gender-Specific Association of ATP2B1 Variants with Susceptibility to Essential Hypertension in the Han Chinese Population
Previous genome-wide association studies (GWASs) found that several ATP2B1 variants are associated with essential hypertension (EHT). But the "genome-wide significant" ATP2B1 SNPs (rs2681472, rs2681492, rs17249754, and rs1105378) are in strong linkage disequilibrium (LD) and are located in the same LD block in Chinese populations. We asked whether there are other SNPs within the ATP2B1 gene associated with susceptibility to EHT in the Han Chinese population. Therefore, we performed a case-control study to investigate the association of seven tagSNPs within the ATP2B1 gene and EHT in the Han Chinese population, and we then analyzed the interaction among different SNPs and nongenetic risk factors for EHT. A total of 902 essential hypertensive cases and 902 normotensive controls were involved in the study. All 7 tagSNPs within the ATP2B1 gene were retrieved from HapMap, and genotyping was performed using the Tm-shift genotyping method. Chi-squared test, logistic regression, and propensity score analysis showed that rs17249754 was associated with EHT, particularly in females. The MDR analysis demonstrated that the interaction of rs2070759, rs17249754, TC, TG, and BMI increased the susceptibility to hypertension. Crossover analysis and stratified analysis indicated that BMI has a major effect on the development of hypertension, while ATP2B1 variants have a minor effect.
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Characteristics of Salmonella spp. Isolated from Wild Birds Confiscated in Illegal Trade Markets, Rio de Janeiro, Brazil
The prevalence of Salmonella spp. was investigated in 109 wild birds poached in the illegal wildlife trade in Rio de Janeiro; most of them are passerines from Thraupidae family and three from Psittacidae. One strain of Salmonella ser. Typhimurium and two strains of Salmonella ser. Panama were isolated from passerine species and all of them showed resistance to multiple antimicrobial drugs, like ampicillin, ceftriaxone, ceftiofur, tetracycline, gentamicin, nalidixic acid, ciprofloxacin, and enrofloxacin. PFGE showed 100% similarity among the Salmonella ser. Typhimurium strain isolated from a Temminck's seedeater (Sporophila falcirostris) and the strains isolated from a human outbreak, in southern Brazil. The two Salmonella ser. Panama strains isolated from two chestnut-capped blackbirds (Chrysomus ruficapillus) present in the same catch showed the same clonal origin and have never been associated with epizooties and human outbreaks. Potential for dissemination of resistant Salmonella through situations offered by captive management and the isolation of the same strain from wild birds and human sources may become a problem for the conservation of natural populations and to public health.
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De novo loss-of-function mutations in X-linked SMC1A cause severe ID and therapy resistant epilepsy in females: expanding the phenotypic spectrum
Abstract
De novo missense mutations and in-frame coding deletions in the X-linked gene SMC1A (Structural Maintenance of Chromosomes 1A), encoding part of the cohesin complex, are known to cause Cornelia de Lange syndrome in both males and females. For a long time, loss-of-function mutations in SMC1A were considered incompatible with life, as such mutations had not been reported in neither male or female patients. However, recently we and others reported loss-of-function mutations in females with ID and epilepsy.
Here we present the detailed phenotype of two females with de novo loss-of-function mutations in SMC1A, including a de novo mutation of single base deletion (c.2364del, p.(Asn788Lysfs*10)), predicted to result in a frameshift, and a de novo deletion of exon 16, resulting in an out-of-frame mRNA splice product (p.(Leu808Argfs*6)). By combining our patients with the other recently reported females carrying SMC1A loss-of-function mutations, we ascertained a phenotypic spectrum of (severe) ID, therapy resistant epilepsy, absence/delay of speech, hypotonia and small hands and feet. Our data show the existence of a novel phenotypic entity – distinct from CdLS –and caused by de novo SMC1A loss-of-function mutations.
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Frontal sinus surgery and sinus distribution of nasal irrigation
Background
Effective mucus lavage and delivery of topical pharmaceuticals are central to successful management of chronic rhinosinusitis (CRS). The frontal sinus remains difficult to penetrate with topical therapies. This study evaluates the benefit of Draf III frontal dissection compared to traditional Draf IIa for distribution of topical therapies.
Methods
Fresh human cadaver heads were dissected sequentially with Draf IIa frontal sinusotomy and then Draf III procedures. Each cavity was irrigated with pediatric (120 mL) and adult (240 mL) irrigation bottles with 1/1000 10% fluorescein-labeled free water in 2 fixed positions (vertex and Frankfort horizontal). An endoscope at a fixed position within the frontal sinus recorded frontal sinus and frontal recess penetration. The images then underwent blinded evaluation of fluid distribution scored as 0 to 4 (nasal cavity only, frontal recess, medial one-half, lateral one-half, and lavage). Ordinal distribution score was analyzed with Kendall's tau-b.
Results
Eight specimens (age 76 ± 11.2 years; 50% female) were assessed. Draf III was superior to Draf IIa in ability to achieve frontal sinus distribution of irrigation (90.6% vs 50.1%, p < 0.001). Vertex head position improved distribution (90.6% vs 50.1%, p < 0.001), was synergistic with Draf III (100% with 87.5% lavage, p < 0.001), but was unable to overcome Draf IIa (81.2% with 25% lavage, p < 0.001). Irrigation volume trended toward improved distribution with larger volume irrigations.
Conclusion
Successful treatment of sinonasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning.
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A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial
Background
Aspirin-exacerbated respiratory disease (AERD) is a clinical triad consisting of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Although respiratory reactions following ingestion of ASA and other nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a hallmark of the condition, respiratory inflammation persists despite patients' avoidance of NSAIDs. Treatment of this condition remains challenging and includes both medical and surgical options.
Methods
A prospective crossover single-blind multicenter study involving 4 tertiary rhinology care centers (n = 30) was conducted in which patients were randomized to start with either 6 weeks of a regular diet or 6 weeks of a low-salicylate diet and then crossed-over for a total study duration of 12 weeks. Patients were evaluated at baseline, 6 weeks (at crossover) and 12 weeks using subjective measures (22-item Sino-Nasal Outcome Test-22 [SNOT-22], Nasal Sinus Symptom Scale [NSSS], and 7-item Asthma Control Questionnaire [ACQ-7]) and objective outcome instruments (Perioperative Sinus Evaluation [POSE] and Lund-Kennedy Endoscopic Score [LKES]).
Results
Data was analyzed for 30 patients. Wilcoxon rank sum tests determined that patients had improvement in their median difference in scores, which were all statistically significant, when they followed the low-salicylate diet compared to their regular diet: SNOT-22: 15 (95% confidence interval [CI], 10 to 23.25), p < 0.001; NSSS: 3 (95% CI, 1.75 to 4), p < 0.001; ACQ-7: 4.5 (95% CI, 1.5 to 8.5), p < 0.001; POSE 6 (95% CI, 2.5 to 10), p < 0.001; and LKES: 2.5 (95% CI, 1.5 to 4), p < 0.001).
Conclusion
The low-salicylate diet may offer a novel treatment adjunct to the current management of AERD. Clinically and statistically significant improvements on both subjective and objective outcome measures were noted for the upper and lower respiratory tracts.
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Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method
Background
Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized because of its surgical complexity and flap breakdown.
Methods
This work is a retrospective review of 13 HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, preprocedure, and postprocedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional 3-flap closure and a simplified 2-flap nasal closure procedure.
Results
The average candidate for nasal closure in this series had an ESS of 7.88, hemoglobin (Hgb) of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the 2-flap method is 0.92 and mean GBI score is 56.3. Comparison of 5 patients who underwent the traditional 3-flap nasal closure procedure and 8 patients receiving the 2-flap nasal closure showed no significant difference in postoperative ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p = 0.0001). Mean time to first revision for 8 nasal closure patients was 21.5 months.
Conclusion
In short-term follow-up, the 2-flap procedure showed comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method.
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A diagnostic dilemma: chronic sinusitis diagnosed by non-otolaryngologists
Background
Ambulatory care visits for chronic sinusitis outnumber visits for acute sinusitis. The majority of these visits are with non-otolaryngologists. In order to better understand patients diagnosed with chronic sinusitis by non-otolaryngologists, we sought to determine if incident cases of chronic sinusitis diagnosed by primary care (PC) or emergency medicine (EM) providers meet diagnostic criteria.
Methods
This was a retrospective cohort study. Patients were identified using administrative data from 2005 to 2006. The dataset was then clinically annotated based on chart review. We excluded prevalent cases.
Results
We identified 114 patients with newly diagnosed chronic sinusitis in EM (75) or PC settings (39). Rhinorrhea (EM 61%, PC 59%) and nasal obstruction (EM 67%, PC 64%) were common in both settings but facial fullness (EM 80%, PC 39%) and pain (EM 40%, PC 18%) were more common in the EM setting. Few patients reported symptoms of 90 days or longer (EM 6.0%, PC 24%) and no patient had evidence of inflammation on physical examination. A minority of patients received a sinus computed tomography (CT) scan (22.8%) or nasal endoscopy (1.8%). In total, only 1 patient diagnosed with chronic sinusitis met the diagnostic criteria.
Conclusion
Most patients diagnosed with chronic sinusitis by non-otolaryngologists do not have the condition. Caution should be used in studying chronic sinusitis using administrative data from non-otolaryngology providers because a large proportion of the patients may not actually have the disease.
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Baseline clinical characteristics predict follow-up clinic attendance in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis
Background
The objective of this work was to describe the association between baseline clinical characteristics and attendance at follow-up visits after endoscopic sinus surgery (ESS).
Methods
A retrospective review of chronic rhinosinusitis (CRS) patients electing ESS at a tertiary-care center (2011-2013) was conducted. Baseline characteristics were studied for association with clinic attendance at 3, 6, 12, and 24 months post-ESS.
Results
We identified 268 patients. Significant decline occurred in the number of patients following up after ESS (3 months: 246 patients [92%]; 6 months: 145 [54%]; 12 months: 94 [35%]; and 24 months: 90 [34%]). Older patients were more likely to follow up at 3 months (mean age 55.7 vs 48.4 years, p = 0.04) and 6 months (57.5 vs 52.3 years; p = 0.01) post-ESS. Those with higher preoperative sinus computed tomography (CT) (Lund-Mackay) scores were more likely to follow at 6 months (11.8 vs 10.3, p = 0.01), 12 months (12.6 vs 10.3, p < 0.001), and 24 months (12.2 vs 10.5, p = 0.01). At 12 months having asthma (p = 0.03), previous ESS (p = 0.04), nasal polyps (p < 0.0001), allergic fungal sinusitis (AFS) (p = 0.002), and granulomatosis with polyangiitis (GPA) (p = 0.01) were associated with clinic attendance. At 24 months asthma status (p = 0.003), previous ESS (p = 0.002), AFS (p = 0.04), GPA (p = 0.001), and aspirin-exacerbated respiratory disease (AERD) (p = 0.006) were associated with higher attendance. Geographical proximity did not impact attendance.
Conclusion
The sharpest decline in patient follow-up occurred between 3–6 months after ESS. Higher preoperative sinus CT scores, previous ESS, presence of asthma, and diagnosis of recalcitrant CRS subtype (nasal polyps, AERD, AFS, GPA) were factors associated with increased long-term attendance.
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Vitamin D deficiency is associated with increased human sinonasal fibroblast proliferation in chronic rhinosinusitis with nasal polyps
Background
Vitamin D3 (VD3) is a steroid hormone with known antiproliferative properties. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have been shown to be VD3-deficient. Moreover, VD3 deficiency is associated with worse disease in patients with CRSwNP. One cell type thought to play a role in chronic rhinosinusitis (CRS) is the human sinonasal fibroblast (HSNF). The aim of this study was to investigate VD3 deficiency and HSNF proliferation in CRSwNP.
Methods
Blood and sinus tissue explants were collected at the time of surgery from patients with CRSwNP (n = 15). Control subjects (n = 12) were undergoing surgery for cerebrospinal fluid leak repair or to remove non–hormone-secreting pituitary tumors. Ex vivo HSNF proliferation was analyzed with flow cytometry using expression of fibroblast-specific protein (FSP) and the proliferation marker Ki67. Plasma levels of 25-hydroxyvitamin D3 (25VD3) were measured by enzyme-linked immunosorbent assay. In vitro analysis of HSNF proliferation after treatment with calcitriol (1,25VD3) was performed using carboxyfluorescein succinimidyl ester (CFSE) and analyzed with flow cytometry.
Results
In CRSwNP patients there was an inverse correlation between 25VD3 and proliferating HSNFs (p = 0.0135). This correlation was not seen for control patients (p = 0.3869). In vitro analysis showed that HSNFs from patients with CRSwNP had a higher proliferation index at baseline than HSNFs from control patients (p < 0.01). When treated with 1,25VD3, there was a significant decrease in HSNF proliferation index in patients with CRSwNP (p < 0.01), but not control patients.
Conclusion
VD3 deficiency is associated with increased HSNF proliferation in CRSwNP. Further investigation into how HSNFs and VD3 impact CRSwNP pathophysiology is warranted.
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Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis
Background
Off-label high-volume sinonasal budesonide irrigations are commonly used during the management of chronic rhinosinusitis (CRS). Although short-term use (4 to 8 weeks) has been demonstrated to be safe, the long-term effects on the hypothalamic-pituitary-adrenal (HPA) axis remain unclear. The objective of this study is to determine whether CRS patients using long-term (minimum greater than 12 months) budesonide sinonasal irrigations have evidence of HPA axis suppression.
Methods
Patients with CRS being managed with high-volume sinonasal budesonide irrigations were recruited from 2 tertiary level rhinology clinics between March 2014 and July 2015. Inclusion criteria were as follows: (1) adult (age greater than 18 years); (2) guideline-based diagnosis of CRS; (3) previous endoscopic sinus surgery; (4) minimum of twice daily high-volume sinonasal budesonide irrigation (concentration of 1 mg per irrigation; total daily dose of 2 mg); and (5) a minimum of 12-month duration. Exclusion criteria included systemic corticosteroid use within 3 months of HPA axis testing. The primary outcomes were morning (am) serum cortisol levels and, when indicated, cosyntropin stimulation levels.
Results
A total of 35 patients fulfilled eligibility criteria and underwent HPA axis testing. Mean duration of budesonide sinonasal irrigation therapy use was 38.2 months (2.9 years). The mean ± standard deviation (SD) am serum cortisol was 431.2 ± 146.9 nmol/L (normal, 200 to 650 nmol/L). Subsequent cosyntropin stimulation tests, in indicated patients (n = 19), demonstrated no evidence of HPA axis suppression.
Conclusion
Outcomes from this study suggest that daily high-volume sinonasal budesonide irrigations fail to produce evidence of HPA axis suppression with prolonged courses lasting longer than 2 years.
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Postoperative relapse after mandibular setback surgery with perioperative counterclockwise rotation of the mandibular proximal segment
Publication date: Available online 11 January 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jae Bong Park, Im Geun Jin, Jeong Joon Han, Soon Jung Hwang
ObjectiveThis study aimed to evaluate whether the perioperative counterioclockwise rotation (CCWR) of the proximal segment (PS) can reduce relapse after mandibular setback surgery.Study designPatients who underwent less than one degree of bilateral perioperative rotation of the PS were assigned to group I (n = 15). Group II (n = 14) included patients showed greater than one degree of perioperative CCWR bilaterally. To evaluate the PS rotation and the relapse, three-dimensional computed tomograms (CT) and lateral cephalograms were analyzed.ResultsEven with significantly different perioperative CCWR of the PS (0.07±0.53° versus -3.47±1.55°), the relapse was not significantly different between group I (1.96±1.15 mm) and group II (1.81±0.92 mm). However, postoperative CCWR of the PS was significantly greater in group I. The relapse was not influenced by the amount of setback.ConclusionSmall degree of relapse is expected after mandibular setback surgery, even with perioperative CCWR of the PS.
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Prognostic factors in patients with malignant pleural effusion: Is it possible to predict mortality in patients with good performance status?
Background and Objectives
The aim of this study was to identify predictors of mortality only in patients with malignant pleural effusion (MPE) showing good performance status which required pleural palliative procedures.
Methods
All patients with MPE submitted to pleural palliative procedure were enrolled in a prospective study between 2013 and 2014. Patients with Eastern cooperative oncology group (ECOG) score zero, one, and two were considered with good performance status. The possible prognostic factors were tested for significance using the log-rank test (Kaplan–Meier method) and those with significance on univariate analysis were entered into a multivariable Cox model.
Results
A total of 64 patients were included in the analysis. Median follow-up time for surviving patients was 263 days. Median survival for the entire cohort was not reached yet. In the multivariate analysis, gastrointestinal primary site (P = 0.006), low albumin concentration in the pleural fluid (P = 0.017), and high serum NLR (P = 0.007) were associated with mortality.
Conclusion
In our cohort of ECOG 0–2 patients with MPE submitted to pleural palliative procedures, gastrointestinal malignancy compared to other sites, low pleural fluid albumin and high NLR were significantly associated with mortality. The identification of these prognostic factors may assist the choice of the optimal palliative technique. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Platelet count is more useful for predicting posthepatectomy liver failure at surgery for hepatocellular carcinoma than indocyanine green clearance test
Background and Objectives
Preoperatively evaluating reserved liver function is critical in preventing posthepatectomy liver failure (PHLF) in patients undergoing liver resection. The commonly used indocyanine green (ICG) clearance test has several drawbacks. Patients would benefit from a more reliable and straightforward means of assessing the risk of PHLF.
Methods
This study included 277 patients with hepatocellular carcinoma (HCC) undergoing liver resection. The predictive value of known risk factors for PHLF was compared to that of ICG.
Results
PHLF was identified in 25 out of 277 patients (9.0%). Multivariate logistic regression analysis for identifying predictors for the PHLF development revealed platelet count and resected liver volume as significant independent predictors. In a subgroup analysis based on resected liver volume, platelet count was significantly correlated with PHLF in both larger volume (≥100 g) and smaller volume resection groups (<100 g), although ICG R15 level was associated with PHLF only in larger volume group.
Conclusions
Platelet count is superior to ICG R15 level in predicting PHLF development in HCC patients. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Evaluation of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a community setting: A cost-utility analysis of a hospital's initial experience and reflections on the health care system
Background
The combination of Cytoreductive Surgery (CRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been gaining a considerable interest by surgeons throughout the United States due to the significant survival improvement it provides for peritoneal surface malignancies and the ability to reproduce comparable clinical results in numerous health care centers. However, CRS plus HIPEC has not been sufficiently investigated from the economic standpoint in the United States where a wide variety of health care insurers exists. This study was conducted to analyze hospital/surgeon cost and reimbursement data at a community hospital offering a new peritoneal surface malignancy program, and expand the discussion to analyze future healthcare implementation on this procedure in the United States.
Methods
This is a retrospective economic analysis of an initial CRS plus HIPEC experience at a community non-teaching medical center. This study was conducted using hospital/surgeon cost and reimbursement based on the Office of Finance data at Edward Hospital Cancer Center (Naperville, IL). All patients who underwent CRS and HIPEC between June 2013 and August 2014 were included in this analysis. We aimed to assess CRS plus HIPEC purely from the financial perspective on the initial admission regardless of the patients' advancement of the disease or postoperative adverse events.
Results
Twenty-five patients underwent 26 CRS plus HIPEC procedures. Twelve patients had private insurance plans (PRV) whereas 13 were covered by public insurers (PUB). Median overall length of stay (LOS) was 10 days (PRV 10 days vs. PUB 11 days; P = 0.76.) Average hospital cost was $38,369 (PRV $37,093 vs. PUB $39,463; P = 0.67), and average reimbursement for our patient population was $45,243 (PRV $48,954 vs. PUB $42,062; P = 0.53). It was noted that CRS plus HIPEC generated more net profit in patients with private insurance than in those with public plans, however, not statistically significant ($11,861 vs. $2,599 per patient, respectively; P = 0.38). Evaluating surgeon's data, average surgeon's charge was $29,139 (PRV $28,440 vs. PUB $29,737; P = 0.80), and average patients' payment was $8,126 (PRV 9,234 vs. PUB 7,176; P = 0.47).
Conclusion
CRS plus HIPEC is profitable in the community setting for both the hospital and surgeon. Both private and public insurers reimbursed profitably, though with a greater profit margin from private insurers. As CRS plus HIPEC is becoming more widely recognized as a standard of care for patients with peritoneal surface malignancy, it is increasingly important to understand and report its associated costs and variability in insurance coverage, especially in light of the current healthcare structure changes in the United States.
It is strongly encouraged to report and present a wider scope of CRS plus HIPEC economic experiences in a variety of hospital settings to provide further evidence for future healthcare implementations in the United States. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Short-term complications of intra-operative radiotherapy for early breast cancer
Introduction
IORT is becoming an accepted radiotherapy technique for treatment of early breast cancer. Data regarding the early complications of breast IORT are lacking.
Objectives
Assess the nature and risk factors for early complications of breast conserving surgery (BCS) and intraoperative radiotherapy (IORT) with INTRABEAM®.
Methods
IORT with INTRABEAM® was administered to breast cancer patients in Carmel Medical Center as part of an institutional clinical registry project. Three hundred and ninety five patients treated during 2006–2013 were included. Clinical and treatment data and data regarding complications documented within 1 year of surgery were collected. The association between clinical and treatment variables and risk of complications was assessed.
Results
Complications were documented in 108 (27.3%) of patients. Grade III or IV complications were found in 5% of patients. Infections were diagnosed in 43 (10.8%) patients, seroma in 40 (10.1%), wound dehiscence in 32 (8.1%), and bleeding and hematomas in 11(2.8%). Two patients had a small size skin necrosis. Sixteen patients with a seroma had a secondary complication. All complications resolved. Diabetes mellitus and use of anticoagulants were associated with an increased risk of wound dehiscence and bleeding, respectively.
Conclusions
IORT for breast cancer is safe in appropriately selected patients. Careful surgical technique and postoperative care is prudent. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Survival effects of adjuvant gemcitabine plus S-1 chemotherapy on pancreatic carcinoma stratified by preoperative resectablity status
Background and Objectives
The aim of this study was to evaluate the efficacy of adjuvant gemcitabine plus S-1(GS) chemotherapy for pancreatic carcinoma patients, stratified by the National Comprehensive Cancer Network (NCCN) preoperative resectability definition.
Methods
A total of 141 consecutive patients with resected pancreatic carcinoma who received adjuvant GS chemotherapy were evaluated retrospectively. According to the NCCN preoperative resectability definition, tumors were divided into resectable tumors (R group), borderline resectable tumors with portal vein contact (BR-PV group), and borderline resectable tumors with arterial contact (BR-A group). Overall survival and prognostic factors were analyzed.
Results
Overall 1-, 2-, and 5-year survival rates for the 141 patients were 89.6%, 69.9%, and 41.1%, respectively. Overall survival of the R group was significantly better than that of the BR-PV group and the BR-A group (P < 0.05). Overall 5-year survival rates of the R group, the BR-PV group, and the BR-A group were 49.0%, 25.0%, and 11.3%, respectively. Arterial contact (P = 0.020), preoperative CA 19-9 level ≥150 U/ml (P < 0.001), and positive nodal involvement (P = 0.025) were independent prognostic factors for poor overall survival.
Conclusions
Adjuvant GS chemotherapy may provide a survival benefit especially for patients with resectable pancreatic carcinoma. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Radiation and breast reconstruction: Algorithmic approach and evidence-based outcomes
Postmastectomy radiation (PMRT) in the setting of immediate breast reconstruction has been associated with increased complications and poorer aesthetic outcomes for both autologous and implant reconstructions. Many centers have attempted to mitigate the deleterious effects associated with radiation by implementing an algorithmic approach to breast reconstruction. Although the literature regarding the optimal timing of radiotherapy and breast reconstruction remains controversial, reported outcomes following various algorithms have been encouraging and warrant further consideration. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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