A Call to Formalize Training in Tobacco Dependence Treatment for Pulmonologists

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 460-461, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VdrEZ4
via IFTTT

Teaching at the Bedside. Maximal Impact in Minimal Time

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 545-548, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VdrEII
via IFTTT

Medical Education at the American Thoracic Society. The Wonderful Twos

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 456-457, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1oLRV24
via IFTTT

Raising the Profile of Pulmonary Education for Physicians in Low- and Middle-Income Countries

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 458-459, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1oLRSDt
via IFTTT

The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 512-521, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VdrFfI
via IFTTT

Adverse Events and Near-Misses Relating to Intensive Care Unit–Ward Transfer: A Qualitative Analysis of Resident Perceptions

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 570-572, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1oLRV1U
via IFTTT

Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 502-511, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1oLRSmX
via IFTTT

A Letter to Prospective and Emerging Clinician Educators

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 462-464, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VdrEbw
via IFTTT

Simulation Testing for Selection of Critical Care Medicine Trainees. A Pilot Feasibility Study

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 529-535, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1VdrEbq
via IFTTT

Variability in Lung Transplant Education during Pulmonary and Critical Care Medicine Fellowship: Results of a National Survey

Annals of the American Thoracic Society, Volume 13, Issue 4, Page 568-569, April 2016.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1oLRS6v
via IFTTT

In vitro performance of two-piece zirconia implant systems for anterior application

Publication date: Available online 8 April 2016
Source:Dental Materials
Author(s): Verena Preis, Armin Kammermeier, Gerhard Handel, Martin Rosentritt
ObjectivesTo investigate the influence of the implant–abutment connection on the long-term in vitro performance and fracture resistance of two-piece zirconia implant systems for anterior application.MethodsSix groups of two-piece zirconia implant systems (n=10/group) with screw-retained (5×) or bonded (1×) connections were restored with full-contour zirconia crowns. A two-piece screw-retained titanium system served as reference. For simulating anterior loading the specimens (n=8/group) were mounted at an angle of 135° in the chewing simulator, and subjected to thermal cycling (TC: 2×9000×5°/55°C) and mechanical loading (ML: 3.6×10⁶×100N). Failed restorations were examined (scanning electron microscopy). Fracture resistance and maximum bending stress of surviving restorations were determined. 2 specimens per group were loaded to fracture after 24h water storage without TCML. Data were statistically analyzed (ANOVA; Bonferroni; Kaplan–Meier-Log-Rank; α=0.05).ResultsThe bonded zirconia system and the titanium reference survived TCML without any failures. Screw-retained zirconia systems showed fractures of abutments and/or implants, partly combined with screw fracture/loosening. Failure frequency (F) varied between the groups (F=8×: 3 groups, F=3×: 1 group, F=1×: 1 group). The Log-Rank-test showed significant (p=0.000) differences. Fracture forces and maximum bending stresses (mean±standard deviation) differed significantly (ANOVA: p=0.000) between 233.4±31.4N/317.1±42.6N/mm² and 404.3±15.1N/549.2±20.5N/mm². Fracture forces after TCML were similar to 24h fracture forces.SignificanceScrew-retained two-piece zirconia implant systems showed higher failure rates and lower fracture resistance than a screw-retained titanium system, and may be appropriate for clinical anterior requirements with limitations. Failures involved the abutment/implant region around the screw, indicating that the connecting design is crucial for clinical success.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/25RaQu5
via IFTTT

Dental adhesives and strategies for displacement of water/solvents from collagen fibrils

Publication date: Available online 8 April 2016
Source:Dental Materials
Author(s): Larissa Sgarbosa de Araújo Matuda, Giselle Maria Marchi, Thaiane Rodrigues Aguiar, Ariene Arcas Leme, Gláucia M.B. Ambrosano, Ana Karina Bedran-Russo
ObjectivesTo evaluate the influence of temperature of evaporation in adhesive systems with different solvents on the apparent modulus of elasticity and mass change of macro-hybrid layers modified by proanthocyanidins (PACs).MethodsAdhesive resin beams (A) from Single Bond Plus (SB), Excite (EX) and One Step Plus (OS) were prepared after solvent evaporation at 23°C or 40°C (n=12). Macro-hybrid layers (M) (n=12) were prepared using demineralized dentin beams sectioned from extracted human third molars. The demineralized dentin specimens were infiltrated with each one of the three adhesive systems at 23°C or 40°C; with or without prior dentin treatment with PACs for 10min. The apparent modulus of elasticity (E) and mass change (Wmc, %) of adhesives beams and resin-infiltrated specimens were assessed in dry and wet conditions after immersion in water (24h, 1, 3 and 6 months). The E was statistically analyzed by Tukey–Kramer test and the Wmc, % by Kruskal Wallis, and Dunn (α=0.05).ResultsSolvent evaporation at 40°C resulted in higher E values for adhesive resin beams at all storage conditions, regardless of the adhesive system (p<0.05). Increased mass loss (3 months: −0.01%; 6 months: −0.05%) was observed in One Step resin beams (p≤0.05). In the macro-hybrid layer models the pretreatment with PACs along with solvent evaporation at 40°C increased E and decreased the Wmc, % (3 months: −2.5; 6 months: 2.75%) for adhesives evaluated over time (p<0.05). No significant differences in ratio (resin/dentin) were found for the macro-hybrid layers (p>0.05).SignificanceImproved solvent evaporation at higher temperature, and increased collagen cross-linking induced by PACs, enhanced the mechanical properties resulting in highly stable macro-hybrid layers over 6 months storage.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1YllEee
via IFTTT

Novel hydroxyapatite nanorods improve anti-caries efficacy of enamel infiltrants

Publication date: Available online 8 April 2016
Source:Dental Materials
Author(s): D.M. Andrade Neto, E.V. Carvalho, E.A. Rodrigues, V.P. Feitosa, S. Sauro, G. Mele, L. Carbone, S.E. Mazzetto, L.K. Rodrigues, P.B.A. Fechine
ObjectivesEnamel resin infiltrants are biomaterials able to treat enamel caries at early stages. Nevertheless, they cannot prevent further demineralization of mineral-depleted enamel. Therefore, the aim of this work was to synthesize and incorporate specific hydroxyapatite nanoparticles (HAps) into the resin infiltrant to overcome this issue.MethodsHAps were prepared using a hydrothermal method (0h, 2h and 5h). The crystallinity, crystallite size and morphology of the nanoparticles were characterized through XRD, FT-IR and TEM. HAps were then incorporated (10wt%) into a light-curing co-monomer resin blend (control) to create different resin-based enamel infiltrants (HAp-0h, HAp-2h and HAp-5h), whose degree of conversion (DC) was assessed by FT-IR. Enamel caries lesions were first artificially created in extracted human molars and infiltrated using the tested resin infiltrants. Specimens were submitted to pH-cycling to simulate recurrent caries. Knoop microhardness of resin-infiltrated underlying and surrounding enamel was analyzed before and after pH challenge.ResultsWhilst HAp-0h resulted amorphous, HAp-2h and HAp-5h presented nanorod morphology and higher crystallinity. Resin infiltration doped with HAp-2h and HAp-5h caused higher enamel resistance against demineralization compared to control HAp-free and HAp-0h infiltration. The inclusion of more crystalline HAp nanorods (HAp-2h and HAp-5h) increased significantly (p<0.05) the DC.SignificanceIncorporation of more crystalline HAp nanorods into enamel resin infiltrants may be a feasible method to improve the overall performance in the prevention of recurrent demineralization (e.g. caries lesion) in resin-infiltrated enamel.

Graphical abstract

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/25RaQtZ
via IFTTT

Poststroke Aphasia Frequency, Recovery, and Outcomes: a systematic review and meta-analysis

Publication date: Available online 8 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Heather L. Flowers, Stacey A. Skoretz, Frank L. Silver, Elizabeth Rochon, Jiming Fang, Constance Flamand-Roze, Rosemary Martino
ObjectiveWe conducted a systematic review to elucidate the frequency, recovery, and associated outcomes for poststroke aphasia over the long-term.Data SourcesUsing the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences, and the grey literature.Study SelectionOur a priori protocol criteria included unselected samples of adult stroke patients from randomized controlled trials or consecutive cohorts. Two independent reviewers rated abstracts and articles for exclusion or inclusion, resolving discrepancies by consensus.Data ExtractionWe documented aphasia frequencies by stroke type and setting and computed odds ratios (OR) with their 95 percent confidence intervals (CI) for outcomes.Data SynthesisWe retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies for mixed stroke (ischemic and hemorrhagic) were 30 and 34 percent for acute and rehabilitation settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to hospital was ≤3 hours from stroke onset. Articles monitoring aphasia for one year demonstrated aphasia frequencies 2 to 12 percent lower than baseline. Negative outcomes associated with aphasia included greater odds of in-hospital death (OR 2.7, CI 2.4-3.1) and longer mean length of stay in days (M 1.6, CI 1.0-2.3) in acute settings. Patients with aphasia had greater disability from 28 days (OR 1.5, CI 1.3-1.7) to two years (OR 1.7, CI 1.6-2.0) than those without aphasia. By two years, they used more rehabilitation services (OR 1.5, CI 1.3-1.6) and returned home less frequently (OR 1.4, CI 1.2-1.7).ConclusionsReported frequencies of poststroke aphasia range widely, depending on stroke type, and setting. Because aphasia is associated with mortality, disability, and use of health services, we recommend long-term interdisciplinary vigilance in the management of aphasia.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1MmqtmY
via IFTTT

Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty

Publication date: Available online 8 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Allison M. Gustavson, Pamela Wolfe, Jason R. Falvey, Donald G. Eckhoff, Michael J. Toth, Jennifer E. Stevens-Lapsley
ObjectiveTo investigate whether sex impacts the trajectory of functional recovery following total knee arthroplasty (TKA).DesignRetrospective analysis from a historical database containing data from three prospective clinical trials and a pilot study.SettingAll studies were performed in a clinical laboratory setting.ParticipantsRecruitment across studies was restricted to patients who underwent an elective unilateral TKA for the treatment of osteoarthritis and were between 50-85 years of age (N=301).InterventionAcross all four studies patients received a TKA and physical therapy intervention. Measures of physical function and strength were assessed prior to TKA, 1, 3, and 6 months after TKA.Main Outcome MeasuresStatistical inference using a maximum likelihood model for repeated measures was done to estimate the changes in outcomes by sex from pre-surgical assessment compared to 1, 3, and 6 months after TKA. Muscle strength was assessed during maximal isometric quadriceps and hamstrings contractions. Muscle activation was assessed in the quadriceps muscle. Physical function outcomes included: Timed-Up-and-Go (TUG), Stair Climbing Test (SCT), and the Six-Minute Walk Test (6MWT).ResultsWomen demonstrated less decline in quadriceps strength than men at 1, 3, and 6 months after TKA (p<0.04), whereas women demonstrated less decline in hamstrings strength 1 month after TKA (p<0.0001). Women demonstrated a greater decline than men on the TUG (p=0.001), SCT (p=0.004), and 6MWT (p=0.001) 1 month after TKA. Sex differences in physical function did not persist at 3 and 6 months following TKA.ConclusionsSex impacted early recovery of muscle and physical function within the first month after TKA. Women demonstrated better preservation of quadriceps strength, but demonstrated greater decline on measures of physical function compared to men.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RXyBqY
via IFTTT

Patient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound

Publication date: Available online 9 April 2016
Source:The Journal of Emergency Medicine
Author(s): Richard M. Maier, Mary Hughes, Abdalmajid Katranji
BackgroundHook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery.Case ReportWe present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery.Why Should an Emergency Physician Be Aware of This?Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1YlhK53
via IFTTT

Current Controversies in Thrombolytic Use in Acute Pulmonary Embolism

Publication date: Available online 9 April 2016
Source:The Journal of Emergency Medicine
Author(s): Brit Long, Alex Koyfman
BackgroundAcute pulmonary embolism (PE) has an annual incidence of 100,000 cases in the United States and is divided into three categories: nonmassive, submassive, and massive. Several studies have evaluated the use of thrombolytics in submassive and massive PE.ObjectiveOur aim was to provide emergency physicians with an updated review of the controversy about the use of thrombolytics in submassive and massive PE.DiscussionNonmassive PE is defined as PE in the setting of no signs of right ventricular strain (echocardiogram or biomarker) and hemodynamic stability. Submassive PE is defined as evidence of right ventricular strain with lack of hemodynamic instability. Massive PE occurs with occlusive thromboembolism that causes hemodynamic instability. Thrombolysis is warranted in patients with massive PE. Thrombolytic use in submassive PE with signs of right ventricular strain or damage presents a quandary for physicians. Several recent studies have evaluated the use of thrombolytics in patients with submassive PE. These studies have inconsistent definitions of submassive PE, evaluate differing primary outcomes, and use different treatment protocols with thrombolytics and anticoagulation agents. Although significant study heterogeneity exists, thrombolytics can improve long-term outcomes, with decreased bleeding risk with half-dose thrombolytics and catheter-directed treatments. Major bleeding significantly increases in patients over age 65 years. The risks and benefits of thrombolytic treatment—primarily improved long-term outcomes—should be considered on a case-by-case basis. Shared decision-making with the patient discussing the risks and benefits of treatment is advised.ConclusionsThrombolytic use in massive PE is warranted, but patients with submassive PE require case-by-case analysis with shared decision making. The risks, including major hemorrhage, and benefits, primarily improved long-term outcomes, should be considered. Half-dose thrombolytics and catheter-directed treatment demonstrate advantages with decreased risk of bleeding and improved long-term functional outcomes. Further studies that assess risk stratification, functional outcomes, and treatment protocols are needed.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/23rWi1P
via IFTTT

Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New?

Abstract

Patients with inflammatory bowel disease (IBD) do not receive routine preventative care at the same rate as general medical patients. This patient population is at increased risk of vaccine preventable illness such as influenza and pneumococcal pneumonia. This review will discuss health maintenance needs and preventative care issues in patients with IBD.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/25R7p6x
via IFTTT

Contents

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5





from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1qA4DlT
via IFTTT

Double spinal cord lesions and pelvic floor electrophysiology

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5
Author(s): David B. Vodušek




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RXrSx4
via IFTTT

Editorial Board

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5





from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1qA4D5D
via IFTTT

Pelvic floor electrophysiology in spinal cord injury

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5
Author(s): H. Tankisi, K. Pugdahl, M.M. Rasmussen, D. Clemmensen, Y.F. Rawashdeh, P. Christensen, K. Krogh, A. Fuglsang-Frederiksen
ObjectiveThe study aimed to investigate sacral peripheral nerve function and continuity of pudendal nerve in patients with chronic spinal cord injury (SCI) using pelvic floor electrophysiological tests.MethodsTwelve patients with low cervical or thoracic SCI were prospectively included. Quantitative external anal sphincter (EAS) muscle electromyography (EMG), pudendal nerve terminal motor latency (PNTML) testing, bulbocavernosus reflex (BCR) testing and pudendal short-latency somatosensory-evoked potential (SEP) measurement were performed.ResultsIn EAS muscle EMG, two patients had abnormal increased spontaneous activity and seven prolonged motor unit potential duration. PNTML was normal in 10 patients. BCR was present with normal latency in 11 patients and with prolonged latency in one. The second component of BCR could be recorded in four patients. SEPs showed absent cortical responses in 11 patients and normal latency in one.ConclusionsPudendal nerve and sacral lower motor neuron involvement are significantly associated with chronic SCI, most prominently in EAS muscle EMG. The frequent finding of normal PNTML latencies supports earlier concerns on the utility of this test; however, BCR and pudendal SEPs may have clinical relevance.SignificanceAs intact peripheral nerves including pudendal nerve are essential for efficient supportive therapies, pelvic floor electrophysiological testing prior to these interventions is highly recommended.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RXrSgM
via IFTTT

FGFR1 N546K and H3F3A K27M mutation in a diffuse leptomeningeal tumor with glial and neuronal markers

Abstract

Glioneuronal tumors (GNTs) are rare central nervous system neoplasms characterized by glial and neuronal markers that typically follow an indolent clinical course (1, 2). Several subgroups of GNTs are currently recognized by the World Health Organization (WHO) including papillary GNT, rosette-forming GNTs of the fourth ventricle, and rosetted GNTs with neuropil-like islands; however a new subset of diffuse leptomeningeal GNTs (DL-GNTs) has been proposed (1-3). While the exact clinical features of diffuse leptomeningeal GNT (DL-GNT) remain controversial, potential defining characteristics include the presence of multiple small cysts/nodules, and lack of an intraparenchymal mass (1).

This article is protected by copyright. All rights reserved.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/22k0vlL
via IFTTT

Editorial board

Publication date: March 2016
Source:Revue des Maladies Respiratoires, Volume 33, Issue 3





from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1TIcz05
via IFTTT

Le robot en chirurgie thoracique : pour ou contre ?

Publication date: March 2016
Source:Revue des Maladies Respiratoires, Volume 33, Issue 3
Author(s): S. Renaud, N. Santelmo




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Yl8oX3
via IFTTT

The Association of Changes in Sedentary Behavior on Changes in Depression Symptomology: Pilot Study

2016-04-09T07-18-16Z
Source: Journal of Behavioral Health
Paul D. Loprinzi, Eveleen Sng.
Objective: It is well established that physical activity is inversely associated with depression symptoms. Emerging work demonstrates that, independent of physical activity, sedentary behavior is associated with unfavorable cardiometabolic parameters. Recent work, albeit limited, has observed an independent association of sedentary behavior and depression symptoms. However, no study, to our knowledge, has examined the influences of changes in sedentary behavior on changes in depression symptom, which was the purpose of this pilot study. Methods: In this pilot study, 29 adults (Agemean = 36.8; 79% female) completed a survey at baseline and again approximately 2-months later. Sedentary behavior (TV and computer use) and depression (PHQ-9), along with potential confounders (e.g., physical activity, anxiety), were subjectively assessed. Results: In a series of nested, sequential multivariable regression models, increases in sedentary behavior over the follow-up period was associated with increased depression symptomology (βadjusted = 0.65; 95% CI: 0.06-1.23; P=0.03). There was no evidence to suggest a bi-directional relationship, in that changes in depression was not associated with follow-up sedentary behavior (β = 0.31; 95% CI: -0.08-71; P=0.11). Conclusion: Increases in sedentary behavior were associated with increased depression symptomology. Future replicative work is needed.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Yl8nCq
via IFTTT

Prevalence of Depressive Disorders in Children with Specific Learning Disabilities

2016-04-09T07-18-16Z
Source: Journal of Behavioral Health
Mona P Gajre, Himali Meshram,Neelkamal Soares,Ms Chedda Nidhi* Afreddy Anagha*.
Prevalence of Depressive Disorders in Children With Specific Learning Disabilities Background: Learning disabled children are at risk for behavioral disorders, including depression. In India, diagnosis and interventions for learning disorders are limited.The purpose of the present study was to examine the prevalence of depression and its severity in school-aged children with specific learning disability (SLD) compared to non-learning disabled peers. Methods: In a tertiary care pediatric neurodevelopmental centre in Mumbai, we identified 200 children consecutively over twelve months referred for low academic performance, by screening of clinical records, academic history, vision-hearing tests, who additionally underwent psychoeducational battery and cognitive testing at the center, and were determined to have average intelligence . but meeting criteria for Specific Learning Disability (SLD). The controls were 100 siblings of the children who were screened for SLD by curriculum based tests.. We assessed depression using Hamilton Rating Scale for Depression (HDRS for 8-12 years) and Beck Depression Inventory II (BDI for 13-14 years).Additionally parental history of prescription medications for mental health needs was also noted. We performed multivariate logistic regression to study the association between SLD and depression. All activities were approved by the Institutional Review Board. Results: The mean (S D) age of children with SLD was 11.9 (1.6) years and of non-SLD children was 11.2 (1.2) years.In SLD group the M:F ratio was 1.5:1 and in the non SLD it was 0.8:1. A significantly higher proportion of children with SLD reported that their academic and extracurricular activities were reduced compared to children without SLD (6% vs 0%, p


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1TIcz00
via IFTTT

Estudio prospectivo de la evolución del acúfeno tras exéresis por vía translaberíntica del neurinoma del acústico

Publication date: Available online 8 April 2016
Source:Acta Otorrinolaringológica Española
Author(s): Leire Alvarez, Ane Ugarte, Miren Goiburu, Iratxe Urreta Barallobre, Xabier Altuna
IntroducciónEl acúfeno es uno de los síntomas más prevalentes entre los pacientes afectos de neurinoma del acústico y su evolución tras cirugía es difícilmente predecible.Material y métodosSe realiza un estudio prospectivo de los pacientes intervenidos por vía translaberíntica en nuestro centro en un período de 4años (2009-2013). Los pacientes contestan al cuestionario de incapacidad del tinnitus (THI). Se recogen de la historia clínica la edad, sexo, tamaño tumoral, audiometría prequirúrgica y función facial postoperatoria.ResultadosParticiparon en el estudio 39pacientes. El 71,8% de pacientes padecían acúfeno. El 50% de los pacientes presentaban un deterioro muy leve, el 17,9% leve, el 10,7% moderado, el 21,4% severo y el 0% muy severo. No encontramos asociación estadísticamente significativa entre ninguna de las variables estudiadas y el acúfeno preoperatorio. El porcentaje total de pacientes con acúfeno postoperatorio fue del 48,7%. El 31,6% presentaron un deterioro muy leve, el 36,8% leve, el 10,5% moderado, el 15,8% severo y el 5,3% muy severo. La diferencia de medias entre el THI pre y postoperatorio resultó estadísticamente significativa (p=0,011), siendo esta diferencia de mayor magnitud en pacientes jóvenes. Asimismo, existió una correlación negativa y significativa (r=–0,335; p=0,037) entre la audición preoperatoria y el THI postoperatorio.ConclusionesNo encontramos asociación significativa entre el tinnitus y la edad, sexo, tamaño tumoral y función facial postoperatoria. La exéresis del neurinoma del acústico por vía translaberíntica disminuye la percepción del acúfeno en esta serie, siendo los pacientes que mejoran más jóvenes. Los mejores resultados del THI posquirúrgico los encontramos entre pacientes con peor audición prequirúrgica.IntroductionTinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable.Materials and methodsWe conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009-2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function.ResultsThe study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P=.011); this difference was greater in younger patients. We have found a significant negative correlation (r=–0.335; P=.037) between preoperative audiometry and postoperative THI.ConclusionsWe did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1TIaVvm
via IFTTT

Hallazgo intraoperatorio, de nervio laríngeo inferior no recurrente, durante intervención por carcinoma papilar de tiroides

Publication date: Available online 8 April 2016
Source:Acta Otorrinolaringológica Española
Author(s): Antonio Prat-Calero, Pedro Cascales-Sánchez, Agustina Martínez-Moreno




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Q0ofEm
via IFTTT

Manejo práctico de fugas periprótesis en pacientes rehabilitados con prótesis fonatorias tipo Provox®2 tras laringectomía total

Publication date: Available online 8 April 2016
Source:Acta Otorrinolaringológica Española
Author(s): Eviatar Friedlander, Paloma Pinacho Martínez, Daniel Poletti Serafini, Carlos Martín-Oviedo, Tomás Martínez Guirado, Bartolomé Scola Yurrita
Introducción y objetivosLa fuga periprótesica de líquidos es una complicación frecuente en pacientes rehabilitados con prótesis fonatorias. Nuestro objetivo es describir y revisar los resultados de procedimientos para el tratamiento de la fuga periprotésica.Materiales y métodosAnálisis retrospectivo de 41 pacientes rehabilitados con prótesis fonatorias Provox® 2 entre 1997 y 2015. Descripción de 3 técnicas: colocación de arandela de silicona periprótesis, inyección de ácido hialurónico en la pared traqueal y la combinación de ambas técnicas. Se presenta un método para reducir el diámetro de la fístula fonatoria mediante retirada de la prótesis y colocación de sonda nasogástrica a través de la fistuloplastia.ResultadosEn los 3 grupos tratados mediante arandela de silicona (n=5, 13 procedimientos), inyección de ácido hialurónico (n=5, 9 procedimientos) y la combinación de ambas técnicas (n=3, 5 procedimientos), observamos un aumento de la vida útil de las prótesis en una media de 56 días (rango 7 a 118 días), 32 días (rango de 3 a 55 días) y 63 días (rango 28 a 136 días) respectivamente. La reducción del diámetro fistuloplastia se produjo en el 100% (n=6) de los pacientes tratados.ConclusionesEl uso de arandelas de silicona, inyección de ácido hialurónico en la pared traqueoesofágica y la combinación de ambas técnicas, para el tratamiento de la fuga periprótesis de líquidos aumenta la vida útil de las prótesis. La retirada protésica temporal y la colocación de sonda nasogástrica también se ha mostrado efectiva en nuestra experiencia. Estas técnicas son sencillas, económicas y reproducibles y reducen el gasto sanitario.Introduction and objectivesPeriprosthetic leakage of liquids is a common complication in patients rehabilitated with voice prostheses. Our objective was to describe and review the results of procedures for treating periprosthetic leakage.Materials and methodsThis was a retrospective analysis of 41 patients rehabilitated with Provox® 2 voice prostheses between 1997 and 2015. We describe 3 techniques: periprosthetic silicon collar placement, injection of hyaluronic acid into the tracheoesophageal wall and the combination of the 2 techniques. We present a method to reduce the diameter of the tracheoesophageal fistula by removing the voice prosthesis and placing a nasogastric tube through the fistula.ResultsIn the 3 groups treated with silicone collar (n=5, 13 procedures), hyaluronic acid injection (n=5, 9 procedures) and the combination of both techniques (n=3, 5 procedures), we observed an increase in prosthesis lifespan of an average of 56 days (range 7-118 days), 32 days (range 3-55 days) and 63 days (range 28-136 days), respectively. The tracheoesophageal fistula diameter reduction was performed in 100% (n=6) of patients.ConclusionsThe use of silicone collars, injection of hyaluronic acid into the tracheoesophageal wall and the combination of both techniques for the treatment of periprosthesis leakage increase the lifespan of the prosthesis. Temporary prosthesis removal and placement of nasogastric tube has also been shown effective in our experience. These techniques are simple, inexpensive and reproducible, thereby reducing healthcare costs.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1TIaX6g
via IFTTT

Lecanicillium longisporum on Cabbage Aphid ( Brevicoryne brassicae ): A New Record from Northeast India

Abstract

Cabbage aphid (Brevicoryne brassicae) is an important pest of cabbage in Northeast India. Infected aphids were spotted on cabbage plants in Meghalaya, India. Morphological (light and scanning electron microscopy) and molecular characterisation of the fungus revealed it to be Lecanicillium longisporum. Pathogenicity tests were also conducted which yielded positive results.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RXjUEe
via IFTTT

The role of mechanical pressure difference in the generation of membrane voltage under conditions of concentration polarization

Abstract

The mechanical pressure difference across the bacterial cellulose membrane located in a horizontal plane causes asymmetry of voltage measured between electrodes immersed in KCl solutions symmetrically on both sides of the membrane. For all measurements, KCl solution with lower concentration was above the membrane. In configuration of the analyzed membrane system, the concentration boundary layers (CBLs) are created only by molecular diffusion. The voltages measured in the membrane system in concentration polarization conditions were compared with suitable voltages obtained from the model of diffusion through CBLs and ion transport through the membrane. An increase of difference of mechanical pressure across the membrane directed as a difference of osmotic pressure always causes a decrease of voltage between the electrodes in the membrane system. In turn, for mechanical pressure difference across the membrane directed in an opposite direction to the difference of osmotic pressure, a peak in the voltage as a function of mechanical pressure difference is observed. An increase of osmotic pressure difference across the membrane at the initial moment causes an increase of the maximal value of the observed peak and a shift of this peak position in the direction of higher values of the mechanical pressure differences across the membrane.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1S94xxZ
via IFTTT

Pools of programmed death-ligand within the oral cavity tumor microenvironment: Variable alteration by targeted therapies

Abstract

Background

Enhanced understanding of programmed death-ligand (PD-L) expression in oral cancer is important for establishing rational combinations of emerging immune checkpoint and molecular targeted therapies.

Methods

We assessed PD-L and interferon (IFN) expression in immunogenic murine oral cancer-1 (MOC1) and poorly immunogenic MOC2 cell models after treatment with mammalian target of rapamycin (mTOR) and MEK1/2 small molecule inhibitors in vitro and in vivo.

Results

PD-L1 but not PD-L2 is expressed on MOC1 and 2 cells and is type I and II IFN-dependent. PD-L1 is differentially expressed on cancer and endothelial cells and infiltrating myeloid-derived suppressor cells, macrophages, and regulatory T cells (Tregs) in highly and poorly immunogenic tumors. PD-L1 expression is variably altered after treatment with inhibitors in vivo, with an imperfect relationship to alterations in IFN levels in the tumor microenvironment.

Conclusion

PD-L1 expressed on cancer and infiltrating immune cells is variably altered by targeted therapies and may, in part, reflect changes in tumor IFN. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1SGeA81
via IFTTT

Association of the upregulated expression of focal adhesion kinase with poor prognosis and tumor dissemination in hypopharyngeal cancer

Abstract

Background

Focal adhesion kinase (FAK) plays an important role in tumor metastasis. The purpose of this study was to evaluate the significance of FAK expression in surgically treated patients with hypopharyngeal cancer.

Methods

We retrospectively reviewed the clinical charts of patients treated at our institution between 2004 and 2012 and identified 87 patients with hypopharyngeal cancer. FAK expression status was retrospectively evaluated using immunohistochemistry.

Results

FAK-positive patients displayed significantly worse disease-specific survival than FAK-negative patients (p = .001). Multivariate analyses revealed that FAK positivity and extracapsular spread (ECS) were independent, significant adverse prognostic factors. Furthermore, FAK positivity significantly correlated with the number of metastatic lymph nodes (p = .048), and FAK-positive patients displayed a higher incidence of distant metastases (p = .009).

Conclusion

The current study demonstrated that upregulated FAK expression correlates with poor prognosis and tumor dissemination in surgically treated patients with hypopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/23khwlP
via IFTTT

Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases

Abstract

Background

Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.

Methods

The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.

Results

No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.

Conclusion

An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1SGezRz
via IFTTT

Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck

Abstract

Background

Perioperative brachytherapy after salvage surgery is a therapeutic option in patients with cervical relapse of a primary, controlled, previously irradiated head and neck squamous cell carcinoma. The purpose of this study was to analyze the outcome of this treatment.

Methods

Between 2008 and 2013, 8 patients underwent cervical brachytherapy after neck dissection. The mean node size was 5.5 cm. Recurrence occurred in an irradiated field (median dose, 50 Gy). Brachytherapy was performed with ¹⁹²iridium and dosimetry in accord with the rules of the Paris system. The dose was 60 to 62.7 Gy on the reference isodose.

Results

The mean follow-up was 17 months. The median overall survival (OS) was 12 months. The OS was 19% at 2 years and 0% at 5 years. A grade 5 postoperative adverse event occurred in 1 patient. At 6 months, all patients had a grade 3 neck soft tissue fibrosis. One patient had a lethal hemorrhage at 56 months.

Conclusion

Brachytherapy is toxic in this population with poor OS. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/23khwSN
via IFTTT

Prognostic value of FDG-PET volumetric parameters in patients with p16-positive oropharyngeal squamous cell carcinoma who received curative resection followed by postoperative radiotherapy or chemoradiotherapy

Abstract

Background

The purpose of this study was to determine whether pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) volumetric parameters add more prognostic information to p16-positive oropharyngeal squamous cell carcinoma (SCC).

Methods

We retrospectively analyzed 86 patients with p16-positive oropharyngeal SCC who underwent surgery and postoperative radiotherapy (RT) or chemoradiotherapy (CRT). Maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured.

Results

Higher total MTV (tMTV), nodal MTV (nMTV), and tumor TLG (tTLG) were significantly associated with lower disease-free survival (DFS) (all p < .05) and higher distant metastasis rates (all p < .05). Multivariate analysis of DFS revealed that tMTV (p = .032), nMTV (p = .004), and tTLG (p = .018) were independently significant prognosticators.

Conclusion

Patients with p16-positive disease with high metabolic tumor burden were associated with higher distant metastasis rates, translating into worse survival. These patients may not be optimal candidates for treatment deintensification. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1SGeBss
via IFTTT

Historical compliance rates for providing postoperative radiotherapy in oral cavity squamous cell carcinoma

Abstract

Background

In 2014, Alberta Health Services released guidelines for treating oral squamous cell carcinoma (OSCC).

Methods

A retrospective analysis was performed to assess the historical selection of patients with OSCC for postoperative radiotherapy (PORT) in a prospectively collected cohort of patients being treated with primary surgery. The primary outcome was compliance with the 2014 Alberta Health Services (AHS) guideline recommendations for PORT. The secondary outcome was the selection of PORT according to published pathological indications of high, intermediate, and low risk of recurrence. Reasons for discordance were analyzed.

Result

Noncompliance with the new AHS guidelines and published indications for PORT was observed in 17% and 30% of cases, respectively. The reasons for discordance with published indications included: clinician decision (n = 41) and unmodifiable factors (n = 17).

Conclusion

The impact of noncompliance on patient outcomes is being studied. The effect of the publication of the guidelines on selection for PORT going forward will be monitored. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1SGeBc6
via IFTTT

Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback

Publication date: Available online 8 April 2016
Source:American Journal of Infection Control
Author(s): Laura Arelí Sánchez-Carrillo, Juan Manuel Rodríguez-López, Dionisio Ángel Galarza-Delgado, Laura Baena-Trejo, Magaly Padilla-Orozco, Lidia Mendoza-Flores, Adrián Camacho-Ortiz
BackgroundThe importance of hand hygiene in the prevention of health care–associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce.MethodsThis study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance.ResultsA total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P <0.05). Discrepancy between both methods was 29.2% (0.4%-59.8%); the average improvement in compliance during the study was 30.6% (range, 7.3%-75.5%). Global and Individual results for each subject revealed a statistically significant Improvement in the majority. Noncompliance according to WHO's 5 Moments for HH was greater for moment 5 (30.1%). We estimated that a health care worker in a hemodialysis unit could take 22-44.3% of working hours for proper hand hygiene compliance.ConclusionsVideo-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Yl1Bg3
via IFTTT

Anchored pseudo-de novo assembly of human genomes identifies extensive sequence variation from unmapped sequence reads

Abstract

The human genome reference (HGR) completion marked the genomics era beginning, yet despite its utility universal application is limited by the small number of individuals used in its development. This is highlighted by the presence of high-quality sequence reads failing to map within the HGR. Sequences failing to map generally represent 2–5 % of total reads, which may harbor regions that would enhance our understanding of population variation, evolution, and disease. Alternatively, complete de novo assemblies can be created, but these effectively ignore the groundwork of the HGR. In an effort to find a middle ground, we developed a bioinformatic pipeline that maps paired-end reads to the HGR as separate single reads, exports unmappable reads, de novo assembles these reads per individual and then combines assemblies into a secondary reference assembly used for comparative analysis. Using 45 diverse 1000 Genomes Project individuals, we identified 351,361 contigs covering 195.5 Mb of sequence unincorporated in GRCh38. 30,879 contigs are represented in multiple individuals with ~40 % showing high sequence complexity. Genomic coordinates were generated for 99.9 %, with 52.5 % exhibiting high-quality mapping scores. Comparative genomic analyses with archaic humans and primates revealed significant sequence alignments and comparisons with model organism RefSeq gene datasets identified novel human genes. If incorporated, these sequences will expand the HGR, but more importantly our data highlight that with this method low coverage (~10–20×) next-generation sequencing can still be used to identify novel unmapped sequences to explore biological functions contributing to human phenotypic variation, disease and functionality for personal genomic medicine.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1MmdNN1
via IFTTT

Allergen Immunotherapy: No Evidence of Infectious Risk

Publication date: Available online 9 April 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Diana S. Balekian, Aleena Banerji, Kimberly Blumenthal, Carlos A. Camargo, Aidan A. Long
Although allergen immunotherapy (AIT) is thought to be a safe treatment for allergic rhinitis, only one prior study reported no risk of infection due to AIT. We examined >130,000 AIT injections and found no infections associated with injections.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/20pqKbf
via IFTTT

Reply

Publication date: Available online 8 April 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Tali Czarnowicki, James G. Krueger, Emma Guttman-Yassky




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1qzVav1
via IFTTT

Systemic B-cell abnormalities in patients with atopic dermatitis?

Publication date: Available online 8 April 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Jorn J. Heeringa, Enes Hajdarbegovic, H. Bing Thio, Menno C. van Zelm




from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/20pqKb8
via IFTTT

Respiratory Syncytial Virus Infection Activates IL-13-Producing Group 2 Innate Lymphoid Cells via Thymic Stromal Lymphopoietin

Publication date: Available online 9 April 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Matthew T. Stier, Melissa H. Bloodworth, Shinji Toki, Dawn C. Newcomb, Kasia Goleniewska, Kelli L. Boyd, Marc Quitalig, Anne L. Hotard, Martin L. Moore, Tina V. Hartert, Baohua Zhou, Andrew N. McKenzie, R. Stokes Peebles
BackgroundRespiratory syncytial virus (RSV) is a major healthcare burden with a particularly high worldwide morbidity and mortality rate among infants. Data suggest that severe RSV-associated illness is in part caused by immunopathology associated with a robust type 2 response.ObjectiveTo determine the capacity of RSV-infection to stimulate group 2 innate lymphoid cells (ILC2) and the associated mechanism in a murine model.MethodsWT BALB/c, TSLPR KO, or WT mice receiving an anti-TSLP neutralizing antibody were infected with the RSV strain 01/2-20. During the first 4-6 days of infection, lungs were collected for evaluation of viral load, protein concentration, airway mucus, airway reactivity, or ILC2 numbers. Results were confirmed with two additional RSV clinical isolates, 12/11-19 and 12/12-6, with known human pathogenic potential.ResultsRSV induced a 3-fold increase in the number of IL-13-producing ILC2 at day 4 post-infection with a concurrent increase in total lung IL-13 levels. Both TSLP and IL-33 were increased 12 hours post-infection. TSLPR KO mice failed to mount an IL-13-producing ILC2 response to RSV infection. Additionally, neutralization of TSLP significantly attenuated the RSV-induced IL-13-producing ILC2 response. TSLPR KO mice displayed reduced lung IL-13 protein, decreased airway mucus and reactivity, attenuated weight loss, and similar viral loads as WT mice. Both 12/11-19 and 12/12-6 similarly induced IL-13-producing ILC2 via a TSLP-dependent mechanism.ConclusionThese data demonstrate that multiple pathogenic strains of RSV induce IL-13-producing ILC2 proliferation and activation via a TSLP-dependent mechanism in a murine model and suggest the potential therapeutic targeting of TSLP during severe RSV infection.

Graphical abstract

Teaser

In a murine model, RSV induced activation of ILC2 that produced IL-13, a Th2 cytokine that mediates airway obstruction and has been linked to severe RSV illness. This ILC2 activation was dependent upon TSLP, an emerging therapeutic target for Th2-driven illness.


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1qzV7zq
via IFTTT

Oral vinorelbine in combination with trastuzumab as a first-line therapy of metastatic or locally advanced HER2-positive breast cancer

Abstract

Purpose

Vinorelbine–trastuzumab combination proved to be an effective first-line treatment for patients with locally advanced or metastatic breast cancer (MBC). Oral chemotherapy represents a step forward in MBC management. To improve patients' comfort using the oral form of vinorelbine, we conducted a multicenter phase II study to investigate the efficacy and safety of the oral vinorelbine–trastuzumab combination in women with MBC with human epidermal growth factor receptor 2 (HER2) overexpression.

Methods

Main eligibility criteria: HER2-positive disease, no adjuvant chemotherapy within the last 6 months and no prior chemotherapy for MBC. Patients were treated with oral vinorelbine 80 mg/m² D1, D8, D15 (following first 3 administrations at 60 mg/m² during the first cycle) for a total of 8 cycles (1 cycle = 3 weeks), in combination with trastuzumab 6 mg/kg on D1 (loading dose: 8 mg/kg) every 3 weeks or 4 mg/kg (loading dose: 6 mg/kg) weekly. Response was evaluated every 2 cycles using RECIST 1.0. Primary endpoint: objective response rate (ORR); secondary endpoints: duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.

Results

In the full population (n = 26), median age was 50.7 years and median WHO PS 0. Median disease-free interval was 50.7 months [95 % CI (43.6–57.9)]. In the evaluable patients population, ORR was 56 % [95 % CI (34.9–75.6)], including 3 complete responses (12 %) and 11 partial (44 %); 8 (32 %) patients had stable disease resulting in a clinical benefit (or disease control) rate of 88 % [95 % CI (68.8–97.5)]. Median DOR was 7.1 months [95 % CI (3.9–10.2)], median PFS 6.7 months (95 % CI 3.5–10), and median OS 27.9 months (95 % CI 17.4–38.3). Treatment was generally well tolerated with main observed grade 3/4 hematological toxicities being neutropenia (46 %) and anemia (4 %). Grade 3–4 nausea–vomiting were observed in 11.5 % of patients.

Conclusions

Our results confirm the efficacy of oral vinorelbine–trastuzumab combination as a first-line treatment in HER2-positive locally advanced or MBC patients with an acceptable safety profile. Oral vinorelbine–trastuzumab optimizes the convenience of this chemotherapy regimen, especially for patients receiving trastuzumab every 3 weeks.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1S2E1mT
via IFTTT

Power Spectral Density Analysis of Electrodermal Activity for Sympathetic Function Assessment

Abstract

Time-domain features of electrodermal activity (EDA), the measurable changes in conductance at the skin surface, are typically used to assess overall activation of the sympathetic system. These time domain features, the skin conductance level (SCL) and the nonspecific skin conductance responses (NS.SCRs), are consistently elevated with sympathetic nervous arousal, but highly variable between subjects. A novel frequency-domain approach to quantify sympathetic function using the power spectral density (PSD) of EDA is proposed. This analysis was used to examine if some of the induced stimuli invoke the sympathetic nervous system's dynamics which can be discernible as a large spectral peak, conjectured to be present in the low frequency band. The resulting indices were compared to the power of low-frequency components of heart rate variability (HRVLF) time series, as well as to time-domain features of EDA. Twelve healthy subjects were subjected to orthostatic, physical and cognitive stress, to test these techniques. We found that the increase in the spectral powers of the EDA was largely confined to 0.045–0.15 Hz, which is in the prescribed band for HRVLF. These low frequency components are known to be, in part, influenced by the sympathetic nervous dynamics. However, we found an additional 5–10% of the spectral power in the frequency range of 0.15–0.25 Hz with all three stimuli. Thus, dynamics of the normalized sympathetic component of the EDA, termed EDASymp_n, are represented in the frequency band 0.045–0.25 Hz; only a small amount of spectral power is present in frequencies higher than 0.25 Hz. Our results showed that the time-domain indices (the SCL and NS.SCRs), and EDASymp_n, exhibited significant increases under orthostatic, physical, and cognitive stress. However, EDASymp_n was more responsive than the SCL and NS.SCRs to the cold pressor stimulus, while the latter two were more sensitive to the postural and Stroop tests. Additionally, EDASymp_n exhibited an acceptable degree of consistency and a lower coefficient of variation compared to the time-domain features. Therefore, PSD analysis of EDA is a promising technique for sympathetic function assessment.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1N0Rg8w
via IFTTT

An Experimental and Numerical Investigation of CO 2 Distribution in the Upper Airways During Nasal High Flow Therapy

Abstract

Nasal high flow (NHF) therapy is used to treat a variety of respiratory disorders to improve patient oxygenation. A CO₂ washout mechanism is believed to be responsible for the observed increase in oxygenation. In this study, experimentally validated Computational Fluid Dynamics simulations of the CO₂ concentration within the upper airway during unassisted and NHF assisted breathing were undertaken with the aim of exploring the existence of this washout mechanism. An anatomically accurate nasal cavity model was generated from a CT scan and breathing was reproduced using a Fourier decomposition of a physiologically measured breath waveform. Time dependent CO₂ profiles were obtained at the entrance of the trachea in the experimental model, and were used as simulation boundary conditions. Flow recirculation features were observed in the anterior portion of the nasal cavity upon application of the therapy. This causes the CO₂ rich gas to vent from the nostrils reducing the CO₂ concentration in the dead space and lowering the inspired CO₂ volume. Increasing therapy flow rate increases the penetration depth within the nasal cavity of the low CO₂ concentration gas. A 65% decrease in inspired CO₂ was observed for therapy flow rates ranging from 0 to 60 L min⁻¹ supporting the washout mechanism theory.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/22jRCsq
via IFTTT

“It is by anatomy only that we can arrive at the knowledge of the true nature of most of the diseases which afflict humanity”

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1qeeAVD
via IFTTT

Erratum to: Spectrum of MRI features of ganglion and synovial cysts

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RKyx17
via IFTTT

Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up

Abstract

Doxorubicin (Dox), a mainstay of adjuvant breast cancer treatment, is associated with cardiac toxicity in the form of left ventricular dysfunction (LVD), LV diastolic dysfunction, or LV systolic dysfunction. Study objectives were to evaluate the prevalence of LVD in long-term breast cancer survivors treated with Dox and determine if brain-type natriuretic peptide (BNP) may help identify patients at risk for LVD. Patients who participated in prospective clinical trials of adjuvant Dox-based chemotherapy for breast cancer with a baseline left ventricular (LV) ejection fraction evaluation from 1999 to 2006 were retrospectively identified from the St Vincent's University Hospital database. Patients were invited to undergo transthoracic echocardiography, BNP analysis, and cardiovascular (CV) risk factor assessment. LVDD was defined as left atrial volume index >34 mL/m² and/or lateral wall E prime <10 m/s, and LVSD as LVEF <50 %. Of 212 patients identified, 154 participated, 19 patients had died (no cardiac deaths), and 39 declined. Mean age was 60.7 [55:67] years. A majority of the patients (128, 83 %) had low CV risk (0/1 risk factors), 21 (13.6 %) had 2 RFs, and 5 (3.2 %) ≥3 RFs. BMI was 27.2 ± 4.9 kg/m². Median Dox dose was 240 mg/m² [225–298]; 92 patients (59.7 %) received ≤240 mg/m² and 62 (40.3 %) > 240 mg/m². Baseline LVEF was 68.2 ± 8 %. At follow-up of 10.8 ± 2.2 years, LVEF was 64.4 ± 6 %. Three (1.9 %) subjects had LVEF <50 % and one (0.7 %) had LVDD. Dox >240 mg/m2 was associated with any LVEF drop. BNP levels at follow-up were 20.3 pg/ml [9.9–36.5] and 21.1 pg/ml [9.8–37.7] in those without LVD and 61.5 pg/ml [50–68.4] in those with LVD (p = 0.04). Long-term prospective data describing the impact of Dox on cardiotoxicity are sparse. At over 10 years of follow-up, decreases in LVEF are common, and dose related, but LVD as defined is infrequent (2.6 %). Monitoring with BNP for subclinical LVD needs further evaluation.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1UPTSZv
via IFTTT