Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 879-884
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 16 Αυγούστου 2016
Decreased undercarboxylated osteocalcin in children with type 2 diabetes mellitus
Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 885-891
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Prevalence of psychosocial morbidity in children with type 1 diabetes mellitus: a survey from Northern India
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 893-899
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Increased GLP-1 response to oral glucose in pre-pubertal obese children
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 901-906
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Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 907-914
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Idiopathic postprandial hyperinsulinaemic hypoglycaemia
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 915-922
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Feeding, eating and behavioral disturbances in Prader-Willi syndrome and non-syndromal obesity
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 923-932
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Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 933-937
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Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 939-945
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Zoledronate for Osteogenesis imperfecta: evaluation of safety profile in children
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 947-952
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Elevated serum adiponectin is related to elevated serum ferritin and interleukin-6 in β-thalassaemia major children
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 953-958
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GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 959-964
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Cystinosis in Eastern Turkey
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 965-969
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Microarray analysis of slipped capital femoral epiphysis growth plates
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 971-978
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Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy: report of three cases from Iran
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 979-983
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Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 29
Issue: 8
Pages: 985-990
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Augmented Renal Clearance in Traumatic Brain Injury: A Single-Center Observational Study of Atrial Natriuretic Peptide, Cardiac Output, and Creatinine Clearance
Journal of Neurotrauma , Vol. 0, No. 0.
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Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
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A Review of the Oncology Patient's Challenges for Utilizing Fertility Preservation Services
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
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To Your Health: NLM update: Better care for disadvantaged kids
Listen to the To Your Health: NLM update on Better care for disadvantaged kids. The transcript is also available.
The health of children from disadvantaged backgrounds will improve if pediatricians and other physicians inquire about a family's economic status as well as provide information about anti-poverty programs, suggests an illuminating perspective recently published in the New England Journal of Medicine...
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An achilles heel for Clostridium difficile infections?
Clostridium difficile is a dangerous superbug. Infections with this bacterium can cause life-threatening diarrhea, and they are most likely to affect the elderly or people with health problems who spend a lot of time in hospitals (where C. difficile flourishes). The Centers for Disease Control a...
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Augmented Renal Clearance in Traumatic Brain Injury: A Single-Center Observational Study of Atrial Natriuretic Peptide, Cardiac Output, and Creatinine Clearance
Journal of Neurotrauma , Vol. 0, No. 0.
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Children with ANSD Fitted with Hearing Aids
Intervention for children with auditory neuropathy spectrum disorder (ANSD) represents a significant challenge in pediatric audiology. A critical tool for the fitting of amplification in young pediatric patients, the auditory brainstem response (ABR), is compromised in this population for estimation of behavioral thresholds. Despite compromised ABR responses, cortical auditory evoked potentials (CAEP) can often be recorded from ANSD patients, and there is emerging research in the application of CAEP for estimation of behavioral thresholds in this population (He et al. 2013).
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AAO-HNS President Speaks at Otorhinolaryngology Frontiers 2015
Sujana S. Chandrasekhar, MD, FACS, FAAO-HNS, president of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), was the guest speaker at Otorhinolaryngology Frontiers 2015, an annual event highlighting research endeavors and emerging technology in the diagnosis and management of common otolaryngologic clinical problems. More than 80 physicians and other healthcare professionals attended the event, which was held on June 27, 2015, at the Brown Foundation Institute of Molecular Medicine of The University of Texas Health Science Center at Houston, and sponsored by the Department of Otorhinolaryngology-Head and Neck Surgery at the McGovern Medical School.
"This event was very well attended – one of our most popular ORL Frontiers presentations to date," says Amber Luong, MD, PhD, associate professor and research director in the Department of Otorhinolaryngology-Head and Neck Surgery who also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. "Dr. Chandrasekhar delivered a very inspirational address on the pathway to leadership, which is often through adversity."
Dr. Chandrasekhar is the third woman and the first person of Indian descent to hold the office of president of the 12,000-member organization. Previously she served as chair of the AAO-HNS Board of Governors.
Dr. Chandrasekhar attended medical school at Mount Sinai School of Medicine in New York City, graduated at the age of 22 and completed her residency in otolaryngology-head and neck surgery at New York University Medical Center in New York. She completed her fellowship in otology and neurotology at the House Ear Clinic and Institute in Los Angeles California. She served on the fulltime academic faculty of both UMDNJ-New Jersey Medical School and Mount Sinai School of Medicine before entering private practice in New York City in 2004. She is currently director of New York Otology, director of neurotology at the James J. Peters Veterans Administration Medical Center, otologist/neurotologist at the New York Head and Neck Institute and voluntary faculty at Mount Sinai. As such, she is at the clinical forefront in management of disorders of hearing, balance, tinnitus, facial nerve and lateral skull base, as well as cochlear and BAHA implants. She is the medical director of the Vestibular Disorders Evaluation Clinic at the Bronx VA Hospital, a multidisciplinary team created to rapidly and thoroughly assess and treat patients with complex dizziness disorders, especially those returning from active duty. She is currently building the Comprehensive Balance Center at Lenox Hill Hospital/Manhattan Eye Ear and Throat Hospital.
Dr. Chandrasekhar presented on two topics: "Evidence-based Management of Sudden Sensorineural Hearing Loss" and "The ABCDs of Leadership Success in ENT."
The following presentations also were made at ORL Frontiers by the Department's faculty and residents:
• "Management and Complications of Tympanostomy Tubes in Head and Neck Cancer Patients" by Jaecel Shah, MD
• "Ear Disease: A Pictorial Review of 30+ Years" by Terry Owens, MD, assistant professor
• "Applications of Transoral Robotics Surgery in the Pediatric Airway" by Jay Ferrell, MD
• "When and What to Pack After Sinus Surgery" by Amber Luong, MD, PhD, FACS, associate professor
• "SCOPIS to Assist Understanding Frontal Sinus Anatomy" by Abib Agbetoba, MD
• "Update on Otitis Media and Tympanostomy Tubes" by Soham Roy, MD, FACS, FAAP, associate professor
• "Lower Eyelid Tightening with the Kuhnt-Szymanowski Repair: An Adjunct to Lower Eyelid Blepharoplasty" by Regina Rodman, MD
• "Case Presentations" by Jo-Lawrence Bigcas, MD
• "Transoral Laser Microsurgery and Transoral Robotics Surgery: A Synthesis of Techniques and Technologies" by Ron Karni, MD, assistant professor
• "Pendant Drop Tensiometry for Measuring Surface Tension Effects of Sinus Rinses on Rhinosinusitis Mucus: A Pilot Study" by Jo-Lawrence Bigcas, MD
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Seven ORL Specialists Named to Top Doctors Lists for 2015
Five members of the Department of Otorhinolaryngology-Head and Neck Surgery have been selected by their peers as outstanding physicians in Texas. Following an extensive nomination and research process conducted by Key Professional Media Inc., the results were published in the June 2015 issue of Texas Monthly magazine.
Martin J. Citardi, MD
Martin J. Citardi, MD, FACS, who specializes in the treatment of complicated sinus and nasal disease and is a core member of the Texas Sinus Institute and Texas Skull Base Physicians, has been named to the Texas Monthly Super Doctors® list for the fifth consecutive year. Dr. Citardi is chief of otorhinolaryngology-head and neck surgery at Memorial Hermann-Texas Medical Center and professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at the John P. and Kathrine G. McGovern Medical School.
An internationally recognized ear, nose and throat surgeon, Dr. Citardi received his medical degree from the Johns Hopkins University School of Medicine. He completed his residency training at Yale University and pursued a rhinology fellowship at the Georgia Rhinology and Sinus Center. He is certified by the American Board of Otolaryngology-Head and Neck Surgery and is a fellow of the American College of Surgeons. Dr. Citardi has been named to the Best Doctors in America® list since 2005 and listed in the Guide to America's Top Surgeons since 2010. He was first named to Houstonia magazine's inaugural listing of Top Doctors in Houston in 2013. His specialty interests include difficult-to-treat chronic sinusitis, revision sinus surgery and minimally invasive surgery for tumors of the nose and sinuses.
Ronda Alexander, MD
Ronda E. Alexander, MD, FACS, formerly named among the Texas Monthly Super Doctors Rising Stars®, joins Dr. Citardi on the Super Doctors list this year. An assistant professor in the Department of Otorhinolaryngology and director of the Texas Voice Performance Institute™ at the McGovern Medical School, Dr. Alexander received her medical degree at the Weill Medical College of Cornell University in New York City. After medical school, she completed her otorhinolaryngology residency at Albert Einstein College of Medicine and a fellowship in laryngology and neuro-laryngology at the New York Center for Voice and Swallowing Disorders. She is certified by the American Board of Otolaryngology and is a fellow of the American College of Surgeons.
Since coming to Texas, she has helped establish the Texas Voice Performance Institute, a comprehensive program for the diagnosis, treatment and management of disorders and diseases that affect the voice and swallowing. Her clinical interests include the evaluation of hoarseness problems of the speaking and singing voice, spasmodic dysphonia, vocal tremor, vocal cord paralysis, extra-esophageal reflux and swallowing disorders. She is specially trained to manage the unique needs of professional voice users. She also has interests in neuromuscular disorders of the head and neck, including tension and migraine headache.
Named to the Texas Monthly Super Doctor Rising Stars list for 2015 are Tang Ho, MD, Ron Karni, MD, and Amber Luong, MD, PhD.
Tang Ho, MD
Dr. Ho is chief of facial plastic and reconstructive surgery and an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery. He received his medical degree from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and returned to Texas to complete his otolaryngology-head and neck residency training at the Baylor College of Medicine in Houston. He subsequently completed subspecialty fellowship training in facial plastic and reconstructive surgery at Johns Hopkins Hospital. Prior to embarking on a career in medicine, Dr. Ho was a U.S. Fulbright Scholar to the United Kingdom, where he received his master's degree in sociology from the University of Edinburgh in Scotland. Dr. Ho is a double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery. His clinical interests include aesthetic and reconstructive surgeries of the face, including facial rejuvenation procedures (facelift, brow lift, Botox® injection, injectable fillers), rhinoplasty, facial reanimation procedures for patients with facial paralysis, reconstructive surgery of skin cancer defects, and complex microvascuar facial reconstruction.
Ron Karni, MD
Dr. Ron Karni serves as chief of the division of Head and Neck Surgical Oncology in the Department of Otorhinolaryngology-Head and Neck Surgery. He received his medical degree at Baylor College of Medicine and completed his residency training at Washington University in St. Louis School of Medicine. He holds dual appointments as an assistant professor in the Department of Otorhinolaryngology and the division of Medical Oncology. Dr. Karni has authored publications on the novel treatment of occult primary oropharyngeal cancer and practical tools to integrate evidence-based methods into the daily practice of medicine. His current research focus includes de-escalation treatment strategies for throat cancer, morphoproteomic analysis of head and neck cancer, and HPV-related malignancies of the head and neck. Dr. Karni is co-principal investigator on a CPRIT grant studying new treatments for head and neck lymphedema using near-infrared fluorescent technology. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. Dr. Karni's practice focuses on the management of benign and malignant tumors of the head and neck, including throat cancer, oral cancer, larynx cancer, locally advanced skin cancer, salivary gland tumors and thyroid/parathyroid disease. He performs transoral robotic surgery for tumors of the throat, a modern approach to minimizing the side effects of treatment for throat cancer. Dr. Karni also performs ultrasound-guided fine needle aspiration biopsy for thyroid nodules and minimally invasive thyroid and parathyroid surgery.
Amber Luong, MD, PhD
Dr. Amber Luong is an associate professor and research director in the Department of Otorhinolaryngology-Head and Neck Surgery who also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. She received her MD/PhD at The University of Texas Southwestern Medical Center at Dallas through the NIH-sponsored Medical Scientist Training Program. She obtained her PhD under the Nobel laureates Dr. Michael Brown and Dr. Joseph Goldstein for the identification and biochemical characterization of a novel human enzyme, acetyl coA synthetase. She then completed her residency training at UT Southwestern and a rhinology fellowship at the Cleveland Clinic. Dr. Luong has co-authored more than 80 peer-reviewed articles and book chapters. Her primary research interest focuses on understanding the role of the innate immune response in the pathophysiology of chronic rhinosinusitis, with a particular interest in the role of environmental fungi in initiating these innate immune responses. Dr. Luong's clinical interest parallels her research interest in allergic fungal rhinosinusitis as well as the medical and surgical management of refractory chronic rhinosinusitis, sinonasal tumors, CSF leak repairs, and endoscopic orbital and dacryocystorhinostomy surgery. She is a fellow of the American College of Surgeons.
Texas Monthly magazine surveys more than 40,000 medical professionals each year and invites them to nominate one or more doctors other than themselves from specified medical specialties based on the question: "If you needed medical care, which doctor would you choose?" Fewer than 5 percent of physicians with active practices in Texas are named to the list.
Dr. Alexander, Dr. Citardi, Dr. Ho, and Dr. Karni were also named to Houstonia magazine's 2015 listing of Top Doctors in Houston. Physicians named to the 2015 list were selected based on nominations solicited from nearly 16,000 medical professionals practicing in eight counties in the Greater Houston area.
Joining them on this year's Houstonia list are Soham Roy, MD, FACS, FAAP, and Sancak Yuksel, MD.
Soham Roy, MD
Dr. Roy is a recognized expert in operating room safety issues and a consultant in the development of innovative and safer surgical devices. An associate professor and vice chair of the Department, he serves as director of pediatric otolaryngology and quality officer, and is also an assistant dean at the McGovern Medical School. Dr. Roy received his undergraduate degree with highest distinction from Stanford University, received a full scholarship for medical education at Washington University School of Medicine in St. Louis, and completed his residency in otolaryngology at the University of Miami. He completed a fellowship in pediatric otolaryngology at the Children's Hospital in Pittsburgh prior to joining the faculty at the University of Miami, where he was named Professor of the Year in 2003, an honor he received again at the McGovern Medical School in 2013. Dr. Roy is board certified by the American Board of Otolaryngology-Head and Neck Surgery and is a fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American College of Surgeons, and the American Academy of Pediatrics. An internationally recognized speaker and author, Dr. Roy has received multiple awards for teaching, clinical care and original scientific research. His clinical interests are airway disorders in children, neonatal airway surgery, hearing loss, tonsil and adenoid disorders and neck masses in children.
Sancak Yuksel, MD
Dr. Sancak Yuksel is an assistant professor in the Department of Otorhinolaryngology. He received his medical degree at the Hacettepe University School of Medicine in Ankara, Turkey, and completed his otorhinolaryngology residency at the Istanbul University Cerrahpasa School of Medicine in Istanbul. After residency, he also received advanced training in head-neck and skull base surgery as a fellow in the same Department. Dr. Yuksel served as a research fellow in the Basic Science Laboratory of the Children's Hospital of Pittsburgh and worked in numerous National Institutes of Health-funded projects focused on the middle ear and the eustachian tube pathophysiology. He completed a two-year clinical fellowship in the Department of Pediatric Otolaryngology at Children's Hospital of Pittsburgh. He also served as an instructor at the University of Pittsburgh School of Medicine. Dr. Yuksel is a member of American Academy of Otolaryngology–Head and Neck Surgery. His clinical interests include pediatric ear diseases, cochlear implantation, newborn and pediatric swallowing and airway problems, and congenital head and neck lesions. He is also an expert in pediatric and adult complex ear and hearing problems and sialendoscopy, minimally invasive endoscopic management of salivary gland stones.
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Shutoff of host translation during viral infection downregulates cellular antiviral activities
Read the full article on ScienceDirect.
Host translation shutoff mediated by non-structural protein 2 is a critical factor in the antiviral state resistance of Venezuelan equine encephalitis virus
Text by Nishank Balla
Alphaviruses are positive-sense, single-stranded RNA viruses belonging to the Togaviridae family of viruses, and are classified as Old World (SINV, CHIKV) and New World (VEEV, EEEV) alphaviruses based on geographic distribution and disease type. Infection of mouse models and humans with SINV and VEEV can induce IFN-α/β that upregulates antiviral mechanisms in infected and uninfected areas of the body. VEEV can replicate more efficiently in the presence of IFN than other tested alphaviruses which are inhibited to different degrees due to the antiviral effects of IFN treatment. In this study we show that inhibition of host translation by VEEV nsP2 in cells already primed with IFN is critical for the virus to resist host antiviral mechanisms and cause disease. We have also identified the viral proteins responsible for inhibition of host transcription and translation, which we show are activities induced independently during infection.
We had previously shown that VEEV could replicate in IFN primed cells very efficiently, as if there was minimal effect of IFN on the virus. In most previous studies, virus-induced transcription and translation inhibition were studied without taking into account that these activities are localized to the same protein in Old world alphaviruses. Our current study attempts to resolve discrepancies in published data and address, separately, the role of transcription and translation inhibition in the antiviral state resistance of alphaviruses.
A major difficulty we encountered was to separate macromolecular synthesis inhibition phenotypes from virus replication efficiency. In our studies and previously demonstrated by others, particular mutations in nsP2 and/or capsid proteins in full-length viruses abrogate this inhibition but also reduce replication rates in cells without functional IFN responses, confounding analyses. We chose to study nsP2 and capsid independently of replication by expressing these proteins from a DNA plasmid. We exerted considerable effort selecting an appropriate plasmid vector that would give high enough expression of nsP2 and/or capsid to observe transcription or translation inhibition, and then to determine measurement times such that levels of viral proteins were high but not directly cytopathic, and the effects of auto-inhibitory activity on expressed protein levels would not give a false-negative result. The breakthrough was demonstrating significantly greater translation inhibition in IFN-primed cells expressing VEEV nsP2 over those expressing SINV, nsP2. This was achieved by manipulating the IFN dose and time of measurement and minimizing the effect of IFN priming on transfection efficiency and expression levels of nsP2.
Figure legend
VEEV nsP2 can shut off global host macromolecular synthesis and downregulate the antiviral state. (A and B) Cells primed with IFN and expressing nsP2 were labeled with [35S] Cys/Met to measure translation levels. VEEV nsP2 expression significantly reduced levels of host translation in primed cells. (C and D) Levels of representative ISGs (IFIT1 and TGTP) were measured in IFN primed cells expressing nsP2. Cells expressing VEEV nsP2 had lower ISG levels due to shutoff of translation. (E) Translation shutoff in IFN primed cells can support the replication of an IFN sensitive virus. Replication of Yellow fever 17-D virus in IFN primed cells expressing VEEV nsP2 was comparable to replication in unprimed cells.
Introducing the authors
Pictured left: Nishank Bhalla; right William B. Klimstra. Both from the Center for Vaccine Research, University of Pittsburgh.
About the research
Host translation shutoff mediated by non-structural protein 2 is a critical factor in the antiviral state resistance of Venezuelan equine encephalitis virus
Nishank Bhalla, Chengqun Sun, L.K. Metthew Lam, Christina L. Gardner, Kate D. Ryman, William B. Klimstra
Virology, Volume 496, September 2016, Pages 147–165
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Detection of Modified Forms of Cytosine Using Sensitive Immunohistochemistry
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Familial occurrence of headache disorders: A population-based study in mainland China
Publication date: October 2016
Source:Clinical Neurology and Neurosurgery, Volume 149
Author(s): Mianwang He, Shengyuan Yu, Ruozhuo Liu, Xiaosu Yang, Gang Zhao, Xiangyang Qiao, Jiachun Feng, Yannan Fang, Xiutang Cao, Timothy J. Steiner
BackgroundHeadache disorders are highly prevalent worldwide, and familial occurrence and heredity are contributory factors attracting the interest of epidemiological researchers. Our purpose, in a large sample drawn nationwide from the Chinese general population, was to evaluate the frequency of similar headache in first-degree relatives (FDRs) of those with different headache types.MethodsThis was a questionnaire-based nationwide cross-sectional door-to-door survey using cluster random-sampling, selecting one adult (18–65 years) per household. Headache was diagnosed by ICHD-II criteria. Participants with headache were asked whether or not any FDRs had similar headache to their own. Chi-squared test and multivariate logistic regression analysis were used to assess the strength and significance of associations.ResultsOf 5041 survey participants (participation rate 94.1%), 1060 (21.0%) were diagnosed with headache (migraine 469 [9.3%], tension-type headache [TTH] 543 [10.8%], headache on ≥15 days/month 48 [0.95%]). From these, 31 were excluded because of missing data about FDRs, leaving 1029 for analysis (male 350 [mean age: 46.7±11.4years]; female 679 [mean age 46.3±11.2years]). Similar headache in one or more FDRs was reported by 22.2% (95% CI: 19.6–24.7%) overall, by 25.1% (21.1–29.1%) of those with migraine, by 19.1% (15.7–22.4%) with TTH and by 29.2% (16.3–42.0%) with headache on ≥15 days/month. The differences was significant between migraine and TTH (OR=1.4, p=0.023), but were not significant between headache on ≥15 days/month and TTH (OR=1.7, p=0.093), migraine and headache on ≥15 days/month (OR=1.2,p=0.534). In multivariate analysis: for migraine versus TTH,AOR=1.2 (p=0.015); for headache on ≥15 days/month versus TTH, AOR 2.3 (p=0.018).ConclusionHeadache was highly prevalent in China and common among FDRs of those with any type of headache (headache on ≥15 days/month>migraine>TTH). Against the background of the general-population prevalence of each disorder, familial occurrence was a very highly influential factor in headache on ≥15 days/month. There are important implications in this for public health and education.
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The sellar and suprasellar region: A “hideaway” of rare lesions. Clinical aspects, imaging findings, surgical outcome and comparative analysis
Source:Clinical Neurology and Neurosurgery, Volume 149
Author(s): Ioannis Petrakakis, Ariyan Pirayesh, Joachim K. Krauss, Peter Raab, Christian Hartmann, Makoto Nakamura
ObjectiveApart from the "common" lesions (e.g. pituitary adenomas, Rathke's cleft cysts, meningiomas and craniopharyngiomas), there is a plethora of rare tumors or tumor-mimicking lesions in the sellar and suprasellar region (SSR). Due to a lack of characteristic imaging features, there is a dilemma in distinguishing these rare lesions from the more "common" ones preoperatively. Consequently, both diagnosis and definition of surgical goals, as well as further treatment strategies continue to be challenging for all attending physicians.To replenish the scarce data on this issue, we analysed all patients with infrequent non-adenomatous pathologies in the SSR treated in our clinic, providing a database for further studies.MethodsA retrospective study was performed including 223 patients who were operated on lesions within the SSR at the Department of Neurosurgery, Hannover Medical School, between 2006 and 2014.The patients' charts were analysed with regard to the results of pre-/postoperative endocrinological and neuroophthalmological examinations. Preoperative T2WI were analysed with special focus on distinct growth patterns within four quadrants constituting the (supra-)sellar region. In this way, a comparative analysis between the diverse lesions regarding their clinical features, resectability and the final outcome was possible.ResultsAfter exclusion of cases with "common" lesions, a collective of 20 patients with rare lesions within the SSR was obtained. The histopathological diagnosis revealed xanthogranulomas (n=6), metastatic tumors (n=5), colloid/epidermal cysts (n=3), pilocytic astrocytomas (n=2), and one case each of gangliocytoma, lymphocytic hypophysitis or concomitant germ cell tumor/rhabdomyosarcoma. In comparison to non-infiltrative lesions, those of infiltrative nature caused more frequently diplopia and deterioration of visual acuity (4 cases; p<0,05) that were less prone to improve postoperatively. Regarding growth pattern, metastatic tumors demonstrated main growth within the third quadrant with destructive remodelling of the dorsum sellae (p<0,05). While patients harbouring large lesions (>20mm) showed a significantly worse outcome regarding hormonal deficits (p=0,0313), the overall prognosis was heavily linked to the histopathological diagnosis.ConclusionThe correlation of the subtle radiological findings demonstrated with the specific clinical features may facilitate the differential diagnosis of rare lesions of the SSR and aid in establishing an interdisciplinary diagnostic and therapeutic procedure for these lesions.
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Action Training Systems Releases New Title: Active Shooter Response
Action Training Systems (ATS), producer of award-winning firefighter, EMS, and industrial fire brigade training programs, is releasing a new title in its Incident Command & Management (ICM) series: Fire/EMS: Active Shooter Response. With the increasing number of active shooter or criminal mass casualty incidents, it is more important than ever for emergency personnel to train together and to operate ...
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Action Training Systems Releases New Title in Incident Command & Management Series
Action Training Systems (ATS), producer of award-winning firefighter, EMS, and industrial fire brigade training programs, is releasing a new title in its Incident Command & Management (ICM) series: ICS: EMS Operations. This new title presents best practices for an organized medical response to a multiple casualty incident (MCI), emphasizing the importance of requesting and utilizing resources in ...
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Peripartales Management bei psychischer Vorerkrankung
Zusammenfassung
Hintergrund
Gerade Frauen mit phasenhaft verlaufenden psychischen Erkrankungen setzen sich oft sehr differenziert mit der Frage der Familiengründung auseinander, wobei sich Überlegungen zu den Auswirkungen der Medikation auf das Kind und die nicht unberechtigte Sorge einer Verschlechterung der psychischen Erkrankung durch die Schwangerschaft und Entbindung mischen. Bei einer Psychopharmakotherapie in der Schwangerschaft steht meist die Sorge um Auswirkungen auf das Kind im Vordergrund, dabei wird das z. T. hohe krankheitsabhängige Rezidivrisiko in der Postpartalzeit zu wenig berücksichtigt. In dieser Konfliktsituation benötigen Frauen fachkompetente Beratung und qualifizierte Unterstützung.
Methoden und Ergebnisse
Auf der Basis der Betreuung von 420 psychisch erkrankten Frauen mit Kinderwunsch und Schwangerschaft seit 2006 und der prospektiven Dokumentation inkl. Geburtsplanung bei 196 Patientinnen wurde das Bonner Konzept zum peripartalen Management (BKPM) entwickelt. Neben konkreten Empfehlungen zur Medikation prä- und postpartal und zum Stillen enthält der Geburtsplan Verhaltensstrategien zu Reizabschirmung, sozialer Unterstützung, Einbeziehung des Partners in die Versorgung des Kindes etc. Lediglich 4,6 % der Frauen erlitten trotz prophylaktischer Strategien ein postpartales Rezidiv. Weitere positive Effekte der partizipativ mit Patientin und Partner erfolgten Geburtsplanung waren ein deutlich verbessertes Erleben von Sicherheit und Autonomie bei den Betroffenen und ihren Familien.
Diskussion
Aus Sicht der Autorinnen kann ein strukturiertes peripartales Management die Gefahr einer erneuten Krankheitsepisode deutlich reduzieren und so psychisch kranke Frauen bei Kinderwunsch und Schwangerschaft unterstützen. Das in Bonn zum Einsatz kommende Konzept entspricht den aktuellen Bemühungen der Peripartalpsychiatrie um Etablierung präventiver Strategien.
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Nach der „Aktion T4“
Zusammenfassung
Hintergrund
Ziel der vorliegenden Untersuchung ist es, die Beteiligung der Heil- und Pflegeanstalt Günzburg an der Durchführung der „regionalisierten Euthanasie" zu analysieren.
Methoden
Anhand definierter Kriterien wurden Patientenakten der zwischen Juli 1941 und Dezember 1943 in der Heil- und Pflegeanstalt Günzburg verstorbenen Patienten auf das Vorhandensein von Kriterien, die für die „regionalisierte Euthanasie" sprechen, untersucht.
Ergebnisse
Insgesamt 45 Patienten aus Günzburg sind wahrscheinlich durch Hungerkost, Vernachlässigung, die Überdosierung von Medikamenten oder durch eine Kombination dieser Handlungen mit unmittelbarer oder mittelbarer Tötungsabsicht verstorben, d. h. getötet worden.
Schlussfolgerungen
Die Heil- und Pflegeanstalt Günzburg war an der „regionalisierten Euthanasie" beteiligt.
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Armrehabilitation
Zusammenfassung
Hintergrund
Armlähmungen nach einem Schlaganfall sind eine zentrale Ursache für Behinderung.
Ziel der Arbeit
Es werden therapeutische Optionen und ihre Wirksamkeit in der Armrehabilitation nach einem Schlaganfall dargestellt.
Material und Methoden
Basierend auf einer systematischen Bewertung randomisierter kontrollierter Studien werden therapeutische Verfahren für die Armparese nach einem Schlaganfall im Kontext ihrer Wirksamkeit vorgestellt, dazu gehören u. a. Robot-Therapie, Spiegeltherapie, „constraint-induced movement therapy", Armbasistraining, Armfähigkeitstraining, neuromuskuläre Elektrostimulation, bilaterales und aufgabenspezifisches Training, mentales Training und transkranielle Stimulationsverfahren („repetitive transcranial magnetic stimulation" [rTMS], „transcranial direct current stimulation" [tDCS]).
Ergebnisse und Diskussion
Eine Reihe therapeutischer Verfahren mit geprüfter Wirksamkeit steht für die Armrehabilitation nach einem Schlaganfall zur Verfügung. Ihre differenzielle Indikationsstellung wird vorgestellt und mit einem Fazit für die Praxis verbunden.
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Wirksamkeit der neurologisch-neurochirurgischen Frührehabilitation
Zusammenfassung
Hintergrund
Nach Abschluss der Akutversorgung bei schweren neurologischen Erkrankungen werden Patienten in Deutschland in der neurologisch-neurochirurgischen Frührehabilitation (NNFR) frühzeitig und nahezu flächendeckend rehabilitiert.
Ziel der Arbeit
Die Wirksamkeit der NNFR wird unter dem Aspekt der evidenzbasierten Medizin hinterfragt, Outcome und Prognosefaktoren werden dargestellt.
Material und Methoden
Es wurde die aktuelle Literatur hinsichtlich der Effektivität der NNFR ab Evidenzstufe Ib mit besonderer Berücksichtigung von Outcome und Prognosefaktoren zusammengefasst.
Ergebnisse
Für die NNFR als komplexes Behandlungskonzept liegt ein Wirksamkeitsnachweis im Sinne der evidenzbasierten Medizin nicht vor, jedoch beinhaltet sie im Einzelnen wirksame Therapieformen. Die Behandlungsdauer in der NNFR betrug in zwei großen multizentrischen Studien im Mittel zwischen 51 und 57 Tagen. Die Sterblichkeit in der NNFR lag zwischen 6 % und 10 % und nahm mit Anteil an beatmeten Patienten zu. Treiber für ein gutes Outcome im Verlauf der NNFR waren ein geringer Unterstützungsbedarf bei Aufnahme und für ein schlechtes Outcome die Beatmungsnotwendigkeit. Indikatoren für ein schlechtes Outcome im Langzeitverlauf waren wiederum v. a. Beatmungspflicht, absaugpflichtiges Tracheostoma, beaufsichtigungspflichtige Schluckstörung, Vorhandensein einer PEG-Sonde und eine schwere Verständigungsstörung zum Ende der NNFR.
Diskussion
Aus diesen Prognosefaktoren ergeben sich als die primären Ziele die Reduktion des Unterstützungsbedarfes und die Herstellung der Rehafähigkeit. Werden diese Ziele erreicht, sind Rehabilitations- und Langzeitoutcome der Patienten der NNFR günstig. Die dargestellten Studien belegen die Nachhaltigkeit der NNFR im Gesamtbehandlungskonzept schwerst neurologisch erkrankter Patienten.
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Praktische Umsetzung eines integrierten Versorgungsmodells in der Mutter-Kind-Behandlung
Zusammenfassung
Im vorliegenden Artikel werden besondere Behandlungsoptionen der gemeinsamen Mutter-Kind-Versorgung bei Frauen mit postpartalen psychischen Erkrankungen dargestellt. Die Inzidenz postpartaler Erkrankungen ist hoch, für die postpartale Depression z. B. kann von Werten zwischen 10 % und 15 % ausgegangen werden. Nicht nur die betroffenen Frauen haben ein hohes Risiko negative Auswirkungen (wie z. B. Chronifizierung, Suizidalität) durch postpartale psychische Störungen zu erleiden, sondern auch die Kinder können von negativen Folgen im Sinne kognitiver Defizite und Verhaltensauffälligkeiten betroffen sein. Aus diesen Gründen ist es wichtig, auch unter den Gesichtspunkten einer primären Prävention bezogen auf die Kinder psychisch erkrankter Mütter eine bedarfsgerechte, zeitnahe und störungsspezifische interaktionale Therapie anzubieten, die auch langfristige Behandlungsaspekte berücksichtigt. In der Celenus Klinik Carolabad konnte ein integriertes Versorgungsmodell „Carola PLUS" etabliert werden, das dem besonders hohen Anspruch der gemeinsamen Versorgung und Therapie von Mutter und Kind Rechnung trägt.
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Environmental risk factors for autism spectrum disorders
Abstract
Background
Autism spectrum disorders (ASD) are syndromes that are predominantly defined by behavioral features such as impaired social interactions, restricted verbal and nonverbal communication, and repetitive or stereotyped behavior. In the past few decades, the reported prevalence of ASD has increased dramatically. This growth can be partially explained by an increased level of awareness of the problem among professionals and better diagnostic methods. Nevertheless, underpinning causes of ASD have not yet been detailed and explained. It is suggested that rather than having a single causative factor, ASD pathogenesis is influenced by environmental or genetic factors, or a combination of both. The aims of this review are to describe the environmental risk factors associated with ASD so as to provide a reference basis for current and future clinical and experimental work.
Materials and methods
On the basis of a PubMed search, we review the existing knowledge on environmental factors associated with ASD.
Results
A series of environmental factors have been repeatedly reported as risk factors for ASD in existing studies.
Conclusion
Air pollution, organic toxicants, seasonal factors, psychological stress, migration, birth order, and nutrition may have a close relationship with the incidence of ASD.
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Developing and Evaluating Multimedia Patient Education Tools to Better Prepare Prostate-Cancer Patients for Radiotherapy Treatment (Randomized Study)
Abstract
The purpose of this study is to determine the effectiveness of multimedia educational tools to improve CT planning preparation for intensity modulated radiotherapy (IMRT) for prostate cancer. Many patients are not prepared when given verbal preparation instructions to have a full bladder and empty rectum for their IMRT and require being rescanned, which results in additional costs for the patient and the hospital. A pamphlet and video outlining the proper preparation for prostate IMRT was created to decrease additional scans and the associated costs, while increasing patient satisfaction. A controlled, randomized experimental group study was conducted to examine the effectiveness of the multimedia tools (the video and the pamphlet), as compared to the pamphlet only, in preparing patients for their planning CT appointment. We found no statistical difference between the multimedia group and the pamphlet group in patients' preparedness for their appointments and the rescanning rate. However, patients in the multimedia group indicated that they felt more prepared about their treatment after watching the video and stated that they would recommend the video to other patients with prostate cancer. Furthermore, patients who had to wait longer for their planning CT appointment felt less prepared by the materials than those with a shorter wait time. We recommend reducing wait times between appointments as much as possible to increase patients' preparedness for the planning CT. We conclude that providing multimedia treatment information and minimizing wait times increases patients' feelings of preparedness leading to a more positive treatment experience and reducing costly rescans.
Trial registration: ClinicalTrials.gov NCT02410291
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Chemopreventive effect of Phaleria macrocarpa on colorectal cancer aberrant crypt foci in vivo
Publication date: 4 December 2016
Source:Journal of Ethnopharmacology, Volume 193
Author(s): Abdrabuh N. Shwter, Nor Azizan Abdullah, Mohammed A. Alshawsh, Hesham R. El-Seedi, Nawal A. Al-Henhena, Shaden A.M. Khalifa, Mahmood A. Abdulla
Ethnopharmacological relevanceNatural products are important ingredients for pharmaceutical applications specifically new entities for treating cancer and other diseases. Phaleria macrocarpa is native of Indonesia and considered as a prolific source of bioactive substances useful for chemoprevention.Aim of the studyTo investigate the chemopreventive properties of Phaleria macrocarpa on azoxymethane (AOM)-induced aberrant crypt foci (ACF) in rats.MethodsThe biological activities of the ethanol extract of P. macrocarpa fruits were evaluated both in vitro and in vivo. First the extract was investigated for its in vitro antioxidant activity by the total phenolic content and ferric reducing antioxidant power assay. Then the chemopreventive effect of P. macrocarpa was performed on AOM-induced aberrant crypt foci as colorectal carcinoma model in rats.Resultthe crude ethanolic extract of P. macrocarpa has high antioxidant activity and modulated the oxidative stress as proved by the up-regulation of glutathione-s-transferase and superoxide dismutase. Immunohistochemical staining of the treated sections showed overexpression of PCNA and Bax, reduced crypt sizes and numbers, indicating the characteristic feature of apoptotic cancer cells. PCNA is a landmark of cell damage and turn-over and can be associated with clinical cancer mutation. The most potent doses were 250mg/kg and 500mg/kg as compared to 35mg/kg 5-fluorouracil.ConclusionIn this sense, the potential modulation of the colorectal pathophysiological pathway by P. macrocarpa natural compounds mostly flavonoids offer a great possibility for the discovery of new leads towards the colorectal cancer.
Graphical abstract
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Protection from diclofenac-induced liver injury by Yulangsan polysaccharide in a mouse model
Publication date: 4 December 2016
Source:Journal of Ethnopharmacology, Volume 193
Author(s): Jianchun Huang, Vanphuc Nguyen, Xiaojun Tang, Jinbin Wei, Xing Lin, Zefeng Lai, Vanminh Doan, Qiuqiao Xie, Renbin Huang
Ethnopharmacological relevanceMillettia pulchra Kurz var-laxior (Dunn) Z. Wei, a wild-growing plant of the family Fabaceae is known to possess multifarious medicinal properties. Yulangsan polysaccharide (YLSPS) is a chief ingredient of its root, which has been used in Chinese traditional medicine with a long history for remedy of acute or chronic hepatitis and jaundice.Aim of the studyTo investigate the ability of the YLSPS to protect against diclofenac-induced hepatotoxicity in mice.Materials and methodsMice were orally treated with YLSPS daily 1h after the injection of diclofenac for 2 weeks. Dimethyl diphenyl bicarboxylate was used as a reference drug.ResultsYLSPS effectively reduced the elevated levels of serum alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase and enhanced the reduction of superoxide dismutase, catalase, and glutathione peroxidase activities in the liver. Moreover, the content of malondialdehyde was reduced by treatment with YLSPS, and histological findings also confirmed the anti-hepatotoxic activity. In addition, YLSPS significantly inhibited proinflammatory mediators, such as tumor necrosis factor-alpha and interleukin 1 beta. YLSPS also enhanced mitochondrial antioxidants and inhibited cell death by preventing the down-regulation of Bcl-2 and the up-regulation and release of Bax along with caspase 9 and 3 activity; thus, these findings confirm the involvement of mitochondria in diclofenac-induced apoptosis.ConclusionThe results indicate that protective effects of YLSPS against diclofenac-induced acute hepatic injury may rely on its effect on reducing oxidative stress, suppressing inflammatory responses, and improving drug-metabolizing enzyme activity in the liver.
Graphical abstract
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Diagnostic Accuracy of the Modified Evan’s Blue Dye Test in Detecting Aspiration in Patients with Tracheostomy: A Systematic Review of the Evidence
Abstract
Oropharyngeal aspiration (OPA) is a common occurrence in patients with tracheostomy. The modified Evan's blue dye test (MEBDT) is an easily administered bedside procedure for the assessment of tracheostomised patients. However, studies evaluating the diagnostic accuracy of the MEBDT reach conflicting results. Therefore, we conducted a systematic review to determine the overall accuracy of the MEBDT in detecting OPA in adults with tracheostomy. The search strategy incorporated searching electronic databases, checking reference lists and citations and retrieving unpublished data. Data of primary studies were extracted and examined by three independent reviewers. The assessment of the methodological quality of included studies was performed using the QUADAS-2 tool. Six studies met the inclusion criteria for this systematic review. The studies presented significant disparities in study design and patient characteristics. Furthermore, high discrepancies in the administration of MEBDT across studies were noted. Therefore, a meta-analysis was not considered appropriate. Sensitivity estimates varied widely across the studies (38–95 %), indicating that the MEBDT is unreliable in detecting OPA. However, the studies emerge with overall high specificity values, ranging from 79 to 100 %. This true negative rate suggests that the MEBDT correctly identifies patients without OPA. This review highlights the need for further research studies assessing the accuracy of the MEBDT in detecting aspiration in patients with tracheostomy, using a standardised and reliable procedure. Outcomes from such studies will update the current level of evidence in relation to the MEBDT and consequently define best clinical practice.
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Rodent Working Heart Model for the Study of Myocardial Performance and Oxygen Consumption
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Algorithmic approach to neuroendocrine tumors in targeted biopsies: Practical applications of immunohistochemical markers
Neuroendocrine tumors (NETs) constitute a heterogeneous group of neoplasms with distinct biological behaviors, depending on the site of origin and the degree of tumor proliferation. Although advances in biochemical and radiological modalities have enhanced the ability to detect NETs, tissue diagnosis remains the gold standard to assess tumor characteristics for treatment decision making. In an era with growing demands for precision diagnostics based on smaller tissue samples, immunohistochemistry has become an indispensable tool in the pathologist's repertoire. In conjunction with clinical findings and cytomorphology, complementary use of 1) markers of neuroendocrine differentiation, 2) markers confirming epithelial nature, 3) markers of cellular proliferation, 4) transcription factors and hormonal markers, as well as 5) predictive and prognostic markers may be necessary to guide patient management in NETs. The current review summarizes common applications of these immunohistochemical markers when confronted with a potential neuroendocrine neoplasm, and proposes a stepwise algorithmic approach to avoid diagnostic errors in targeted biopsies. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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