Medicine by Sfakianakis Alexandros: 07/26/17

Τετάρτη 26 Ιουλίου 2017

Optimising the surgical outcome in a case of post-traumatic cataract using ultrasound biomicroscopy

A 12-year-old boy was brought with the chief complaint of diminution of vision in his left eye for the past 1 month. History revealed a blunt trauma to his left eye with a wooden stick 6âweeks ago.Visual acuity was 20/20 and hand movement close to face in right and left eye, respectively, without any relative afferent pupillarydefect. Slit-lamp examination showed a total cataractous lens with signs suggestive of suspected posterior capsular (PC) defect. The PC defect was screened initially using B-scan ultrasound of the posterior segment, followed by confirmation of the same using ultrasound biomicroscopy. Left eye lens aspiration along with limited anterior vitrectomy followed by placement of multipiece intraocular lens in the sulcus was performed. Best-corrected visual acuity at 6 months of follow-up was 20/20.

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Giant oesophageal gastrointestinal stromal tumour presenting with dyspnoea and clubbed fingers

Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms of the gastrointestinal tract originating from the interstitial cells of Cajal. Giant oesophageal GISTs are rare since the oesophagus is rarely the primary site of GISTs, and they are usually diagnosed early due to complaints such as dysphagia. We present the case of a giant oesophageal GIST presenting with prominent clubbing. The case underlined the diagnostic importance of clubbing and the careful consideration of chemotherapy. Although clubbed fingers associated with GISTs are rare, our experience demonstrates the importance of physicians' recognition of clubbing as a paraneoplastic phenomenon for early diagnosis of malignancies since patients seldom notice their own clubbing by themselves. Chemotherapy using imatinib, an Bcr-Abl kinase inhibitor, is the standard option for unresectable giant GISTs. However, careful consideration must be made of the risk of complications associated with rapid mass reduction due to imatinib such as bleeding, oesophageal perforation and mediastinitis.

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Type I talon cusp on mandibular incisor

Description

Talon cusp is a comparably rare developmental dental anomaly assumed to arise because of evagination on the surface of a tooth crown during tooth calcification stage. Talon cusp also called as Eagle's is a well-defined extra cusp like structure located on lingual or palatal surface of deciduous or permanent anterior teeth. Its occurrence may be either unilateral or bilateral, single or multiple teeth in males or females. Prevalence of talon's cusp is reported to be between 0.06% to 7.7%. Eagle's talon is most commonly seen in maxillary lateral incisor >maxillary central incisor> maxillary canine> mandibular incisor.1

Mandibular talon cusp is a rare entity to occur. Mandibular talon cusps are more prevalent in men than women. Occurrence in talon cusp is more common in permanent dentition. Most of the mandibular talon cusp shows unilateral presentation. Talon cusp associated with permanent central incisor and primary lateral incisor...

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Between fire and ice: refractory hypothermia and warmth-induced pain in inherited erythromelalgia

Inherited erythromelalgia (IEM) is a well-described pain disorder caused by mutations of sodium channel Na_v1.7, a peripheral channel expressed within dorsal root ganglion and the sympathetic ganglion neurons. Clinically, IEM is characterised by paroxysmal attacks of severe pain, usually in the distal extremities, triggered by warmth or exercise. Pain is not adequately treated by existing pharmacological agents. Individuals with IEM classically cool their limbs for relief, in some cases resulting in tissue injury. We describe a patient from a family with IEM due to the L858F mutation of Na_v1.7 who presented with refractory hypothermia due to overcooling. This presentation of refractory hypothermia necessitating warming strategies, complicated by severe warmth-induced pain, posed a substantial therapeutic challenge. We report our experience in overcoming hypothermia lasting 3 weeks in a child with IEM, discuss possible pathophysiological mechanisms underlying this unusual complication and suggest potential therapeutic interventions.

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It Takes Two: One Resects, One Reconstructs

Care of patients with advanced head and neck cancer is a multidisciplinary effort through all phases of care. Head and neck cancer surgery involves balancing oncologic control, functional preservation, and aesthetics. Given the advances in free tissue reconstruction, the majority of defects can be reconstructed using free tissue transfer flaps. A 2-team approach allows for early, continual communication and meticulous operative planning. Operations can be combined into a single effort. This approach maximizes efficiency and enables multidisciplinary collaboration for comprehensive surgical treatment. We present our experience and an outline of how responsibilities between the ablative and reconstructive teams are shared.

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Multidisciplinary Approach to Head and Neck Cancer

The complexity of cancer care in the twenty-first century mandates the input of a spectrum of health care providers to achieve the best possible outcome. Head and neck cancer in particular occurs in an anatomical region unmatched in the number of physiological functions potentially affected with disease and treatment, including respiration, physical appearance, vocalization, gustation, olfaction, and alimentation. Further complicating treatment is the wide range of tumor types and tumor locations in head and neck cancer, all of which taken separately are relatively rare cancers.

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Systemic Treatment for Squamous Cell Carcinoma of the Head and Neck

In patients with locally advanced squamous cell cancer of the head and neck, a multimodality treatment approach is recommended. The addition of platinum-based systemic therapy concurrently with radiation has been shown to be superior to radiation alone and is considered standard therapy for locally advanced disease. No study has shown superiority of induction therapy followed by chemoradiotherapy versus chemoradiotherapy alone. In the adjuvant setting only patients with nodal extracapsular extension or positive margins seem to benefit from chemoradiotherapy versus radiotherapy alone. In the recurrent or metastatic setting, systemic treatment with chemotherapy is palliative. A subset of patients treated with PD-1 immunotherapy may achieve durable responses.

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Psychosocial Distress and Distress Screening in Multidisciplinary Head and Neck Cancer Treatment

Psychosocial distress screening (DS) for cancer and head and neck cancer (HNC) patients is rapidly becoming the standard of care. DS is of particular importance for patients with HNC, given their heightened incidence of distress, depression, anxiety, suicide, quality of life impacts, and negative medical outcomes. In the absence of DS, distress is frequently missed in oncology settings. However, when identified, distress is highly responsive to treatment, with cognitive behavioral and behavioral medicine interventions demonstrating evidence of efficacy. Multidisciplinary HNC teams are uniquely positioned to implement effective DS programs and treatment tailored to HNC patients' psychological and medical vulnerabilities.

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Survivorship

Survivorship encompasses the entire therapeutic, psychosocial, functional, and financial experience of living with and through a cancer diagnosis. The period of survivorship starts on the day of the cancer diagnosis and lasts until the end of the survivor's life, regardless of the cause of death. The National Cancer Institute's Office of Cancer Survivorship expands the term "survivor" to include, importantly, caregivers, family, and friends close to the survivor who also live through this period.

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CME Accreditation Page

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Immunotherapy

Recurrent and/or metastatic head and neck cancer portends a poor prognosis with traditional treatments, but current immunotherapy with immune checkpoint inhibitors has the potential to improve these clinical outcomes. This review focuses on the major breakthroughs that have led to the current understanding of immunotherapy in head and neck cancer as well as the future direction of the field. Ultimately, this understanding will guide clinicians on the selection of patients with head and neck cancer and practical considerations before starting immunotherapy.

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Copyright

Elsevier

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More than Just Mitoses: Complete Care of the Patient with Head and Neck Cancer

Dr Maie St John has put together a most comprehensive, readable "monograph" on care of the patient with head and neck cancer, in this issue of Otolaryngologic Clinics of North America.

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Sujana S. Chandrasekhar

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Th9 cells induce steroid-resistant bronchial hyperresponsiveness in mice

Publication date: Available online 26 July 2017
Source:Allergology International
Author(s): Mayumi Saeki, Osamu Kaminuma, Tomoe Nishimura, Noriko Kitamura, Akio Mori, Takachika Hiroi
BackgroundReduced responsiveness to corticosteroid therapy is a major problem for patients with severe asthma. Although Th9 cells, along with Th2 cells, facilitate antigen-induced airway eosinophilia and bronchial hyperresponsiveness (BHR), the sensitivity of Th9 cell-mediated responses to steroid therapy remains unknown. In this study, we investigated the effect of dexamethasone (Dex) on antigen-induced airway inflammation in Th9 cell-transferred mice.MethodsOvalbumin (OVA)-specific Th2 and Th9 cells were polarized from the CD4⁺ T cells of DO11.10/RAG-2^−/− mice. BALB/c mice were adoptively transferred with Th2 or Th9 cells and challenged with OVA. Dex treatment was performed twice, at 1 h before and at 24 h after the OVA challenge. Following treatment, the number of inflammatory cells in the bronchoalveolar lavage fluid and the bronchial responsiveness to inhaled methacholine were determined.ResultsIn both the Th2 and Th9 cell-transferred mice, substantial accumulation of eosinophils in the lungs and BHR were induced by challenge with the specific antigen. In the Th2 cell-transferred mice, these responses were significantly diminished by Dex treatment. In contrast, neither cellular infiltration nor BHR was affected by Dex treatment in the Th9 cell-transferred mice, although the Th9 cells substantially expressed glucocorticoid receptor α. Accordingly, antigen-induced interleukin-9 expression in the Th9 cells was attenuated by Dex treatment at least in vitro. Antigen-induced lung infiltration of infused Th2 cells but not Th9 cells was significantly suppressed by Dex.ConclusionsIn contrast to Th2-mediated responses, Th9-mediated airway inflammation was not affected by Dex. Th9 cells might be involved in the developmental mechanisms of steroid-resistant asthma.

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The effect of active components from citrus fruits on dentin MMPs

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Zhengya Liu, Fang Li, Ling Zhang, Haohan Yu, Fan Yu, Jihua Chen
ObjectivesThis study was aimed to evaluate the anti-matrix metalloproteinases (MMPs) ability of active components from citrus fruits (hesperetin: Hst, hesperidin: Hsd and naringenin: Nge).MethodsInactivation effects of citrus flavonoids (Hst, Hsd, Nge) at different concentrations on soluble collagenase were measured using a fluorometric assay. Matrix-bound endogenous MMPs activity was evaluated via dry mass loss and hydroxyproline (HYP) release of demineralized human dentin. Demineralized dentin beams were pretreated with 500μg/mL citrus flavonoids for 10min. Chlorhexidine (CHX) was used as inhibitor control. Beams pretreated with distilled water served as blank control. Dentin slabs were used for in situ zymography and evaluated under confocal microscopy. Ultrastructure of demineralized collagen fibers was exhibited by Transmission Electron Microscopy (TEM).ResultsCitrus flavonoids exhibited inactivation function on soluble MMPs and the extent of inactivation increased in a dose-dependent manner. The inactivation percent of citrus flavonoids reached above 90% at the concentration of 500μg/mL. Compared with control group, citrus flavonoids pretreated demineralized dentin beams exhibited less dry mass loss, lower hydroxyproline release and more intact collagen architecture after 15days storage. Dentin samples pretreated with citrus flavonoids showed lower enzymes activities in in situ zymography.ConclusionsHst, Hsd or Nge have anti-MMPs ability and can preserve dentin collagen from degradation.Clinical Significance: Hst, Hsd and Nge may have the potential to be used in dentin bonding systems and improve the resin-dentin bonding durability.

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Oral bexarotene for post-transplant cutaneous T-cell lymphoma

Abstract

Organ transplant recipients receiving immunosuppression have an increased risk of developing post-transplant lymphoproliferative diseases (PTLDs). Traditionally, PTLDs refer to Epstein-Barr virus (EBV)-induced B-cell lymphoma. However, post-transplant T-cell lymphoma may also occur and tends to have a poorer response to reduced immunosuppressive therapy. As such, additional therapy is often needed for post-transplant T-cell lymphoma, including post-transplant cutaneous T-cell lymphoma (PT-CTCL). We present only the third case of PT-CTCL occurring after liver transplantation. The patient was diagnosed with stage IB mycosis fungoides (MF). His lesions were refractory to multiple skin-directed therapies, and so he was given oral bexarotene 150 mg daily and his oral tacrolimus dose was decreased to 2 mg daily. Remarkably, his MF patches have demonstrated a complete response to oral bexarotene 75 mg daily without recurrence over 11 years of follow-up. He developed hypertriglyceridemia with bexarotene 150 mg, so his dose was decreased to 75 mg, without loss of response. Our report is the second to describe PT-CTCL demonstrating a long-term complete response to oral bexarotene. Given its anti-carcinogenic properties and favorable toxicity profile, oral bexarotene represents an appealing treatment option for PT-CTCL refractory to skin-directed therapies.

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Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience

To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea.

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Surgical considerations and safety of cochlear implantation in otitis media with effusion

To evaluate the effects of otitis media with effusion on surgical parameters, patient safety, perioperative and postoperative complications.

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Endoscopic contralateral transmaxillary approach for pterygoid process osteotomy in total maxillectomy: A technical case report

An approach for total maxillectomy with endoscopic transection of the pterygoid process via the contralateral maxillary sinus is described. In total maxillectomy, the resection of the pterygoid process of the sphenoid is a key step for successful resection. However, a conventional craniofacial approach requires extensive incision in the face, elevation of the lateral cheek flap. Even after elevation of the lateral cheek flap, visualization of this region is not good. An endoscopic approach through the contralateral maxillary sinus improved visualization of the pterygoid process, and osteotomy using a diamond-drilling bar was successfully performed.

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Unilateral Headache Status after Intra-Aortic Balloon Pump Placement

Introduction. Intra-aortic balloon pump (IABP) counterpulsation is a catheter-based treatment for coronary artery disease and decompensated heart failure to increase coronary blood flow and improve cardiac output. IABP is generally well tolerated, and complications are usually related to peripheral vasculature or red blood cell and platelet consumption. The usual insertion site via femoral artery renders the patient bedbound. Recently, axillary artery has been used in patients with atherosclerotic peripheral vascular disease and documented small arteries or in those awaiting transplant to ensure ambulation and prevent deconditioning. Case Report. We present a patient with ischemic cardiomyopathy and severe left ventricular dysfunction, awaiting Orthotropic Heart Transplant. His worsening intractable angina and dyspnea necessitated IABP placement via left axillary artery, significantly improving his condition. He subsequently experienced migraine-type persistent unilateral headache refractory to standard pain management. Multiple strategies were utilized to treat his pain, but the patient insisted that his pain commenced after IABP placement. Ultimately, the removal of the pump led to complete resolution with no recurrence. Conclusion. The authors hypothesize that the unilaterally directed blood flow and direct increase in cerebral perfusion from the intra-aortic balloon pump may have caused vasodilation of the extracranial arteries, leading to a persistent and debilitating headache in this susceptible patient.

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Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience

Publication date: Available online 26 July 2017
Source:Auris Nasus Larynx
Author(s): Sang Hyun Kwak, Ji Hoon Kim, Da Hee Kim, Jung Min Kim, Hyung Kwon Byeon, Won Shik Kim, Yoon Woo Koh, Se-Heon Kim, Eun Chang Choi
ObjectivesTo report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea.MethodsWe retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T).ResultsA total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, P<0.05). There were no significant differences in length of hospital stay or postoperative complications among groups.ConclusionThe Korean DRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system.Level of evidence4.

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Pathway discovery using transcriptomic profiles in adult-onset severe asthma

Publication date: Available online 26 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pieter-Paul Hekking, Matt J. Loza, Stelios Pavlidis, Bertrand De Meulder, Diane Lefaudeux, Fred Baribaud, Charles Auffray, Ariane H. Wagener, Paul Brinkman, Rene. Lutter, ArunaT. Bansal, Ana R. Sousa, Steve. Bates, Yannis Pandis, Louise J. Fleming, Dominique E. Shaw, Stephen J. Fowler, Y. Guo, Andrea Meiser, Kai Sun, Julie. Corfield, Peter. Howarth, Elisabeth H. Bel, Ian M. Adcock, K.F. Chung, Ratko Djukanovic, Peter J. Sterk
RationaleAdult-onset severe asthma is characterized by highly symptomatic disease despite high intensity asthma treatments. Understanding of the underlying pathways of this heterogeneous disease needed for the development of targeted treatments. Gene Set Variation Analysis (GSVA) is a statistical technique to identify gene profiles in heterogeneous samples.ObjectiveTo identify gene profiles associated with adult-onset severe asthma.MethodsThis was a cross-sectional, observational study in which adult patients with adult-onset of asthma (defined as starting at ≥18yrs old) as compared to childhood-onset severe asthma (<18 yrs) were selected from the U-BIOPRED cohort. Gene expression was assessed on the total RNA of induced sputum (n=83), nasal brushings (n=41), and endobronchial brushings (n=65) and biopsies (n=47) (Affymetrix HT HG-U133+ PM). GSVA was used to identify differentially enriched pre-defined gene signatures of leukocyte lineage, inflammatory and induced lung injury pathways.ResultsSignificant differentially enriched gene signatures in patients with adult-onset as compared to childhood-onset severe asthma were identified in nasal brushings (5 signatures), sputum (3 signatures) and endobronchial brushings (6 signatures). Signatures associated with eosinophilic airway inflammation, mast cells and group 3 innate lymphoid cells (ILC3) were more enriched in adult-onset severe asthma, whereas signatures associated with induced lung injury were less enriched in adult-onset severe asthma.ConclusionsAdult-onset severe asthma is characterized by inflammatory pathways involving eosinophils, mast cells and ILC3s. These pathways could represent useful targets for the treatment of adult-onset severe asthma.

Graphical abstract

Teaser

This study elucidates distinct gene profiles in adult-onset severe asthma compared to childhood-onset severe asthma. Identified gene profiles include those associated with eosinophils, ILC3s and mast cells, and may represent targets for new treatments.

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Liver disease predicts mortality in patients with XHIM but can be prevented by early hematopoietic stem cell transplantation

Publication date: Available online 26 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Vian Azzu, Lucinda Kennard, Beatriz Morillo-Gutierrez, Mary Slatter, J.David M. Edgar, Dinakantha S. Kumararatne, William JH. Griffiths

Teaser

In the largest detailed study of liver disease in X-linked immunodeficiency with hyper-IgM, we show that liver disease is commoner than generally recognized and that early hematopoietic stem cell transplantation may prevent liver disease progression and improve survival.

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Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study

Publication date: Available online 26 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Mari Sasaki, Jennifer J. Koplin, Shyamali C. Dharmage, Michael J. Field, Susan M. Sawyer, Vicki McWilliam, Rachel L. Peters, Lyle C. Gurrin, Peter J. Vuillermin, Jo Douglass, Angela Pezic, Maia Brewerton, Mimi L.K. Tang, George C. Patton, Katrina J. Allen
BackgroundRising rates of food-induced anaphylaxis have recently been shown in the adolescent age group, following earlier descriptions of a rise in children younger than 5 years. However, few population-based studies have examined the prevalence of food allergy in adolescence using objective measures such as oral food challenge (OFC).ObjectiveWe sought to determine the prevalence of food allergy among a population-based sample of 10- to 14-year-old adolescents using clinical evaluation including OFC to confirm the diagnosis.MethodsSchools were randomly selected from greater metropolitan Melbourne, Australia. Students aged 10 to 14 years, and their parents, were asked to complete a questionnaire regarding the adolescent's food allergy or food-related reactions. Clinic evaluation, which consisted of skin prick tests and OFC where eligible, was undertaken if students were suspected to have current food allergy from parent response. Among 9816 students assessed, 5016 had complete parent response and clinic evaluation when eligible. An additional 4800 students had student questionnaires only.ResultsThe prevalence of clinic-defined current food allergy based on history, sensitization data, and OFC results was 4.5% (95% CI, 3.9-5.1), with the most common food triggers being peanut, 2.7% (95% CI, 2.3-3.2), and tree nut, 2.3% (95% CI, 1.9-2.8). Among the additional group of 4800 adolescents who had only self-reported food allergy status available, the prevalence of self-reported current food allergy was 5.5% (95% CI, 4.9-6.2), with peanut, 2.8% (95% CI, 2.3-3.3), and tree nut, 2.3% (95% CI, 1.9-2.8), the most common.ConclusionsApproximately 1 in 20 10- to 14-year-old school students in Melbourne has current food allergy. This high prevalence suggests that the previously reported rise in food-induced anaphylaxis in this age group may reflect an increasing prevalence of food allergy rather than simply increased reporting of anaphylaxis.

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A partially hydrolyzed 100% whey formula and the risk of eczema and any allergy: an updated meta-analysis

Recently, the role of using hydrolyzed formula for the prevention of allergic disease has been questioned. However, not all hydrolyzed formulas are equal. The efficacy of each hydrolyzed formula should be esta...

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New UV-B Laser Promising for Vitiligo

Reuters Health Information

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Hemoglobin Himeji and inconsistent hemoglobin A1c values: a case report

Hemoglobin A1c is used to evaluate the glycemic control in patients with diabetes and is a risk marker for chronic complications of diabetes. Hemoglobin variants are reported to falsely lower or increase hemog...

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Hypercapnic respiratory failure during pregnancy due to polymyositis-related respiratory muscle weakness: a case report

Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-thre...

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Predictions of Speech Chimaera Intelligibility Using Auditory Nerve Mean-Rate and Spike-Timing Neural Cues

Abstract

Perceptual studies of speech intelligibility have shown that slow variations of acoustic envelope (ENV) in a small set of frequency bands provides adequate information for good perceptual performance in quiet, whereas acoustic temporal fine-structure (TFS) cues play a supporting role in background noise. However, the implications for neural coding are prone to misinterpretation because the mean-rate neural representation can contain recovered ENV cues from cochlear filtering of TFS. We investigated ENV recovery and spike-time TFS coding using objective measures of simulated mean-rate and spike-timing neural representations of chimaeric speech, in which either the ENV or the TFS is replaced by another signal. We (a) evaluated the levels of mean-rate and spike-timing neural information for two categories of chimaeric speech, one retaining ENV cues and the other TFS; (b) examined the level of recovered ENV from cochlear filtering of TFS speech; (c) examined and quantified the contribution to recovered ENV from spike-timing cues using a lateral inhibition network (LIN); and (d) constructed linear regression models with objective measures of mean-rate and spike-timing neural cues and subjective phoneme perception scores from normal-hearing listeners. The mean-rate neural cues from the original ENV and recovered ENV partially accounted for perceptual score variability, with additional variability explained by the recovered ENV from the LIN-processed TFS speech. The best model predictions of chimaeric speech intelligibility were found when both the mean-rate and spike-timing neural cues were included, providing further evidence that spike-time coding of TFS cues is important for intelligibility when the speech envelope is degraded.

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4-month omalizumab efficacy outcomes for severe allergic asthma: the Dutch National Omalizumab in Asthma Registry

Omalizumab is licensed as add-on therapy for patients with severe allergic asthma. Response is in most studies scored by the physician's global evaluation of treatment effectiveness (GETE). A good clinical and...

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Predictions of Speech Chimaera Intelligibility Using Auditory Nerve Mean-Rate and Spike-Timing Neural Cues

Abstract

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Amelanotic Melanoma, MC1R Status, and Prior Amelanotic Melanoma

This cohort study investigates whether phenotypic characteristics, carriage of MC1R variants, and history of amelanotic melanoma are associated with histopathologically amelanotic melanoma.

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Fractional CO 2 Laser Treatment of Elastosis Perforans Serpiginosa

This case report describes the use of carbon dioxide laser to treat a patient with elastosis perforans serpiginosa.

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Erythematous, Burning and Painful Scrotal Nodules

A man in his 60s who had been treating intertrigo of the groin with a combination of clotrimazole and hydrocortisone developed bright red, burning and painful nodules around his scrotum. What is your diagnosis?

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Melanoma Metastases Treated With Checkpoint Inhibitors and Multisite Radiotherapy

This study examines the treatment of patients with metastatic melanoma receiving multisite radiotherapy with in conjunction with immunotherapy.

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Missing Conflict of Interest Disclosure

In the article titled "Efficacy and Tolerance of Anti–Tumor Necrosis Factor α Agents in Cutaneous Sarcoidosis: A French Study of 46 Cases," a conflict of interest disclosure was missing. "Dr Chosidow received personal honorarium fees from Abbvie in 2016" has been added to the Conflict of Interest Disclosures paragraph in the end matter. This article was corrected online.

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Radiotherapy for Extremity and Trunk Merkel Cell Carcinoma After Resection

This cohort study analyzes the National Cancer Database records of patients with Merkel cell carcinoma treated with curative radiation therapy to evaluate the overall survival of 4 different radiation dose regimens.

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Risk Factors for Melanoma in Renal Transplant Recipients

This cohort study uses data from the United States Renal Data System to investigate risk factors and characteristics of renal transplant recipients who develop melanoma.

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American Academy of Dermatology (AAD) 2017 Summer Meeting

Read clinically focused news coverage of key developments from AAD 2017.
Medscape Dermatology

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Tube feeding during treatment for head and neck cancer – Adherence and patient reported barriers

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Teresa Brown, Merrilyn Banks, Brett G.M. Hughes, Charles Lin, Lizbeth Kenny, Judith Bauer
ObjectivesThe main aim was to investigate the incidence of patient adherence to nutritional tube feeding recommendations in patients with head and neck cancer and to determine patient barriers to meeting tube feeding prescription.Materials and methodsThis was an observational study from a randomised controlled trial in patients with head and neck cancer deemed at high nutritional risk with prophylactic gastrostomy (n=125). Patients were randomised to receive early tube feeding prior to treatment (intervention group) or standard care. All patients in the intervention and standard care groups then commenced clinical tube feeding as required during treatment. Patients maintained a daily record of gastrostomy intake, main nutrition impact symptom necessitating gastrostomy use, and reasons for not meeting nutrition prescription. Adherence was defined as meeting ≥75% of total prescribed intake.ResultsPatients were predominantly male (89%), median age 60, with oropharyngeal tumours (78%), stage IV disease (87%) treated with chemoradiotherapy (87%). Primary reasons for gastrostomy use were poor appetite/dysgeusia (week 2–3) and odynophagia/mucositis (week 4–7). Early tube feeding adherence was 51%. Clinical tube feeding adherence was significantly higher in the intervention group (58% vs 38%, p=0.037). Key barriers to both phases of tube feeding were; nausea, early satiety and treatment factors (related to hospital healthcare processes).ConclusionsEarly tube feeding can improve patient adherence to clinically indicated tube feeding during treatment. Low adherence overall is a likely explanation for clinically significant weight loss despite intensive nutrition interventions. Optimising symptom management and strategies to overcome other barriers are key to improving adherence.Clinical trial registration: This trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897.

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Post-operative therapy following transoral robotic surgery for unknown primary cancers of the head and neck

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Sapna A. Patel, Aarthi Parvathaneni, Upendra Parvathaneni, Jeffrey J. Houlton, Ron J. Karni, Jay J. Liao, Neal D. Futran, Eduardo Méndez
ObjectivesOur primary objective is to describe the post- operative management in patients with an unknown primary squamous cell carcinoma of the head and neck (HNSCC) treated with trans-oral robotic surgery (TORS).Materials & MethodsWe conducted a retrospective multi-institutional case series including all patients diagnosed with an unknown primary HNSCC who underwent TORS to identify the primary site from January 1, 2010 to June 30, 2016. We excluded those with recurrent disease, ≤6months of follow up from TORS, previous history of radiation therapy (RT) to the head and neck, or evidence of primary tumor site based on previous biopsies. Our main outcome measure was receipt of post-operative therapy.ResultsThe tumor was identified in 26/35 (74.3%) subjects. Post-TORS, 2 subjects did not receive adjuvant therapy due to favorable pathology. Volume reduction of RT mucosal site coverage was achieved in 12/26 (46.1%) subjects who had lateralizing tumors, ie. those confined to the palatine tonsil or glossotonsillar sulcus. In addition, for 8/26 (30.1%), the contralateral neck RT was also avoided. In 9 subjects, no primary was identified (pT0); four of these received RT to the involved ipsilateral neck nodal basin only without pharyngeal mucosal irradiation.ConclusionSurgical management of an unknown primary with TORS can lead to deintensification of adjuvant therapy including avoidance of chemotherapy and reduction in RT doses and volume. There was no increase in short term treatment failures. Treatment after TORS can vary significantly, thus we advocate adherence to NCCN guideline therapy post-TORS to avoid treatment-associated variability.

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Therapeutic Effects of Topical Tranexamic Acid in Comparison with Hydroquinone in Treatment of Women with Melasma

Abstract

Introduction

Few studies have focused on therapeutic as well as side effects of tranexamic acid (TXA) as a topical drug compared to other topical drugs in treating melasma. The present study aimed to assess and compare the beneficial therapeutic effects and also side effects of local TXA in comparison with hydroquinone in treating women with melasma.

Methods

This randomized double-blinded clinical trial was performed on 60 women who suffered from melasma and were referred to the skin disorders clinic at the Rasoul-e-Akram hospital in Tehran in 2015. The patients were then randomly assigned via computerized randomization to two groups: group A received TXA%5 (topically twice a day for 12 weeks in the location of the melasma) and group B (received hydroquinone 2% with the same treatment order). Prior to intervention and at 12 weeks after intervention, the intensity and extension of melasma were assessed based on the Melasma Area and Severity Index (MASI) scoring method.

Results

The mean MASI score in both treatment groups decreased considerably after completion of treatment and was not significant between the two groups. No side effects were detected in group A, but 10% of those in group B complained of drug-related side effects including erythema and skin irritation (p = 0.131). Regarding the level of patient satisfaction, the patients in group A had a significantly higher level of satisfaction level of 33.3% compared with 6.7% in group B (p = 0.015) (Fig. 9). Multivariate linear regression modeling with the presence of age, history of systemic disorder, drug history, and family history of melasma demonstrated no difference in the mean MASI between the two groups.

Conclusion

Topical use of TXA significantly reduced both melanin level and MASI score. Given its high efficiency and low drug side effects, this regimen results in high patient satisfaction compared with topical hydroquinone. IRCT code: IRCT2016040627220N2.

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The Burden of Chronic Urticaria from Brazilian Patients’ Perspective

Abstract

Introduction

Chronic urticaria (CU), a proxy for chronic spontaneous urticaria, has been associated with a negative impact on health-related quality of life (HRQoL) and costs, but there is limited evidence on the burden of CU in Brazil. The objective of this study was to estimate the prevalence of CU and assess the burden of CU on HRQoL and healthcare resource utilization (HRU) among adults in Brazil.

Methods

This retrospective, cross-sectional study, pooled data from the 2011, 2012, and 2015 National Health and Wellness Survey in Brazil (n = 36,000). Respondents (aged ≥18 years) diagnosed with and treated for CU provided data on demographics, health history, HRQoL (mental and physical health status) on Short-Form SF-36v2, presence of psychological complaints, work impairment, activity impairment, and HRU. Generalized linear models, controlling for covariates, examined differences between those treated for CU and matched controls on the outcome variables.

Results

The prevalence of diagnosed CU was 0.41% (n = 249) and treated CU was 0.21% (n = 127). After adjustments, CU (currently treated for CU) was associated with worse mental functioning, physical functioning, and health utilities compared with controls (all p < 0.01). CU had over twice the odds of anxiety and sleep difficulties, over 1.5 times the work and activity impairment, twice the number of total physician visits, eight times the number of allergist visits, and twice the number of emergency room visits as controls (all p < 0.01).

Conclusions

Many CU patients using prescription treatment experienced anxiety and sleep disturbances, poorer HRQoL, significant work and activity impairment, and high HRU, compared with matched general population controls. Findings suggest an unmet need for more effective treatment and management of CU in Brazil.

Funding

Novartis Pharma AG and Genentech.

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Long-term adverse effects of intramuscular oil injection

Description

A 33-year-old male former bodybuilder presented with painful deformities located to his arms. Roughly a decade ago, he had injected liquid paraffin into his biceps and triceps as a shortcut to achieve muscular enhancement. Today, some of the oil has descended to the forearms, leaving him with painful swellings (paraffinomas) (figure 1) and paraesthesia. MRI revealed localised intramuscular distribution of liquid paraffin in the upper arm muscles (figure 2) and diffuse and localised subcutaneous distribution in the forearms. The patient is currently reviewed regularly as an outpatient and is still able to work as an engineer. A careful history has not revealed any overt systemic complications related to the injections and, so far, he has not required active treatment for his condition.

Figure 1

Muscular hypertrophy and swellings (arrows) after liquid paraffin injection.

Figure...

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A Hollow-Structured CuS@Cu2S@Au Nanohybrid: Synergistically Enhanced Photothermal Efficiency and Photoswitchable Targeting Effect for Cancer Theranostics

It is of great importance in drug delivery to fabricate multifunctional nanocarriers with intelligent targeting properties, for cancer diagnosis and therapy. Herein, hollow-structured CuS@Cu₂S@Au nanoshell/satellite nanoparticles are designed and synthesized for enhanced photothermal therapy and photoswitchable targeting theranostics. The remarkably improved photothermal conversion efficiency of CuS@Cu₂S@Au under 808 nm near-infrared (NIR) laser irradiation can be explained by the reduced bandgap and more circuit paths for electron transitions for CuS and Cu₂S modified with Au nanoparticles, as calculated by the Vienna ab initio simulation package, based on density functional theory. By modification of thermal-isomerization RGD targeting molecules and thermally sensitive copolymer on the surface of nanoparticles, the transition of the shielded/unshielded mode of RGD (Arg-Gly-Asp) targeting molecules and shrinking of the thermally sensitive polymer by NIR photoactivation can realize a photoswitchable targeting effect. After loading an anticancer drug doxorubicin in the cavity of CuS@Cu₂S@Au, the antitumor therapy efficacy is greatly enhanced by combining chemo- and photothermal therapy. The reported nanohybrid can also act as a photoacoustic imaging agent and an NIR thermal imaging agent for real-time imaging, which provides a versatile platform for multifunctional theranostics and stimuli-responsive targeted cancer therapy.

A novel hollow CuS@Cu₂S@Au nanoshell/satellite structure is presented that can synergistically enhance photothermal therapy under 808 nm near-infrared irradiation and cooperative molecular conformation motion for photoswitchable targeting to U87MG cancer cells.

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Highly Luminescent 2D-Type Slab Crystals Based on a Molecular Charge-Transfer Complex as Promising Organic Light-Emitting Transistor Materials

A new 2:1 donor (D):acceptor (A) mixed-stacked charge-transfer (CT) cocrystal comprising isometrically structured dicyanodistyrylbenzene-based D and A molecules is designed and synthesized. Uniform 2D-type morphology is manifested by the exquisite interplay of intermolecular interactions. In addition to its appealing structural features, unique optoelectronic properties are unveiled. Exceptionally high photoluminescence quantum yield (Φ_F ≈ 60%) is realized by non-negligible oscillator strength of the S₁ transition, and rigidified 2D-type structure. Moreover, this luminescent 2D-type CT crystal exhibits balanced ambipolar transport (µ_h and µ_e of ≈10⁻⁴ cm² V⁻¹ s⁻¹). As a consequence of such unique optoelectronic characteristics, the first CT electroluminescence is demonstrated in a single active-layered organic light-emitting transistor (OLET) device. The external quantum efficiency of this OLET is as high as 1.5% to suggest a promising potential of luminescent mixed-stacked CT cocrystals in OLET applications.

A novel 2D-type slab crystal based on 2:1 donor:acceptor mixed-stacked charge-transfer (CT) complex is developed. Unique optoelectronic properties: balanced ambipolar transport (µ_e, µ_h ≈ 10⁻⁴ cm² V⁻¹ s⁻¹) and bright luminescence (Φ_F ≈ 60%) are successfully bridged in organic field-effect transistor (OFET) devices, demonstrating the first CT organic light-emitting transistors with high external quantum efficiency up to 1.5%.

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Edge Sites with Unsaturated Coordination on Core–Shell Mn3O4@MnxCo3−xO4 Nanostructures for Electrocatalytic Water Oxidation

Transition-metal oxides are extensively investigated as efficient electrocatalysts for the oxygen evolution reaction (OER). However, large-scale applications remain challenging due to their moderate catalytic activity. Optimized regulation of surface states can lead to improvement of catalytic properties. Here, the design of Mn@Co_xMn₃₋_xO₄ nanoparticles with abundant edge sites via a simple seed-mediated growth strategy is described. The unsaturated coordination generated on the edge sites of Co_xMn₃₋_xO₄ shells makes a positive contribution to the surface-structure tailoring. Density functional theory calculations indicate that the edge sites with unsaturated coordination exhibit intense affinity for OH⁻ in the alkaline electrolyte, which greatly enhances the electrochemical OER performance of the catalysts. The resulting Mn@Co_xMn₃₋_xO₄ catalysts yield a current density of 10 mA cm⁻² at an overpotential of 246 mV and a relatively low Tafel slope of 46 mV dec⁻¹. The successful synthesis of these metal oxides nanoparticles with edge sites may pave a new path for rationally fabricating efficient OER catalysts.

Mn@Co_xMn₃₋_xO₄ nanoparticles with abundant edge sites are designed and synthesized via a simple seed-mediated growth strategy. The edge sites with unsaturated coordination exhibit intense affinity for OH⁻ in the alkaline electrolyte, which greatly enhances the electrochemical oxygen evolution reaction performance.

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A rare case of an ectopic pregnancy in the rudimentary tube of a patient with an isolated unicornuate uterus

Uterine anomalies are relatively uncommon and go undiagnosed in many cases. Ectopic pregnancies have been reported in such patients, although rarely, in the non-communicating rudimentary horns of unicornuate uteri. However, the case presented is of an ectopic pregnancy in the rudimentary fallopian tube related to an undescended ovary in a patient with an isolated unicornuate uterus, a phenomenon which is extremely rare.

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Migration of intraocular silicone oil into brain

Description

An 84 -year-old woman was admitted following a slight mechanical fall while she was in her garden. She had banged the back of her head followed by a brief period of nausea and vomiting which was self-limiting.

One year before, the patient underwent surgical repair for retinal detachment of left eye with involvement of the macula. She underwent a vitrectomy, endolaser therapy and injection of silicone oil into the vitreous. There was no recovery of vision in the left eye. Medical history included hypertension and bilateral glaucoma.

On examination, she looked well. She had no light perception in the left eye and the visual acuity in the right eye was N10 on the near reading chart with normal peripheral fields of vision. She was managed conservatively but died shortly due to bowel ischaemia, that was unrelated to her presentation.

A CT scan of brain at presentation revealed hyperdensity in...

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Severe asymptomatic rhabdomyolysis complicating a mycoplasma pneumonia

Rhabdomyolysis is a very rare and serious extrapulmonary manifestation of a Mycoplasma pneumoniae infection. We describe a case of a 47-year-old male patient who presented with progressive dyspnoea, hypoxaemia and cough during the last 3 days. He had no relevant muscular complaints but was diagnosed with severe rhabdomyolysis for which he was treated with hyperhydration. Molecular diagnostics confirmed M. pneumoniae as the causative agent and our patient was successfully treated with doxycycline.

Only a few cases of rhabdomyolysis complicating a M. pneumoniae infection have been described, mostly in infants. In this case, typical suggestive complaints of rhabdomyolysis were absent suggesting that the complication might be underdiagnosed.

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Stroke of the inferiomedial temporal lobe causing word agnosia

A 69-year-old man presented with sudden loss of ability to recognise written words and remember the meaning of words and names. He could not name the town he lived in nor name his children. It was difficult for him to remember the meaning of concrete and abstract nouns. His speech fluency and understanding of casual talks were normal. He remembered that he had a conversation with his family that morning, but not the exact content. He was referred to the transient ischaemic attack clinic by his general practitioner as he scored low on the abbreviated mental test score. He underwent a brain MRI scan (T2 weighted, diffusion weighted and fluid-attenuated inversion recovery) which showed an acute infarction in the left medial temporal region affecting the fusiform and parahippocampal gyri. He also noticed that it was easier to retrieve numbers, for example, his mobile number. He recovered on waking up the next day.

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Barium aspiration through a tracheo-oesophageal fistula caused by percutaneous tracheostomy

Description

A healthy 43-year-old gravida 14, para 12+1 woman, developed Sheehan syndrome followed by disseminated intravascular coagulopathy and sepsis post-Caesarean section. Her postoperative course was further complicated by a hospital-acquired pneumonia for which she required endotracheal intubation and mechanical ventilation. Enteral feeding and medications were administered via a nasogastric tube (NGT). After three failed attempts at extubation, a tracheostomy was inserted percutaneously. Over the next 2 weeks, she improved and was successfully weaned off ventilatory support. She was transferred to a medical ward with the tracheostomy in situ with minimum oxygen requirement.

Her rehabilitation progressed slowly while the NGT was kept in situ in view of recurrent aspiration with oral intake. A barium study was performed via the NGT after she developed severe vomiting and CT of the abdomen was reported as normal. This demonstrated mild gastritis and delayed gastric emptying due to ileus. No immediate complications were apparent during...

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Discitis and Clostridium perfringens bacteraemia

The authors present a case involving an 80-year-old man with infectious T10/T11 discitis on the background of a recent Clostridium perfringens bacteraemia. This case report describes a case of probable C. perfringens discitis as further investigations failed to identify any causative agents. He was treated with intravenous piperacillin/tazobactam to good effect, achieving favourable clinical outcome. Diagnosis of discitis/osteomyelitis can often be delayed and mismanaged due to its non-specific presentations. Timing of empirical antimicrobial therapy requires careful consideration based on haemodynamic stability and neurological function to maximise microbiological yield.

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Muscular sarcocystosis: an index case in a native Malaysian

A previously healthy 20-year-old man presented with prolonged intermittent low grade fever and cough for 6months. He had bilateral calf pain and lower limb weakness 2days prior to admission. Physical examination revealed multiple enlarged lymph nodes with hepatomegaly. There was bilateral calf tenderness with evidence of proximal myopathy. Full blood picture showed lymphocytosis with reactive lymphocytes and eosinophilia. Creatine kinase and lactate dehydrogenase were markedly elevated. Over 2 weeks of admission, patient was treated symptomatically until the muscle biopsy of right calf revealed eosinophilic myositis with muscular sarcocystosis. He was treated with albendazole and high-dose corticosteroids. Symptoms subsided on reviewed at 2weeks and the dose of corticosteroid was tapered down slowly over a month. Due to poor compliance, he was readmitted 1month later because of relapsed. High-dose corticosteroid was restarted and duration for albendazole was prolonged for 1month. His symptom finally resolved over 2weeks.

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A complication of meningitis and infective endocarditis due to Streptococcus pyogenes

We described a rare case of meningitis and infective endocarditis (IE) due to Streptococcus pyogenes. An 80-year-old woman was admitted to our hospital with unconsciousness. Glasgow Coma Scale was E1V3M5. We diagnosed her with acute meningitis due to S. pyogenes and started treatment using ceftriaxone. In spite of the improvement of her unconscious state, she developed a new-onset systolic murmur on day 13, and echocardiography revealed severe mitral valve regurgitation with vegetation. Therefore, we also diagnosed her with IE and continued the antibiotics for 6 weeks after we confirmed the negative blood cultures. The patient was finally transferred to another hospital for rehabilitation 57 days after admission. Considering that the number of S. pyogenes infections has been reported to increase in Japan and worldwide, we need to be more careful about the rare complication of meningitis and IE due to S. pyogenes.

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Unusual case of odontogenic maxillary sinusitis

Description

A 76-year-old woman presented with intermittent infection around the upper right 2 (UR2) area of the maxilla for several years. She also complained of persistent rhinorrhoea and right-sided facial pain.

Seven years previously, she had presented with similar right maxillary pain, after undergoing root canal treatment of the UR2, 3 and 4 teeth. An orthopantomogram had shown uptake around the UR2 region (figure 1). There was a suspicion of retained tooth fragment, and she underwent a Caldwell-Luc procedure under local anaesthetic but no tooth fragment was identified at surgery.

Figure 1

Orthopantomogram.

Examination revealed a sinus draining buccally around UR2 and a fluctuant swelling of the palate. She was tender over the right maxilla. Nasal endoscopy did not demonstrate any purulent discharge from the right middle meatus.

A CT scan identified (1) opacification of the sinus, (2) a calcified...

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Long-term adverse effects of intramuscular oil injection

Description

Figure 1

Muscular hypertrophy and swellings (arrows) after liquid paraffin injection.

Figure...

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Johns Hopkins Researchers Present Findings at AIDS Meeting in Paris

Richard Chaisson, M.D., primary investigator of these studies and director of the Center for Tuberculosis Research at the Johns Hopkins University School of Medicine will be available at IAS 2017 to comment on this research.

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McCune Albright Syndrome (MAS) : polyostotic fibrous dysplasia

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A Double-Stimuli-Responsive Fluorescent Center for Monitoring of Food Spoilage based on Dye Covalently Modified EuMOFs: From Sensory Hydrogels to Logic Devices

Unsafe food is a huge threat to human health and the economy, and detecting food spoilage early is an ongoing and imperative need. Herein, a simple and effective strategy combining a fluorescence sensor and one-to-two logic operation is designed for monitoring biogenic amines, indicators of food spoilage. Sensors (methyl red@lanthanide metal–organic frameworks (MR@EuMOFs)) are created by covalently modifying MR into [BOND] NH₂-rich EuMOFs, which have a high quantum yield (48%). A double-stimuli-responsive fluorescence center is produced via energy transfer from the ligands to Eu³⁺ and MR. Portable sensory hydrogels are obtained by dispersing and solidifying MR@EuMOFs in water-phase sodium salt of carboxy methyl cellulose (CMC-Na). The hydrogels exhibit a color transition upon "smelling" histamine (HI) vapor. This transition and shift in the MR-based emission peak are closely related to the HI concentration. Using the HI concentration as the input signal and the two fluorescence emissions as output signals, an advanced analytical device based on a one-to-two logic gate is constructed. The four output combinations, NOT (0, 1), YES (1, 0), PASS 1 (1, 1), and PASS 0 (0, 0), allow the direct analysis of HI levels, which can be used for real-time food-freshness evaluation. The novel strategy suggested here may be a new application for a molecular logic system in the sensing field.

By covalently modifying COOH-rich methyl red (MR) to NH₂-rich lanthanide metal–organic frameworks, a double-stimuli-responsive fluorescent sensor for detection of biogenic amines is fabricated and an advanced analytical device based on a one-to-two logic gate is constructed for application in real-time monitoring of food spoilage when taking the concentration of the biogenic amine (HI) as the input signal.

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Measurement Error of a Simplified Protocol for Quantitative Sensory Tests in Chronic Pain Patients.

Measurement Error of a Simplified Protocol for Quantitative Sensory Tests in Chronic Pain Patients.

Reg Anesth Pain Med. 2017 Jul 24;:

Authors: Müller M, Biurrun Manresa JA, Limacher A, Streitberger K, Jüni P, Andersen OK, Curatolo M

Abstract
BACKGROUND AND OBJECTIVES: Large-scale application of Quantitative Sensory Tests (QST) is impaired by lacking standardized testing protocols. One unclear methodological aspect is the number of records needed to minimize measurement error. Traditionally, measurements are repeated 3 to 5 times, and their mean value is considered. When transferring QST to a clinical setting, reducing the number of records would be desirable to meet the time constraints encountered in a routine clinical environment and to reduce the testing burden to chronic pain patients. However, there might be a trade-off between measurement error and number of records. We determined the measurement error of a single versus the mean of 3 records of pressure pain detection threshold (PPDT), electrical pain detection threshold (EPDT), and nociceptive withdrawal reflex threshold (NWRT) in 429 chronic pain patients recruited in a routine clinical setting.
METHODS: We calculated intraclass correlation coefficients and performed a Bland-Altman analysis.
RESULTS: Intraclass correlation coefficients were all clearly greater than 0.75, and Bland-Altman analysis showed minute systematic errors with small point estimates and narrow 95% confidence intervals. Reducing the number of records from traditionally 3 to only 1 did not lead to relevant measurement error in PPDT, EPDT, or NWRT.
CONCLUSIONS: This study contributes to a standardized QST protocol, and based on the minimal measurement error of 1 single record of PPDT, EPDT, and NWRT, we submit to reduce the testing burden. This would allow saving time, resources, and patient discomfort.

PMID: 28742627 [PubMed - as supplied by publisher]

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Top Reviewers

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Eligibility for phase 3 clinical trials of systemic therapy in real-world patients with metastatic renal cell cancer managed in a rural region

Abstract

Previous research has identified disparities between urban and rural cancer care, including clinical trial access. Therefore, we addressed three different questions in patients with metastatic renal cell cancer managed according to national guidelines in a rural Norwegian standard practice setting. (1) How many patients would have been eligible for three recent landmark randomized clinical trials? (2) Is survival different between eligible and non-eligible patients receiving first-line systemic therapy? (3) Is survival different between eligible patients and published trial results? We performed a retrospective analysis of 101 consecutive patients (2006–2016). Only 52% of the patients were eligible for the first-line study of pazopanib versus sunitinib. The main reasons for violating inclusion or exclusion criteria were presence of brain metastases, absence of clear cell histology, and poor performance status. Even fewer patients were eligible for trials of nivolumab and cabozantinib in pre-treated patients. Eligible patients had significantly better survival than non-eligible patients, median 29.2 versus 8.5 months (p = 0.0001). These results confirm that many patients from rural practices do not fulfill all mandatory trial eligibility criteria. However, eligible patients managed according to national guidelines had survival outcomes in line with published first-line trial results.

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Data from a survey of Clostridium perfringens and Clostridium difficile shedding by dogs and cats in the Madrid region (Spain), including phenotypic and genetic characteristics of recovered isolates

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Sergio Álvarez-Pérez, José L. Blanco, Celine Harmanus, Ed J. Kuijper, Marta E. García
This article contains information related to a recent survey of the prevalence of fecal shedding of Clostridium perfringens and C. difficile by dogs and cats attended in veterinary clinics located in the Madrid region (Spain). Specifically, we provide detailed information about the clinics that participated in the survey, the demographic and clinic characteristics of recruited animals and the genetic and phenotypic characteristics (including antimicrobial susceptibility data), of recovered bacterial isolates.

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Geostatistical exploration of dataset assessing the heavy metal contamination in Ewekoro limestone, Southwestern Nigeria

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Kehinde D. Oyeyemi, Ahzegbobor P. Aizebeokhai, Hilary I. Okagbue
The dataset for this article contains geostatistical analysis of heavy metals contamination from limestone samples collected from Ewekoro Formation in the eastern Dahomey basin, Ogun State Nigeria. The samples were manually collected and analysed using Microwave Plasma Atomic Absorption Spectrometer (MPAS). Analysis of the twenty different samples showed different levels of heavy metals concentration. The analysed nine elements are Arsenic, Mercury, Cadmium, Cobalt, Chromium, Nickel, Lead, Vanadium and Zinc. Descriptive statistics was used to explore the heavy metal concentrations individually. Pearson, Kendall tau and Spearman rho correlation coefficients was used to establish the relationships among the elements and the analysis of variance showed that there is a significant difference in the mean distribution of the heavy metals concentration within and between the groups of the 20 samples analysed. The dataset can provide insights into the health implications of the contaminants especially when the mean concentration levels of the heavy metals are compared with recommended regulatory limit concentration.

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Sample preparation and electrochemical data of Co3O4 working electrode for seawater splitting

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Malkeshkumar Patel, Wang-Hee Park, Abhijit Ray, Joondong Kim, Jung-Ho Lee
In this data article, we presented the electrochemical data of the working electrode made of Co3O4 semi-transparent film. Electrochemically stable, porous nature of Kirkendall-diffusion grown Co3O4 films were applied to generate hydrogen from the seawater splitting (Patel et al., 2017) [1]. The data presented in this article includes the photograph of prepared samples, polarization curves for water oxidation and Tafel plot, linear sweep voltammetry measurements under the pulsed light condition in 0.1M Na2S2O3 electrolyte, and transient photoresponses with natural sea water. Moreover, seawater splitting using the Co3O4 working electrode is demonstrated.

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Proteogenomics data for deciphering Frankia coriariae interactions with root exudates from three host plants

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Guylaine Miotello, Amir Ktari, Abdellatif Gueddou, Imen Nouioui, Faten Ghodhbane-Gtari, Jean Armengaud, Maher Gtari
Frankia coriariae BMG5.1 cells were incubated with root exudates derived from compatible (Coriaria myrtifolia), incompatible (Alnus glutinosa) and non-actinorhizal (Cucumis melo) host plants. Bacteria cells and their exoproteomes were analyzed by high-throughput proteomics using a Q-Exactive HF high resolution tandem mass spectrometer incorporating an ultra-high-field orbitrap analyzer. MS/MS spectra were assigned with two protein sequence databases derived from the closely-related genomes from strains BMG5.1 andDg1, the Frankia symbiont of Datisca glomerata. The tandem mass spectrometry data accompanying the manuscript describing the database searches and comparative analysis (Ktari et al., 2017, http://ift.tt/2v7AH7h) [1] have been deposited to the ProteomeXchange with identifiers PXD005979 (whole cell proteomes) and PXD005980 (exoproteome data).

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Whole transcriptome data of primary human NK cells under hypoxia and interleukin 15 priming: A 2×2 factorial design experiment

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Ana Sofia Figueiredo, Doreen Killian, Jutta Schulte, Carsten Sticht, Holger A. Lindner
Natural Killer (NK) cells mediate innate immunity against cancer and intracellular infection, at that, operating in often oxygen-deprived environments. We performed a microarray experiment with a 2×2 factorial design to profile gene expression in human NK cells (Velasquez et al., 2016) [1]. In this experiment, NK cells from 5 healthy volunteers were primed or not for 6h with the survival factor and inflammatory cytokine interleukin 15 (IL-15) under hypoxic or normoxic culture conditions (20 samples in total). Here, we provide details on the culture setup that govern the actual O2 partial pressure (pO2) experienced by the cells, as well as on the RNA extraction procedure used, which we optimized from commercial spin column protocols to obtain highly concentrated total RNA. We present a quality control analysis of the normalized microarray data, as well as overviews for differentially regulated genes. These data provide insights into NK cell transcriptional responses to immune stimulation under physiologically relevant low oxygen conditions. This dataset is deposited in the Gene Expression Omnibus database (accession number GSE70214).

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Biochemical characteristics of a free cyanide and total nitrogen assimilating Fusarium oxysporum EKT01/02 isolate from cyanide contaminated soil

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Enoch A. Akinpelu, Adewole T. Adetunji, Seteno K.O. Ntwampe, Felix Nchu, Lukhanyo Mekuto
Sustainability of nutrient requirements for microbial proliferation on a large scale is a challenge in bioremediation processes. This article presents data on biochemical properties of a free cyanide resistant and total nitrogen assimilating fungal isolate from the rhizosphere of Zeamays (maize) growing in soil contaminated with a cyanide-based pesticide. DNA extracted from this isolate were PCR amplified using universal primers; TEF1-α and ITS. The raw sequence files are available on the NCBI database. Characterisation using biochemical data was obtained using colorimetric reagents analysed with VITEK^® 2 software version 7.01. The data will be informative in selection of biocatalyst for environmental engineering application.

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Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Mary Clyde Pierce, Kim Kaczor, Deborah Acker, Tina Webb, Allen Brenzel, Douglas J. Lorenz, Audrey Young, Richard Thompson
This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article "History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse" (Pierce et al., 2017) [1].

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Data regarding the growth of Lactobacillus acidophilus NCFM on different carbohydrates and recombinant production of elongation factor G and pyruvate kinase

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Hasan Ufuk Celebioglu, Sita Vaag Olesen, Kennie Prehn, Sampo J. Lahtinen, Susanne Brix, Maher Abou Hachem, Birte Svensson
The present study describes the growth of the very well-known probiotic bacterium Lactobacillus acidophilus NCFM on different carbohydrates. Furthermore, recombinant production of putative moonlighting proteins elongation factor G and pyruvate kinase from this bacterium is described. For further and detailed interpretation of the data presented here, please see the research article "Mucin- and carbohydrate-stimulated adhesion and subproteome changes of the probiotic bacterium Lactobacillus acidophilus NCFM" (Celebioglu et al., 2017) [1].

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Estimates of average energy requirements in Bangladesh: Adult Male Equivalent values for use in analyzing household consumption and expenditure surveys

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Jillian L. Waid, Jessica R. Bogard, Shakuntala H. Thilsted, Sabine Gabrysch
This dataset contains Adult Male Equivalent (AME) values for use in Bangladesh. These were constructed using prescriptive nutritional constructs adapted to the actual growth and weight pattern seen in Bangladesh. This dataset provides a common base to facilitate for future work with household consumption and expenditure data in Bangladesh while updating the average energy requirements for infants and young children for the WHO 2006 growth standards and 2007 growth reference curves.

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Primary pituitary tubercular abscess as a differential diagnosis for sellar suprasellar mass.

Primary pituitary tubercular abscess as a differential diagnosis for sellar suprasellar mass.

Br J Neurosurg. 2017 Jul 25;:1-2

Authors: Pamidimukkala V, Sahebrao Mandwe D, K SR, Batsala H

Abstract
Only four cases of primary pituitary tubercular abscess have been reported. A 20-year-old ladypresented to us with headache and pituitary dysfunction. Radiology showedsellar tubercular abscess with suprasellar extension. Microscopic examination of pus collected during surgery showed granulomatous tissues and Acid Fast Bacilli. The response to antitubercular therapy was remarkable.

PMID: 28741962 [PubMed - as supplied by publisher]

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Computed Tomography Score an Excellent Marker: Differentiates Eosinophilic and Non-eosinophilic Variants of Chronic Rhinosinusitis with Nasal Polyp

Abstract

Eosinophilic and non-eosinophilic subtypes of chronic rhinosinusitis with nasal polyp (CRSwNP) have different clinical profile and management. Currently the 2 subtypes are differentiated based on tissue eosinophilic infiltration, which is identified after surgery by histopathological examination. Hence this study was conducted to compare utility of computed tomography (CT) scans, serum IgE levels, absolute eosinophil count (AEC) and Sino-nasal Outcome Test (SNOT)-20 score for discriminating the 2 subtypes. In this prospective study of 1 year duration, patients suspected of CRSwNP were recruited. Serum IgE levels and AEC estimation were performed by ELISA and standard numerical formula respectively, along with histopathological examination of nasal polyp biopsies. CT score and ratio of CT score for ethmoid sinus and maxillary sinus (E/M ratio) were calculated. Patients were asked to fill SNOT-20 questionnaire. Receiver-operating characteristic (ROC) curve analysis was performed. Out of 52 patients studied, 38 and 14 were no. of eosinophilic and non-eosinophilic CRSwNP cases respectively on the basis of histopathological examination. E/M ratio and overall CT score were found to be highly accurate with area under ROC curve of 0.990 and 0.964 respectively, while rest 3 parameters had low accuracy. Optimal cut-off of CT score and E/M ratio for eosinophilic CRSwNP were 6 and 2.065 respectively. This study demonstrated E/M ratio and total CT score as the most useful surrogate markers for preoperative differentiation of eosinophilic and non-eosinophilic CRSwNP, and hence can be used to predetermine postoperative management before surgery.

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Maintaining Distinctiveness at Increased Speaking Rates: A Comparison between Congenitally Blind and Sighted Speakers

Objectives: The effects of increased speaking rates on vowels have been well documented in sighted adults. It has been reported that in fast speech, vowels are less widely spaced acoustically than in their citation form. Vowel space compression has also been reported in congenitally blind speakers. The objective of the study was to investigate the interaction of vision and speaking rate in adult speakers. Patients and Methods: Contrast distances between vowels were examined in conversational and fast speech produced by 10 congenitally blind and 10 sighted French-Canadian adults. Acoustic analyses were carried out. Results: Compared with the sighted speakers, in the fast speaking condition, the blind speakers produced more vowels with contrast along the height, place of articulation, and rounding features located within the auditory target regions typical of French vowels. Conclusion: Blind speakers relied more heavily than sighted speakers on auditory properties of vowels to maintain perceptual distinctiveness.
Folia Phoniatr Logop 2016;68:232-238

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Piezoelectric Material - A Promising Approach for Bone and Cartilage Regeneration

Publication date: Available online 25 July 2017
Source:Medical Hypotheses
Author(s): Namdev More, Govinda Kapusetti
Bone and cartilage are major weight-bearing connective tissues in human and possesses utmost vulnerability for degeneration. The potential causes are mechanical trauma, cancer and disease condition like osteoarthritis and osteoporosis, etc. The regeneration/ repair is a challenging, since their complex structures and activities. Current treatment options comprise of auto graft, allograft, artificial bone substituent, autologous chondrocyte implantation, mosaicplasty, marrow stimulation and tissue engineering. Were incompetent to overcome the problem like abandoned growth factor degradation, indistinct growth factor dose and lack of integrity and mechanical properties in regenerated tissues. Present, paper focuses on the novel hypothesis for regeneration of bone and cartilage by using piezoelectric smart property of scaffold material.

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Physical functioning and activities of daily living in adults with amyoplasia, the most common form of arthrogryposis. A cross-sectional study.

Physical functioning and activities of daily living in adults with amyoplasia, the most common form of arthrogryposis. A cross-sectional study.

Disabil Rehabil. 2017 Jul 24;:1-13

Authors: Steen U, Wekre LL, Vøllestad NK

Abstract
BACKGROUND: Amyoplasia, the most common form of arthrogryposis is characterized by typical deformities of the joints and replacement of skeletal muscles by fibrous tissue and fat. There is sparse literature on adaptation to adult life with amyoplasia.
PURPOSE: To describe physical function and activity strategies in adults with amyoplasia, as this knowledge is important for relevant function-enhancing measures.
MATERIALS AND METHODS: Twenty-two adults (20-91 years) with amyoplasia participated. Demographic factors and clinical history were registered. Body proportions were measured. Joint mobility and muscle strength in the upper limbs were examined. The Functional Independent Measure was used to assess performance of activities of daily living. Compensatory strategies were described.
RESULTS: The majority had undergone comprehensive conservative and surgical treatment. Mean height was below typical. Range of motion was below lower limit of normal in most joints, passive range of motion was mainly larger than active. Muscle strength was reduced for most movements. Seven were independent in all activities. Need of assistance was highest regarding bathing and dressing. A variety of compensatory strategies were used.
CONCLUSIONS: Adults with amyoplasia are heterogeneous regarding function. Independence in everyday life requires a combination of muscle strength to move against gravity, ability to passive joint motion, and use of compensatory strategies. Implications for rehabilitation The ability to joint motion in the upper extremities is essential for independency in activities of daily living, especially when the muscle strength is impaired. Training of muscle strength is recommended, whenever possible, as muscle strength to move against gravity makes the performing of everyday tasks easier. The use of compensatory techniques, adaptions to the environment and relevant, often custom made, assistive devices is required to perform activities of daily living. Living an active life with physical challenges like in amyoplasia requires flexible and individually adapted solutions.

PMID: 28738752 [PubMed - as supplied by publisher]

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Computed Tomography Score an Excellent Marker: Differentiates Eosinophilic and Non-eosinophilic Variants of Chronic Rhinosinusitis with Nasal Polyp

Abstract

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Foxp3 expression in lymph node metastases in patients with head and neck cancer.

Foxp3 expression in lymph node metastases in patients with head and neck cancer.

Acta Otolaryngol. 2017 Jul 25;:1-5

Authors: Boduc M, Roessler M, Mandic R, Netzer C, Güldner C, Walliczek-Dworschak U, Stuck BA, Mandapathil M

Abstract
INTRODUCTION: The prevalence and activity of regulatory T cells in patients with cancer correlates with poor prognosis. These cells are characterized by their expression of Forkhead box protein-3 (Foxp3). Squamous cell carcinoma is the most prevalent type of cancer in the head and neck region with overall poor survival rates, also due to early spread of metastatic cells.
MATERIAL AND METHODS: Primary tumor specimens as well as lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of Foxp3 expression. Demographics, diagnoses, histopathology and subsequent outcome were analyzed.
RESULTS: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10) with the following tumor locations: oral cavity n = 16, oropharynx n = 28, hypopharynx n = 11 and larynx n = 10 (Stage III n = 18; Stage IVA n = 45; Stage IVB n = 2). The H-score for Foxp3 expression in the primary lesion as well as metastatic lymph nodes was significantly higher in advanced stages compared to early stages with differences among tumor locations, which were not significant. High Foxp3 expression was associated with inferior overall survival rates at a mean follow-up of 83.4 months (6-204 months) Conclusions: Foxp3 expression in HNSCC varied from the anatomical site and correlated positively with tumor stage and was associated with poor prognosis. Therefore, Foxp3 expressions in primary lesions as well as lymphogenic metastases appear to predict high-risk HSNCC patients. Novel therapeutic approaches targeting Foxp3(+) cells might seem promising for this patient population.

PMID: 28741409 [PubMed - as supplied by publisher]

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Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy.

Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy.

Acta Otolaryngol. 2017 Jul 25;:1-5

Authors: Hernández-García E, San-Román JJ, González R, Nogueira A, Genol I, Stoica B, Toledano N, Plaza G

Abstract
BACKGROUND: To determine the clinical outcomes and morbidity of endoscopic medial wall combined with transcutaneous lateral orbital wall decompression in Graves' orbitopathy.
METHODOLOGY: A retrospective noncomparative case series of patients who underwent surgical decompression for Graves' orbitopathy at Hospital Universitario de Fuenlabrada between 2004 and 2014 was performed. We reviewed the patients' charts and analyzed before and after the decompression, the visual acuity (Snellen chart), optic nerve compression (fundoscopy and optic coherence tomography), exophthalmometry (Hertel measurement), ocular motility, diplopia, eyelid surgery needed after decompression and its possible complications.
RESULTS: A total of 20 patients (36 orbits) were operated. The mean follow-up was 44 months (range 18-84). Vision improved dramatically in all compressive optic neuropathy cases (5 cases). Hertel measurements improved on average 3.5 mm (range 1.5-4.5). Diplopia was cured in eight patients (40%) and nine patients with severe preoperative diplopia required strabismus surgery after decompression. Eyelid surgery was further needed in 13 patients. Hyaluronic acid injection was the most used technique for the treatment of eyelid retraction (6 out of 13 patients). Only two major complications were observed: one case had a major post-operative epistaxis and another a cerebrospinal fluid leak. Both were resolved without further sequelae.
CONCLUSIONS: These results suggest that endoscopic medial wall combined with transcutaneous lateral wall orbital decompression is an effective and safe treatment for the symptomatic dysthyroid eye disease with important proptosis or compressive optic neuropathy.

PMID: 28741406 [PubMed - as supplied by publisher]

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Comparative study between the caloric vestibular and the video-head impulse tests in unilateral Menière's disease.

Comparative study between the caloric vestibular and the video-head impulse tests in unilateral Menière's disease.

Acta Otolaryngol. 2017 Jul 25;:1-5

Authors: Cordero-Yanza JA, Arrieta Vázquez EV, Hernaiz Leonardo JC, Mancera Sánchez J, Hernández Palestina MS, Pérez-Fernández N

Abstract
OBJECTIVE: Compare the caloric vestibular test (CVT) and the video head impulse test (vHIT) in the evaluation of Meniere's disease (MD) and to analyze their diagnostic accuracy.
MATERIALS AND METHODS: Retrospective review of CVT and vHIT performed in MD patients at a tertiary care referral center in Spain.
RESULTS: A total of 88 patients were reviewed. The CVT was abnormal in 67% (n = 59) of patients, while the vHIT was abnormal in 66% (n = 58) of them. Agreement between both tests was poor, regardless of whether the horizontal semicircular canal (SCC) or all SCC were analyzed (kappa = .21). Anterior SCC pathology was found in 30% (n = 27) of the subjects while 51% (n = 45) had altered gains in the posterior SCC.
CONCLUSIONS: Our study shows that patients with MD can have functional deficit involving the vertical semicircular canals, which cannot be detected by the CVT alone. Therefore, both tests should be used in a complementary fashion.

PMID: 28741403 [PubMed - as supplied by publisher]

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Robot-Applied Resistance Augments the Effects of Body Weight-Supported Treadmill Training on Stepping and Synaptic Plasticity in a Rodent Model of Spinal Cord Injury.

Robot-Applied Resistance Augments the Effects of Body Weight-Supported Treadmill Training on Stepping and Synaptic Plasticity in a Rodent Model of Spinal Cord Injury.

Neurorehabil Neural Repair. 2017 Jul 01;:1545968317721016

Authors: Hinahon E, Estrada C, Tong L, Won DS, de Leon RD

Abstract
BACKGROUND: The application of resistive forces has been used during body weight-supported treadmill training (BWSTT) to improve walking function after spinal cord injury (SCI). Whether this form of training actually augments the effects of BWSTT is not yet known.
OBJECTIVE: To determine if robotic-applied resistance augments the effects of BWSTT using a controlled experimental design in a rodent model of SCI.
METHODS: Spinally contused rats were treadmill trained using robotic resistance against horizontal (n = 9) or vertical (n = 8) hind limb movements. Hind limb stepping was tested before and after 6 weeks of training. Two control groups, one receiving standard training (ie, without resistance; n = 9) and one untrained (n = 8), were also tested. At the terminal experiment, the spinal cords were prepared for immunohistochemical analysis of synaptophysin.
RESULTS: Six weeks of training with horizontal resistance increased step length, whereas training with vertical resistance enhanced step height and movement velocity. None of these changes occurred in the group that received standard (ie, no resistance) training or in the untrained group. Only standard training increased the number of step cycles and shortened cycle period toward normal values. Synaptophysin expression in the ventral horn was highest in rats trained with horizontal resistance and in untrained rats and was positively correlated with step length.
CONCLUSIONS: Adding robotic-applied resistance to BWSTT produced gains in locomotor function over BWSTT alone. The impact of resistive forces on spinal connections may depend on the nature of the resistive forces and the synaptic milieu that is present after SCI.

PMID: 28741434 [PubMed - as supplied by publisher]

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Foxp3 expression in lymph node metastases in patients with head and neck cancer.

Foxp3 expression in lymph node metastases in patients with head and neck cancer.

Acta Otolaryngol. 2017 Jul 25;:1-5

Authors: Boduc M, Roessler M, Mandic R, Netzer C, Güldner C, Walliczek-Dworschak U, Stuck BA, Mandapathil M

PMID: 28741409 [PubMed - as supplied by publisher]

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Using low-dose radiation to potentiate the effect of induction chemotherapy in head and neck cancer: Results of a prospective phase 2 trial.

Using low-dose radiation to potentiate the effect of induction chemotherapy in head and neck cancer: Results of a prospective phase 2 trial.

Adv Radiat Oncol. 2016 Oct-Dec;1(4):252-259

Authors: Arnold SM, Kudrimoti M, Dressler EV, Gleason JF, Silver NL, Regine WF, Valentino J

Abstract
PURPOSE: Low-dose fractionated radiation therapy (LDFRT) induces effective cell killing through hyperradiation sensitivity and potentiates effects of chemotherapy. We report our second investigation of LDFRT as a potentiator of the chemotherapeutic effect of induction carboplatin and paclitaxel in locally advanced squamous cell cancer of the head and neck (SCCHN).
EXPERIMENTAL DESIGN: Two cycles of induction therapy were given every 21 days: paclitaxel (75 mg/m(2)) on days 1, 8, and 15; carboplatin (area under the curve 6) day 1; and LDFRT 50 cGy fractions (2 each on days 1, 2, 8, and 15). Objectives included primary site complete response rate; secondary included overall survival, progression-free survival (PFS), disease-specific survival, and toxicity.
RESULTS: A total of 24 evaluable patients were enrolled. Primary sites included oropharynx (62.5%), larynx (20.8%), oral cavity (8.3%), and hypopharynx (8.3%). Grade 3/4 toxicities included neutropenia (20%), leukopenia (32%), dehydration/hypotension (8%), anemia (4%), infection (4%), pulmonary/allergic rhinitis (4%), and diarrhea (4%). Primary site response rate was 23/24 (95.8%): 15/24 (62.5%) complete response, 8/24 (33.3%) partial response, and 1/24 (4.2%) stable disease. With median follow-up of 7.75 years, 9-year rates for overall survival were 49.4% (95% confidence interval [CI], 30.5-79.9), PFS was 72.2% (CI, 55.3-94.3), and disease-specific survival was 65.4% (44.3-96.4).
CONCLUSION: Chemopotentiating LDFRT combined with paclitaxel and carboplatin is effective in SCCHN and provided an excellent median overall survival of 107.2 months, with median PFS not yet reached in this locally advanced SCCHN cohort. This compares favorably to prior investigations and caused fewer grade 3 and 4 toxicities than more intensive, 3-drug induction regimens. This trial demonstrates the innovative use of LDFRT as a potentiator of chemotherapy.

PMID: 28740895 [PubMed]

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The larynx ruler to measure height and profile of vocal folds: a proof of concept.

The larynx ruler to measure height and profile of vocal folds: a proof of concept.

Med Devices (Auckl). 2017;10:149-155

Authors: Desuter G, Mertens B, Delchambre A, van Lith-Bijl J, van Benthem PP, Sjögren E

Abstract
INTRODUCTION: Glottic leakage during phonation is a direct consequence of unilateral vocal fold (VF) paralysis. This air leakage can be in the horizontal plane and in the vertical plane. Presently, there is no easily applicable medical device allowing noninvasive, office-based measurement of the relative vertical position of the VFs. The larynx ruler (LR) is a laser-based measuring device that could meet the previously stated need, using a flexible endoscope. This study represents a proof of concept regarding the use of the LR in assessing VF relative positions in the vertical plane.
MATERIALS AND METHODS: One fresh male human cadaver larynx, free of neurologic and anatomic disease, was explored with the LR system through the operative channel of a flexible gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated. Tilting of the VF was obtained by pulling or pushing the arytenoid cartilage with a mosquito forceps fixed to the stump of the previously sectioned superior tip of the posterior crico-arytenoid muscle allowing anterior and posterior tilting of the arytenoid cartilage in order to induce an elevation or a depression of the VF process. Ten "push" and ten "pull" sessions were performed. The distance from the tip of the video-endoscope to each illuminated pixel of the laser beam was recorded. The level difference between the left and right VFs was measured for each recording.
RESULTS: Data provided by the LR were consistently in accordance with the movements applied on the VFs. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the human larynx.
CONCLUSION: The LR system represents a feasible technique to evaluate respective vertical position of VFs in the human larynx. Technical limitations were identified that will require improvements before experimental use on human beings.

PMID: 28740437 [PubMed]

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The treatment and outcome analysis of primary squamous cell carcinoma of the thyroid.

The treatment and outcome analysis of primary squamous cell carcinoma of the thyroid.

Auris Nasus Larynx. 2017 Jul 21;:

Authors: Yasumatsu R, Sato M, Uchi R, Nakano T, Hashimoto K, Kogo R, Taura M, Matsuo M, Nakashima T, Nakagawa T

Abstract
OBJECTIVES: Primary squamous cell carcinoma (SCC) of the thyroid is a rare disease. It usually presents with locally advanced disease and has an overall poor prognosis. In this study, we investigated the characteristics and outcomes of patients with SCC of the thyroid, and reported our experience with chemotherapy with lenvatinib in the treatment of SCC of the thyroid.
METHODS: The management outcome of 10 patients who had SCC of the thyroid between January 2000 and 2015 at Kyushu University Hospital or associated facilities was reviewed.
RESULTS: There were 3 males and 7 females, ranging in age from 53 to 77 years. Extent of disease was staged as follows: stage IVA, 3 cases; stage IVB, 3 cases; stage IVC, 4 cases. Only tracheostomy was applied for 2 cases, surgical resection, such as total thyroidectomy and neck dissection, for the other 8 cases. Radiotherapy following surgical treatment was applied for 9 cases. Four patients started on oral lenvatinib due to recurrent or progressive SCC of the thyroid. The one year actuarial survival rate of patients was 22.7%. There was no 2-year survivor of all patients.
CONCLUSIONS: Treatment should primarily be targeted at surgical resection with negative margins in patients with resectable disease. Lenvatinib may show promise to potentially extend survival.

PMID: 28739190 [PubMed - as supplied by publisher]

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Τετάρτη 26 Ιουλίου 2017

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