Medicine by Sfakianakis Alexandros: 03/06/16

Κυριακή 6 Μαρτίου 2016

Fractionated elution using the TEKCIS technetium-99m generator.

Fractionated elution using the TEKCIS technetium-99m generator.

Nucl Med Commun. 2016 Mar 4;

Authors: Vigne J, De Mil R, Peyronnet D, Hecquard C, Agostini D, Lemonnier F

Abstract
The TEKCIS technetium-99m (Tc) generator was designed to allow dry column shipment and automatized conception. A high Tc radioactive concentration is required in a subset of radiopharmacy procedures. Fractionated elution can be a useful tool to meet this requirement, especially when current elution is close to the generator expiration date. The aim of our study was to assess TEKCIS generator elution kinetics and to determine the optimal fractionated elution time to fit with procedures requiring the highest Tc radioactive concentration in clinical use. After duplicate elution at several predetermined elution times, the volume and activity of each eluate were measured. Two optimal time points were selected to perform fractionated elution and repeatability (n=34 and 33) assessed on TEKCIS generators calibrated at 6 or 8 GBq. The complete eluate volume (5 ml) was collected after 60 s of elution. A logarithmic equation was established between eluate volume (v, ml) from elapsed elution time (t, s): v=1.8335ln(t)-2.5965. Using the reciprocal equation, elution times required to obtain some commonly eluted volumes were calculated. Fractionated elutions during 15 and 20 s were selected and an average elution volume from 2.74 to 3.27 ml was collected, with an average elution yield of approximately 90 and 100%, respectively. Our work provides a simple and reliable methodology for the use of fractionated elution with the new TEKCIS generator.

PMID: 26945284 [PubMed - as supplied by publisher]

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Facilitation of bone resorption activities in synovial lavage fluid patients with mandibular condyle fractures

Summary

The aim of this study was to investigate the bone resorption effect of the mediators delivered in joint cavity of patients with mandibular condyle fractures by detecting osteoclast markers using cellular biochemistry methods, and by analysing bone resorption activities via inducing osteoclast differentiation of the infiltrated cells from arthrocentesis. Sixteen joints in 10 patients with mandibular condyle fractures were evaluated. The control group consisted of synovial fluid (SF) samples from seven joints of four volunteers who had no clinical signs or symptoms involving the temporomandibular joint (TMJ) or disc displacement. We collected SF cells from all patients during therapeutic arthrocentesis. The infiltrating cells from TMJ SF were cultured, differentiated into tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and examined bone resorption activities. We also investigated factors related to osteoclast induction of SF, using ELISA procedures. Osteoclast-like cells were induced from the SF cells obtained from all patients with condylar fractures. These multinucleated giant cells were positive for TRAP and actin, and had the ability to absorb dentin slices. The levels of macrophage colony-stimulating factor (M-CSF), prostaglandin E2 (PGE2), soluble form of receptor activator of nuclear factor kappa-B ligand (sRANKL) and osteoprotegerin (OPG), in SF samples from the patients, were significantly higher than in the controls. These findings indicate that bone resorption activities in SF from patients with mandibular condyle fractures were upregulated and may participate in the pathogenesis and wound healing.

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Case of isolated epidermolytic acanthoma: Genetic and immunohistochemical analysis

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Effects of systemic propranolol treatment on physical growth of patients with infantile hemangiomas

Abstract

Propranolol has been widely used in the treatment of infantile hemangiomas since 2008. This study aimed to investigate complications of systemic propranolol therapy for infantile hemangiomas, especially its effect on infants' physical growth. In this study, propranolol was given at a dose of 2 mg/kg per day. Abnormal symptoms and growth parameters were recorded in detail during the therapy. Follow-up visits were arranged to continue at least through the age of 2 years. A total of 76 patients with complete growth parameters were enrolled into the study. Complications of propranolol were minor, and mainly included sleeping disorders, diarrhea, decrease in fasting glucose, bronchial hyperactivity and hyperkalemia. Four (5.26%) patients' growth curve dropped off more than 20 percentiles during therapy and half of them returned to normal after withdrawal of the medications. None of them suffered from underweight, wasting or stunning when medication was stopped. Systemic propranolol was proved to be a safe treatment for problematic infantile hemangiomas and did not affect the physical growth.

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Superficial CD34-positive fibroblastic tumor: A new case from Japan

Abstract

A 48-year-old Japanese woman presented with a painless, slow-growing, brown nodule of 15 mm in diameter on the left thigh. She noticed the nodule a few years before the first presentation to our hospital. She underwent total resection of the nodule. On histopathological examination, a relatively well-defined tumor with infiltrative growth was located in the dermis and extended into the subcutis. The tumor was composed of spindle to polygonal cells with pleomorphic nuclei arranged in a sheet-like or fascicular pattern. Tumor cells with granular cytoplasm were also scattered. Immunohistochemical examination revealed that the tumor cells were strongly positive for CD34. The fusion transcripts of the collagen type 1 alpha 1 platelet-derived growth factor beta chain were not detected. After excluding other fibroblastic tumors through histopathological and immunohistochemical examinations, a diagnosis of superficial CD34-positive fibroblastic tumor (SCPFT) was made. SCPFT is a recently proposed fibroblastic tumor that is characterized by striking pleomorphism, granular cytoplasm, low mitotic rate and diffuse CD34 expression. Only two reports with 20 cases have been reported so far. The present case is the first that corresponds to SCPFT in Japan.

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Serum levels of soluble programmed death-1 and programmed death ligand-1 in systemic sclerosis: Association with extent of skin sclerosis

Abstract

The interaction of programmed death-1 (PD-1) with its ligand, programmed death ligand-1 (PD-L1), has been considered to play a key role in the negative regulation of immune responses. Patients with diffuse cutaneous systemic sclerosis (SSc) had higher levels of soluble PD-1 (sPD-1) than those with limited cutaneous SSc and healthy individuals. Serum sPD-1 levels positively correlated with the severity of skin sclerosis. In contrast, serum sPD-L1 levels were significantly increased in patients with SSc compared with healthy individuals. Moreover, serum sPD-L1 levels were not associated with the extent of skin sclerosis and were elevated not only in patients with diffuse cutaneous SSc, but also in those with limited cutaneous SSc. These results suggested that serum sPD-1 levels may increase in patients with SSc and correlate with the severity of skin sclerosis. PD-1/PD-L1 interaction may contribute to the development of skin sclerosis in SSc.

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Is bevacizumab a culprit of intractable skin ulcers?

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Pemphigus with features of both vulgaris and foliaceus variants localized to the nose

Abstract

We report the case of a 74-year-old man affected by an unusual variant of pemphigus. He presented with a crusty and scaly lesion of the nose. We performed reflectance confocal microscopy and optical coherence tomography on the lesion, which suggested an unexpected diagnosis of pemphigus. Therefore, to confirm our diagnostic suspicions, we executed indirect immunofluorescence and two biopsies, one for histopathological examination and one for direct immunofluorescence. Histopathological evaluation showed acantholysis with formation of clefts in the granular and spinous layers of the epidermis. Direct immunofluorescence revealed immunoglobulin G and C3 deposit to the full thickness of the epidermis. Indirect immunofluorescence showed intercellular antibodies at a titer of 1:40 in the suprabasal epidermis. The immunoblot analysis using epidermal extract revealed the presence of circulating antibodies directed to 130- and 160-kDa antigens in the patient's serum. These two antigens were evidenced from nitrocellulose membrane with colorimetric AP systems, which highlighted the presence of autoantibodies against desmoglein (Dsg)1 and Dsg3 (sodium dodecylsulfate polyacrylamide gel electrophoresis). We also performed an enzyme-linked immunoassay. All these findings suggested that this patient's pemphigus had features of both vulgaris and foliaceus variants.

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Erosive oral lichen planus as a sign of paraneoplastic pemphigus

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Management of erythematous skin lesions in bullous pemphigoid associated with atopic dermatitis

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Spindle cell hemangioma in an elderly patient: Uncommon benign vascular neoplasm

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The binding mode prediction and similar ligand potency in the active site of Vitamin D Receptor (VDR) with QM/MM interaction, MESP and MD simulation

Abstract

Non-secosteroidal ligands are well-known Vitamin D Receptor agonists. In this study, we described a combined QM/MM to define the protein ligand interaction energy A strong positive correlation in both QM-MM interaction energy and binding free energy against the biological activity. The molecular dynamics simulation study was performed and specific interactions were extensively studied. The molecular docking results and surface analysis shed light on steric and electrostatic complementarities of these non-secosteroidal ligands to VDR. Finally, the drug likeness properties were also calculated and found within the acceptable range. The results show that bulky group substitutions in side chain decrease the VDR activity, whereas a small substitution increased it. Functional analyses of H393A and H301A mutations substantiate their roles in the VDR agonistic and antagonistic activity. Apart from the His393 and His301, two other amino acids in the hinge region viz. Ser233 and Arg270 acted as an electron donor/acceptor specific to the agonist in the distinct ligand potency. The results from the present study disclose the binding mechanism of VDR agonists and structural modifications required to improve the selectivity.

Different in silico approaches were applied to study the specific interactions of non-secosteroidal ligands in VDR active site. The article summarizes the importance of similar ligand efficacy and the distinct ligand potency in the VDR active site. The results could be useful for the designing of potent agonists in the lead optimization phase of drug discovery against VDR.

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[Competency-based Neurosurgery Residency Programme].

[Competency-based Neurosurgery Residency Programme].

Neurocirugia (Astur). 2016 Mar 1;

Authors: Lobato RD, Jiménez Roldan L, Alen JF, Castaño AM, Munarriz PM, Cepeda S, Lagares A

Abstract
A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal.
DURATION OF THE PROGRAMME: Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period.
STRUCTURE OF THE PROGRAMME: It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations.
INSTRUCTION METHODS: Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques.
EVALUATION METHODS: Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually assess the overall operation of the programme. Results of evaluations are registered, together with other relevant data, in the Resident's Book.
PROGRAMME'S NATIONAL COMMITTEE: The creation of a Programme Committee directly attached to the SENEC (National Commission) that, aside from generating a final version of the programme, monitors its implementation (level of adherence and operation in the different departments), assumes the creation of test banks and the centralized administration of knowledge tests (in the middle of the residency and/or at the end of it) and centralizes information collected by tutors that could be used for re-accreditation of the services, is proposed.

PMID: 26944384 [PubMed - as supplied by publisher]

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Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

Neurocirugia (Astur). 2016 Mar 1;

Authors: Rivera-Fernández R, Guerrero-López F, Rodríguez-Rubio D, Gómez-Jiménez FJ, Rodríguez-Vilanova F, Mora-Ordóñez J, Olea-Jiménez V, Arias-Verdú MD, Quesada-García G, Acebal-Blanco F, Castillo-Lorente E, Arráez-Sánchez MÁ

Abstract
OBJECTIVE: To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH).
MATERIALS AND METHODS: The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012.
DATA COLLECTED: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge RESULTS: A total of 263 patients were included. Mean age: 59.74±14.14 years. GCS: 8±4 points, APACHE II: 20.7±7.68 points. ICH Score: 2.32+1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p=0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n=78) versus those conservatively managed (58.9%, n=185); specifically in those with IVH surgically treated (34.2%, n=38) versus non-operated IVH (67.2%, n=125), p<0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33-3.22) in patients without IVH versus 0.19 (95% CI; 0.07-0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07-0.75), p=0.01.
CONCLUSIONS: Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhage.

PMID: 26944383 [PubMed - as supplied by publisher]

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[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

Neurocirugia (Astur). 2016 Mar 1;

Authors: Narro-Donate JM, Huete-Allut A, Velasco-Albendea FJ, Escribano-Mesa JA, Mendez-Román P, Masegosa-González J

Abstract
Cranial chondromas are tumours arising from chondrocyte embryonic remnants cells that usually appear in the skull base synchondrosis. In contrast to the rest of the organism, where chondroid tumours are the most common primary bone tumour just behind the haematopoietic lineage ones, they are a rarity at cranial level, with an incidence of less than 1% of intracranial tumours. The case is reported on a 42 year-old male referred to our clinic due to the finding of an extra-axial lesion located close to the Meckel's cave region, with extension to the posterior fossa and brainstem compression after progressive paraparesis of 6 months onset. With the diagnosis of trigeminal schwannoma, a subtotal tumour resection was performed using a combined supra-infratentorial pre-sigmoidal approach. The postoperative histopathology report confirmed the diagnosis of cranial chondroma.

PMID: 26944382 [PubMed - as supplied by publisher]

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The Novel Affordable Telford Temporal Bone Holder

Abstract

Surgical training is constantly evolving and junior trainees now perform fewer operations than ever. To maintain standards, greater emphasis is placed on simulation, often requiring attendance to expensive courses. While virtual reality systems have been developed recently, cadaveric dissection remains the cornerstone of training. To allow effective development of the essential finely tuned dextrous skills that are required by otologists there must be optimal tools available to the trainee, the most important being the temporal bone holder.

The original cumbersome temporal bone holder has its disadvantages. With this in mind we have produced an extremely cheap alternative that allows trainees to maintain surgical position easily and facilitate dissection more efficiently. Our design provides excellent and easily adjustable position that delivers optimum surgical field for textbook surgical training at a fraction of the price.

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Baseline features and differences in 48 week clinical outcomes in patients with gastroparesis and type 1 vs type 2 diabetes

Abstract

Background

In studies of diabetic gastroparesis, patients with type 1 and type 2 diabetes mellitus (T1DM, T2DM) are often combined for analyses. We compared gastroparesis severity, healthcare utilization, psychological function, and quality of life in T1DM vs T2DM gastroparesis patients.

Methods

Questionnaire, laboratory, and scintigraphy data from patients with gastroparesis and T1DM and T2DM from seven centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Registry were compared at enrollment and after 48 weeks. Multiple regression models assessed baseline and follow-up differences between diabetes subtypes.

Key Results

At baseline, T1DM patients (N = 78) had slower gastric emptying, more hospitalizations, more gastric stimulator implantations, higher hemoglobin A1c (HbA1c), and more anxiety vs T2DM patients (N = 59). Independent discriminators of patients with T1DM vs T2DM included worse gastroesophageal reflux disease, less bloating, more peripheral neuropathy, and fewer comorbidities (p ≤ 0.05). On follow-up, gastrointestinal (GI) symptom scores decreased only in T2DM (p < 0.05), but not in T1DM patients who reported greater prokinetic, proton pump inhibitor, anxiolytic, and gastric stimulator usage over 48 weeks (p ≤ 0.03). Gastrointestinal symptoms at baseline and 48 weeks with both subtypes were not associated with HbA1c, peripheral neuropathy, psychological factors, or quality of life.

Conclusions & Inferences

Baseline symptoms were similar in T1DM and T2DM patients, even though T1DM patients had worse gastric emptying delays and higher HbA1c suggesting other factors mediate symptom severity. Symptom scores at 48 weeks decreased in T2DM, but not T1DM patients, despite increased medical and surgical treatment utilization by T1DM patients. Defining causes of different outcomes in diabetic gastroparesis warrants further investigation.

This study defined similarities and differences in gastroparesis severity, healthcare utilization, psychological function, and quality of life in patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus and gastroparesis. At baseline enrollment, T1DM patients had higher hemoglobin A1c levels and more severe emptying delays, but the severity of GI symptoms was similar to those of patients with T2DM and gastroparesis. After 48 weeks of follow-up, gastroparesis symptom scores significantly decreased in T2DM patients but not in T1DM patients despite increased use of prokinetic, acid suppressant, anxiolytic, and gastric electrical stimulation therapy in the T1DM group.

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Optimising treatment strategies in spinal ependymoma based on 20years of experience at a single centre.

Optimising treatment strategies in spinal ependymoma based on 20years of experience at a single centre.

J Clin Neurosci. 2016 Mar 1;

Authors: Keil VC, Schmitt AJ, Martin SC, Cadoux-Hudson TA, Pereira EA

Abstract
Spinal ependymomas are rare tumours, with total resection favoured where possible. Several case series assessing the outcome following neurosurgical treatment for spinal ependymoma advocate the usage of adjuvant radiotherapy in cases of subtotal resection, or in unencapsulated tumours. We assessed the outcome of 61 consecutive cases of spinal ependymoma in a single centre over a 20year period using a variety of outcome measures. Sex distribution was equal, with a mean age at surgery of 43.6years (range 5-76years). Overall, most tumours occurred in the lumbosacral region (70.5%), with fewer in the thoracic (27.9%) and cervical regions (18.0%). Myxopapillary features were seen in 41.0% of tumours, and were more common when occurring in the lumbar region (51.2%). Gross total resection was achieved in 52.5%, subtotal resection in 37.7% and biopsy alone in 9.8% of patients and 31.1% received adjuvant radiotherapy. Two-thirds of patients achieved an excellent post-operative neurological outcome (Frankel grade E). Tumour recurrence was rare. Gross total resection and good preoperative neurological condition were most strongly predictive of good outcome. Post-operative radiotherapy did not seem to confer survival benefit in this case series, even in cases of incomplete resection, leading us to question its utility for all cases of spinal cord ependymoma.

PMID: 26944215 [PubMed - as supplied by publisher]

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[Competency-based Neurosurgery Residency Programme].

[Competency-based Neurosurgery Residency Programme].

Neurocirugia (Astur). 2016 Mar 1;

Authors: Lobato RD, Jiménez Roldan L, Alen JF, Castaño AM, Munarriz PM, Cepeda S, Lagares A

PMID: 26944384 [PubMed - as supplied by publisher]

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Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

Neurocirugia (Astur). 2016 Mar 1;

PMID: 26944383 [PubMed - as supplied by publisher]

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[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

[Chondroma adjacent to Meckel's cave mimicking a fifth cranial nerve neurinoma. A case report].

Neurocirugia (Astur). 2016 Mar 1;

Authors: Narro-Donate JM, Huete-Allut A, Velasco-Albendea FJ, Escribano-Mesa JA, Mendez-Román P, Masegosa-González J

PMID: 26944382 [PubMed - as supplied by publisher]

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When Absence of Evidence Is Evidence of Absence: Rational Inferences From Absent Data

Abstract

Identifying patterns in the world requires noticing not only unusual occurrences, but also unusual absences. We examined how people learn from absences, manipulating the extent to which an absence is expected. People can make two types of inferences from the absence of an event: either the event is possible but has not yet occurred, or the event never occurs. A rational analysis using Bayesian inference predicts that inferences from absent data should depend on how much the absence is expected to occur, with less probable absences being more salient. We tested this prediction in two experiments in which we elicited people's judgments about patterns in the data as a function of absence salience. We found that people were able to decide that absences either were mere coincidences or were indicative of a significant pattern in the data in a manner that was consistent with predictions of a simple Bayesian model.

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Risk of Esophageal Cancer Following Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients: A Nationwide Population-Based Cohort Study in Taiwan.

Risk of Esophageal Cancer Following Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients: A Nationwide Population-Based Cohort Study in Taiwan.

Medicine (Baltimore). 2016 Mar;95(9):e2958

Authors: Lin KT, Lin CS, Lee SY, Huang WY, Chang WK

Abstract
Esophageal cancers account for majority of synchronous or metachronous head and neck cancers. This study examined the risk of esophageal cancer following percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients using the Taiwan National Health Insurance Research Database.From 1997 to 2010, we identified and analyzed 1851 PEG patients and 3702 sex-, age-, and index date-matched controls.After adjusting for esophagitis, esophagus stricture, esophageal reflux, and primary sites, the PEG cohort had a higher adjusted hazard ratio (2.31, 95% confidence interval [CI] = 1.09-4.09) of developing esophageal cancer than the controls. Primary tumors in the oropharynx, hypopharynx, and larynx were associated with higher incidence of esophageal cancer. The adjusted hazard ratios were 1.49 (95% CI = 1.01-1.88), 3.99 (95% CI = 2.76-4.98), and 1.98 (95% CI = 1.11-2.76), respectively.Head and neck cancer patients treated with PEG were associated with a higher risk of developing esophageal cancer, which could be fixed by surgically placed tubes.

PMID: 26945412 [PubMed - as supplied by publisher]

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Is MDM2 SNP309 Variation a Risk Factor for Head and Neck Carcinoma?: An Updated Meta-Analysis Based on 11,552 Individuals.

Is MDM2 SNP309 Variation a Risk Factor for Head and Neck Carcinoma?: An Updated Meta-Analysis Based on 11,552 Individuals.

Medicine (Baltimore). 2016 Mar;95(9):e2948

Authors: Zhuo X, Ye H, Li Q, Xiang Z, Zhang X

Abstract
Murine double minute-2 (MDM2) is a negative regulator of P53, and its T309G polymorphism has been suggested as a risk factor for a variety of cancers. Increasing evidence has shown the association of MDM2 T309G polymorphism with head and neck carcinoma (HNC) risk. However, the results are inconsistent. Thus, we performed a meta-analysis to elucidate the association.The meta-analysis retrieved studies published up to August 2015, and essential information was extracted for analysis. Separate analyses on ethnicity, source of controls, sample size, detection method, and cancer types were also conducted. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to estimate the association.Pooled data from 16 case-control studies including 4625 cases and 6927 controls failed to indicate a significant association. However, in the subgroup analysis of sample sizes, an increased risk was observed in the largest sample size group (>1000) under a recessive model (OR = 1.52; 95% CI = 1.08-2.13). Increased risks were also found in the nasopharyngeal cancer in the subgroup analysis of cancer types (GG vs TT: OR = 2.07; 95% CI = 1.38-3.12; dominant model: OR = 1.48; 95% CI = 1.13-1.93; recessive model: OR = 1.76; 95% CI = 1.17-2.65).The results suggest that homozygote GG alleles of MDM2 SNP309 may be a low-penetrant risk factor for HNC, and G allele may confer nasopharyngeal cancer susceptibility.

PMID: 26945408 [PubMed - as supplied by publisher]

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Cancer Risk in Patients With Empyema: A Nationwide Population-Based Study.

Cancer Risk in Patients With Empyema: A Nationwide Population-Based Study.

Medicine (Baltimore). 2016 Mar;95(9):e2934

Authors: Teng CJ, Hu YW, Yeh CM, Chen TJ, Liu CJ

Abstract
This study aimed to evaluate cancer risk and possible risk factors in patients diagnosed with empyema.A total of 31,636 patients with newly diagnosed empyema between January 1, 1999 and December 31, 2010 were included in this study. Standardized incidence ratios (SIRs) were calculated to compare the cancer incidence in these empyema patients to that in the general population. Adjusted hazard ratios were also calculated to investigate whether characteristics increased cancer risk.During the 12-year study period, 2,654 cancers occurred in 31,636 patients with empyema, yielding an SIR of 2.67 (95% confidence interval [CI] 2.57-2.78). We excluded cancer that occurred within 1 year to avoid surveillance bias. The cancer risk remained significantly increased (SIR 1.50, 95% CI 1.41-1.58). Specifically, patients with empyema had higher SIR of cancers of the head and neck (1.50, 95% CI 1.41-1.58), esophagus (2.56, 95% CI 1.92-3.33), stomach (1.49, 95% CI 1.16-1.89), liver and biliary tract (2.18, 95% CI 1.93-2.45), and lung and mediastinum (1.62, 95% CI 1.39-1.86). Age ≥ 60, male sex, diabetes mellitus, and liver cirrhosis were independent risk factors for cancer development.Our study demonstrates an increased incidence of cancer development in patients with empyema, and patients' age ≥ 60, men, and those with diabetes mellitus and liver cirrhosis showed a higher incidence of developing cancer compared to the general population. The association between such kind of infection and secondary malignancy may be elucidated by further study.

PMID: 26945399 [PubMed - as supplied by publisher]

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Soft Tissue Necrosis in Head and Neck Cancer Patients After Transoral Robotic Surgery or Wide Excision With Primary Closure Followed by Radiation Therapy.

Soft Tissue Necrosis in Head and Neck Cancer Patients After Transoral Robotic Surgery or Wide Excision With Primary Closure Followed by Radiation Therapy.

Medicine (Baltimore). 2016 Mar;95(9):e2852

Authors: Yun Hee L, Kim YS, Chung MJ, Yu M, Jung SL, Yoo IR, Lee YS, Kim MS, Sun DI, Kang JH

Abstract
Risk factors were evaluated for surgical bed soft tissue necrosis (STN) in head and neck cancer patients treated with postoperative radiation therapy (PORT) after transoral robotic surgery (TORS) or wide excision with primary closure. Sixty-seven patients were evaluated. STN was defined as ulceration and necrosis of the surgical bed or persistently unhealed high-grade acute mucositis with pain after PORT. The median RT dose of primary site was 63.6 Gy (range, 45-67.15 Gy) with 2 Gy/fx (range 1.8-2.2 Gy/fx). Total 41 patients (61.2%) were treated with concurrent chemoradiotherapy. The median follow-up period was 26 months. STN was diagnosed in 13 patients (19.4%). Most of the patients were treated with oral steroids, antibiotics, and analgesics and the lesions were eventually improved (median of 6 months after PORT). STN did not influence local control. A depth of invasion (DOI > 1.4 cm, odds ratio [OR] 14.04, p = 0.004) and maximum dose/fraction (CTVpmax/fx > 2.3 Gy, OR 6.344, p = 0.043) and grade 3 acute mucositis (OR 6.090, p = 0.054) were related to STN. The 12 (23.5%) of 51 oropharyngeal cancer patients presented STN, and the risk factors were DOI > 1.2 cm (OR 21.499, P = 0.005), CTVpmax/fx > 2.3 Gy (OR 12.972, P = 0.021) and grade 3 acute mucositis (OR 10.537, P = 0.052). Patients treated with TORS or WE with primary closure followed by PORT had a high risk of surgical bed STN. STN risk factors included DOI (>1.2-1.4 cm) and CTVpmax/fx (>2.3 Gy). Radiation therapy after TORS must be carefully designed to prevent STN.

PMID: 26945367 [PubMed - as supplied by publisher]

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Adverse Effects of Oral Nonselective and cyclooxygenase-2-Selective NSAIDs on Hospitalization for Acute Kidney Injury: A Nested Case-Control Cohort Study.

Adverse Effects of Oral Nonselective and cyclooxygenase-2-Selective NSAIDs on Hospitalization for Acute Kidney Injury: A Nested Case-Control Cohort Study.

Medicine (Baltimore). 2016 Mar;95(9):e2645

Authors: Chou CI, Shih CJ, Chen YT, Ou SM, Yang CY, Kuo SC, Chu D

Abstract
To investigate the association between the use of nonselective or cyclooxygenase (COX)-2-selective nonsteroidal antiinflammatory drugs (NSAIDs) and risk of acute kidney injury (AKI) in a general Asian population.We conducted an observational, nationwide, nested case-control cohort study using Taiwan's National Health Insurance Research Database between 2010 and 2012. AKI cases were defined as hospitalization with a principle diagnosis of AKI. Each case was matched to 4 randomly selected controls based on age, sex, and the month and year of cohort entry. Odds ratios (ORs) were used to demonstrate the association between hospitalization for AKI and current, recent, or past use of an oral NSAID.During the study period, we identified 6199 patients with AKI and 24,796 matched controls. Overall, current users (adjusted OR 2.73, 95% confidence interval [CI] 2.28-3.28) and recent users (adjusted OR 1.17, 95% CI 1.01-1.35) were associated with increased risk of hospitalization for AKI. The risk was also similar for nonselective NSAIDs. However, neither current nor recent use of COX-2 inhibitors was significantly associated with AKI events.Our study supported that the initiation of nonselective NSAIDs rather than COX-2 inhibitors is associated with an increased risk of AKI requiring hospitalization. Future randomized trials are needed to elucidate these findings.

PMID: 26945352 [PubMed - as supplied by publisher]

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Recurrent BCOR Internal Tandem Duplication and YWHAE-NUTM2B Fusions in Soft Tissue Undifferentiated Round Cell Sarcoma of Infancy: Overlapping Genetic Features With Clear Cell Sarcoma of Kidney.

Recurrent BCOR Internal Tandem Duplication and YWHAE-NUTM2B Fusions in Soft Tissue Undifferentiated Round Cell Sarcoma of Infancy: Overlapping Genetic Features With Clear Cell Sarcoma of Kidney.

Am J Surg Pathol. 2016 Mar 3;

Authors: Kao YC, Sung YS, Zhang L, Huang SC, Argani P, Chung CT, Graf NS, Wright DC, Kellie SJ, Agaram NP, Ludwig K, Zin A, Alaggio R, Antonescu CR

Abstract
Soft tissue undifferentiated round cell sarcoma (URCS) occurring in infants is a heterogenous group of tumors, often lacking known genetic abnormalities. On the basis of a t(10;17;14) karyotype in a pelvic URCS of a 4-month-old boy showing similar breakpoints with clear cell sarcoma of kidney (CCSK), we have investigated the possibility of shared genetic abnormalities in CCSK and soft tissue URCS. Most CCSKs are characterized by BCOR exon 16 internal tandem duplications (ITDs), whereas a smaller subset shows YWHAE-NUTM2B/E fusions. Because of overlapping clinicopathologic features, we have also investigated these genetic alterations in the so-called primitive myxoid mesenchymal tumor of infancy (PMMTI). Among the 22 infantile URCSs and 7 PMMTIs selected, RNA sequencing was performed in 5 and 2 cases, with frozen tissue, respectively. The remaining cases with archival material were tested for YWHAE-NUTM2B/E by fluorescence in situ hybridization (FISH) or reverse transcription-polymerase chain reaction (RT-PCR), and BCOR ITD by PCR. A control group of 4 CCSKs and 14 URCSs in older children or adults without known gene fusion and 20 other sarcomas with similar histomorphology or age at presentation were also tested. A YWHAE-NUTM2B fusion was confirmed in the index case by FISH and RT-PCR, whereas BCOR ITD was lacking. An identical YWHAE-NUTM2B fusion was found in another URCS case of a 5-month-old girl with a back lesion. The remaining cases and control group lacked YWHAE gene rearrangements; instead, consistent BCOR ITDs, similar to CCSK, were found in 15/29 (52%) infantile sarcoma cases (9/22 infantile URCS and 6/7 PMMTI). In the control cohort, BCOR ITD was found only in 3 CCSK cases but not in the other sarcomas. Histologically, URCS with both genotypes and PMMTI shared significant histologic overlap, with uniform small blue round cells with fine chromatin and indistinct nucleoli. A prominent capillary network similar to CCSK, rosette structures, and varying degree of myxoid change were occasionally seen. BCOR ITD-positive tumors occurred preferentially in the somatic soft tissue of the trunk, abdomen, and head and neck, sparing the extremities. RNAseq showed high BCOR mRNA levels in BCOR ITD-positive cases, compared with other URCSs. In summary, we report recurrent BCOR exon 16 ITD and YWHAE-NUTM2B fusions in half of infantile soft tissue URCS and most PMMTI cases, but not in other pediatric sarcomas. These findings suggest a significant overlap between infantile URCS and CCSK, such as age at presentation, histologic features, and genetic signature, thus raising the possibility of a soft tissue counterpart to CCSK.

PMID: 26945340 [PubMed - as supplied by publisher]

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Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography.

Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography.

Otol Neurotol. 2016 Mar 3;

Authors: Dalbert A, Huber A, Veraguth D, Roosli C, Pfiffner F

Abstract
OBJECTIVE: To assess cochlear trauma during cochlear implantation by electrocochleography (ECoG) and cone beam computed tomography (CBCT) and to correlate intraoperative cochlear trauma with postoperative loss of residual hearing.
METHODS: ECoG recordings to tone bursts at 250, 500, 750, and 1000 Hz and click stimuli were recorded before and after insertion of the cochlear implant electrode array, using an extracochlear recording electrode. CBCTs were conducted within 6 weeks after surgery. Changes of intraoperative ECoG recordings and CBCT findings were correlated with postoperative threshold shifts in pure-tone audiograms.
RESULTS: Fourteen subjects were included. In three subjects a decrease of low-frequency ECoG responses at 250, 500, 750, and 1000 Hz occurred after insertion of the electrode array. This was associated with no or minimal residual hearing 4 weeks after surgery. ECoG responses to click stimuli were present in six subjects and showed a decrease after insertion of the electrode array in three. This was associated with a mean hearing loss of 21 dB in postoperative pure-tone audiograms. Scalar dislocation of the electrode array was assumed in one subject because of CBCT findings and correlated with a decrease of low-frequency ECoG responses and a complete loss of residual hearing.
CONCLUSION: Hearing loss of ≤11 dB is not associated with detectable decrease in ECoG recordings during cochlear implantation. However, in a majority of patients with threshold shifts of >11 dB or complete hearing loss, an intraoperative decrease of high- or low-frequency ECoG signals occurs, suggesting acute cochlear trauma.

PMID: 26945317 [PubMed - as supplied by publisher]

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Insertion of Cochlear Implant Electrode Array Using the Underwater Technique for Preserving Residual Hearing.

Insertion of Cochlear Implant Electrode Array Using the Underwater Technique for Preserving Residual Hearing.

Otol Neurotol. 2016 Mar 3;

Authors: Anagiotos A, Beutner D, Gostian AO, Schwarz D, Luers JC, Hüttenbrink KB

Abstract
OBJECTIVE: To describe a method of cochlear implantation in which the opening of the cochlea and the electrode array insertion are performed under water (underwater technique).
STUDY DESIGN: Retrospective patient review.
SETTING: Academic tertiary referral center.
PATIENTS: Fifteen implantations in children and adult patients with residual hearing at the frequencies 250, 500, and 1000 Hz on the unaided preoperative pure-tone audiometry were included in this study.
INTERVENTION(S): Cochlear implantation with a conventional full-length electrode, in which the opening of the cochlea and the electrode array insertion are performed after the tympanic cavity was filled with body-temperature Ringer solution.
MAIN OUTCOME MEASURE(S): Changes on residual hearing 6 to 8 weeks after surgery and at subsequent follow-up appointments were analyzed. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1000 Hz.
RESULTS: Overall postimplant hearing preservation 6 to 8 weeks after implantation was achieved in 13 of the patients (87%). Subsequent follow-up was performed on average 15.2 months after surgery (range, 7-32) in 14 out of 15 patients. At this late postoperative evaluation preservation of hearing was recorded in nine patients (64%), whereas in the remaining five patients (36%) no residual hearing was measured.
CONCLUSION: The underwater technique offers a reliable nontraumatic method for electrode array insertions during cochlear implantation. The method respects the physiology of the cochlea und minimizes the pressure variations during cochlear opening and implantation.

PMID: 26945314 [PubMed - as supplied by publisher]

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Comparison of Middle Ear Visualization With Endoscopy and Microscopy.

Comparison of Middle Ear Visualization With Endoscopy and Microscopy.

Otol Neurotol. 2016 Mar 3;

Authors: Bennett ML, Zhang D, Labadie RF, Noble JH

Abstract
INTRODUCTION: The primary goal of chronic ear surgery is the creation of a safe, clean dry ear. For cholesteatomas, complete removal of disease is dependent on visualization. Conventional microscopy is adequate for most dissection, but various subregions of the middle ear are better visualized with endoscopy.
OBJECTIVE: The purpose of the present study was to quantitatively assess the improved visualization that endoscopes afford as compared with operating microscopes.
METHODS: Microscopic and endoscopic views were simulated using a three-dimensional model developed from temporal bone scans. Surface renderings of the ear canal and middle ear subsegments were defined and the percentage of visualization of each middle ear subsegment, both with and without ossicles, was then determined for the microscope as well as for 0-, 30-, and 45-degree endoscopes. Using this information, we analyzed which mode of visualization is best suited for dissection within a particular anatomical region.
RESULTS: Using a 0-degree scope provides significantly more visualization of every subregion, except the antrum, compared with a microscope. In addition, angled scopes permit visualizing significantly more surface area of every subregion of the middle ear than straight scopes or microscopes.
CONCLUSIONS: Endoscopes offer advantages for cholesteatoma dissection in difficult-to-visualize areas including the sinus tympani and epitympanum.

PMID: 26945313 [PubMed - as supplied by publisher]

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Congenital Stapes Ankylosis in Children: Surgical Findings and Results in 35 Cases.

Congenital Stapes Ankylosis in Children: Surgical Findings and Results in 35 Cases.

Otol Neurotol. 2016 Mar 3;

Authors: Vincent R, Wegner I, Kamalski DM, Bittermann AJ, Grolman W

Abstract
OBJECTIVE: To evaluate surgical findings and hearing results in children undergoing middle ear surgery for congenital stapes ankylosis with or without other ossicular malformations (Teunissen and Cremers class I and class II malformations).
STUDY DESIGN: A nonrandomized, nonblinded case series of prospectively collected data.
SETTING: A tertiary referral center.
PATIENTS: Twenty-eight consecutive pediatric patients who underwent 35 surgical procedures for congenital stapes ankylosis with or without other ossicular malformations and had available postoperative pure-tone audiometry.
INTERVENTION: Primary stapedotomy with vein graft interposition and reconstruction with a Teflon piston, bucket handle prosthesis or total ossicular replacement prosthesis.
MAIN OUTCOME MEASURES: Pre- and postoperative audiometric evaluation using four-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps (ABGs) were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter.
RESULTS: Overall, a postoperative ABG closure of 10 dB or less was achieved in 73% of class I cases and in 50% of class II cases. A postoperative ABG closure of 20 dB or less was achieved in 77% of class I cases and 67% of class II cases. Postoperative sensorineural hearing loss occurred in one class I case (4%) and none of the class II cases.
CONCLUSION: Stapedotomy is a safe and feasible treatment option in children with congenital stapes ankylosis.

PMID: 26945311 [PubMed - as supplied by publisher]

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Living an everyday life with head and neck cancer 2-2.5 years post-diagnosis - A qualitative prospective study of 56 patients.

Living an everyday life with head and neck cancer 2-2.5 years post-diagnosis - A qualitative prospective study of 56 patients.

Soc Sci Med. 2016 Feb 20;154:54-61

Authors: Isaksson J, Salander P, Lilliehorn S, Laurell G

Abstract
RATIONALE: There are many studies available describing how patients are affected by head and neck cancer (HNC) and its treatment. Usually these studies are quantitative and focus on assessing patients' quality of life or distress post-treatment. These studies are important, but they are of limited value if we are interested in understanding more about HNC in an everyday life context.
OBJECTIVE: The purpose was to determine how life was lived and valued during and after treatment for HNC and to detect different transitions in returning to everyday life.
METHODS: During 2009-2012, 56 patients with HNC were consecutively included, and interviewed at 6, 12, and 24 months post-treatment about how they lived their lives. All patients received primary treatment at a tertiary referral university hospital in Sweden.
RESULTS: Four different trajectories and transitions emerged. The first group (n = 15) evaluated their illness experience as a past parenthesis in their life suggesting that they had psychologically left the illness behind. In the second group (n = 9), the impact of the disease seemed to be diluted by other strains in their life, and although these patients to some extent were still hampered by side effects, they regarded them as 'no big deal'. The cancer really made a difference in the third group (n = 12) in both positive and negative ways and seemed to reflect a balance between such effects. In the fourth group (n = 20), the physical and/or psychological problems predominated and the patients' lives had changed for the worse.
CONCLUSION: The narratives showed that being afflicted by HNC has different impacts depending on how the patients live their lives - it is a matter of individual transition in an everyday life context. This idiosyncrasy challenges the meaningfulness of screening efforts to identify vulnerable groups for psychosocial intervention.

PMID: 26945172 [PubMed - as supplied by publisher]

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Protein expression of CYP1A1, CYP1B1, ALDH1A1, and ALDH2 in young patients with oral squamous cell carcinoma.

Protein expression of CYP1A1, CYP1B1, ALDH1A1, and ALDH2 in young patients with oral squamous cell carcinoma.

Int J Oral Maxillofac Surg. 2016 Mar 1;

Authors: Kaminagakura E, Caris A, Coutinho-Camillo C, Soares FA, Takahama-Júnior A, Kowalski LP

Abstract
The purpose of this study was to evaluate the expression of the enzymes involved in the biotransformation of tobacco and alcohol. A study group of 41 young patients (≤40 years old) with oral squamous cell carcinoma (OSCC) was compared to 59 control subjects (≥50 years old) with tumours of similar clinical stages and topographies. The immunohistochemical expression of CYP1A1, CYP1B1, ALDH1A1, and ALDH2 was evaluated using the tissue microarray technique. There was a predominance of males, smokers, and alcohol drinkers in both groups. Most tumours were located in the tongue (43.9% vs. 50.8%), were well-differentiated (63.4% vs. 56.6%), and were in clinical stages III or IV (80.5% vs. 78.0%). No difference was observed in the expression of CYP1A1, ALDH1A1, or ALDH2 between the two groups. CYP1A1 and ALDH2 protein expression had no influence on the prognosis. The immunoexpression of CYP1B1 was significantly higher in the control group than in the young group (P<0.001). The 5-year relapse-free survival was better in patients with CYP1B1 overexpression vs. protein underexpression (64% vs. 25%; P<0.05), regardless of age. ALDH1A1 expression improved relapse-free survival in young patients. These results suggest a lower risk of recurrence with increased metabolism of carcinogens by CYP1B1. Further studies involving other genes and proteins are necessary to complement the results of this research.

PMID: 26944893 [PubMed - as supplied by publisher]

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Predictive Factors for Central Lymph Node Metastasis in Patients with CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis.

Predictive Factors for Central Lymph Node Metastasis in Patients with CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis.

Int J Surg. 2016 Mar 1;

Authors: Ma B, Wang Y, Yang S, Ji Q

Abstract
BACKGROUND AND OBJECTIVES: Recently, some single-institution studies have reported risk factors of CLNM in cN0 PTC patients, but results from those studies are not consistent. The meta-analysis aimed to identify some risk factors that can be predictive of CLNM in cN0 PTC patients.
METHODS: We performed a systematic search for relevant literature published prior to December 2015 using the following search engines: PubMed, EMBASE, Ovid and Web of Science. We included retrospective, prospective, and observational studies that investigated the risk factors for CLNM in patients with cN0 PTC.
RESULTS: Thirty-one studies, including 37,355 patients with cN0 PTC from seven countries were included in the meta-analysis. The pooled analysis indicated that age<45 years (OR=1.57, 95%CI:1.48-1.66, P<0.001), male gender (OR=1.79, 95%CI: 1.69-1.91, P<0.001), tumor size>10 mm (OR=2.61, 95%CI:2.27-3.00, P<0.001), bilaterality (OR=1.52, 95%CI:1.31-1.77, P<0.001), multifocality (OR=1.46, 95%CI: 1.31-1.61, P<0.001), extracapsular invasion (OR=2.10, 95%CI:1.81-2.43, P<0.001), angiolymphatic invasion (OR=8.02, 95%CI:5.00-12.87, P<0.001), high histologic risk (OR=2.62, 95%CI:2.13-3.22, P<0.001) and BRAF(V600E) mutation (OR:1.78, 95%CI:1.38-2.30, P<0.001) were significantly associated with CLNM, and upper third location (OR=0.54, 95%CI:0.43-0.67, P<0.001) and lymphocytic thyroiditis (OR=0.64, 95%CI:0.42-0.97, P=0.034) were decreased risk factors of CLNM.
CONCLUSIONS: We identified several predictive factors for CLNM in cN0 PTC patients. Some certain risk factors could be considered in preoperative clinical decision regarding the necessity of prophylactic central lymph node dissection in cN0 PTC patients.

PMID: 26944586 [PubMed - as supplied by publisher]

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Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases.

Prevention of neck infection by endoscopic suture closure of pyriform sinus fistulae: a report of two cases.

Braz J Otorhinolaryngol. 2016 Feb 15;

Authors: Matsuzaki H, Makiyama K, Suzuki H, Ohshima T

PMID: 26944366 [PubMed - as supplied by publisher]

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Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment.

Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment.

Mayo Clin Proc. 2016 Mar;91(3):386-96

Authors: Marur S, Forastiere AA

Abstract
Squamous cell carcinoma arises from multiple anatomic subsites in the head and neck region. The risk factors for development of cancers of the oral cavity, oropharynx, hypopharynx, and larynx include tobacco exposure and alcohol dependence, and infection with oncogenic viruses is associated with cancers developing in the nasopharynx, palatine, and lingual tonsils of the oropharynx. The incidence of human papillomavirus-associated oropharyngeal cancer is increasing in developed countries, and by 2020, the annual incidence could surpass that of cervical cancer. The treatment for early-stage squamous cell cancers of the head and neck is generally single modality, either surgery or radiotherapy. The treatment for locally advanced head and neck cancers is multimodal, with either surgery followed by adjuvant radiation or chemoradiation as indicated by pathologic features or definitive chemoradiation. For recurrent disease that is not amenable to a salvage local or regional approach and for metastatic disease, chemotherapy with or without a biological agent is indicated. To date, molecular testing has not influenced treatment selection in head and neck cancer. This review will focus on the changing epidemiology, advances in diagnosis, and treatment options for squamous cell cancers of the head and neck, along with data on risk stratification specific to oropharyngeal cancer, and will highlight the direction of current trials.

PMID: 26944243 [PubMed - in process]

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A convenient flap for repairing the donor area of a distally based sural flap: Gastrocnemius perforator island flap.

A convenient flap for repairing the donor area of a distally based sural flap: Gastrocnemius perforator island flap.

J Plast Reconstr Aesthet Surg. 2016 Feb 3;

Authors: Eser C, Gencel E, Kesiktaş E, Kokaçya Ö, Yavuz M

Abstract
OBJECTIVE: The reconstruction of complex lower leg and foot defects is difficult for plastic surgeons. The distally based sural flap (DBSF) is an option for non-free flap lower leg reconstruction. However, one of the major drawbacks of the DBSF is its aesthetically non-acceptable donor area scarring.
MATERIALS AND METHODS: Eight patients (six men and two women) who had lower leg or foot defects were evaluated in this study. We used an ipsilateral or cross-leg DBSF to repair the defect. A medial or lateral gastrocnemius perforator island flap (average size 8.1 × 6.1 cm) was used to cover the donor area of the DBSF in a two-stage operative procedure.
RESULTS: We did not observe any complications with the gastrocnemius perforator island flap. Two patients had local infections under the DBSF and were treated with bacteria-specific antibiotherapy. All patients were followed up for 1 year postoperatively. The donor areas of the distally based sural flaps were aesthetically acceptable. Patients gained ambulatory status during the follow-up period.
CONCLUSIONS: Reconstruction of the donor area of a DBSF with a gastrocnemius perforator island flap allows for more acceptable aesthetics and functional results than do other reconstructive procedures.

PMID: 26944233 [PubMed - as supplied by publisher]

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Increasing the availability of nerve transfer for cervical spinal cord injury.

Increasing the availability of nerve transfer for cervical spinal cord injury.

J Plast Reconstr Aesthet Surg. 2016 Feb 12;

Authors: Ward J, Power D

PMID: 26944232 [PubMed - as supplied by publisher]

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Remitting seronegative symmetrical synovitis with pitting oedema syndrome with oedematous skin histopathologically characterized by granulomatous change

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome was first described in 1985¹ and is characterized by symmetrical synovitis of acute onset with pitting oedema over the affected joints, especially the dorsum of the hands,² giving them a 'boxing-glove appearance'.³ Its pathogenesis remains to be elucidated, but the association with late-onset rheumatoid arthritis and polymyalgia rheumatica has been suggested. Moreover, the causative roles of paraneoplastic condition, drugs, infection and diabetes mellitus/insulin therapy have been proposed.⁴ This disease usually responds well to low-dose corticosteroids.⁵

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Multiple gait parameters derived from iPod accelerometry predict age-related gait changes

Publication date: Available online 5 March 2016
Source:Gait & Posture
Author(s): Nienke M Kosse, Nicolas Vuillerme, Tibor Hortobágyi, Claudine JC Lamoth
IntroductionNormative data of how natural aging affects gait can serve as a frame of reference for changes in gait dynamics due to pathologies. Therefore, the present study aims 1) to identify gait variables sensitive to age-related changes in gait over the adult life span using the iPod and 2) to assess if these variables accurately distinguish young (aged 18-45) from healthy older (aged 46-75) adults.MethodsTrunk accelerations were recorded with an iPod Touch in 59 healthy adults during three minutes of overground walking. Gait variables included gait speed and accelerometry-based gait variables (stride, amplitude, frequency, and trajectory-related variables) in the anterior-posterior (AP) and medio-lateral (ML) directions. Multivariate partial least square analysis (PLS) identified variables sensitive to age-related differences in gait. To classify young and old adults, a PLS-discriminant analysis (PLS-DA) was used to test the accuracy of these variables.ResultsThe PLS model explained 42% of variation in age. Influential variables were: mean stride time, phase variability index, root mean square, stride variability, AP sample entropy and ML maximal Lyaponov exponent. PLS-DA classified 83% of the participants correctly with a sensitivity of 83% and specificity of 71%.DiscussionContrary to the frequently reported high gait variability observed in old adults with frailty and fall history, the present study showed that younger compared with older healthy adults had a more variable, less predictable and more symmetrical gait pattern. A model based on a combination of variables reflecting gait dynamics, could distinguish healthy younger adults from older adults.

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Microvascular decompression for elderly patients with trigeminal neuralgia.

Microvascular decompression for elderly patients with trigeminal neuralgia.

J Clin Neurosci. 2016 Mar 1;

Authors: Phan K, Rao PJ, Dexter M

Abstract
Microvascular decompression (MVD) has been demonstrated to be an excellent surgical treatment approach in younger patients with trigeminal neuralgia (TN). However, it is not clear whether there are additional morbidity and mortality risks for MVD in the elderly population. We performed a systematic literature review using six electronic databases for studies that compared outcomes for MVD for TN in elderly (cut-off ⩾60, 65, 70years) versus younger populations. Outcomes examined included success rate, deaths, strokes, thromboembolism, meningitis, cranial nerve deficits and cerebrospinal fluid leaks. There were 1524 patients in the elderly cohort and 3488 patients in the younger cohort. There was no significant difference in success rates in elderly versus younger patients (87.5% versus 84.8%; P=0.47). However, recurrence rates were lower in the elderly (11.9% versus 15.6%; P=0.03). The number of deaths in the elderly cohort was higher (0.9% versus 0.1%; P=0.003). Rates of stroke (2.5% versus 1%) and thromboembolism (1.1% versus 0%) were also higher for elderly TN patients. No differences were found for rates of meningitis, cranial nerve deficits or cerebrospinal fluid leak. MVD remains an effective and reasonable strategy in the elderly population. There is evidence to suggest that rates of complications such as death, stroke, and thromboembolism may be significantly higher in the elderly population. The presented results may be useful in the decision-making process for MVD in elderly patients with TN.

PMID: 26944213 [PubMed - as supplied by publisher]

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Infiltrating spinal cord astrocytomas: Epidemiology, diagnosis, treatments and future directions.

Infiltrating spinal cord astrocytomas: Epidemiology, diagnosis, treatments and future directions.

J Clin Neurosci. 2016 Mar 1;

Authors: Abd-El-Barr MM, Huang KT, Chi JH

Abstract
Spinal cord gliomas, consisting mostly of ependymomas and astrocytomas, are rare entities. Of the gliomas, infiltrating astrocytomas are particularly challenging entities to treat due to their invasive nature. Surgical resection is oftentimes not possible without subjecting patients to permanent neurological deficits because of the difficulty in establishing clear tissue planes. As more is learned about the molecular genetics, genomics, and biology of these tumors, it is becoming more apparent that there are important differences between these tumors and their more common intracranial counterparts. There also appears to be important clinical differences between low-grade and high-grade astrocytomas. A multidisciplinary approach is needed to optimize the treatment of these difficult tumors.

PMID: 26944214 [PubMed - as supplied by publisher]

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'Sailing in troubled waters': a review of the use of anticoagulation in adult cancer patients with thrombocytopenia.

'Sailing in troubled waters': a review of the use of anticoagulation in adult cancer patients with thrombocytopenia.

Blood Coagul Fibrinolysis. 2016 Mar 4;

Authors: Ibrahim RB, Skewes MD, Kuriakose P

Abstract
Simply providing anticoagulation therapy is not as straightforward of a solution in cancer patients who have concurrent thrombocytopenia owing to the increased risk of bleeding complications. Currently, few guidelines are in place to assist clinicians in safely managing thrombocytopenic cancer patients on anticoagulation. The purpose of this review is to critically examine the available body of biomedical literature surrounding anticoagulant use against the backdrop of cancer-related thrombocytopenia in adult patients. Available evidence for the use of parenteral anticoagulants (low molecular weight heparins, unfractionated heparin, pentasaccharides, and direct thrombin inhibitors) and oral anticoagulants (vitamin K antagonists and novel oral anticoagulants) in thrombocytopenic cancer patients is described. The review revealed many inconsistencies between reports on this topic, which made it difficult to draw firm conclusions as to, for example, the ideal well tolerated anticoagulant dose in thrombocytopenic cancer patients? Intriguingly, critical clinical information including (but not limited) patient platelet nadirs, platelet counts during bleeding episodes, and platelet transfusion support was absent from a not-so-insignificant number of publications. Despite these shortcomings, the review sets out to formulate recommendations on the management of anticoagulation, at prophylactic or treatment doses, in adult cancer patients who also have concurrent thrombocytopenia. It also enlists a call for the medical community, by mapping select clinical guideposts, for further research in this setting. With the inclusion of these criteria in future studies, only then formal recommendations on the ideal safe dosage of anticoagulants in cancer patients, based on solid evidence, are conceived.

PMID: 26945262 [PubMed - as supplied by publisher]

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Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study.

Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study.

BMC Palliat Care. 2016;15(1):27

Authors: Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, Deliens L

Abstract
BACKGROUND: To improve the quality of end-of-life care in geriatric hospital wards we developed the Care Programme for the Last Days of Life. It consists of 1) the Care Guide for the Last Days of Life, 2) supportive documentation and 3) an implementation guide. The aim of this study is (1) to determine the feasibility of implementing the Care Programme for the Last Days of Life in the acute geriatric hospital setting and (2) to explore the health care professionals' perceptions of the effects of the Care Programme on end-of-life care.
METHODS: A phase 2 mixed methods study according with the MRC framework was performed in the acute geriatric ward of Ghent University Hospital between 1 April and 30 September 2013. During the implementation process a mixed methods approach was used including observation, interviews and the use of a quantitative process evaluation tool. This tool measured the success of implementation using several indicators, such as whether a steering group was formed, whether and how much of the health care staff was informed and trained and how many patients were cared for according to the Care Guide for the Last Days of Life.
RESULTS: The process evaluation tool showed that implementing the Care Programme for the Last Days of Life in the geriatric ward was successful and thus feasible; a steering group was formed consisting of two facilitators, health care staff of the geriatric ward were trained in using the Care Guide for the Last Days of Life which was subsequently introduced onto the ward and approximately 57 % of all dying patients were cared for according to the Care Guide for the Last Days of Life. With regard to health care professionals' perceptions, nurses and physicians experienced the Care Guide for the Last Days of Life as improving the overall documentation of care, improving communication among health care staff and between health care staff and patient/family and improving the quality of end-of-life care. Barriers to implementing the Care Programme for the Last Days of Life successfully are, among others, difficulties with the content of the documents used within the Care Programme for the Last Days of Life and the low participation rate of physicians in the training sessions and audits.
CONCLUSIONS: Results of this mixed methods study suggest that implementing the Care Programme for the Last Days of Life is feasible and that it has favorable effects on end-of-life care as reported by health care professionals. Based on the identified barriers during the implementation process, we were able to make recommendations for future implementation and further refine the Care Programme for the Last Days of Life before implementing it in a phase 3 cluster randomized controlled trial for the evaluation of its effectiveness.

PMID: 26944263 [PubMed - as supplied by publisher]

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Targeting of microRNA-199a-5p protects against pilocarpine-induced status epilepticus and seizure damage via SIRT1-p53 cascade

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Summary

Objective

MicroRNAs (miRNAs) are noncoding small RNAs that control gene expression at the posttranscriptional level. Some dysregulated miRNAs have been shown to play important roles in epileptogenesis. The aim of this study was to determine if miR-199a-5p regulates seizures and seizure damage by targeting the antiapoptotic protein silent information regulator 1 (SIRT1).

Methods

Hippocampal expression levels of miR-199a-5p, SIRT1, and acetylated p53 were quantified by quantitative real-time polymerase chain reaction (RT-PCR) and Western blotting in the acute, latent, and chronic stages of epilepsy in a rat lithium-pilocarpine epilepsy model. Silencing of miR-199a-5p expression in vivo was achieved by intracerebroventricular injection of antagomirs. The effects of targeting miR-199a-5p and SIRT1 protein on seizure and epileptic damage post-status epilepticus were assessed by electroencephalography (EEG) and immunohistochemistry, respectively.

Results

miR-199a-5p expression was up-regulated, SIRT1 levels were decreased, and neuron loss and apoptosis were induced in epilepsy model rats compared with normal controls, as determined by up-regulation of acetylated p53 and cleaved caspase-3 expression. In vivo knockdown of miR-199a-5p by an antagomir alleviated the seizure-like EEG findings and protected against neuron damage, in accordance with up-regulation of SIRT1 and subsequent deacetylation of p53. Furthermore, the seizure-suppressing effect of the antagomir was partly SIRT1 dependent.

Significance

The results of this study suggest that silencing of miR-199a-5p exerts a seizure-suppressing effect in rats, and that SIRT1 is a direct target of miR-199a-5p in the hippocampus. The effect of miR-199a-5p on seizures and seizure damage is mediated via down-regulation of SIRT1. The miR-199a-5p/SIRT1 pathway may thus represent a potential target for the prevention and treatment of epilepsy and epileptic damage.

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Proteomics, photosynthesis and salt resistance in crops: An integrative view

Publication date: Available online 5 March 2016
Source:Journal of Proteomics
Author(s): Joaquim A.G. Silveira, Fabricio E.L. Carvalho
Salinity is a stressful condition that causes a significant decrease in crop production worldwide. Salt stress affects several photosynthetic reactions, including the modulation of several important proteins. Despite these effects, few molecular-biochemical markers have been identified and evaluated for their importance in improving plant salt resistance. Proteomics is a powerful tool that allows the analysis of multigenic events at the post-translational level that has been widely used to evaluate protein modulation changes in plants exposed to salt stress. However, these studies are frequently fragmented and the results regarding photosynthesis proteins in response to salinity are limited. These constraints could be related to the low number of important photosynthetic proteins differently modulated in response to salinity, as has been commonly revealed by conventional proteomics. In this review, we present an evaluation and perspective on the integrated application of proteomics for the identification of photosynthesis proteins to improve salt resistance. We propose the use of phospho-, thiol- and redox-proteomics, associated with the utilization of isolated chloroplasts or photosynthetic sub-organellar components. This strategy may allow the characterization of essential proteins, providing a better understanding of photosynthesis regulation. Furthermore, this may contribute to the selection of molecular markers to improve salt resistance in crops.

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Data in support of dyslipidemia-associated alterations in B cell subpopulations frequency and phenotype during experimental atherosclerosis

Publication date: Available online 5 March 2016
Source:Data in Brief
Author(s): Héctor Rincón-Arévalo, Diana Castaño, Janny Villa-Pulgarín, Mauricio Rojas, Gloria Vásquez, Luis A. Correa, José R. Ramírez-Pineda, Lina M. Yassin
Cardiovascular diseases are the most common cause of death in the world, atherosclerosis being its main underlying disease. Information about the role of B cells during atherosclerotic process is scarce, but both proatherogenic and atheroprotective properties have been described in the immunopathology of this disease. Frequency and phenotype of B cell subpopulations were studied in wild type and apolipoprotein-E-deficient (apoE^−/−) mice fed or not with high-fat diet (HFD), by flow cytometry. Here, we provide the information about the materials, methods, analysis and additional information related to our study published in Atherosclerosis (DOI: 10.1016/j.atherosclerosis.2015.12.022, article reference: ATH14410) [1]. The data contained in this article shows and supports that mice with advanced atherosclerosis have a variety of alterations in frequency and phenotype of B cell subsets, most of which associated with dyslipidemia.

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Time-resolved searchlight analysis of imagined visual motion using 7T ultra-high field fMRI: Data on interindividual differences

Publication date: Available online 5 March 2016
Source:Data in Brief
Author(s): Thomas C. Emmerling, Jan Zimmermann, Bettina Sorger, Martin Frost, Rainer Goebel
Interindividual differences play a crucial role in research on mental imagery. The inherently private nature of imagery does not allow for the same experimental control that is possible in perception research. Even when there are precise instructions subjects will differ in their particular imagery strategy and, hence, show different brain activations. Here, we show results of a time-resolved searchlight analysis for 12 individual subjects who perform a visual motion imagery task. The data show the spatial and temporal extent of brain areas and time windows that allow for a successful decoding of the direction of imagined motion out of four options. Accuracy maps for six different time windows are shown for every individual subject and are made freely available on NeuroVault. These data accompany the findings in the publication "Decoding the direction of imagined visual motion using 7T ultra-high field fMRI" [1].

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Tiotropium add-on therapy in adolescents with moderate asthma: A 1-year randomized controlled trial

Publication date: Available online 5 March 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Eckard Hamelmann, Eric D. Bateman, Christian Vogelberg, Stanley J. Szefler, Mark Vandewalker, Petra Moroni-Zentgraf, Mandy Avis, Anna Unseld, Michael Engel, Attilio L. Boner
BackgroundResults from phase III clinical trials in adults and phase II clinical trials in children and adolescents demonstrate that tiotropium is an effective treatment when added to inhaled corticosteroid (ICS) maintenance therapy.ObjectiveWe sought to assess the efficacy and safety of once-daily tiotropium Respimat added to ICSs with or without a leukotriene receptor antagonist in a phase III trial in adolescent patients with moderate symptomatic asthma.MethodsIn this 48-week, double-blind, placebo-controlled, parallel-group study, 398 patients aged 12 to 17 years were randomized to receive 5 μg (2 puffs of 2.5 μg) or 2.5 μg (2 puffs of 1.25 μg) of once-daily tiotropium or placebo (2 puffs) administered through the Respimat device every evening, each as add-on treatment to ICS background therapy, with or without a leukotriene receptor antagonist; long-acting β2-agonist therapy was not permitted during the study.ResultsImprovement in peak FEV1 within 3 hours after dosing at 24 weeks (primary end point) was statistically significant with both tiotropium doses compared with placebo: 5 μg of tiotropium, 174 mL (95% CI, 76-272 mL); 2.5 μg of tiotropium, 134 mL (95% CI, 34-234 mL). Significant improvements in trough FEV1 at week 24 (a secondary end point) were observed with the 5-μg dose only. Trends for improvement in asthma control and health-related quality of life over the 48-week treatment period were observed.ConclusionsOnce-daily tiotropium significantly improved lung function and was safe and well tolerated when added to at least ICS maintenance therapy in adolescent patients with moderate symptomatic asthma. Larger responses were observed with the 5-μg tiotropium dose.

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Κυριακή 6 Μαρτίου 2016

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