Development and Validation of the Mastocytosis Activity Score: MAS

Abstract

Background

Mastocytosis is a heterogeneous disease characterized by a clonal expansion of mast cells in various organs. The vast majority of patients suffer from signs and symptoms caused by mediator release from mast cells. Although the disease burden is high, there is currently no specific and validated instrument to measure and monitor signs and symptoms in patients with mastocytosis.

Objective

To develop and validate a disease-specific tool to measure and monitor the activity of signs and symptoms in patients with mastocytosis, the Mastocytosis Activity Score (MAS).

Methods

Nineteen potential MAS items were developed in a combined approach consisting of semi-structured patient interviews, expert input, and literature research. Item selection was performed by impact analysis with 76 patients followed by a review for face validity. The resulting MAS was tested for validity, reliability and influence factors. In parallel, a US American-English version of the MAS was developed.

Results

68 mastocytosis patients took part in the MAS validation study. The final 9-item MAS was found to have a three-domain structure ('skin', 'gastrointestinal tract', 'other'), a valid total score and an excellent test-retest-reliability. Multiple regression analysis revealed that disease duration, age, or gender are no significant determinant of the MAS results.

Conclusions

The MAS is a disease-specific, valid and reliable patient reported outcome measure for adult patients with cutaneous and indolent systemic mastocytosis. It may serve as a valuable tool to measure and monitor mastocytosis activity, both, in clinical trials and in routine care.

This article is protected by copyright. All rights reserved.

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Baseline neutrophil to lymphocyte ratio combined with serum LDH level associated with outcome of nivolumab immunotherapy in a Japanese advanced melanoma population

Abstract

Although immune checkpoint inhibitors (ICI) significantly improve the survival of advanced melanoma, more than half of the patients received no benefit. To predict outcomes, efforts to associate baseline peripheral blood biomarkers were started in patients given treatment with ipilimumab. Among the most critical markers is an increased neutrophil-to-lymphocyte ratio (NLR), which negatively correlates with outcome. Although several baseline factors have been reported to correlate with outcome in patients treated with nivolumab/pembrolizumab (eosinophil count, lymphocyte count, lactate dehydrogenase [LDH], and c-reactive protein [CRP]), a positive link between NLR and outcome has yet to be shown.

This article is protected by copyright. All rights reserved.

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Wide skin markings pattern - melanoma descriptor or patient-related factor?

Abstract

We are intrigued by the findings reported in the letter titled "Uncovering the diagnostic dermoscopic features of flat melanomas located on the lower limbs"(1). Bassoli et al investigated the association of the "wider skin marking pattern" with cutaneous melanoma. They state that this feature corresponds to "…linear intercepting furrows, lighter than the lesion's overall pigmentation and wider compared to the surrounding skin. The authors conclude that "recognition of wider skin markings may…prompt the clinician to obtain a biopsy specimen." We respectfully ask the authors to clarify several aspects of their study methodology.

This article is protected by copyright. All rights reserved.

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Application of in vivo reflectance confocal microscopy (RCM) and ex vivo fluorescence confocal microscopy (FCM) in most common subtypes of Basal Cell Carcinoma and correlation with histopathology

Abstract

Basal cell carcinoma (BCC) accounts for 80% of non-melanoma skin cancer. The identification of the histological subtype is crucial for the correct management of the tumor. In vivo reflectance confocal microscopy (RCM) is a novel technique that has demonstrated high sensitivity and specificity in the in vivo diagnosis of BCC. In an effort to determine reliable criteria for preoperative diagnosis of BCC subtypes, Longo et al. and Peppelman et al., described RCM criteria present in different BCC subtypes.

This article is protected by copyright. All rights reserved.

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Hyaluronan metabolism enhanced during epidermal differentiation is suppressed by vitamin C

Abstract

Background

Hyaluronan is a large, linear glycosaminoglycan present throughout the narrow extracellular space of the vital epidermis. Increased hyaluronan metabolism takes place in epidermal hypertrophy, wound healing and cancer. Hyaluronan is produced by hyaluronan synthases (HAS1-3) and catabolized by hyaluronidases (HYAL1 and -2), reactive oxygen species (ROS), and the KIAA1199 protein.

Objectives

To investigate the changes in hyaluronan metabolism during epidermal stratification and maturation, and the impact of vitamin C.

Methods

Hyaluronan synthesis and expression of the hyaluronan-related genes were analyzed during epidermal maturation from a simple epithelium to a fully differentiated epidermis in organotypic cultures of rat epidermal keratinocytes (REK) using qRT-PCR, immunostainings, and western blotting, in the presence and absence of vitamin C.

Results

With epidermal stratification, both the production and the degradation of hyaluronan were enhanced, resulting in an increase of hyaluronan fragments of various sizes. While the mRNA levels of Has3 and KIAA1199 remained stable during the maturation, Has1, Has2, and Hyal2 showed a transient upregulation during stratification, Hyal1 remained permanently increased, and the hyaluronan receptor Cd44 decreased. At maturation, Vitamin C downregulated Has2, Hyal2 and Cd44, while it increased high molecular mass hyaluronan in the epidermis, and reduced small fragments in the medium, suggesting stabilization of epidermal hyaluronan.

Conclusions

Epidermal stratification and maturation is associated with enhanced hyaluronan turnover, and release of large amounts of hyaluronan fragments. The high turnover is suppressed by vitamin C, which is suggested to enhance normal epidermal differentiation in part through its effect on hyaluronan.

This article is protected by copyright. All rights reserved.

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Levocarnitine for vismodegib-associated muscle spasms: a pilot randomized, double-blind, placebo-controlled, investigator initiated trial

Abstract

Smoothened inhibitors (SIs) are a new, targeted therapy for the treatment of advanced basal cell carcinoma (BCC), but their usage is significantly limited by the most common side effect, muscle spasms. Muscle spasms affect up to 80% of users, and are the most common reason for drug discontinuation despite tumor response. Currently, no placebo-controlled trials exist to guide the management of vismodegib-related muscle spasms. The medical literature suggests that the naturally occurring substance, levocarnitine (LC), can improve contractile function of muscle and reduce markers of exercise-induced stress. Hence, we explored the effect of oral LC on vismodegib-related muscle spasms via a double-blind, randomized, placebo-controlled, two-period crossover design.

This article is protected by copyright. All rights reserved.

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Factors associated with delayed referral for infantile hemangioma necessitating propranolol

Abstract

Background

Oral propranolol is the gold-standard to treat infantile hemangiomas. There is better efficacy and a lower risk of sequelae if therapy is started before the end of the growth phase, but most children are referred too late. Herein, we report the first study to investigate the delay and its associated factors when referring infants with infantile hemangiomas that need propranolol therapy.

Objectives

The primary objective was to determine the delay in referral (time between age at referral [first phone contact] and the optimal age for referral (fixed at 75 days). The second objective was to determine the impact of weighted factors associated with delayed referral assessed by logistic regression performed on two subgroups (referral <75 vs. >75 days).

Methods

Monocentric, retrospective, observational study included infants with infantile hemangiomas treated with oral propranolol between August 2014 and May 2017.

Results

82 children (83% females) were included. Before referral, 81 (99%) children had seen another physician (a pediatrician in 67% of cases). Median age at referral was 99 [2-478] days and 63% phoned after 75 days. Median age at the first visit was 111 days [2-515] and median age when propranolol was started was 128 days [32-541]. After adjustment, in multivariate analyses, location on the lips (OR (CI_95%): 4.21[1.19–14.89]) and superficial hemangioma (OR (CI_95%): 4.19 [1.55–11.34]) emerged as the most significant factors to influence referral before 75 days.

Conclusions

This study adds to our understanding regarding delayed referral and has identified targets for future information campaigns.

This article is protected by copyright. All rights reserved.

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Comparison of fungal fluorescent staining and ITS rDNA PCR-based sequencing with conventional methods for the diagnosis of onychomycosis

Abstract

Background

The current gold standard for diagnosing onychomycosis is direct microscopic examination and culturing. Fungal culture is a time-consuming procedure, while direct microscopy of potassium hydroxide (KOH) mounts suffers from low sensitivity. More rapid and sensitive methods for the diagnosis of onychomycosis are in high demand.

Objective

To establish an effective method for the diagnosis of onchomycosis by assessing the efficacies of fungal fluorescent staining and internal transcribed spacer (ITS) ribosomal DNA (rDNA) polymerase chain reaction (PCR)-based sequencing.

Methods

A total of 204 clinical specimens from patients with suspected onychomycosis were analysed. The gold standard for a true positive sample was positive by KOH, culturing, or both methods. All specimens were also tested by fungal fluorescent staining and its rDNA PCR-based sequencing. We compared the detection, sensitivity, and specificity for these two methods with conventional methods.

Results

In total, 126 (62%) and 102 (50%) were detected by fluorescent staining and PCR-based sequencing, respectively. According to the conventional diagnostic standard, the sensitivity of fluorescent staining and PCR-based sequencing was 97% and 78%, respectively, and specificities of 89% and 90%, respectively. Use of fluorescence enhanced the sensitivity of direct examination by 12% compared with KOH. PCR-based sequencing increased the sensitivity by 6% compared with culturing.

Conclusions

Fluorescence microscopy has a higher sensitivity for the detection of fungi in nail specimens compared with KOH and can be used as a rapid screening tool. PCR-based sequencing was faster and more sensitive compared with culture and when used in conjunction with fluorescence microscopy resulted in higher efficiency.

This article is protected by copyright. All rights reserved.

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Molecular genetic analyses of human endogenous retroviral elements belonging to the HERV-P and -R family in Primary Cutaneous T-Cell Lymphomas

Abstract

Mycosis fungoides (MF) is characterized by longstanding, scaly patch lesions preferentially involving the buttocks and body areas infrequently exposed to sunlight and by a slow evolution over years from patches to plaques and eventually tumors or erythroderma. Lymph node and visceral involvement, as well as large cell transformation, frequently occur in the late stages of the disease [1]. Sézary syndrome (SS) is an erythrodermic cutaneous T-cell lymphoma (CTCL) with leukemic involvement, an aggressive clinical behavior and poor prognosis [2].

This article is protected by copyright. All rights reserved.

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Studying the effect of systemic and biological drugs on intima-media thickness in patients suffering from moderate and severe psoriasis

Abstract

Background

Psoriasis has been related to a large number of cardiovascular risk factors such as hypertension, diabetes mellitus and arteriosclerosis. The increased carotid intima-media thickness (IMT) could be considered to be a marker of generalized arteriosclerosis.

Objective

To assess the effect of systemic and biological drugs on psoriatic patients′ carotid IMT.

Methods

A prospective study was performed. We studied 53 patients with moderate and severe psoriasis from our psoriasis dermatological unit, analyzing lipid and glucose metabolism and performing a carotid IMT sonography before introduction of systemic and biological drugs. After that, we performed an 8-month closely analytic and sonographic follow-up.

Results

The IMT of the psoriatic patients treated with biological drugs tended to decrease, although this occurrence was not statistically significant (p=0.086). The subgroup analysis revealed that patients treated with Methotrexate (p=0,045) and Anti Il-12/23 (p=0,010) presented a decrease of their IMT levels. This analysis also showed a decrease in glycaemia and insulin levels in patients treated with TNF-alpha Inhibitors and Ustekinumab.

Conclusions

Our study suggest that the carotid-IMT may benefits from treatment with biological drugs, particularly Anti IL-12/23, and methotrexate in patients suffering from moderate and severe psoriasis. However, larger longitudinal studies should be performed in order to fully confirm these results.

This article is protected by copyright. All rights reserved.

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Use of Medical Photography Among Dermatologists: A Nationwide Online Survey Study

Abstract

Background

Medical photography enhances patient care, medical education, and research. Despite medical photography's widespread use, little is known about how dermatologists choose to implement photography in routine clinical practice, and how they approach issues of image storage, image security, and patient consent.

Objective

To characterize dermatologists' medical photography habits and opinions.

Methods

A 32-item anonymous, multiple-choice SurveyMonkey questionnaire about medical photography practices was emailed to program directors of the 117 United States (US) dermatology residency programs between May and August 2015, with a request to forward to faculty and affiliated dermatologists. Only board-certified dermatologists practicing in the US were eligible. The Institutional Review Board exempted our study from full review.

Results

Our survey included 153 board-certified dermatologists, primarily representing the northeast (43.1%) and identifying as academic dermatologists (75.5%). Medical photography is prevalent: 61.8% report everyday use and 21.7% photograph every patient. Those reporting rare use (3.3%) were, on average, 20 years older. Dermatologists most commonly use photography to mark biopsy sites (87.5%), track disease (82.9%), and for education/teaching (72.4%). Nearly half (46%) use smartphone cameras. Emailing and texting photographs with patients or colleagues are common (69.1%). Most dermatologists (75.7%) always request patient consent for photographs. Only 23.7% adhere to a photography protocol and 73.9% desire more training opportunities.

Conclusion

Dermatologists value medical photography. While patterns of image acquisition, storage, and consent are noted, a variety of methods and preferences exist. Clearer photography guidelines and increased educational resources are likely to improve image quality, exchangeability, and confidentiality.

This article is protected by copyright. All rights reserved.

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Herpes zoster at the vaccination site in immunized healthy children

Abstract

In this case series, we report seven immunized healthy children without underlying immunodeficiency who presented with herpes zoster that correlated with varicella-zoster vaccination site. The morphology of the lesions included erythematous papules, pseudovesicles, and plaques, with associated pain in two and pruritus in three patients; systemic symptoms ranged from none to low-grade fevers, upper respiratory symptoms, and joint pain. These cases highlight the clinical, diagnostic, and therapeutic implications of herpes zoster in vaccinated children.

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Das Recht am eigenen Bild

Laryngo-Rhino-Otol 2018; 97: 121-122
DOI: 10.1055/s-0043-118941

© Georg Thieme Verlag KG Stuttgart · New York

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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 141-145
DOI: 10.1055/s-0043-124386

© Georg Thieme Verlag KG Stuttgart · New York

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Endoskopisch ausgeführte Tympanoplastik mit Vorteilen

Laryngo-Rhino-Otol 2018; 97: 82-83
DOI: 10.1055/s-0043-121839

Kuo CH et al. Comparison of endoscopic and microscopic tympanoplasty. Eur Arch Otorhinolaryngol 2017;274:2727–2732 Welche Vor-und Nachteile hat die endoskopisch durchgeführte Tympanoplastik? Wie sieht die Erfolgs- und die Komplikationsrate bei alleiniger Rekonstruktion des Trommelfells und bei Wiederherstellung einer funktionalen Gehörknöchelchenkette aus?
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 138-139
DOI: 10.1055/s-0044-101037

© Georg Thieme Verlag KG Stuttgart · New York

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Erhöhtes Schlaganfallrisiko nach Neck Dissection?

Laryngo-Rhino-Otol 2018; 97: 83-84
DOI: 10.1055/s-0043-121847

Cramer JD et al. Is Neck Dissection Associated with an Increased Risk of Postoperative Stroke? Otolaryngol Head Neck Surg 2017; 157(2): 226–232 Der Schlaganfall gehört zu den schwersten Komplikationen der Kopf- und Hals- Chirurgie. Wie hoch das Risiko speziell nach einer Neck Dissection ist, haben Cramer und Kolleginnen/Kollegen jetzt in einer retrospektiven Kohortenstudie genauer untersucht.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Medikamentöse Therapie des Schilddrüsenknotens

Laryngo-Rhino-Otol 2018; 97: 89-91
DOI: 10.1055/s-0043-124607

Während in Regionen mit ausreichender Iodversorgung die Therapie des Schilddrüsenknotens mit Levothyroxin weitgehend verlassen wurde und auch nicht mehr in den Leitlinien empfohlen wird, gibt es für eine medikamentöse Therapie von Schilddrüsenknoten in Deutschland eine Indikation, wie die randomisierte, placebokontrollierte LISA-Studie nachgewiesen hat.Wesentlicher Grund ist ein leichter Iodmangel bei Patienten mit Schilddrüsenknoten. In der LISA-Studie führte eine Levothyroxin-Iodid-Kombinationstherapie zu einer mindestens 50 %igen Volumenreduktion der Knoten bei 21,6 % der Patienten gegenüber bei nur 5,2 % der Placebo-Behandelten.Unter der kombinierten L-T4-Iodidtherapie wird der TSH-Wert im unteren Referenzbereich eingestellt, eine TSH-Suppression (latente Hyperthyreose) muss vermieden werden, da sie zu Herzrhythmusstörungen führen kann.Im höheren Alter muss aufgrund der kardiovaskulären Risiken die Indikation zu einer Schilddrüsenhormontherapie überprüft, die Dosis häufig reduziert oder die Therapie abgesetzt werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Tympanoplastik Typ I im frühen Kindesalter erfolgsversprechend

Laryngo-Rhino-Otol 2018; 97: 84-85
DOI: 10.1055/s-0043-123911

Singh GB et al. Paediatric tympanoplasty: comparative study between patients aged 5–8 years and those aged over 14 years. J Laryngol Otol 2016; 130: 635–639
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Aktueller Status der Therapie und Prophylaxe des Oropharynxkarzinoms

Laryngo-Rhino-Otol 2018; 97: 123-137
DOI: 10.1055/s-0043-121329

Die Inzidenz von Oropharynxkarzinomen nimmt weltweit signifikant zu. Aufgrund ihres Zusammenhangs mit chronischem Tabak-/Alkoholkonsum, zunehmend aber auch mit dem humanen Papillomavirus HPV-16, sind die Oropharynxkarzinome eine genetisch heterogene Tumorgruppe mit hoher prognostischer Diversifikation. Dieser Beitrag versucht auf Basis der aktuellen Evidenzlage Empfehlungen zu Therapie, Prophylaxe und Früherkennung darzulegen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Durchführung und Interpretation der FEES (Fiberoptic Endoscopic Evaluation of Swallowing)

Laryngo-Rhino-Otol 2018; 97: 86-88
DOI: 10.1055/s-0043-125007

© Georg Thieme Verlag KG Stuttgart · New York

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„Das Thema künstliche Intelligenz ist in der Radiologie angekommen“

Laryngo-Rhino-Otol 2018; 97: 140-140
DOI: 10.1055/s-0043-125319

Zum zweiten Mal nach 2017 findet im Februar 2018 der Kongress Emerging Technologies in Medicine – ETIM statt. Initiator des Zukunftskongresses ist Prof. Dr. Michael Forsting, Direktor der Universitätsradiologie Essen. Im Interview skizziert er die Themen der kommenden Tagung und welche Bedeutung sie für die Radiologie haben.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Seltener Nasennebenhöhlen Tumor

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-123652

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 79-80
DOI: 10.1055/s-0044-100459

[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Tropical Dermatology, 2nd ed

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Response to: baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO

We read with interest comments from Oppenheimer and Greenberger1 highlighting the baseline findings of the PROSPERO trial that describe a real-world population with moderate to severe asthma accompanied by multiple comorbidities, a substantial disease burden, and a heterogeneous biomarker profile who were initiated on omalizumab.2 We agree with their conclusions that patients with severe asthma represent a challenging population and that multiple factors must be considered when evaluating patients as candidates for biologic therapies.

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Biologics in allergic and immunologic diseases: promises and challenges in the era of personalized medicine

Discovery of new biologics offer promise in the treatment of chronic, refractory allergic and immunologic conditions. Emerging biologic therapies have ushered in an era of personalized medicine, also referred to as precision medicine, whereby physicians can choose targeted therapies based on disease phenotype. Undoubtedly, this has been a significant advance for patients with conditions such as severe asthma, and also offers hope for successful management of other allergic and immunologic conditions, such as severe atopic dermatitis and refractory chronic urticaria.

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New Research Suggests Your Immune System Can Protect Against MRSA Infections

After years of investigation, researchers at Johns Hopkins, the University of California, Davis, and the National Institute of Allergy and Infectious Diseases have discovered how the immune system might protect a person from recurrent bacterial skin infections caused by Staphylococcus aureus (staph).

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MicroRNA-186 serves as a tumor suppressor in oral squamous cell carcinoma by negatively regulating the protein tyrosine phosphatase SHP2 expression

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Zhen Cai, Xiu-Yan Hao, Feng-Xin Liu
ObjectiveMicroRNAs (miRs) have been shown to play critical roles in the pathogenesis of oral squamous cell carcinoma (OSCC), the current study is designed to identify the potential role of miR-186 in OSCC.Materials and methodsRealtime polymerase chain reaction was used to determine miR-186 expression in paired tissue samples (OSCC and adjacent normal tissues) and multiple oral cell lines (normal oral keratinocyte HOK cell and OSCC cell lines). Cell viability, colony formation and flow cytometry assays were used to assess the biological function of miR-186. Furthermore, luciferase and western blot assays were used to verify the predicted target of miR-186.ResultsWe found that miR-186 expression was significantly downregulated in OSCC tissues and cell lines. Overexpression of miR-186 produced an anti-growth effect and induced apoptosis in Tca8113 and SCC-25 cells. Luciferase assay revealed that miR-186 directly targeted PTPN11 (a gene encodes the protein tyrosine phosphatase SHP2) mRNA 3′ untranslated region and suppressed its expression. Consistently, MiR-186 and SHP2 were negatively correlated in OSCC tissues. Consequently, miR-186 inhibited signaling activities of Extracellular Regulated protein Kinases (ERK) and Protein kinase B (AKT), which act downstream of SHP2 and are critical for growth of cancer cells.ConclusionWe identify that miR-186 serves as a tumor suppressor in OSCC. Downregulation of this microRNA may lead to a higher expression of oncogenic factor SHP2, which leads to activation of growth promoting signaling. Thus, miR-186 may be a novel and effective therapeutic agent for the treatment of OSCC.



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An in vitro study on the influence of viscosity and frequency of application of fluoride/tin solutions on the progression of erosion of bovine enamel

Publication date: Available online 3 February 2018
Source:Archives of Oral Biology
Author(s): Letícia Oba Sakae, Sávio José Cardoso Bezerra, Samira Helena João-Souza, Alessandra Buhler Borges, Idalina V. Aoki, Ana Cecília Côrrea Aranha, Taís Scaramucci
ObjectiveTo evaluate the influence of the viscosity and frequency of application of solutions containing sodium fluoride (NaF) and stannous chloride (SnCl2) on enamel erosion prevention.DesignBovine enamel specimens were randomly distributed into 12 groups (n = 10), according to the following study factors: solution (C: deionized water; F: 500 ppm F⁻; F + Sn: 500 ppm F⁻ + 800 ppm Sn²⁺); viscosity (low and high); and frequency of application (once and twice a day). Specimens were submitted to an erosive cycling model, consisting of 5 min immersion in 0.3% citric acid, followed by 60 min exposure to a mineral solution. This procedure was repeated 4x/day, for 5 days. Treatment with the experimental solutions was performed for 2 min, 1x/day or 2x/day. Enamel surface loss (SL) was determined by optical profilometry. Data were analyzed by 3-way ANOVA and Tukey tests (α = 0.05).ResultsThere were significant differences between the levels of the factor solution (p < 0.001), viscosity (p < .001) and in the interaction between solution and viscosity (p = 0.01). Regarding solution, the mean SL ± standard deviation for the groups was F + Sn (4.90 ± 1.12) < F (7.89 ± 1.19) < C (14.20 ± 1.69). High viscosity solutions demonstrated less SL than low viscosity; however, only when applied once a day (p < .001). Applying the solutions twice a day yielded lower SL than once a day, but only for the low viscosity solutions (p = 0.003).ConclusionsUnder the conditions of this short-term in vitro experiment, it could be concluded that increasing the viscosity of the oral rinse solutions reduced enamel loss by erosion; however, this effect was small and only observed when the solutions were applied once a day.



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Comparative proteomic profiling of human dental pulp stem cells and periodontal ligament stem cells under in vitro osteogenic induction

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): He Wang, Dandan Ma, Xiaoyi Zhang, Shuaimei Xu, Tingting Ning, Buling Wu
ObjectiveThis study aimed to compare the proteomic profiling of human dental pulp stem cells (DPSCs) and periodontal ligament stem cells (PDLSCs) under in vitro osteogenic induction, which imitates the microenvironment during osteo-/odontogenesis of DPSCs and PDLSCs.DesignThe proteomic profiles of osteoinduced DPSCs and PDLSCs from a single donor were compared using the isobaric tag for relative and absolute quantitation (iTRAQ) technique and subsequent bioinformatics analysis.ResultsA total of 159 differentially expressed proteins in PDLSCs and DPSCs were identified, 82 of which had a higher expression level in PDLSCs, while 77 were more highly expressed in DPSCs. Among these enriched proteins, certain members from the collagen, heat shock protein and protein S100 families may distinguish osteoinduced PDLSCs and DPSCs. Gene ontology (GO) classification revealed that a large number of the enriched terms distinguishing PDLSCs and DPSCs are involved in catalytic activity, protein binding, regulation of protein metabolic processes and response to stimulus. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated several involved pathways, including the fatty acid biosynthesis pathway, pantothenate and CoA biosynthesis pathway, arachidonic acid metabolism pathway and PPAR signaling pathway. Further verification showed that the mineralization and migration capacities of PDLSCs were greater than those of DPSCs, in which heat shock protein beta-1, Protein S100-A10 and S100-A11 may play a part.ConclusionsLess than 5% of the differentially expressed proteins make up the comparative proteomic profile between osteoinduced PDLSCs and DPSCs. This study helps to characterize the differences between osteoinduced PDLSCs and DPSCs in vitro.



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Maresin 1 regulates autophagy and inflammation in human periodontal ligament cells through glycogen synthase kinase–3β/β-catenin pathway under inflammatory conditions

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Li Du, Yucheng Li, Weifeng Liu
ObjectiveAccumulating lines of evidence suggest that maresin 1 (MaR-1) exerts anti-inflammatory effects in many cell types and plays beneficial roles in inflammatory disease, such as peritonitis and colitis. Moreover, it has been demonstrated that MaR-1 play protective roles against localized aggressive periodontitis. However, the function and mechanism of MaR-1 in human periodontal ligament cells (PDL) cells from periodontitis are poorly understood. The present study aimed to clarify the effects and molecular mechanism of MaR-1 in PDL cell survival and inflammation.MethodsPDL cells were isolated from the middle third of the root surface of premolars from four healthy humans; MTT assay and cell death detection ELISA assay were used to detect cell survival and apoptosis; Inflammatory cytokines level was measured by ELISA assay; RT-PCR and western blot was used to measure the mRNA and protein expression in this study.ResultsHere we found that MaR-1 treatment markedly promotes survival and inhibits apoptosis in PDL cell treated by LPS. MaR-1 treatment strikingly suppressed the production of LPS-induced pro-inflammatory cytokines IL-6, IL-8, TNF-α and IL-1β. MaR-1 also promotes autophagy by increasing the ratio of LC3II/LC3I, the level of beclin-1 and reduced the expression of p62 in LPS treated PDL cells, which is beneficial to cell survival. Moreover, the results showed that MaR-1-mediated autophagy is dependent on the glycogen synthase kinase–3β(GSK-3β)/β-catenin signal pathway. The inhibitor of autophagy 3-MA and the inhibitor of the GSK-3β/β-catenin signal pathway LiCL both reverse the effects of MaR-1 on LPS-treated PDL cell survival and inflammation.ConclusionMaR-1 promotes cell survival and alleviates cell inflammation by activating GSK-3β/β-catenin-dependent autophagy. These results provide new insights into the mechanism of chronic periodontitis.



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The PBII gene of the human salivary proline-rich protein P-B produces another protein, Q504X8, with an opiorphin homolog, QRGPR

Publication date: April 2018
Source:Archives of Oral Biology, Volume 88
Author(s): Eiichi Saitoh, Takuya Sega, Akane Imai, Satoko Isemura, Tetsuo Kato, Akihito Ochiai, Masayuki Taniguchi
ObjectivesThe NCBI gene database and human-transcriptome database for alternative splicing were used to determine the expression of mRNAs for P-B (SMR3B) and variant form of P-B. The translational product from the former mRNA was identified as the protein named P-B, whereas that from the latter has not yet been elucidated. In the present study, we investigated the expression of P-B and its variant form at the protein level.DesignTo identify the variant protein of P-B, (1) cationic proteins with a higher isoelectric point in human pooled whole saliva were purified by a two dimensional liquid chromatography; (2) the peptide fragments generated from the in-solution of all proteins digested with trypsin separated and analyzed by MALDI-TOF-MS; and (3) the presence or absence of P-B in individual saliva was examined by 15% SDS-PAGE.ResultsThe peptide sequences (I³⁷PPPYSCTPNMNNCSR⁵², C⁵³HHHHKRHHYPCNYCFCYPK⁷², R⁵⁹HHYPCNYCFCYPK⁷² and H⁶⁰HYPCNYCFCYPK⁷²) present in the variant protein of P-B were identified. The peptide sequence (G⁶PYPPGPLAPPQPFGPGFVPPPPPPPYGPGR³⁶) in P-B (or the variant) and sequence (I³⁷PPPPPAPYGPGIFPPPPPQP⁵⁷) in P-B were identified. The sum of the sequences identified indicated a 91.23% sequence identity for P-B and 79.76% for the variant. There were cases in which P-B existed in individual saliva, but there were cases in which it did not exist in individual saliva.ConclusionsThe variant protein is produced by excising a non-canonical intron (CC-AC pair) from the 3′-noncoding sequence of the PBII gene. Both P-B and the variant are subject to proteolysis in the oral cavity.



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Third molar agenesis as a potential marker for craniofacial deformities

Publication date: April 2018
Source:Archives of Oral Biology, Volume 88
Author(s): Clarissa Christina Avelar Fernandez, Christiane Vasconcellos Cruz Alves Pereira, Ronir Raggio Luiz, Italo M. Faraco, Mary L. Marazita, Maria Arnaudo, Flavia M. de Carvalho, Fernando E. Poletta, Juan C. Mereb, Eduardo E. Castilla, Iêda M. Orioli, Marcelo de Castro Costa, Alexandre Rezende Vieira
The identification of clinical patterns of tooth agenesis in individuals born with craniofacial deformities may be a useful tool for risk determination of these defects. We hypothesize that specific craniofacial deformities are associated with third molar agenesis.ObjectiveThe aim of this study was to identify if third molar agenesis could have a relation with other craniofacial structure alterations, such as cleft lip and palate, skeletal malocclusion, or specific growth patterns in humans.DesignData were obtained from 550 individuals ascertained as part of studies aiming to identify genetic contributions to oral clefts. 831 dental records of patients aged over eight years seeking orthodontic treatment were also included. SN-GoGn angle were used to classify the growth pattern (hypo-divergent, normal and hyper-divergent), and the ANB angle was used to verify the skeletal malocclusion pattern (Class I, II and III). Panoramic radiographs were used to determine third molar agenesis.ResultsA high frequency of third molar agenesis among individuals born with cleft lip with or without cleft palate (55%), as well as among their relatives (93.5%) was found. Third molar agenesis was not associated to skeletal malocclusion or growth pattern.ConclusionIt appears that third molar agenesis is associated with the disturbances that lead to cleft lip and palate.



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Structure, property, and function of sheepshead (Archosargus probatocephalus) teeth

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): J.F. Deang, A.K. Persons, A.L. Oppedal, H. Rhee, R.D. Moser, M.F. Horstemeyer
ObjectivesThis paper studies A. probatocephalus teeth and investigates the mechanical properties and chemical composition of the enameloid and dentin.DesignNanoindentation tests with a max load of 1000 μN and X-ray Energy Dispersive Spectroscopy (EDS) were performed along the diameter of the polished sample. Microstructural analysis of the dentin tubules was performed from SEM images.ResultsFrom nanoindentation testing, the dentin of the sheepshead teeth has a nanoindentation hardness of 0.89 ± 0.21 (mean ± S.D.) GPa and a reduced Young's modulus of 23.29 ± 5.30 GPa. The enameloid of A. probatocephalus has a hardness of 4.36 ± 0.44 GPa and a mean reduced Young's modulus of 98.14 ± 6.91 GPa. Additionally, nanoindentation tests showed that the enameloid's hardness and modulus increased closer to the surface of the tooth. X-ray Energy Dispersive Spectroscopy (EDS) data further suggests that the gradient may be a result of the wt% fluoride within the enameloid, where an increase in fluoride results in an increase in reduced Young's modulus and hardness.ConclusionThe microstructural characterization of the number density and area of the dentin tubules were used to address the porosity effect in the dentin to achieve the experimentally validated microhardness. The mechanical properties of the sheepshead teeth were also compared with previous nanoindentation tests from other aquatic species. The sheepshead teeth exhibit a greater reduced Young's modulus and hardness compared to shark and piranha teeth.

Graphical abstract

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Differentiation of stem cells from human deciduous and permanent teeth into spiral ganglion neuron-like cells

Publication date: April 2018
Source:Archives of Oral Biology, Volume 88
Author(s): Thanasup Gonmanee, Charoensri Thonabulsombat, Kutkao Vongsavan, Hathaitip Sritanaudomchai
ObjectiveStem cells from pulp tissue are a promising cell-based therapy for neurodegenerative patients based on their origin in the neural crest. The aim of this study was to differentiate and evaluate the ability of human dental pulp stem cells from permanent teeth (DPSC) and stem cells from human exfoliated deciduous teeth (SHED) to differentiate into spiral ganglion neurons.DesignAfter isolation and characterization of mesenchymal stem cell properties, DPSC and SHED were treated with the neurotrophins brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and glial cell-derived neurotrophic factor (GDNF). The differentiation was identified by immunostaining and qRT-PCR analysis of neuronal markers and measuring intracellular calcium activity.ResultsAfter 2 weeks of induction, morphological changes were observed in both DPSC and SHED. The differentiated cells expressed neuron-specific class III beta-tubulin, GATA binding protein 3 (GATA3) and tropomyosin receptor kinase B, protein markers of spiral ganglion neurons. These cells also showed upregulation of the genes encoding these proteins, namely GATA3 and neurotrophic receptor tyrosine kinase 2. Intracellular calcium dynamics that reflect neurotransmitter release were observed in differentiated DPSC and SHED.ConclusionThese results demonstrate that dental pulp stem cells from permanent and deciduous teeth can differentiate into spiral ganglion neuron-like cells.



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Effects of sub-minimum inhibitory concentrations of lemon essential oil on the acid tolerance and biofilm formation of Streptococcus mutans

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Yanwei Sun, Sijia Chen, Chen Zhang, Yali Liu, Li Ma, Xiangyu Zhang
ObjectivesLemon essential oil (LEO) is a kind of secondary metabolite from lemon peels and has been found to inhibit cariogenic bacteria for decades. However, its effects on main cariogenic virulence factors are rarely reported. The present study aimed to investigate the effects of sub-minimum inhibitory concentrations (sub-MICs) of LEO on the acid tolerance and biofilm formation of Streptococcus mutans (S. mutans) and preliminarily reveal the possible underlying mechanisms.DesignsEffects of LEO on the acid tolerance and biofilm formation of S. mutans were investigated by the broth dilution method and crystal violet staining method respectively. The expression of luxS, srtA and spaP gene was also determined to explore the underlying mechanism. In addition, Tea polyphenols (TP), a major natural inhibitor of cariogenic virulence factors, and limonene (LIM), the major component of LEO, were selected as comparisons to evaluate the effects of LEO.ResultsSub-MICs of LEO, LIM and TP exhibited a dose-dependent inhibition of growth of S. mutans at pH ranging from 4.0 to 7.0. The formation of S. mutans biofilm was remarkably inhibited and the inhibitory rates of LEO, LIM and TP were 97.87%, 94.88% and 96.01% respectively at 1/2 MIC. Similarly, a down-regulation was observed in the expression of luxS, srtA and spaP gene at sub-MIC levels.ConclusionsEffects of LEO were similar or slightly stronger than LIM and TP, suggesting that LEO might represent a novel, natural anticarious agent that inhibited the specific genes associated with bacterial acid tolerance and biofilm formation without necessarily affecting the growth of oral bacteria.



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Proteomics and immunohistochemistry identify the expression of α-cardiac myosin heavy chain in the jaw-closing muscles of sooty mangabeys (order primates)

Publication date: Available online 3 February 2018
Source:Archives of Oral Biology
Author(s): Christine E. Wall, Megan Holmes, Erik Soderblom, Andrea B. Taylor
ObjectiveThe jaw-closing muscles of humans and nonprimate mammals express alpha-cardiac fibers but MyHC α-cardiac has not been identified in the jaw adductors of nonhuman primates. We determined whether MyHC α-cardiac is expressed in the superficial masseter and temporalis muscles of the sooty mangabey (Cercocebus atys), an African Old World monkey that specializes on hard seeds.DesignLC-MS/MS based proteomics was used to identify the presence of MyHC Iα.Immunohistochemistry was used to analyze the composition and distribution of fiber types in the superficial masseter and temporalis muscles of eight C. atys. Serial sections were stained against MyHC α-cardiac (MYH6), as well as MyHC-1 (NOQ7.5.4D), MyHC-2 (MY-32), and MyHC-M (2F4).ResultsProteomics analysis identified the presence of Myosin-6 (MyHC α-cardiac) in both heart atrium and superficial masseter. MyHC α-cardiac was expressed in abundance in the superficial masseter and temporalis muscles of all eight individuals and hybrid fibers were common.ConclusionsThe identification of MyHC α-cardiac in the jaw adductors of sooty mangabeys is a novel finding for nonhuman primates. The abundance of MyHC α-cardiac indicates a fatigue-resistant fiber population characterized by intermediate speed of contraction between pure MyHC-1 and MyHC-2 isoforms. We suggest that α-cardiac fibers may be advantageous to sooty mangabeys, whose feeding behavior includes frequent crushing of relatively large, hard seeds during the power stroke of ingestion. Additional studies comparing jaw-adductor fiber phenotype of hard-object feeding primates and other mammals are needed to explore this relationship further.



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Causes and treatments for nasolabial folds

Nasolabial folds are the lines on either side of the mouth that extend from the edge of the nose to the mouth's outer corners. Learn more here.

http://ift.tt/2EIutNe

Cochlear implants and 1.5 T MRI scans: the effect of diametrically bipolar magnets and screw fixation on pain

The probability that a patient will need an MRI scan at least once in a lifetime is high. However, MRI scanning in cochlear implantees is associated with side effects. Moreover, MRI scan-related artifacts, dis...

http://ift.tt/2FNn5PE

Cavernous sinus involvement is not a risk factor for the primary tumor site treatment outcome of Sinonasal adenoid cystic carcinoma

Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. This stu...

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Cavernous sinus involvement is not a risk factor for the primary tumor site treatment outcome of Sinonasal adenoid cystic carcinoma

Abstract

Background

Sinonasal adenoid cystic carcinoma is a rare malignancy of the head and neck. Cavernous sinus invasion from sinonasal adenoid cystic carcinoma and its related management have rarely been investigated. This study evaluated the relationship between treatment outcome and cavernous sinus involvement in addition to other parameters.

Methods

A retrospective case series study was conducted at a tertiary referral center. The medical records of 47 patients diagnosed with primary sinonasal adenoid cystic carcinoma between 1984 and 2015 were retrospectively reviewed. The survival impact of the primary treatment modalities and the anatomic sites of tumor involvement were analyzed.

Results

Cavernous sinus invasion was observed in 8 patients (17%), of whom 7 had ACC tumors originating from the maxillary sinus. The results of univariate analysis revealed that tumor stage, primary surgery, and the absence of skull-base and infratemporal fossa invasion were associated with better overall survival (P = 0.033, P = 0.012, P = 0.011, and P = 0.040, respectively) and better disease-free survival (P = 0.019, P = 0.001, P = 0.017, and P = 0.029, respectively). Multivariate analysis identified primary surgery as the only independent prognostic factor for disease-free survival (P = 0.026). Cavernous sinus invasion by sinonasal adenoid cystic carcinoma was not associated with worse overall survival or disease-free survival (P = 0.200 and P = 0.198, respectively).

Conclusions

Because maxillary adenoid cystic carcinoma is associated with a higher rate of cavernous sinus invasion, such cases warrant caution during preoperative planning. Primary surgery as the initial therapy provides better locoregional control and survival for patients with sinonasal adenoid cystic carcinoma. Cavernous sinus invasion did not significantly impact survival; thus, it should not be regarded as a contraindication for curative treatment.

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Agminated Spitz naevi or metastatic spitzoid melanoma?

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Endoscope-assisted conservative resection and reconstruction in recurrent subglottic carcinoma

Abstract

Background

Very few cases of conservative laryngectomy in recurrent carcinoma of subglottis postradiotherapy have been reported. Technical aspects of conservative resection and reconstruction in subglottic carcinoma have not been well described.

Methods

Herein, we present a case of recurrent carcinoma of subglottis for which conservative resection with adequate margins was done with endoscope assistance and defect reconstructed by buccal mucosa, conchal cartilage, and temporoparietal free flap. The technique of resection, reconstruction, complications, postoperative outcome, and our suggestions are described.

Results

The lesion could be removed with wide margins. Reconstruction could preserve the voice, and deglutition was unaffected. There was no donor site-related complication. Complications were a result of the choice of the stent, which included infection and difficulty in removal.

Conclusion

Selected cases of recurrent carcinoma of the subglottis can be managed by conservative resection with adequate margins and appropriate reconstruction with good functional outcomes.

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Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis

Abstract

Background

Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated.

Methods

We conducted a systematic search of electronic databases and provide a review and meta-analysis.

Results

Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02).

Conclusion

This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery.

http://ift.tt/2GMEOIq

Oral retinoids and depression: reply from the authors

We strongly agree with both teams that our review has limitations including the paucity of the information of some reported cases and the limitations inherent to the Naranjo score. Nevertheless, the Naranjo score was developed to achieve consensus in estimating the probability that a drug has caused an adverse event. It is the only tool that can be used to homogenize the reading of very heterogeneous notifications.

This article is protected by copyright. All rights reserved.

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Ficlatuzumab With or Without Cetuximab in Treating Patients With Cetuximab-Resistant, Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Conditions:   Head and Neck Basaloid Carcinoma;   Recurrent Head and Neck Squamous Cell Carcinoma;   Recurrent Oropharyngeal Squamous Cell Carcinoma;   Squamous Cell Carcinoma of Unknown Primary Origin;   Stage IV Lip and Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IV Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma AJCC v7;   Stage IV Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7;   Stage IV Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Lip and Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVA Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma AJCC v7;   Stage IVA Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7;   Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Lip and Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVB Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma AJCC v7;   Stage IVB Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7;   Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVC Lip and Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVC Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma AJCC v7;   Stage IVC Nasopharyngeal Keratinizing Squamous Cell Carcinoma AJCC v7;   Stage IVC Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Head and Neck Cancer;   Oropharyngeal Cancer;   HNSCC
Interventions:   Biological: Cetuximab;   Drug: Ficlatuzumab;   Other: Laboratory Biomarker Analysis;   Other: Quality-of-Life Assessment;   Other: Questionnaire Administration
Sponsors:   University of Arizona;   National Cancer Institute (NCI)
Recruiting

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Treatment of Metastatic Soft Tissue Sarcoma (STS) Patients (FIBROSARC USA)

Condition:   Patients With Diagnosis of Unresectable or Metastatic Soft Tissue Sarcoma
Interventions:   Drug: Doxorubicin;   Combination Product: L19TNF plus doxorubicin
Sponsor:   Philogen S.p.A.
Not yet recruiting

http://ift.tt/2GOwyHV

Satisfaction and Quality of Life Comparison Between Patients Using Cicaplast Baume B5 Versus Dexeryl for the Management of Cutaneous Toxicities Induced by Epidermal Growth Factor Receptor Inhibitors (iEGFR)

Conditions:   Head and Neck Squamous Cell Carcinoma;   Colorectal Cancer;   Non Small Cell Lung Cancer;   Epidermal Growth Factor Receptor Inhibitor
Interventions:   Other: Cicaplast Balm B5;   Other: Dexeryl
Sponsor:   Centre Leon Berard
Not yet recruiting

http://ift.tt/2s8LIEN

Phase II Study of Atezolizumab + FLOT vs. FLOT Alone in Patients With Gastric Cancer and GEJ

Conditions:   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Atezolizumab;   Drug: 5-Fluorouracil;   Drug: Calciumfolinat;   Drug: Oxaliplatin;   Drug: Docetaxel
Sponsor:   IKF Klinische Krebsforschung GmbH at Krankenhaus Nordwest
Not yet recruiting

http://ift.tt/2GRY8nM

Docetaxel and Radiation Therapy in Treating Patients With HPV Positive Oropharynx Cancer

Conditions:   Human Papillomavirus Positive;   Oropharyngeal Squamous Cell Carcinoma
Interventions:   Drug: Cisplatin;   Drug: Docetaxel;   Radiation: Image Guided Radiation Therapy;   Radiation: Intensity-Modulated Radiation Therapy;   Other: Laboratory Biomarker Analysis;   Procedure: Quality-of-Life Assessment;   Other: Questionnaire Administration
Sponsors:   Mayo Clinic;   National Cancer Institute (NCI)
Recruiting

http://ift.tt/2s5IUbu

Ex-Vivo Expanded Allogeneic NK Cells For The Treatment Of Pediatric Solid Tumors

Conditions:   Malignant Neoplasms of Bone and Articular Cartilage;   Malignant Neoplasms of Female Genital Organs;   Malignant Neoplasms of Independent (Primary) Multiple Sites;   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Malignant Neoplasms of Male Genital Organs;   Malignant Neoplasms of Mesothelial and Soft Tissue;   Malignant Neoplasms of Thyroid and Other Endocrine Glands;   Malignant Neoplasms of Urinary Tract;   Melanoma and Other Malignant Neoplasms of Skin
Interventions:   Drug: Cyclophosphamide;   Drug: Etoposide;   Procedure: NK Cell Infusion;   Drug: Mesna
Sponsor:   M.D. Anderson Cancer Center
Not yet recruiting

http://ift.tt/2s5X7VE

Brain Stimulation For Cancer Smokers

Conditions:   Cancer of Head and Neck;   Breast Cancer;   Prostate Cancer;   Nicotine Dependence
Intervention:   Device: Transcranial Magnetic Stimulation Clinical Research System
Sponsor:   Medical University of South Carolina
Recruiting

http://ift.tt/2GOAPuS

Development of a pediatric ebola predictive score, Sierra Leone

Fitzgerald, F; Wing, K; Naveed, A; Gbessay, M; Ross, JCG; Checchi, F; Youkee, D; ... Yeung, S; + view all Fitzgerald, F; Wing, K; Naveed, A; Gbessay, M; Ross, JCG; Checchi, F; Youkee, D; Jalloh, MB; Baion, DE; Mustapha, A; Jah, H; Lako, S; Oza, S; Boufkhed, S; Feury, R; Bielicki, J; Williamson, E; Gibb, DM; Klein, N; Sahr, F; Yeung, S; - view fewer (2018) Development of a pediatric ebola predictive score, Sierra Leone. Emerging Infectious Diseases , 24 (2) pp. 311-319. 10.3201/eid2402.171018 . Green open access

http://ift.tt/2E3XNQS

Difficult communication in Radiology: a training course on responding to inter-professional conflict

Noble, LM; Peters, F; Butt, S; von Stempel, C; Young, J; (2016) Difficult communication in Radiology: a training course on responding to inter-professional conflict. Presented at: EACH 2016 International Conference on Communication in Healthcare, Heidelberg, Germany. Green open access

http://ift.tt/2nJQzqs

Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection

Bell, LCK; Noursadeghi, M; (2018) Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection. [Review]. Nature Reviews Microbiology , 16 (2) pp. 80-90. 10.1038/nrmicro.2017.128 .

http://ift.tt/2E4FqM1

Masculinities on the Continuum of Structural Violence: The Case of Mexico’s Homicide Epidemic

Gamlin, JB; Hawkes, SJ; (2017) Masculinities on the Continuum of Structural Violence: The Case of Mexico's Homicide Epidemic. Social Politics 10.1093/sp/jxx010 . (In press). Green open access

http://ift.tt/2nKT1wW

Carrier Phase Estimation in Dispersion-Unmanaged Optical Transmission Systems

Xu, T; Bayvel, P; Liu, T; Zhang, Y; Jacobsen, G; Li, J; Popov, S; (2017) Carrier Phase Estimation in Dispersion-Unmanaged Optical Transmission Systems. In: (Proceedings) IEEE Advanced Information Technology, Electronic and Automation Control Conference (IAEAC). IEEE (In press). Green open access

http://ift.tt/2E4VM7m

Comparative and Transnational History: Central European Approaches and New Perspectives, edited by Heinz-Gerhard Haupt and Jürgen Kocka

Bowersox, J; (2011) Comparative and Transnational History: Central European Approaches and New Perspectives, edited by Heinz-Gerhard Haupt and Jürgen Kocka. [Review]. Canadian Journal of History , 46 (2) pp. 489-491. 10.3138/cjh.46.2.489 . Green open access

http://ift.tt/2nL9W27

GLS loss of function causes autosomal recessive spastic ataxia and optic atrophy

Lynch, DS; Chelban, V; Vandrovcova, J; Pittman, A; Wood, NW; Houlden, H; (2018) GLS loss of function causes autosomal recessive spastic ataxia and optic atrophy. Annals of Clinical and Translational Neurology 10.1002/acn3.522 . (In press). Green open access

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Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

Withington, J; Neves, JB; Barod, R; (2017) Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass. Current Urology Reports , 18 (8) 10.1007/s11934-017-0705-8 .

http://ift.tt/2nKmMOt

EACH in the UK: a network for healthcare communication researchers, educators and practitioners

Noble, LM; Riddell, R; (2016) EACH in the UK: a network for healthcare communication researchers, educators and practitioners. Presented at: EACH 2016 International Conference for Communication in Healthcare, Heidelberg, Germany. Green open access

http://ift.tt/2E3XEgi

Determing the minimal clinically important difference in radiotherapy-induced xerostomia

Mercadante, V; Porter, S; Fedele, S; (2016) Determing the minimal clinically important difference in radiotherapy-induced xerostomia. Presented at: 13th Biennal Congress of EAOM, Turin, Italy.

http://ift.tt/2nIKWsq

Multivariate calibration of energy-dispersive X-ray diffraction data for predicting the composition of pharmaceutical tablets in packaging

Crews, C; Kenny, PS; O'Flynn, D; Speller, RD; (2018) Multivariate calibration of energy-dispersive X-ray diffraction data for predicting the composition of pharmaceutical tablets in packaging. Journal of Pharmaceutical and Biomedical Analysis , 151 pp. 186-193. 10.1016/j.jpba.2017.12.036 . (In press). Green open access

http://ift.tt/2E1fmB6

End of the Road for Adjunctive Vitamin D Therapy for Pulmonary Tuberculosis?

Abubakar, I; Kloprogge, F; (2017) End of the Road for Adjunctive Vitamin D Therapy for Pulmonary Tuberculosis? American Journal of Respiratory and Critical Care Medicine , 196 (5) pp. 544-545. 10.1164/rccm.201707-1509ED .

http://ift.tt/2nNHddo

Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis

Gameiro, J; Neves, JB; Rodrigues, N; Bekerman, C; Melo, MJ; Pereira, M; Teixeira, C; ... Lopes, JA; + view all Gameiro, J; Neves, JB; Rodrigues, N; Bekerman, C; Melo, MJ; Pereira, M; Teixeira, C; Mendes, I; Jorge, S; Rosa, R; Lopes, JA; - view fewer (2016) Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis. Clinical Kidney Journal , 9 (2) pp. 192-200. 10.1093/ckj/sfv144 . Green open access

http://ift.tt/2E1eix6

UCL Communication Clinic

Dean, MP; (2015) UCL Communication Clinic. Presented at: British Aphasiology Society Conference, London, United Kingdom. Green open access

http://ift.tt/2nKSpYa

Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis

Sahdev, V; Albersen, M; Christodoulidou, M; Parnham, A; Malone, P; Nigam, R; Bomanji, J; Sahdev, V; Albersen, M; Christodoulidou, M; Parnham, A; Malone, P; Nigam, R; Bomanji, J; Muneer, A; - view fewer (2017) Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis. BJU International , 119 (4) pp. 573-578. 10.1111/bju.13680 . Green open access

http://ift.tt/2nKGBoA

Quantum noise spectra for periodically driven cavity optomechanics

Aranas, EB; Akram, MJ; Malz, D; Monteiro, TS; (2017) Quantum noise spectra for periodically driven cavity optomechanics. Physical Review A , 96 (6) , Article 063836. 10.1103/PhysRevA.96.063836 . Green open access

http://ift.tt/2E3b24v

Empirically Determined Vascular Smooth Muscle Cell Mechano-Adaptation Law

Steucke, KE; Win, Z; Stemler, TR; Walsh, EE; Hall, JL; Alford, PW; (2017) Empirically Determined Vascular Smooth Muscle Cell Mechano-Adaptation Law. Journal of Biomechanical Engineering , 139 (7) , Article 071005. 10.1115/1.4036454 .

http://ift.tt/2nKtqEh

Optical coherence tomography angiography: a review of current and future clinical applications

Ang, M; Tan, ACS; Cheung, CMG; Keane, PA; Dolz-Marco, R; Sng, CCA; Schmetterer, L; (2018) Optical coherence tomography angiography: a review of current and future clinical applications. Graefe's Archive for Clinical and Experimental Ophthalmology , 256 (2) pp. 237-245. 10.1007/s00417-017-3896-2 . (In press).

http://ift.tt/2E3bf7J

No association between ACTN3 R577X and ACE I/D polymorphisms and endurance running times in 698 Caucasian athletes

Papadimitriou, ID; Lockey, SJ; Voisin, S; Herbert, AJ; Garton, F; Houweling, PJ; Cieszczyk, P; ... Eynon, N; + view all Papadimitriou, ID; Lockey, SJ; Voisin, S; Herbert, AJ; Garton, F; Houweling, PJ; Cieszczyk, P; Maciejewska-Skrendo, A; Sawczuk, M; Massidda, M; Calo, CM; Astratenkova, IV; Kouvatsi, A; Druzhevskaya, AM; Jacques, M; Ahmetov, II; Stebbings, GK; Heffernan, S; Day, SH; Erskine, R; Pedlar, C; Kipps, C; North, KN; Williams, AG; Eynon, N; - view fewer (2018) No association between ACTN3 R577X and ACE I/D polymorphisms and endurance running times in 698 Caucasian athletes. BMC Genomics , 19 , Article 13. 10.1186/s12864-017-4412-0 . Green open access

http://ift.tt/2nMeB3V

1985, Scientists can’t do science alone, they need publics

Gouyon, JB; (2016) 1985, Scientists can't do science alone, they need publics. Public Understanding of Science , 25 (6) pp. 754-757. 10.1177/0963662516650361 . Green open access

http://ift.tt/2E4UFEI

Cochlear implants and 1.5 T MRI scans: the effect of diametrically bipolar magnets and screw fixation on pain

Abstract

Background

The probability that a patient will need an MRI scan at least once in a lifetime is high. However, MRI scanning in cochlear implantees is associated with side effects. Moreover, MRI scan-related artifacts, dislodging magnets, and pain are often the most frequent complications. The aim of this study was to evaluate the occurrence of pain in patients with cochlear implant systems using 1.5T MRI scans.

Methods

In a prospective case study of 10 implantees, an MRI scan was performed and the degree of pain was evaluated by a visual analog scale. Scans were performed firstly with and depending on the degree of discomfort/pain, without a headband. Four of the cochlear implants contained a screw fixation. Six cochlear implants contained an internal diametrically bipolar magnet. MRI observations were performed with a 1.5 T scanner.

Results

MRI scans were performed on all patients without causing any degree of pain, even without the use of a headband.

Conclusion

Patients undergoing 1.5 T MRIs with devices including a diametrically bipolar magnet or a rigid implant screw fixation, experienced no pain, even without headbands.

http://ift.tt/2s85Rut

Monilethrix: A case report imaged by trichoscopy, reflectance confocal microscopy and histopathology

http://ift.tt/2E1Psxo

BRCA Mutations: Cancer Risk and Genetic Testing

A fact sheet about the BRCA1 and BRCA2 genes, how BRCA1 and BRCA2 gene mutations (changes) affect a person's risk of cancer, genetic testing for cancer risk, interpreting test results, and the benefits and risks of genetic testing.

http://ift.tt/2dMtmCh

Parental Enrollment in Medicaid Yields Increase in Preventive Health Care for Children

Enrolling in Medicaid may have health benefits not only for low-income parents but also for their children, according to a Johns Hopkins analysis of over 50,000 parent-child pairs.

http://ift.tt/2E4tQAs

Initial Observations on Lighting Situations in The British Museum

Garside, DJ; (2015) Initial Observations on Lighting Situations in The British Museum. Presented at: SEAHA 2015, London, United Kingdom. Green open access

http://ift.tt/2FJJ2iC

Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF)

Win, T; Screaton, NJ; Porter, JC; Ganeshan, B; Maher, TM; Fraioli, F; Endozo, R; ... Groves, AM; + view all Win, T; Screaton, NJ; Porter, JC; Ganeshan, B; Maher, TM; Fraioli, F; Endozo, R; Shortman, RI; Hurrell, L; Holman, BF; Thielemans, K; Rashidnasab, A; Hutton, BF; Lukey, PT; Flynn, A; Ell, PJ; Groves, AM; - view fewer (2018) Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF). European Journal of Nuclear Medicine and Molecular Imaging 10.1007/s00259-017-3917-8 . (In press). Green open access

http://ift.tt/2EeHrEC

MEASUREMENTS OF COSMIC-RAY PROTON AND HELIUM SPECTRA FROM THE BESS-POLAR LONG-DURATION BALLOON FLIGHTS OVER ANTARCTICA

Abe, K; Fuke, H; Haino, S; Hams, T; Hasegawa, M; Horikoshi, A; Itazaki, A; ... Yoshimura, K; + view all Abe, K; Fuke, H; Haino, S; Hams, T; Hasegawa, M; Horikoshi, A; Itazaki, A; Kim, KC; Kumazawa, T; Kusumoto, A; Lee, MH; Makida, Y; Matsuda, S; Matsukawa, Y; Matsumoto, K; Mitchell, JW; Myers, Z; Nishimura, J; Nozaki, M; Orito, R; Ormes, JF; Picot-Clemente, N; Sakai, K; Sasaki, M; Seo, ES; Shikaze, Y; Shinoda, R; Streitmatter, E; Suzuki, J; Takasugi, Y; Takeuchi, K; Tanaka, K; Thakur, N; Yamagami, T; Yamamoto, A; Yoshida, T; Yoshimura, K; - view fewer (2016) MEASUREMENTS OF COSMIC-RAY PROTON AND HELIUM SPECTRA FROM THE BESS-POLAR LONG-DURATION BALLOON FLIGHTS OVER ANTARCTICA. The Astrophysical Journal , 822 (2) , Article 65. 10.3847/0004-637X/822/2/65 . Green open access

http://ift.tt/2FNsCWH

COMSOL ANALYSIS OF WHEELCHAIR PUSHRIM SIX DOF LOAD CELL FOR QUANTIFYING PROPULSION EFFICIENCY BY SENSEWHEEL

Suzuki, Tatsuto; Holloway, C; Symonds, A; Smitham, P; Taylor, SJG; (2015) COMSOL ANALYSIS OF WHEELCHAIR PUSHRIM SIX DOF LOAD CELL FOR QUANTIFYING PROPULSION EFFICIENCY BY SENSEWHEEL. Presented at: ISB 2015, Glasgow, Scotland.

http://ift.tt/2EkpMLs

Characterization of cyclically fully commutative elements in finite and affine Coxeter groups

Petreolle, M; (2017) Characterization of cyclically fully commutative elements in finite and affine Coxeter groups. European Journal of Combinatorics , 61 pp. 106-132. 10.1016/j.ejc.2016.10.006 . Green open access

http://ift.tt/2FMSv8Z

Editorial Comment

Neves, JB; (2017) Editorial Comment. The Journal of Urology , 198 (1) pp. 63-64. 10.1016/j.juro.2017.01.095 .

http://ift.tt/2EjQ7cA

Incompressible limit of the Navier—Stokes model with a growth term

Vauchelet, N; Zatorska, E; (2017) Incompressible limit of the Navier—Stokes model with a growth term. Nonlinear Analysis: Theory, Methods and Applications , 163 pp. 34-59. 10.1016/j.na.2017.07.003 .

http://ift.tt/2FNk8yN

The 'I' in fibromyalgia - How does fibromyalgia shape academic identity?

Brown, N; (2016) The 'I' in fibromyalgia - How does fibromyalgia shape academic identity? Presented at: SRHE Newer and Early Career Researchers Conference, Newport, South Wales. Green open access

http://ift.tt/2E2KsIL

Making internal fixation work with limited bone stock

Meeson, R; (2017) Making internal fixation work with limited bone stock. In Practice , 39 (3) pp. 98-106. 10.1136/inp.j595 . Green open access

http://ift.tt/2nHOZoM

She knows that she will not come back: tracing patients and new thresholds of collective surveillance in PMTCT Option B+

Cataldo, F; Seeley, J; Nkhata, MJ; Mupambireyi, Z; Tumwesige, E; Gibb, DM; Lablite Team, ; (2018) She knows that she will not come back: tracing patients and new thresholds of collective surveillance in PMTCT Option B+. BMC Health Services Research , 18 , Article 76. 10.1186/s12913-017-2826-7 . Green open access

http://ift.tt/2E2rTV2

Molecular characteristics of long-term epilepsy-associated tumours (LEATs) and mechanisms for tumour-related epilepsy (TRE)

Stone, TJ; Rowell, R; Jayasekera, BAP; Cunningham, MO; Jacques, TS; (2018) Molecular characteristics of long-term epilepsy-associated tumours (LEATs) and mechanisms for tumour-related epilepsy (TRE). Neuropathology and Applied Neurobiology 10.1111/nan.12459 . (In press).

http://ift.tt/2nKus31

Molecular evolution of HIV-1 integrase during the 20 years prior to the first approval of integrase inhibitors

Meixenberger, K; Yousef, KP; Smith, MR; Somogyi, S; Fiedler, S; Bartmeyer, B; Hamouda, O; ... Kücherer, C; + view all Meixenberger, K; Yousef, KP; Smith, MR; Somogyi, S; Fiedler, S; Bartmeyer, B; Hamouda, O; Bannert, N; Von Kleist, M; Kücherer, C; - view fewer (2017) Molecular evolution of HIV-1 integrase during the 20 years prior to the first approval of integrase inhibitors. Virology Journal , 14 , Article 223. 10.1186/s12985-017-0887-1 . Green open access

http://ift.tt/2E3xfPI

Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm: A Systematic Review

Young, B; Lewis, S; Katikireddi, SV; Bauld, L; Stead, M; Angus, K; Campbell, M; ... Langley, T; + view all Young, B; Lewis, S; Katikireddi, SV; Bauld, L; Stead, M; Angus, K; Campbell, M; Hilton, S; Thomas, J; Hinds, K; Ashie, A; Langley, T; - view fewer (2018) Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm: A Systematic Review. Alcohol and Alcoholism 10.1093/alcalc/agx094 . (In press). Green open access

http://ift.tt/2nIhKlq

Absence of sex differences in mental rotation performance in autism spectrum disorder

Rohde, MS; Georgescu, AL; Vogeley, K; Fimmers, R; Falter-Wagner, CM; (2017) Absence of sex differences in mental rotation performance in autism spectrum disorder. Autism 10.1177/1362361317714991 .

http://ift.tt/2E3UPvZ

Predicting Flux And Pressure Relationships of Large Scale Filtration with USD Model Inputs: Method and application

Hussain, MS; Ma, GJ; Zhou, Y; (2016) Predicting Flux And Pressure Relationships of Large Scale Filtration with USD Model Inputs: Method and application. Presented at: 13th Annual bioProcessUK Conference – Processing priorities for the future, Newcastle, United Kingdom. Green open access

http://ift.tt/2E3x8DM

No evidence for accelerated ageing-related brain pathology in treated HIV: longitudinal neuroimaging results from the Comorbidity in Relation to AIDS (COBRA) project

Cole, JH; Caan, MWA; Underwood, J; De Francesco, D; van Zoest, RA; Wit, FWNM; Mutsaerts, HJMM; ... COBRA collaboration, ; + view all Cole, JH; Caan, MWA; Underwood, J; De Francesco, D; van Zoest, RA; Wit, FWNM; Mutsaerts, HJMM; Leech, R; Geurtsen, GJ; Portegies, P; Majoie, CBLM; Schim van der Loeff, MF; Sabin, CA; Reiss, P; Winston, A; Sharp, DJ; COBRA collaboration, ; - view fewer (2018) No evidence for accelerated ageing-related brain pathology in treated HIV: longitudinal neuroimaging results from the Comorbidity in Relation to AIDS (COBRA) project. Clinical Infectious Diseases 10.1093/cid/cix1124 . (In press).

http://ift.tt/2nL0BHQ

Effects of ambroxol on the autophagy-lysosome pathway and mitochondria in primary cortical neurons

Magalhaes, J; Gegg, ME; Migdalska-Richards, A; Schapira, AH; (2018) Effects of ambroxol on the autophagy-lysosome pathway and mitochondria in primary cortical neurons. Scientific Reports , 8 (1) , Article 1385. 10.1038/s41598-018-19479-8 . Green open access

http://ift.tt/2E1Vpdp

Encountering pain: hearing, seeing, speaking - a conference with a difference

Padfield, DG; Zakrzewska, JM; (2017) Encountering pain: hearing, seeing, speaking - a conference with a difference. Presented at: UNSPECIFIED.

http://ift.tt/2nJQrat

Expansionism, Extremism and Exceptionalism in Life: Boltzmann Brains as trans-disciplinary methodology

Walford, AC; Kirk, D; (2018) Expansionism, Extremism and Exceptionalism in Life: Boltzmann Brains as trans-disciplinary methodology. Environmental Humanities , 9 (2) pp. 341-358. 10.1215/22011919-4215334 . Green open access

http://ift.tt/2E2Z4b3

Bottleneck: A Generalized, Flexible, and Extensible Framework for Botnet Defense

Ramay, NR; Khattak, S; Syed, AA; Khayam, SA; (2012) Bottleneck: A Generalized, Flexible, and Extensible Framework for Botnet Defense. Presented at: UNSPECIFIED.

http://ift.tt/2nKt28H

Nasoseptal Perforation: from Etiology to Treatment

Abstract

Purpose of Review

Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment.

Recent Findings

NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience.

Summary

When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.

http://ift.tt/2FKBrAj

Physician turnover effect for in-hospital cardiopulmonary resuscitation: a 10-year experience in a tertiary academic hospital

Abstract

Purpose

Controversy exists as to whether the physician turnover affects patient outcome in academic hospitals. In-hospital cardiopulmonary resuscitation (CPR) is an important indicator of in-hospital mortality. This study aimed to investigate whether the physician turnover is associated with the in-hospital CPR rate.

Methods

This retrospective cohort study was conducted at a single center; all in-hospital CPR cases among in-patients from 1 January 2007 to 31 December 2016 were analyzed. The turnover period was defined as the changeover of the trainee workforce in March, May, and November. The primary outcome was any variation in the monthly in-hospital CPR events (per 1000 admissions). The secondary outcomes were return of spontaneous circulation (ROSC), CPR in intensive care unit (ICU), monthly in-hospital deaths per 1000 admissions, and average length of hospital stay.

Results

A total of 2182 in-hospital CPR cases were included in the analysis. Monthly in-hospital CPR rates were greater during the turnover period when compared to the non-turnover period (4.66 ± 1.02 vs. 4.18 ± 1.56, P = 0.027). There was no significant difference in ROSC rate, CPR in ICU rate, monthly in-hospital deaths per 1000 admissions, or average length of hospital stay between the two periods.

Conclusion

Our findings indicate that physician turnover may be associated with in-hospital CPR rate. However, physician turnover was not associated with ROSC rate, rate of CPR in the ICU, in-hospital death, or length of hospital stay.

http://ift.tt/2E3Hccb

Outcome of portopulmonary hypertension after liver transplantation: perhaps not so optimistic

No abstract available

http://ift.tt/2FICTU4

Waste anesthetic gas exposure and strategies for solution

Abstract

As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.

http://ift.tt/2s2XAb2

Lichen sclerosus on the face

http://ift.tt/2GMkZkv

SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain

SmartTots (http://smarttots.org/) represents a public–private partnership between the International Anesthesia Research Society and the US Food and Drug Administration. Over the past 7 years, SmartTots has worked in collaboration with various stakeholders to determine whether anesthetic drugs have detrimental effects on the developing brain. SmartTots has funded clinical and preclinical studies, organized meetings, served as a repository of peer-reviewed information, and facilitated the development of consensus-based statements. Here, we report advances in the field of anesthetic neurotoxicity and provide an update on SmartTots' activities. Clinical studies have provided some reassurance that a brief exposure to anesthetic drugs does not cause overt, persistent cognitive deficits. New recommendations aim to increase the reproducibility and "clinical relevance" of data from studies of laboratory animals. Overall, the field has advanced substantially; however, it remains paramount to definitively resolve whether anesthetic drugs are neurotoxic to the immature brain. The results of SmartTots efforts will either ally unwarranted fears or substantially change pediatric anesthetic practice and prompt studies to identify neuroprotective strategies. Accepted for publication November 28, 2017. Funding: None. The authors declare no conflicts of interest. The opinions expressed in this article are those of the authors, not SmartTots or the US Food and Drug Administration (FDA). The authors represent the Board of Trustees of the International Anesthesia Research Society (IARS) on the Executive Council and Scientific Advisory Board of SmartTots. Reprints will not be available from the authors. Address correspondence to Beverley A. Orser, MD, PhD, University of Toronto, Room 3318, Medical Sciences Bldg, 1 King's College Cir, Toronto, Ontario M5S1A8, Canada. Address e-mail to Beverley.Orser@utoronto.ca. © 2018 International Anesthesia Research Society

http://ift.tt/2EgulGM

Chronic Pain and the Opioid Epidemic: Are We Ignoring the Potential Benefits of Nitrous Oxide?

No abstract available

http://ift.tt/2nEHwb3

Teaching Medical Students Clinical Anesthesia

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education. Accepted for publication December 5, 2017. Funding: Departmental. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Saundra E. Curry, MD, Department of Anesthesiology, Columbia University, PH 5–133, 622 W 168th St, New York, NY 10032. Address e-mail to sc42@cumc.columbia.edu. © 2018 International Anesthesia Research Society

http://ift.tt/2BWNIzn

Effect-Site Target-Controlled Infusion in the Obese: Model Derivation and Performance Assessment

BACKGROUND: The aim of this study is to derive a propofol pharmacokinetic (PK) pharmacodynamic (PD) model to perform effect-site target-controlled infusion (TCI) in obese patients, and to analyze its performance along with that of other available PK models. METHODS: In the first step of the study, a 3-compartment PK model linked to a sigmoidal inhibitory Emax PD model by a first-order rate constant (keo) was used to fit propofol concentration–bispectral index (BIS) data. Population modeling analysis was performed by nonlinear mixed effects regression in NONMEM (ICON, Dublin, Ireland). PK data from 3 previous studies in obese adult patients (n = 47), including PD (BIS) data from 1 of these studies (n = 20), were pooled and simultaneously analyzed. A decrease in NONMEM objective function (ΔOBJ) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. In the second step of the study, we analyzed the predictive performance (median predictive errors [MDPE] and median absolute predictive errors [MDAPE]) of the current model and of other available models using an independent data set (n = 14). RESULTS: Step 1: The selected PKPD model produced an adequate fit of the data. Total body weight resulted in the best size scalar for volumes and clearances (ΔOBJ, −18.173). Empirical allometric total body weight relationships did not improve model fit (ΔOBJ, 0.309). A lag time parameter for BIS response improved the fit (ΔOBJ, 89.593). No effect of age or gender was observed. Step 2: Current model MDPE and MDAPE were 11.5% (3.7–25.0) and 26.8% (20.7–32.6) in the PK part and 0.4% (−10.39 to 3.85) and 11.9% (20.7–32.6) in the PD part. The PK model developed by Eleveld et al resulted in the lowest PK predictive errors (MDPE =

http://ift.tt/2nCJqcj

The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro

BACKGROUND: Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin. We hypothesized that intermittent oxytocin pretreatment would result in superior subsequent oxytocin-induced contractility than continuous oxytocin pretreatment. METHODS: This in vitro study was undertaken using myometrium obtained from women undergoing elective cesarean deliveries. Each myometrial strip was mounted in an individual organ bath with physiological salt solution under homeostatic conditions and allocated to one of 3 groups: (1) control (no pretreatment); (2) continuous (pretreatment with oxytocin 10−5 M for 2 hours); or (3) intermittent (pretreatment with alternating oxytocin 10−5 M and physiological salt solution every 15 minutes, for 2 hours). After pretreatment, dose–response testing to oxytocin 10−10 to 10−5 M was performed and contractile parameters were measured. The primary outcome was motility index (MI, amplitude × frequency) of contractions. RESULTS: Eighteen women were recruited, and 86 successful experiments were performed (control n = 29, continuous n = 28, intermittent n = 29). The means (standard errors) of MI (√g·contractions/10 min) in the control, continuous, and intermittent groups were 2.34 (0.09), 1.78 (0.09), and 2.13 (0.11), respectively. The MI was significantly reduced in the continuous group when compared to the control (estimated difference [95% confidence interval {CI}], −0.56 [−0.81 to −0.31]; P

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In Response

No abstract available

http://ift.tt/2nCCX0K

Adding Dopamine to Proxymetacaine or Oxybuprocaine Solutions Potentiates and Prolongs the Cutaneous Antinociception in Rats

Background: We evaluated the interaction of dopamine–proxymetacaine and dopamine– oxybuprocaine antinociception using isobolograms. Methods: This experiment uses subcutaneous drug (proxymetacaine, oxybuprocaine, and dopamine) injections under the skin of the rat's back, thus simulating infiltration blocks. The dose-related antinociceptive curves of proxymetacaine and oxybuprocaine alone and in combination with dopamine were constructed, and then the antinociceptive interactions between the local anesthetic and dopamine were analyzed using isobolograms. Results: Subcutaneous proxymetacaine, oxybuprocaine, and dopamine produced a sensory block to local skin pinpricks in a dose-dependent fashion. The rank order of potency was proxymetacaine (0.57 [0.52–0.63] μmol/kg) > oxybuprocaine (1.05 [0.96–1.15] μmol/kg) > dopamine (165 [154–177] μmol/kg; P oxybuprocaine > dopamine. Coadministration of proxymetacaine or oxybuprocaine with dopamine produced a synergistic antinociceptive effect. Dopamine prolonged the duration of skin antinociception caused by proxymetacaine or oxybuprocaine. This study tests subcutaneous injections under the hairy skin, thus simulating infiltration blocks that occur during surgery. Reprints will not be available from the authors. Address correspondence to Ching-Hsia Hung, PhD, Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1 Ta-Hsueh Rd, Tainan, Taiwan. Address e-mail to chhung@mail.ncku.edu.tw. © 2018 International Anesthesia Research Society

http://ift.tt/2BWo3GW

Comparison of Nasal Intubations by GlideScope With and Without a Bougie Guide in Patients Who Underwent Maxillofacial Surgeries: Randomized Clinical Trial

BACKGROUND: Nasotracheal intubation is commonly performed to provide a secure airway for the maintenance of general anesthesia in maxillofacial surgeries. Routine nasotracheal intubation is performed under general anesthesia by direct laryngoscopy, frequently with the aid of Magill forceps. This method can be time-consuming and may cause bleeding in the field of view. A gum elastic bougie (GEB) is a cheap, slender, and flexible device that could expedite nasotracheal intubation. The aim of this study was to evaluate the use of a GEB during nasotracheal intubation to facilitate the procedure and reduce the rate of complications. METHODS: In this randomized clinical trial study, 110 patients with American Society of Anesthesiologists (ASA) physical status I–II from 15 to 65 years of age were randomized into 2 equal groups. In both groups, a GlideScope and armored tube were used. In the GEB group, GEB was used to facilitate nasal intubation while the nasal intubation was performed without the aid of GEB in the routine group. The difficult intubation (defined as >1 attempt for intubation) was the primary outcome, and the duration of the intubation, the presence of traces of bleeding, the need for a tube replacement, and the usage of Magill forceps were the secondary outcomes. RESULTS: The incidence of bleeding in the GEB group was 1.81% vs 43.63% in the routine group (P

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