Nerve distributions in insertional achilles tendinopathy - a comparison of bone, bursae and tendon.

Nerve distributions in insertional achilles tendinopathy - a comparison of bone, bursae and tendon.

Histol Histopathol. 2016 Jun 20;:11790

Authors: Andersson G, Backman LJ, Christensen J, Alfredson H

Abstract
BACKGROUND/AIM: In a condition of pain in the Achilles tendon insertion there are multiple structures involved, such as the Achilles tendon itself, the retrocalcaneal bursa and a bony protrusion at the calcaneal tuberosity called Haglund's deformity. The innervation patterns of these structures are scarcely described, and the subcutaneous calcaneal bursa is traditionally not considered to be involved in the pathology. This study aimed at describing the innervation patterns of the four structures described above to provide a better understanding of possible origins of pain at the Achilles tendon insertion.
METHODS: Biopsies were taken from 10 patients with insertional Achilles tendinopathy, which had pathological changes in the subcutaneous and retrocalcaneal bursae, a Haglund deformity and Achilles tendon tendinopathy as verified by ultrasound. The biopsies were stained using immunohistochemistry in order to delineate the innervation patterns in the structures involved in insertional Achilles tendinopathy.
RESULTS: Immunohistochemical examinations found that the subcutaneous bursa scored the highest using a semi-quantitative evaluation of the degree of innervation when compared to the retrocalcaneal bursa, the Achilles tendon, and the calcaneal bone.
CONCLUSIONS: These findings suggest that the subcutaneous bursa, which is traditionally not included in surgical treatment, may be a clinically important factor in insertional Achilles tendinopathy.

PMID: 27320798 [PubMed - as supplied by publisher]

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Prophylactic treatment of vestibular migraine.

Prophylactic treatment of vestibular migraine.

Braz J Otorhinolaryngol. 2016 Jun 2;

Authors: Salmito MC, Duarte JA, Morganti LO, Brandão PV, Nakao BH, Villa TR, Ganança FF

Abstract
INTRODUCTION: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce.
OBJECTIVE: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic.
METHODS: Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed.
RESULTS: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p<0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p<0.001) and headache (p<0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug.
CONCLUSIONS: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

PMID: 27320656 [PubMed - as supplied by publisher]

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Does the intravenous administration of frusemide reduce endolymphatic hydrops?

Related Articles

Does the intravenous administration of frusemide reduce endolymphatic hydrops?

J Laryngol Otol. 2016 Mar;130(3):242-7

Authors: Fiorino F, Mattellini B, Vento M, Mazzocchin L, Bianconi L, Pizzini FB

Abstract
OBJECTIVE: To verify the hypothesis that intravenous frusemide reduces endolymphatic hydrops, as evaluated by three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging following intratympanic gadolinium administration.
METHODS: The study comprised 12 patients (7 females and 5 males, aged 19-74 years) with Ménière's disease. Disease duration ranged from 0.5 to 8 years, with a frequency of 0.5 to 6 vertigo spells per month, as calculated in the last 6 months. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging was performed 24 hours after intratympanic injection of gadobutrol diluted eight-fold. Frusemide 20 mg was given intravenously immediately after imaging. Magnetic resonance imaging was repeated after 1 hour, using the same parameters and sequence.
RESULTS: All patients showed enhancement defects, indicating endolymphatic hydrops of variable degrees. No modifications occurred at the second magnetic resonance imaging performed 1 hour after frusemide administration.
CONCLUSION: There was no evidence of endolymphatic hydrops modification 1 hour after intravenously administered frusemide. Therefore, loop diuretics in Ménière's disease, which are today used on an empirical basis, must be reconsidered. Implications of these outcomes are discussed and related to the role of endolymphatic hydrops in the development of Ménière's disease.

PMID: 26763125 [PubMed - indexed for MEDLINE]

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T2-prepared velocity selective labelling: A novel idea for full-brain mapping of oxygen saturation

Publication date: 1 October 2016
Source:NeuroImage, Volume 139
Author(s): Thomas Alderliesten, Jill B. De Vis, Petra M.A. Lemmers, Frank van Bel, Manon J.N.L. Benders, Jeroen Hendrikse, Esben T. Petersen
Background and aimDisturbances in cerebral oxygenation saturation (SO2) have been linked to adverse outcome in adults, children, and neonates. In intensive care, the cerebral SO2 is increasingly being monitored by Near-InfraRed Spectroscopy (NIRS). Unfortunately NIRS has a limited penetration depth. The "modified T2-prepared Blood Imaging of Oxygen Saturation" (T2-BIOS) MR sequence provides a step towards full brain SO2 measurement.Materials and methodsTissue SO2, and venous SO2 (SvO2) were obtained simultaneously by T2-BIOS during a respiratory challenge in ten healthy volunteers. These two measures were compared to SO2 that was obtained by a single probe MR-compatible NIRS setup, and to cerebral blood flow and venous SO2 that were obtained by arterial spin labelling and T2-TRIR, respectively.ResultsSO2-T2-BIOS and SO2-NIRS had a mean bias of −4.0% (95% CI −21.3% to 13.3%). SvO2-T2-BIOS correlated with SO2-NIRS (R²=0.41, p=0.002) and SvO2-T2-TRIR (R²=0.87, p=0.002). In addition, SO2-NIRS correlated with SvO2-T2-TRIR (R²=0.85, p=0.003) Frontal cerebral blood flow correlated with SO2-T2-BIOS (R²=0.21, p=0.04), but was not significant in relation to SO2-NIRS.Discussion/conclusionFull brain SO2 assessment by any technique may help validating NIRS and may prove useful in guiding the clinical management of patient populations with cerebral injury following hypoxic-ischaemic events. The agreement between NIRS and T2-BIOS provides confidence in measuring cerebral SO2 by either technique. As it stands now, the T2-BIOS represents a novel idea and future work will focus on improvements to make it a reliable tool for SO2 assessment.



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[Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper respiratory tract infection among patients with type 2 diabetes: a network meta-analysis].

[Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper respiratory tract infection among patients with type 2 diabetes: a network meta-analysis].

Beijing Da Xue Xue Bao. 2016 Jun 18;48(3):454-459

Authors: Li ZX, Wu SS, Yang ZR, Zhan SY, Sun F

Abstract
OBJECTIVE: To systematically review the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on two common respiratory system adverse events (RSAE: nasopharyngitis and upper respiratory tract infection) among type 2 diabetes (T2DM).
METHODS: Medline, Embase, Clinical trials and Cochrane library were searched from inception through May 2015 to identify randomized clinical trials(RCTs) assessed safety of GLP-1RAs versus placebo or other anti-diabetic drugs in T2DM. Network meta-analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of RSAE.
RESULTS: In the study, 50 RCTs were included, including 13 treatments: 7 GLP-1RAs (exenatide, exenatide-long-release-agent, liraglutide, lixisenatide, taspoglutide, albiglutide and dulaglutide), placebo and 5 traditional anti-diabetic drugs(insulin, metformin, sulfonylureas, sitagliptin and thiazolidinediones ketones). Compared with insulin, taspoglutide significantly decreased the incidence of nasopharyngitis (OR=0.67, 95%CI: 0.46-0.96). Significant lowering effects on upper respiratory tract infection were found when taspoglutide versus placebo (OR=0.57, 95%CI: 0.34-0.99) and insulin (OR=0.39, 95%CI: 0.23-0.73). The result from the network meta-analysis based on Bayesian theory could be used to rank all the treatments included, which showed that taspoglutide ranked last with minimum risk on nasopharyngitis and upper respiratory tract infection.
CONCLUSION: Taspoglutide was associated with significantly lowering effect on RSAE.

PMID: 27318907 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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Double minute chromosomes in acute myeloid leukemia, myelodysplastic syndromes, and chronic myelomonocytic leukemia are associated with micronuclei, MYC or MLL amplification, and complex karyotype.

Double minute chromosomes in acute myeloid leukemia, myelodysplastic syndromes, and chronic myelomonocytic leukemia are associated with micronuclei, MYC or MLL amplification, and complex karyotype.

Cancer Genet. 2016 May 27;

Authors: Huh YO, Tang G, Talwalkar SS, Khoury JD, Ohanian M, Bueso-Ramos CE, Abruzzo LV

Abstract
Double minute chromosomes (dmin) are small, paired chromatin bodies that lack a centromere and represent a form of extrachromosomal gene amplification. Dmin are rare in myeloid neoplasms and are generally associated with a poor prognosis. Most studies of dmin in myeloid neoplasms are case reports or small series. In the current study, we present the clinicopathologic and cytogenetic features of 22 patients with myeloid neoplasms harboring dmin. These neoplasms included acute myeloid leukemia (AML) (n = 18), myelodysplastic syndrome (MDS) (n = 3), and chronic myelomonocytic leukemia (CMML) (n = 1). The AML cases consisted of AML with myelodysplasia-related changes (n = 13) and therapy-related AML (n = 5). Dmin were detected in initial pre-therapy samples in 14 patients with AML or CMML; they were acquired during the disease course in 8 patients who had AML or MDS. The presence of dmin was associated with micronuclei (18/18; 100%), complex karyotype (17/22; 77.3%), and amplification of MYC (12/16; 75%) or MLL (4/16; 25%). Immunohistochemical staining for MYC performed on bone marrow core biopsy or clot sections revealed increased MYC protein in all 19 cases tested. Except for one patient, most patients failed to respond to risk-adapted chemotherapies. At last follow up, all patients had died of disease after a median of 5 months following dmin detection. In conclusion, dmin in myeloid neoplasms commonly harbor MYC or MLL gene amplification and manifest as micronuclei within leukemic blasts. Dmin are often associated with myelodysplasia or therapy-related disease, and complex karyotypes.

PMID: 27318442 [PubMed - as supplied by publisher]

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